Running head: HEALTH CARE POLICY PAPER 1

Health Care Policy Paper

Morgan Butler

Bon Secours Memorial College of Nursing

NUR 4240

Catherine Mikelaites

"I Pledge"
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Health Care Policy Paper

Health care providers are sometimes met with several obstacles when attempting to

provide appropriate and quality care for their patients. The health care environment, at present, is

woven together with policies, regulations, as well as laws that are put in place by government,

private insurance companies, or even health care institutions. These are all important factors, but

it is also important for health care providers to understand what drives these things as well as

how to initiate change when needed. Health care policy determines many things, including the

following: who provides services, who receives services, what services are provided, quality

standards, requirements for reimbursement, and improvement initiatives. These are all huge

factors in health care, and if they are not working then health care providers need to know what

to do to make a change. One way to initiate change is through legal means, and support of a

health care bill could make a significant impact on change in the health care environment.

Health Care Bill

Currently, there is a bill being considered by the U.S. Congress regarding nurse staffing

ratios. The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of

2017 (H.R.2392, 2017) acknowledges the fact that patients are presenting with higher acuity

levels and that registered nurse staffing practices are inadequate and poorly monitored. The bill

proposes minimum staffing ratios as follows for registered nurses: 1:1 for Trauma Emergency

Units, and Operating Room; 2:1 for ICUs, emergency critical care, L&D, coronary care units,

acute respiratory units, postanesthesia units, and burn units; 3:1 for Emergency rooms, pediatrics,

stepdown, telemetry, antepartum, and combined L&D/Postpartum units; 4:1 for Med/Surg units,

intermediate care nurseries, acute psychiatric units, and other specialty care units; 5:1 for

Rehabilitation units and skilled nursing units; and 6:1 for postpartum units and well-baby
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nursery units (H.R. 2392, 2017). This bill sets a standard for minimum nurse staffing ratios, but

also clearly defines issues that could accompany this such as need for flexibility, support staff,

roles of video monitoring, and roles of nurse managers. It also addresses issues such as

prohibition of mandatory overtime to meet ratios and exemptions in emergencies. This bill is

very detailed in all things related to nurse staffing ratios.

This bill notes that studies have shown that patient outcomes are directly correlated to

direct care registered nurse staffing levels. This is a very important correlation to consider, as

nursing staff is too often, “short,” at present. It is noted in the bills findings that proper staffing

would also improve nurse retention, as the demands created by being inadequately staffed would

not be an issue. Different sections of this bill address topics such as the following: staffing

requirements, whistleblower and patient protections, enforcement, recording and auditing, and

adjustments in reimbursement. The bill was introduced into the House Ways and Means on

05/04/17 and is awaiting further consideration. It currently has 23 cosponsors between 11 U.S.

States or Territories.

Impact on Nursing Profession & Patients

It has been noted, by the previously stated bill, that current staffing practices results in

too few registered nurses providing direct patient care can decrease quality of care and

increase the incidence of medical errors. Proper staffing would increase the quality of care and

outcomes for patients, and nursing staff morale would improve due to decreased demands.

Proper staffing would also lead to better registered nurse retention, because at present many

RN’s consider leaving direct patient care because of demands created by inadequate staffing. The

American Nurses Association notes that proper staffing can eliminate almost 1/5 of all hospital

deaths, and reduce the relative risk of adverse patient events.

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The American Nurses Association’s Optimal Nurse Staffing to Improve Quality of Care

and Patient Outcomes: Executive Summary (2015) discusses how proper nurse staffing can

impact clinical as well as economical outcomes, and notes that proper nurse staffing is associated

with the following: improved patient satisfaction, improved health-related quality of life,

decrease in medication errors, decrease in re-admissions, decrease in patient length of stay,

decrease in patient mortality, decrease in number of adverse patient events, decrease of patient

care costs, as well as a decrease in nursing fatigue. The ANA notes it’s support of state and

federal regulation that allows for flexible nurse staffing plans, as well as public reporting of

staffing data to promote transparency and penalizing institutions that fail to comply with minimal

safe staffing standards (ANA, 2015). The previously mentioned bill seems to line up with the

ANA’s standards.

Financial Implications

Proper nurse staffing could have a significant impact on health care spending. The

American Nurses Association’s Safe Staffing Fact Sheet (2017) notes that proper nurse staffing

and the benefits associated with it previously, could decrease patient length of stay as well as re-

admissions. The ANA Sate Staffing Fact Sheet (ANA, 2017) notes proper nurse staffing that can

yield a cost savings of almost $3 billion or the equivalent of more than 4 million extra stay days

for patients that could have been avoided. In addition to this, the ANA notes that the cost of

recruiting and replacing an RN is 1.1 to 1.6 times an annual nurses’ salary, and nurse retention as

a result of proper staffing would reduce the amount spent on recruitment as well as training of

new RN’s. Although it may be a jump in costs to hire additional staff to meet minimum staffing

requirements, the benefits of doing so would most likely result in money-saved over

time. The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of
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2017 (H.R.2392, 2017) notes that if the bill were to pass, no more than 2 years after it’s

enactment, the Medicare Payment Advisory Commission would submit a report estimating total

costs and savings attributable to compliance and recommendations on the need, if any, to adjust

reimbursement for Medicare payments to Congress.

Opportunities and Challenges

If minimum staffing ratios were established, there would be increased opportunities for

quality nursing care and improved patient outcomes. As previously stated, patient outcomes are

directly correlated to direct care registered nurse staffing levels. Improving patient outcomes and

providing safe, efficient care is so important. The use of minimum nurse staffing ratios definitely

has the potential to improve staff morale and nursing retention, therefore allowing for more

focused training for nurses. If a nurse is able to stay on a unit that they love, and receive more

unit-specific specialized training due to proper staffing, then the patient benefits from this extra

knowledge that has been gained. At present, due to staffing challenges, nurse often will change

units or specialties because they cannot meet the demands of other units. Challenges with the

concept of staffing ratios could include the following: intensity of patient need, level of

experience of nursing staff, layout of the unit, amount of ancillary support, and need for

flexibility of staffing plans. The minimum proposed staffing ratios would be very helpful, but

planning for them leaving room for flexibility could be a huge challenge.

Conclusion

There are currently no set rules to deal with the nurse staffing issue, and this bill would

change things significantly. Setting a legally required minimum staffing ratio could improve

nursing morale as well as patient quality of care and outcomes. This could make a huge impact

on numerous issues in the health field, as well as decrease health care spending due to the
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improved patient quality of care and improved patient outcomes. This bill also takes into

consideration the need for flexibility of staffing and protection of health care staff, which is also

very important. Overall, it seems that The Nurse Staffing Standards for Hospital Patient Safety

and Quality Care Act of 2017 has taken many factors into consideration to improve the health

care environment for the nursing profession.

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References

American Nurses Association (2015). Optimal Nurse Staffing to Improve Quality of Care and

Patient Outcomes: Executive Summary. ANA. Web. Retrieved from

http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-

Agenda-Reports/State-StaffingPlansRatios/Optimal-Nurse-Staffing-ES-Sep15.pdf

American Nurses Association. (2017). Safe Staffing Fact Sheet. ANA. Web. Retrieved from

http://www.nursingworld.org/SafeStaffingFactsheet.aspx

Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017, H.R. 2392,
115 Cong. (2017)