Discussion 1: Policy Analysis Summary NURS 8100
Discussion 1: Policy Analysis Summary NURS 8100
Discussion 1: Policy Analysis Summary NURS 8100
Policy Analysis Summary
The purpose of this discussion post is to provide information on a health care topic of interest to policy makers. The policy brief development around staff staffing for our hospitals is a point of interest that should be brought to attention on a larger scale. The writer would like to discussion Michigan specifically regarding safe staffing in hospitals. The problem is there is no law in Michigan, that limits the number of patients a registered nurse can be assigned or the number of hours registered nurses are forced to work.
Some ICU’s in Michigan, a registered nurse may have up to four patients at a time but in other Michigan hospitals the registered nurse may have a limit of one to two. “The risk of dying in the ICU increases by a factor of 3.5 when the patient-to-nurse ratio is greater than 2.5 to 1” (Neuraz et al., 2015). Registered nurses are reporting that their workload is rarely or never adjusted when they report having an unsafe assignment. Michigan hospitals do not have to disclose current staffing levels. Registered nurses can be fired for refusing to work longer hours because administration classifies this as patient abandonment – this could also lead to the nurse losing their license. Scientific studies provide evidence of the link between inadequate registered nurse staffing and poor outcomes for hospital patients. Evidence supports: “The risk of death from cardiac arrest in the hospital is nearly 20% higher on the night shift, when RN staffing typically lower” (Peberdy et al., 2008). Additionally, not only do patients have a higher risk of dying of cardiac arrest due to staffing they also have an increase risk of getting an infection during their hospital stay. “Patients cared for in hospitals with higher RN staffing were 68% less likely to acquire infections” (Rogowski et al., 2013).
The involvement of Michigan Nurse Association has been a positive push towards the resolution of the staffing issues that Michigan hospitals have. The primary two things that MNA has done to support the Safe Patient Care Act: Connect members with legislators to share their stories and grown bipartisan support for the legislation and recruited the most cosponsors in the legislation’s history. The bipartisan Safe Patient Care Act is a plan to increase the safety of patients in Michigan hospitals and retain our nurses in an already stressful environment. The issue at hand is that there is no law that limits the number of patients a registered nurse can be assigned to take care of in the hospital. This is not only alarming nut is very unsafe for both the patient and nurse. There is also no law to prevent hospitals from making nurses work unlimited hours (leading to shifts of 14, 16 or even 20 hours). Nurses are becoming exhausted and stressed which increases the risk of mistakes and errors which is a very dangerous situation. Quality care and patient advocacy is a priority of the registered nurse. Understaffing and being overworked leads to unplanned events such as falls, infections, medication errors and deaths. There is a solution to lowering these risks and making a safer environment for our patients and registered nurses. “The Michigan Safe Patient Care Act is a 3-part bipartisan package in the state House and Senate that addresses rampant RN understaffing and excessive forced RN overtime. It will force administrators to make decisions based on patients’ needs, rather than misguided cost-cutting in the hospital industry” (MI Nurse Association, 2021).
The solution is the Michigan Safe Patient Care Act! The Michigan Safe Patient Care Act is a 3-part bipartisan package in the state House and Senate that addresses rampant RN understaffing and excessive forced RN overtime. It will force administrators to make decisions based on patients’ needs, rather than misguided cost-cutting in the hospital industry.
References
Lavis, J. N., Permanand, G., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy & Systems, Health Research Policy & Systems, 71–79.
MI Nurse Association. (2021). The bipartisan Safe Patient Care Act. https://www.misaferhospitals.org/uploads/7/7/1/1/7711851/with_bill_numbers_2021_spca_bills_cheat_sheet.pdf
Neuraz, A., Guérin, C., Polazzi, S., Aubrun, F., Dailler, F., Lehot, J.-J., Piriou, V., Neidecker, J., Rimmelé, T., Schott, A.-M., & Duclos, A. (2015). Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study. Critical Care Medicine, 43. https://doi.org/10.1097/CCM.0000000000001015
Peberdy, M. A., Ornato, J., Larkin, G. L., Braithwaite, R. S., Kashner, T. M., Carey, S., Meaney, P., Cen, L., Nadkarni, V., Praestgaard, A., & Berg, R. (2008). Survival From In-Hospital Cardiac Arrest During Nights and Weekends. JAMA. http://www.protectmasspatients.org/pdf/JAMA_2_08_Cardiac_Arrest.pdf
Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. T. (2013). Nurse staffing and NICU infection rates. JAMA Pediatrics, 167(5), 444–450.
