Introduction
The provision of the high-quality patient care is directly connected with the question of nurse staffing. While representing the Florida Nurses Association, it is important to concentrate on the initiatives which can be discussed as effective to change the situation for better. To decrease the high levels of the nurse turnover, to predict understaffing in hospitals, the situations of overworking, making medical errors, it is necessary to regulate the question of the staffing ratio in relation to the number of cared patients. In November of 2011, House Bill (HB) 795: Florida Hospital Patient Protection Act was filed and proposed for discussion. The bill was developed to address the question of the nurse staff shortages while proposing to focus on the staffing level requirements for health care institutions, to address the staff high turnover, and increase the quality of the patient care while improving the nurses’ workplace conditions. In March of 2012, the bill died in Health and Human Services Quality Subcommittee (HB 795: Health Care, 2012). In spite of the fact that the bill did not get the hearing in the Senate, the propositions listed in the bill should be revised and proposed for the new series of discussions; the changes proposed in the bill can be discussed as effective to improve the work conditions for nurses and the whole quality of the patient care in Florida.
Evidence-Based Guidelines Published on the Issue
The Florida Hospital Patient Protection Act was developed and filed in 2011 as the reaction to the negative tendencies in the health care industry of Florida. There is the direct connection between the quality of the patient care, the appropriate number of the registered nurse staff, and turnover rates. The problem is in the fact that the mortality of patients in the units and facilities where there is the shortage of the nurse staff is rather high (Delaney & Shattell, 2012, p. 340). Such a controversial situation is associated with the ineffective policy in the sphere, and such acts as the Florida Hospital Patient Protection Act are developed to address the problem and decrease the nurse shortage in the health care industry because the situations of overworking lead to the nurses’ burnout and decreases in the quality of patient care (HB 795: Health Care, 2012). The Florida Hospital Patient Protection Act was developed to provide the protection not only for overworking nurses but also for patients who could suffer from the results of the inappropriate approach to regulating staffing question in hospitals (HB 795, 2012; McHugh, 2010, p. 442).
Key Policy Events: Regulatory and Legislative Events
The policymakers began to develop the Florida Hospital Patient Protection Act in 2010. The first step was the focus on the problem of overworking and high nurse turnover in the health care units of Florida. The next step was the focus on the necessity to provide the reasonable ratio of nurses to patients in the hospitals of Florida. House Bill 795 was filed in November of 2011. In December of 2011, the bill was referred to Health and Human Services Quality Subcommittee (HB 795: Health Care, 2012). The bill was also discussed by the Rulemaking and Regulation Subcommittee, the Health Care Appropriations Subcommittee, and by the Health and Human Services Committee. The bill died in Health and Human Services Quality Subcommittee in March of 2012, and the bill was not passed to come into effect in July of 2012 (HB 795, 2012). The main financial and regulatory issues were associated with developing staffing plans for facilities and establishing the classification system for patients.
Financial Data
The Florida Hospital Patient Protection Act can be discussed as the attempt to cope with the financial problems associated with the necessity to cover the nurse shortages in the hospitals of Florida. The proposition to focus on the minimum staffing level requirements which are related to the ratio of nurses to patients and the proposition to use the staffing plan can contribute to resolving the financial issue because hospitals in the United States can spend about $300,000 annually to cover the increased rates in the registered nurses’ turnover rate (Wright & Bretthauer, 2010, p. 374). The resolution of nurse staffing shortages can lead to saving more than $6 billion because of decreasing the costs associated with the patient care. More savings are associated with the nurses’ increased productivity (Delaney & Shattell, 2012, p. 341). Thus, the development of the staffing plan for hospitals, and the focus on hiring the adequate number of registered nurses can result in more than $200 million annual savings (Seo & Spetz, 2014, p. 216).
Major Stakeholders
Referring to the Florida Hospital Patient Protection Act, the one group of main stakeholders are the policymakers and the Florida Senate and House of Representatives. The policymakers and the government representatives are interested in supporting the bill which is most advantageous for the health care industry of the state. The next group of stakeholders is the federal government because the focus on the bill makes the federal policymakers revise the approach to the nursing staff in the hospitals of the USA with the focus on the problem of staff shortages. The registered nurses working in the hospitals of Florida and the representatives of the Florida Nurses Association are the next group of stakeholders who are interested in passing the act in spite of the character of possible amendments (Hicks, 2014, p. 112). Patients are also the important stakeholders who need receiving the high-quality care.
Social, Economic, Ethical, Legal, and Political Factors
The issue of nursing staff’s shortage is one of the most challenging in Florida because of affecting the quality of the patient care and the whole development of the health care industry. It is important to pay attention to the fact that the nursing shortage in the U.S. hospitals, including units in Florida, is predicted to grow continuously. According to the data presented by the National Center for Health Workforce Analysis, by 2020 more than 35% of the nursing staff will be required to fill the positions in the United States (Wright & Bretthauer, 2010, p. 373). Furthermore, the overall number of the nursing shortage could become 500,000 by 2025 (Wright & Bretthauer, 2010, p. 374). As a result, policymakers in Florida should focus on developing the policy which can address the problem directly, while contributing to inviting more nurses to work in hospitals of Florida.
