Proposal for mandatory staffing ratios
Introduction: Reflection

Public Policy Issue

This policy will mandate that mandatory staffing ratios be met by hospitals throughout the nation. This is an important public policy issue because it would oblige hospitals that are part of the Medicare program to create a committee that is partly made of nurses who can discuss the issue of staffing. As Fowler and Comeaux (2017) point out, staffing is still a major challenge for nurses. If there are too few nurses on staff it can lead to nurse burnout. The right ratio of nurses to patients is required to prevent nurses from being overburdened (Martin, 2015). The reason I selected this policy is because it is clearly important to nurses’ own health and ability to do their jobs. It can also play a part in preventing turnover rates from going too high (Laschinger & Fida, 2015). Therefore, this is an issue that can address a lot of problems in health care and improve community health.

Relevance

The policy on staffing ratios is relevant to nursing because it can be a solution to the problem of low quality care (Fowler & Comeaux, 2017) and it can be a way to ensure that nurses feel confident about their work (Martin, 2015). As Martin (2015) shows, better staffing ratios helps to improve quality care for patients. And as Laschinger and Fida (2015) show, when nurses feel they are giving quality care they are happier in their jobs and are more satisfied. When they are more satisfied they are more likely to stay in their jobs, too, which means lower turnover.

Financial Impact

The financial impact of mandatory staffing ratios has to be viewed in two ways. First, it has to be viewed in terms of the initial cost to the facility. Second, it has to be viewed in terms of the overall savings over time. First, the cost of mandatory staffing will be an increase in labor costs, which is likely to be over one million dollars for hospitals that have to increase staffing to meet the mandatory ratio (Reiter, Harless, Pink & Mark, 2012). These are the direct costs of nursing, which make up 30% of hospital costs (Reiter et al., 2012). Twigg, Myers, Duffield, Giles and Evans (2015).point out that increased staffing with a 4:1 ratio of patients to nurses can have a $40,000 cost per life saved for the hospital. Second, however, is the long-term savings. Twigg et al. (2015) also show that if staffing is increased by one full time RN equivalent per patient per day, the savings from years of life and productivity in society can be up to $13 billion. This shows that up-front costs exist but that there are also long term economic benefits for society.

My Values

My values impact my position on this policy in that I believe it is important for the right number of nurses to be on staff to treat patients. If there are too few nurses, patients do not receive the attention they deserve. Health care should be about putting patients first. I believe in patient-centered care and that hospitals should have a patient-centered care approach. They should have mandatory staffing ratios so as to ensure that quality care is always delivered.

Ethical Theory

The ethical theory of deontology is what underpins my perspective. Deontology or duty ethics argues that the morality of an action is determined by the role of the individual. The role of the hospital is to treat patients using quality care. If there are not enough nurses on staff, that quality care will not be possible. The hospital will not be doing its duty towards the patient. From the standpoint of deontology, the hospital has a duty to have the right ratio of nurses to patients because of the savings in terms of life years and economic benefit for society. If hospitals want to be in the industry they should be held accountable to society standards.

Policy Brief

Decision Maker

The decision maker who will receive this policy brief is Sen. Rand Paul from Kentucky. He is a member of the Senate Health Committee and will be able to draw attention to this issue because he is well-known in politics. This public policy requires Paul’s attention because a national law for mandatory staffing ratios will be effective at obliging hospitals to increase staffing (Fowler & Comeaux, 2017). Paul is a trusted senator who can help to promote this policy and see it through to legislation.

As Twigg et al. (2015) show, there is also an economic case to be made for investing in improving staffing ratios. That is one other argument that Paul can make to help promote this policy in the Senate. When there are too few nurses to treat patients, the patients do not receive the kind of quality care they require. They in turn do not get back to good or normal health. They lose years on their lives because there are not enough nurses on staff to help them learn how to care for themselves appropriately. Because nurses are overburdened they do not have time to engage in preventive medicine. All they can do is treat patients and move on to the next one. Emergency rooms are overwhelmed because there is just not enough help to go around.

To improve access to care, which is one of the Institute of Medicine’s aims for the health care industry and one of the Healthy People 2020 goals, mandatory staffing ratios should be required. The decision maker should argue in Congress that a bill to make staffing ratios mandatory is needed. The reason for this is simple: access to health care has to be improved, and nursing shortages are a big obstacle to access to care. Obliging hospitals to meet staffing ratios would solve that problem and help to make America healthier.

Main Challenges

The main challenges of addressing this policy are that hospitals are likely to push back against it and they have...…Community

The community will play a role in solving the problem by discussing the access to care needs of the community and representing patients who have stories about the care they have received in the past. Their opinions will help to provide support for the policy. They will be useful for the focus group organized by the senator, too, as the senator seeks to gain support for the bill. They will also be needed to help make the social media campaign go viral to raise support for the policy.

Key Elements

Key elements of developing a collaborative evaluation plan using CBPR principles are to:

1) use a cyclical and iterative process, starting with the partnership and going through all the stages of development;

2) identifying what social factors lead to health

3) sharing the findings so that the community knows and has access to the language used

4) strengthening the relationship for the long-term

5) making sure the members of the team are able to learn from one another

Evaluation

The success of the community can be evaluated by measuring outcomes such as how many users are tweeting the #MandatoryStaffing hashtag or whatever the hashtag will be. It will measure how many followers promoters of the policy have. It will measure how many respondents from the community share their stories on social media. This is the type of bottom-up approach that is needed to evaluate the success of the community plan.

Strengths and Challenges

The strengths of the top-down and bottom-up approaches in achieving policy changes are that they tackle the issue from two different perspectives. The top-down approach starts with the decision-makers at the top—the people in Congress who write the laws. They have to be convinced of the big picture and why the policy will bring about the outcomes that the community desires. The strengths of the bottom-up approach are that the community has to buy in to the policy for the bottom-up approach to work. When the community buys into it, the policy can gain traction quickly and gain a lot of interest from legislators, especially if the media puts a spotlight on the movement.

The challenges of the top-down approach are that it can be very difficult to gain the attention of a lawmaker without having a big following behind the policy. The challenges of the bottom-up approach are that even if a movement for a policy change does gain traction in the community, there is no guarantee it will get attention from Congress.

The approach that I would recommend as the most effective to address this policy issue is the top-down approach because grassroots movements and community-based movements can take years to gain traction. The top-down approach can be more effective in addressing policy change because it goes straight to the source of power and moves from there. Getting a decision maker to agree that the policy is needed is a big step in the right direction.

References

ANA. (2019). Nurse staffing. Retrieved from https://www.nursingworld.org/practice-policy/advocacy/state/nurse-staffing/

Dousay,…