Discussion 1: Policy Analysis SummaryHealth care policy can facilitate or impede the delivery of services. For the past severalweeks, you have been engaging in an authentic activity by critically analyzing a specifichealth care policy and various aspects of the impact associated with its implementation.A critical step in the policy process is communicating your findings with others. Thisweek, you will share information from your policy analysis and its implications.To prepare: Briefly summarize your policy analysis, focusing on the implications for clinical practicethat may be most relevant or interesting for your colleagues. Include how evidence-based practice influenced the policy, policy options, or solutions.By Day 3Post a 1- to 2-paragraph succinct summary of your policy analysis paper. Include atleast two of the options or solutions for addressing the policy and the resultingimplications for nursing practice and health care consumers.Read a selection of your colleagues’ postings.By Day 5Respond to at least two of your colleagues sharing insights or contrasting perspectivesbased on readings and evidence, and the practice implications of the policy.Note: Please see the Syllabus and Discussion Rubric for formal Discussion questionposting and response evaluation criteria.Return to this Discussion in a few days to read the responses to your initial posting.
Discussion 1 Policy Analysis Summary NURS 8100
Note what you learned and/or any insights you gained as a result of the commentsmade by your colleagues.Be sure to support your work with specific citations from this week’s LearningResources and any additional sources.Submission and Grading InformationGrading CriteriaWeek 11 Discussion 1 RubricPost by Day 3 and Respond by Day 5To participate in this Discussion:Week 11 Discussion 1
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Note: To access this week’s required library resources, please click on the link to theCourse Readings List, found in the Course Materials section of your Syllabus.Required ReadingsBodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinicalapproach (7th ed.). New York, NY: McGraw-Hill Medical. Chapter 17, “Conclusion: Tensions and Challenges”This chapter concludes with final thoughts on the challenge of providing qualityhealth care and controlling health care costs. The solution is likely to be resolvedonly by a collaborative approach, involving all health care stakeholders, and byhealth professionals taking the lead.Howard, J., Levy, F., Mareiniss, D. P., Craven, C. K., McCarthy, M., Epstein-Peterson,Z. D., & et al. (2010). New legal protections for reporting patient errors under the PatientSafety and Quality Improvement Act: A review of the medical literature andanalysis. Journal of Patient Safety, 6(3), 147-152.Note: You will access this article from the Walden Library databases.The authors studied the dissemination of information on the Patient Safety and QualityImprovement Act (PSQIA), a federal act that affords protection to those reportingmedical errors. They found medical literature to be inadequate in this regard, and as aresult, medical personnel were uninformed on their legal protections. This lack ofinformation has become a barrier to policy implementation.Jacobson, N., Butterill, D., & Goering, P. (2003). Development of a framework forknowledge translation: Understanding user context. Journal of Health ServicesResearch & Policy, 8(2), 94–99.Note: You will access this article from the Walden Library databases.Lau, B., San Miguel, S., & Chow, J. (2010). Policy and clinical practice: Audit tools tomeasure adherence. Renal Society of Australasia Journal, 6(1), 36–40.Note: You will access this article from the Walden Library databases.
The authors study the compliance to renal-care policies by health care professionals.They conclude with the necessity for nurses to support evidence-based protocols aswell as to obtain continuing education on new protocols.McCracken, A. (2010). Advocacy: It is time to be the change. Journal of GerontologicalNursing, 36(3), 15-17.Note: You will access this article from the Walden Library databases.
The author proposes that nurses, as patient advocates, need to be more involved in themaking of health care policy instead of reacting to policies that are constantly changing.The article provides a guide to help organize initial policy efforts.Nannini, A., & Houde, S. C. (2010). Translating evidence from systematic reviews forpolicy makers. Journal of Gerontological Nursing, 36(6), 22–26.Note: You will access this article from the Walden Library databases.
The article cites geronotological nurses as examples of those who are able to translateresearch into policy briefs that can be clearly understood by policy makers.Geronotological nurses are in this unique position because of their clinical experienceand educational background.Paterson, B. L., Duffet-Leger, L., & Cuttenden, K. (2009). Contextual factors influencingthe evolution of nurses' roles in a primary health care clinic. Public Health Nursing,26(5), 421-429.Note: You will access this article from the Walden Library databases.
This article provides details on a study conducted in a nurse-managed clinic related tothe changing roles of nurses. The authors found that nurses, in response to social,political, and economic forces, became involved in advocacy for the clinic throughpolitical action, government funding issues, and media relations roles.Sistrom, M. (2010). Oregon's Senate bill 560: Practical policy lessons for nurseadvocates. Policy, Politics, & Nursing Practice, 11(1), 29-35. doi:10.1177/1527154410370786Note: You will access this article from the Walden Library databases.
