Scenario
Your nursing leader has asked you to provide her with information regarding the legislation on California’s nursing union negotiated staffing ratios. You will prepare a policy briefing document that details the process and outcome associated with this piece of legislation. Your nursing leader will use this briefing document to guide her decision on whether this is a good policy to support in your state.
Instructions
Prepare a policy briefing document that:
Part One – Process of Legislation
- Explains the critical concern(s) that prompted this legislation, who proposed the issue, as well as who drafted and sponsored this legislation.
- Describes how long the process took and the steps taken from the initial idea to legislation implementation as well as the critical elements of the legislation that was passed.
Part Two – Outcome of Legislation
- Answers the following questions:
- Does the research support that mandated ratios improved nurse turnover rates?
- Does the research support that mandated ratios improved patient outcomes?
- Discusses recommendations on whether your nursing leader should support working with other nurse leaders on similar legislation.
- Examines at least two pros and two cons for your recommendation based on research.
- Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the policy briefing document.
Rubric
Exemplary explanation of the critical concerns that prompted this legislation, who proposed the issue, as well as who drafted and sponsored his legislation with comprehensive supporting details.
Exemplary description of how long the process took and steps taken from the initial idea to legislation implementation of the critical elements of the legislation that passed with comprehensive supporting details
Thoroughly answer the questions regarding whether research supports improved nurse turnover rates and patient outcomes with comprehensive supporting details
Exemplary discussion of recommendations on whether your nursing leader should support working with other nurse leaders on similar legislation with comprehensive supporting details
Exemplary examination of at least two pros and two cons for your recommendation based on research with comprehensive supporting details
APA format, credible sources
The Process of Policy-Making in Healthcare Delivery
Student’s Name
Institutional Affiliations
The Process of Policy-Making in Healthcare Delivery
Nurses play an essential role in improving health and health care delivery. One of the best ways through which they influence improvements in the healthcare delivery processes is by participating in policy. According to the American Nurses Association (n.d.), as policy-makers, nurse leaders normally influence decisions that affect both patients and nurses in their organizations. The purpose of this assignment is to explore the process and outcomes of legislation with reference to California’s nurse staffing law.
Part One: Process of Legislation
The state of California enacted a nurse staffing ratio law in 2004. The law compels all healthcare organizations in California to maintain a minimum ratio of one nurse to five patients across all departments (California Nurses Association, n.d.). The critical concerns that prompted this legislation were the rising incidences of adverse patient outcomes and increasing nurse turnover rates. Concerns that led to the legislation of the California nurse staffing ratio law began in 1999. During this time, a bill titled AB 394 was passed that prompted hospitals in California to establish minimum staffing ratios for their wards (California Nurses Association, n.d.). Nurses usually feel overworked, fatigued, and demotivated when they are required to handle several patients at a time. This affects their performance leading to poor patient outcomes. Additionally, severe burnout among these nurses influences them to develop a desire to leave their organizations contributing to their high turnover rates (Haegdorens et al., 2019). The registered nurses staffing ratio bill was proposed, sponsored, and drafted by Assemblywoman Sheila James Kuehl, a Democrat of Santa Monica (Purdum, 1999).
The process of enacting the registered nurse staffing law in California started in 1999. The enactment of the initial bill into law in California took several steps with critical steps being passed at each subsequent step. The original AB 394 bill was initially presented before the Assembly Committee on 6th April 1999. From the Assembly Committee, it moves to the Assembly Floor twice, to the Senate Committee thrice, to the Senate Floor five times, and finally to the Assembly Floor once (California.gov). The bill was then signed into law by Governor Gray Davis on 10th October 1999. Critical elements that were passed were those that required the Department of Health Services to set regulations for hospitals prompting them to have minimum nurse staffing ratios and preventing them from hiring unqualified nurses (Purdum, 1999). By 2004, all hospitals were expected to have met the expectations of the legislation by ensuring that they kept nurse to patient ratios below 1:5 in all wards.
Part Two: Outcome of Legislation
Nurse Turnover Rates
The California’s mandated nurse staffing ratio law not exceeding 1:5 have improved nurse turnover rates in the state. According to Leigh (2016), the California’s registered nurses staffing law compelled hospitals to hire additional nurses and this helped to address the shortage that had been caused by high turnover rates. Generally, safe nurse staffing in California has helped to reduce the workload, burnout, and injuries for the nurse, a factor that has helped to reduce rates of turnover (Department for Professional Employees, 2019). This evidence should encourage other states to enact mandates or legislation to direct nurse staffing.
Patient Outcomes
Research supports the positive impacts of California’s nurse staffing law on patient outcomes. As reported by the Department for Professional Employees (2019), California began to witness the positive effects of its nursing law as early as 2010. Research comparing California with Pennsylvania and New Jersey states revealed that the state of California had significantly better patient outcomes than the other two states. The parameters that were being compared include patient mortality, surgical site infections, within 30-day readmission rates, and patient falls. Another study conducted in 2018 showed that an increase of one nurse resulted in a 14% reduction in health risks for patients (Department for Professional Employees, 2019). These findings support the need for states to have mandated nurse staffing ratios.
Recommendations
The nursing leader should support working with other nurse leaders on similar legislation to ensure adequate staffing in the facility. As supported by the American Nurses Association (n.d.), nurses should always strive to improve the lives of both patients and their fellow nurses through policy. Therefore, by supporting such legislation, the nurse leader will contribute greatly to improving the lives of both patients and nurses in the organization.
Pros and Cons
The above recommendation has both pros and cons. One of the advantages is that it will help to reduce nurse turnover rates. Besides, supporting such a recommendation will improve patient outcomes. However, implementing such a policy might be costly for the organization. Additionally, it might cause a disruption in the workforce, a factor that might impact workflow and staff performance (Leigh, 2016; Department for Professional Employees, 2019).
Conclusion
Contemporary nurses do not only provide health care to patients and their families but they also participate in policy-making and implementation to improve health care and the health care delivery process. This assignment has evaluated the process and outcomes of California’s registered nurses’ staffing ratio law. As policy-makers, nurse leaders should support working with other nurse leaders on similar legislation to ensure adequate staffing in the facilities.
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References
American Nurses Association. (n.d.). Health policy. https://www.nursingworld.org/practice-policy/health-policy/
California.gov. AB-394 Health facilities: nursing staff. (1999-2000). https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=199920000AB394.
California Nurses Association. (n.d.). 2004 California RN staffing ratio law. https://www.cga.ct.gov/2004/rpt/2004-r-0212.htm
Department for Professional Employees. (2019). Safe staffing: critical for patients and nurses. https://www.dpeaflcio.org/factsheets/safe-staffing-critical-for-patients-and-nurses
Haegdorens, F., Van Bogaert, P., De Meester, & Monsieurs, K. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC Health Services Research, 19, 864. https://doi.org/10.1186/s12913-019-4688-7.
Leigh, P. (2016). California’s nurse-to-patient ratio law reduced nurse injuries by more than 30 percent. https://www.epi.org/blog/californias-nurse-to-patient-ratio-law-reduced-nurse-injuries-by-more-than-30-percent/
Purdum, T. (1999). California to set level of staffing for nursing care. The New York Times, Oct. 12, https://www.nytimes.com/1999/10/12/us/california-to-set-level-of-staffing-for-nursing-care.html