Policy Briefing Document

Answer

Policy Briefing Document

Process of Legislation

            The nurse-to-patient ratio law enacted in 2004 was prompted by the need to improve the level of care offered to patients (Clarke, 2008). A safety crisis was being experienced in care institutions due to poor staffing (Clarke, 2008). Cases such as increased preventable medical errors and increased death toll alongside prolonged patient stays were being experienced in health institutions. Moreover, the staff members were experiencing heavy workloads which worsened due to inadequate staffing in the case institutions (Clarke, 2008). The issue was proposed by Doris Carroll who began noticing the nurse staffing concerns in the 1990s. The California Nurses Association (CAN) drafted and sponsored the nurse-to-patient ratio legislation (“California Healthcare Foundation”, 2009).

The legislation process took five years before nurse-to-patient ratio was enacted to law. During this time, nursing unions took part in intensive lobbying which facilitated the enactment process (Kuwata, 2017).  Additionally, political scales were also utilized in favor of the nurses’ unions after Gray Davis was elected as the governor. Notably, Davis was endorses by the unions which represented the nurses in California (Kuwata, 2017). The critical elements of the legislation included making it mandatory that a minimum ration of a single nurse for every five patients in a care setting should be maintained in hospital wards (Kuwata, 2017). In intensive care units a ratio of one nurse to two patients should be maintained (Kuwata, 2017). 

Outcome of Legislation

Turnover Rates and Patient Safety

            The mandated ratio under the nurse-to-patient ratio law resulted to an improvement in the nurse turnover rates. Bolton, Aydin, Donaldson, Brown, Sandhu, Fridman and Aronow (2007) support this by recording that after the legislation was implemented, a decrease in nurse turnover rates was experienced as well as reliance on temporary nurse staff to meet the required ratio. Additionally, it is also evident that the mandated ratios resulted to improved patient outcomes. According to Martin (2015), the implementation of the legislation resulted to lower nurse turnover rates which further foresaw an improvement in the quality of care among patient. Notably, instances of increased lengths of stay in acute care settings reduced and patient safety rates improved.

Recommendations

            It is recommended that nurse leaders should support working with other professionals to come up with a similar legislation in different states. Notably, the nurse-to-patient ratio is only applicable in California while other states have not yet implemented a similar law. This will result in several advantages. For instance, coming up with a similar legislation will be effective in promoting patient outcomes and supporting nursing practice. According to Clarke (2008), the legislation will see a reduction in nurse turnover rates which provides a depiction that nurses will no longer have to work for longer hours and expose themselves to instances of burnout. As a result, nurses will be in their best physical condition to offer effective care to patients. This suggests that cases which results to safety concerns will significantly reduce, hence constituting better patient outcomes (Kuwata, 2017). To support the initiative seeking the attention and input of other stakeholder groups such as unions and the community to support the initiative is necessary as it makes it easier for the people to understand the benefits related with the implementation of a similar law in different parts of America (Kuwata, 2017). Therefore, the derived benefits associated with this initiative will be a founding basis for convincing the manager about the importance of implementing this recommendation despite the noted high costs.

            Despite the associated benefits with the recommendation, it is evident that the implementation of this factor will result in several cons. For instance, implementing a similar legislation as the nurse-to-patient ratio law will result in increased operational cost for health care institutions (“California Healthcare Foundation”, 2009). Notably, more financial resources will be allocated towards paying the salaries and wages of nurses as more professionals within this group will need to be employed to meet the ratio requirements of the law. The high costs of staffing further constitute the high costs reported by the overall health care system. Additionally, patients may also be affected in that they will end up experiencing extended wait times. However, through completing a cost benefit analysis, it is evident that the derived benefits from the implementation of the law are higher than the experienced costs. Arguably, with the associated benefit of increased patient outcomes, an influx of patient will be experienced. However, the patients may have to wait longer before receiving care to maintain the required nurse-to-patient ratios (“California Healthcare Foundation”, 2009). Failure to enact a similar law may prompt instances of medical errors, poor quality services, nurse burnout and other concerns which increase the costs of care even further (Clarke, 2008). However, the law is effective in reversing this downside to ensure a successful patient and staff outcomes.