The author uses the efforts by a nurse advocate in lobbying for an Oregon bill related tohealthy food in public schools to illustrate nurse advocacy and policy making. The bill,developed in response to childhood obesity, did not immediately become law. Theauthor concludes with the importance of considering the political environment whencreating successful policy.Spenceley, S. M., Reutter, L., & Allen, M. N. (2006). The road less traveled: Nursingadvocacy at the policy level. Policy, Politics, & Nursing Practice, 7(3), 180-194. doi:10.1177/1527154410370786Note: You will access this article from the Walden Library databases.
Nurses have always been advocates at the patient-level of care, but the authors of thisarticle promote the need for all nurses to become advocates at the policy level as well.They discuss factors that have kept nurses from getting involved with policy making andthey provide strategies to resolve these challenges.Wyatt, E. (2009). Health policy advocacy: Oncology nurses make a difference. ONSConnect, 24(10), 12-15.Note: You will access this article from the Walden Library databases.
The author presents information on two nurses who have become health care policyadvocates—one as a policy maker and one as an elected legislator. Both have beenable to use their perspectives from their nursing careers to affect health policy.Zomorodi, M., & Foley, B. J. (2009). The nature of advocacy vs. paternalism in nursing:Clarifying the ‘thin line.’ Journal of Advanced Nursing, 65(8), 1746-1752.Note: You will access this article from the Walden Library databases.
The authors attempt to distinguish the concepts of advocating for a patient andpaternalism, or overriding a patient’s wishes. They provide clinical examples to illustratethe differences between these concepts, and they conclude with strategies to use inpractice.Required MediaLaureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy:Advocating through policy. Baltimore: Author.
Note: The approximate length of this media piece is 7 minutes.
In this media presentation, Dr. Joan Stanley and Dr. Kathleen White discuss hownurses can influence practice and engage in advocacy through the policy process.
Accessible playerOptional ResourcesBirnbaum, D. (2009). North American perspectives: POA, HAC and neverevents. Clinical Governance: An International Journal, 14(3), 242–244.
Discussion 1: Policy Analysis Summary
The selected policy is HB3871 Safe Patient Limits Act, which is currently pending action in the Illinois Legislature. The proposed policy sets a minimum nurse staffing requirement for all hospitals in Illinois. It states the maximum number of patients assigned to a registered nurse in specific situations. It also provides that nothing shall bar a healthcare facility from assigning fewer patients to a registered nurse than the limits stated in Act (Illinois General Assembly, n.d.). Besides, it provides that nothing in the Act stops the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act. Nonetheless, the maximum patient assignments in the Act may not be exceeded, despite using and applying any patient acuity system.
The policy can be addressed by having each hospital’s clinical team make staffing decisions for their hospitals depending on the unique circumstances at the specific hospital at any given time (Han et al., 2021). The policy can also be addressed by having professional nursing organizations advocate the implementation of the mandated staffing ratios in all hospitals to promote better working conditions for nurses and improve patient safety and quality of care. Implementing the policy can reduce nurse burnout and low job satisfaction associated with high workloads and physical and emotional fatigue (Lasater et al., 2021). In addition, it can improve the safety of patient care and patient outcomes and reduce healthcare costs.
References
Han, X., Pittman, P., & Barnow, B. (2021). Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing. Medical care, 59(10 Suppl 5), S463. doi: 10.1097/MLR.0000000000001614
Illinois General Assembly. (n.d.). Bill status for HB2604. https://www.ilga.gov/legislation/BillStatus.asp?DocTypeID=HB&DocNum=2604&GAID=15&SessionID=108&LegID=118738
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study. BMJ open, 11(12), e052899. doi:10.1136/bmjopen-2021-052899
The policy I addressed was the Title VIII Nursing Workforce Reauthorization Act of 2019. This policy/bill expands and empowers nursing workforce development programs through FY2024 (Congress, n.d.). This bill builds on the Institute of Medicine (IOM) (2010) report that recommends nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progress. This policy/bill was first passed in 2017 and has required significant nursing leadership advocation. I utilized a framework by Fawcette and Russell (2001) to look at social, ethical, legal, and financial impacts of the policy.
Numerous options/solutions for addressing the policy were addressed including no change, partial change, and a radical change. A partial solution to the barrier of nursing education funding would be the proposal of the Title VIII Nursing Workforce Reauthorization Act. This could encourage the standardization of nursing programs and create one uniform degree requirement for entry level nursing. Nurses could also access clear instructions on how to advance their degree with various clinical pathways outlined. This solution requires nursing leaders to be a strong advocate both in policy reform and nursing organizations to fill the gap until a more radical solution could be proposed. This can positively impact the nursing practice as it increases nurse education dollars and could improve staff to patient radios for improved patient outcomes. A radical change to address the nursing education pipeline would be providing free four-year education at a public university. This would take significant funding from taxpayers and bipartisan support. This radical solution would require nursing leaders to be highly involved in nursing legislature to ensure the solution was implemented. The cost of this radical option could be exorbitant and would require significant dedication, consensus, and support to obtain. The impact to the nursing profession as a result of this solution is unknown but one can posit that it would increase the number of healthcare professionals entering the field, improve staffing ratios and ultimately positively impact patient and organizational outcomes.