The impossibility to regulate the question of the nurse staff shortages in Florida can lead to affecting the welfare of registered nurses and patients, to increasing the levels of mortality and infection rates, to increasing the cases of the nurse’ burnout, and to hospitals’ significant financial problems. Registered nurses should work in the effective environment while following the carefully developed schedules. More than 54% of registered nurses note that the main cause of their medical errors is the burnout associated with overworking (Temple, Dobbs, & Angel, 2009, p. 182). Thus, the problem is directly connected with the ethical issues of the patients’ increased rates of mortality. Delaney and Shattell state that not only social and ethical factors matter but also economic ones because the focus on new schedules can save more than $6 billion for the U.S. hospitals (Delaney & Shattell, 2012, p. 341). Referring to legal and political factors, it is important to state that policymakers have problems with passing the Florida Hospital Patient Protection Act because of the necessity to reform the whole approach to organizing the work of the registered nurses in Florida, and this approach is associated with a range of regulatory and financial challenges.
Policy Intervention Options
To resolve the problem of the registered nurses staff’s shortages in Florida, it is necessary to focus on such available options as the revision of the bill’s propositions and the implementation of the separate approaches and strategies proposed in the bill of 2011/2012. The most recent legislative activity on the issue is associated with the further creation of the Florida Hospital Patient Protection Act and promotion of SB 1732 in 2013 (ACOG: District XII Florida Update, 2013). In 2014, the discussion of the options connected with creating the Florida Hospital Patient Protection Act is continued.
The process of creating the Florida Hospital Patient Protection Act is rather challenging, and it takes about 5 years. The possible alternative options include such regulations and policies as the (1) increase of the ratio of registered nurses to patients in the hospitals of Florida with the focus on increasing the healthcare budget in order to avoid the burnout and improve the patient care; (2) the implementation of staffing plans in health care units and facilities in order to avoid overworking; and to (3) prohibit assigning the unlicensed personnel for working in the areas of the licensed personnel’s duties in order to increase the quality of the patient care (Parker, Desborough, & Forrest, 2012, p. 382). The other options can include the development of uniform standards and registered nurses’ responsibilities.
Proposed Recommendations
The main recommendation to address the issue of nurse staff’s shortages in Florida and creation of the Florida Hospital Patient Protection Act is to focus on revising the current version of the bill proposed for the House of Representatives and Senate of Florida and to promote to changing to bill’s status into the ‘Passed’ one. From this point, it is necessary to concentrate on supporting such approaches as the changes in the ratio of registered nurses to patients and implementation of staffing plans. The approaches to addressing the nurses’ rights should also be revised according to the current standards.
Nursing Implications
The opportunity to pass the bills associated with creating the Florida Hospital Patient Protection Act is important for the registered nurses working in hospitals of Florida because this policy can resolve the problem of the nurses’ burnout, stress, and decrease the cases of overworking (McHugh, 2010, p. 442; Seo & Spetz, 2014, p. 216). Furthermore, patients can also benefit from promoting the bill because the quality of the care will increase and the rates of medical errors will decrease.
Conclusion
The adequate patient care can be discussed as a result of the effective work of registered nurses. Such factors as the high turnover rates, nurse shortages, burnout, and overwork contribute to decreasing the quality of the patient care. To regulate the question of the staffing ratio in relation to the number of cared patients in the hospitals of Florida, it is necessary to support HB 795: Florida Hospital Patient Protection Act. The focus on revising the bill and filing the new variant can lead to improving the overall situation associated with the work of registered nurses.
References
ACOG: District XII Florida Update. (2013). Jacksonville, FL: ACOG.
Delaney, K., & Shattell, M. (2012). Registered nurse workforce trends for new entrants age 23-26: Hope for the psychiatric nursing workforce shortage. Issues in Mental Health Nursing, 33(5), 340-341.
HB 795. (2012). Web.
HB 795: Health Care. (2012). Web.
Hicks, L. (2014). Economics of health and medical care. Burlington, MA: Jones & Bartlett Publishers.
McHugh, M. (2010). Hospital nurse staffing and public health emergency preparedness: Implications for policy. Public Health Nursing, 27(5), 442-449.
Parker, R., Desborough, J., & Forrest, L. (2012). Stakeholder perceptions of a nurse led walk-in centre. BMC Health Services Research, 12(1), 382-388.
Seo, S., & Spetz, J. (2014). Demand for temporary agency nurses and nursing shortages. The Journal of Health Care Organization, Provision, and Financing, 50(3) 216–228.
Temple, A., Dobbs, D., & Angel, R. (2009). Exploring correlates of turnover among nursing assistances in the National Nursing Home survey. Health Care management Review, 34(2), 182-190.
Wright, D., & Bretthauer, K. (2010). Strategies for addressing the nursing shortage: Coordinated decision making and workforce flexibility. Decision Sciences, 41(2), 373-401.