References
Congress. (n.d.). H.R. 728 Title VIII Nursing Workforce Reauthorization Act of 2019. https://www.congress.gov/bill/116th-congress/house-bill/728
Fawcette, J., & Russell, G. (2001). A conceptual model of nursing and health policy. Policy, Politics, & Nursing, 2(2), 108-116. https://doi.org/10.1177/152715440100200205
Institute of Medicine (2010). The future of nursing: Leading change, advancing health.
Grading Rubric
Accomplished
Emerging
Unsatisfactory
Content
Points Range:62.25 (41.50%) – 75 (50.00%)
Responds clearly, thoroughly, and effectively to all aspects of the assignment. All content is accurate and/or supported.
Points Range:57 (38.00%) – 61.5 (41.00%)
Responds adequately to the assignment but may not be thorough.
Points Range:0 (0.00%) – 56.25 (37.50%)
Does not respond to the assignment.
Focus and Detail
Points Range:31.125 (20.75%) – 37.5 (25.00%)
There is a clear, well-focused topic. Main ideas are clear and are well supported by detailed and accurate information gathered from scholarly sources.
Points Range:28.5 (19.00%) – 30.75 (20.50%)
There is a clear, well-focused topic. Main ideas are clear but are not well supported by scholarly sources and detailed information.
Points Range:0 (0.00%) – 28.125 (18.75%)
The topic and main ideas are not clear.
Organization
Points Range:18.675 (12.45%) – 22.5 (15.00%)
The introduction is inviting, states the main topic, and provides an overview of the paper. Information is relevant and presented in a logical order. The conclusion is strong.
Points Range:17.1 (11.40%) – 18.45 (12.30%)
The introduction states the main topic and provides an overview of the paper. A conclusion is included.
Points Range:0 (0.00%) – 16.875 (11.25%)
There is no clear introduction, structure, or conclusion.
Mechanics and APA
Points Range:12.45 (8.30%) – 15 (10.00%)
The assignment consistently follows current APA format and is free of errors in formatting, citation, and references. There are no grammatical, spelling, or punctuation errors. All sources are correctly cited and referenced.
Points Range:11.4 (7.60%) – 12.3 (8.20%)
The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are correctly cited and referenced.
Points Range:0 (0.00%) – 11.25 (7.50%)
The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Many sources are incorrectly cited and referenced or citations and references are missing.
Discussion 1: Policy Analysis Summary
Health care policy can facilitate or impede the delivery of services. For the past several weeks, you have been engaging in an authentic activity by critically analyzing a specific health care policy and various aspects of the impact associated with its implementation. A critical step in the policy process is communicating your findings with others. This week, you will share information from your policy analysis and its implications.
To prepare:
Briefly summarize your policy analysis, focusing on the implications for clinical practice that may be most relevant or interesting for your colleagues. Include how evidence-based practice influenced the policy, policy options, or solutions.
By Day 3
Post a 1- to 2-paragraph succinct summary of your policy analysis paper. Include at least two of the options or solutions for addressing the policy and the resulting implications for nursing practice and health care consumers.
Read a selection of your colleagues’ postings.
By Day 5
Respond to at least two of your colleagues sharing insights or contrasting perspectives based on readings and evidence, and the practice implications of the policy.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
RANDI
RE: Discussion 1 – Week 11
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Policy Analysis Summary
The purpose of this discussion post is to provide information on a health care topic of interest to policy makers. The policy brief development around staff staffing for our hospitals is a point of interest that should be brought to attention on a larger scale. The writer would like to discussion Michigan specifically regarding safe staffing in hospitals. The problem is there is no law in Michigan, that limits the number of patients a registered nurse can be assigned or the number of hours registered nurses are forced to work.
Some ICU’s in Michigan, a registered nurse may have up to four patients at a time but in other Michigan hospitals the registered nurse may have a limit of one to two. “The risk of dying in the ICU increases by a factor of 3.5 when the patient-to-nurse ratio is greater than 2.5 to 1” (Neuraz et al., 2015). Registered nurses are reporting that their workload is rarely or never adjusted when they report having an unsafe assignment. Michigan hospitals do not have to disclose current staffing levels. Registered nurses can be fired for refusing to work longer hours because administration classifies this as patien
