Currently, there are many issues in the health care industry that directly influence the professional practice of nurses. For instance: nurse turnover, nurse staffing ratios, patient satisfaction, quality improvement and much more. One of the biggest problems nurses face today is low staffing: nurses are often forced to provide nursing care for more patients than required, which consequently results in medication errors, negative outcomes and patient dissatisfaction.
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According to American Nurses Association (2017), “As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients ” (para.1). Safe staffing can positively influence the quality of the provided nursing care. The issue of nurse-patient ratios is a highly discussable topic both in health care industry and the legislation. Legislation can significantly modify the way nurses perform their duties on a daily basis.
For that reason, it is important to be aware of new policies concerning the nursing profession. This paper will examine a Florida HB 187: Staffing Ratios in Health Care Facilities and discuss how it would impact nursing practice today.
The House Bill 187: Staffing Ratios in Health Care Facilities was introduced by Representative Barbara Watson and Senator Oscar Braynon on September 17, 2015. This bill required “minimum staffing levels of direct care registered nurses in health care facility” with specified nurse-to-patient staffing ratios; “prohibited hospitals from using video cameras or monitors as a substitution for required level of care” (Staffing Ratios in Health Care Facilities, 2016, Sec. 1).
It also included provisions to prohibit mandatory overtime and prohibit interference with nurses’ right to organize or bargain collectively. Furthermore, it required annual evaluation of staffing; prohibited “assigning unlicensed personnel to perform functions of licensed or registered nurse”; prohibited facility from interfering with nurses’ right to organize meetings or collective bargains (Staffing Ratios in Health Care Facilities, 2016, Sec. 1). It enacts specific procedures for receiving and investigating complaints and lets the civil monetary penalties to be imposed for a violation. Moreover, the bill requires public reporting of staffing information, which additionally ensures transparency.
Recently, there has been an increase of interest toward the issue of nursing staffing. A considerable amount of research showed that the quality of healthcare highly depends on proper nurse staffing. For instance, studies found that improved nurse staffing increased the likelihood of surviving a heart attack (McHugh et al., 2016), patient mortality was associated with the availability of staff resources (Neuraz et al., 2015), and a connection was found between heavy nurse workloads, education and patient survival after surgery (Aiken et al., 2014) and much more.
The research of the bill also illustrates that patient safety is correlated with the number of working nurses: “Higher staffing levels by experienced registered nurses are related to lower rates of negative patient outcomes” (Staffing Ratios in Health Care Facilities, 2016, Sec. 2). It also suggests that human factors such as staffing, employee fatigue, stress and working overtime is one of the key elements causing errors in patient care, patient satisfaction and even patient deaths.
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This trend seems to have begun in 1990’s when hospitals started cutting the personnel and replaced registered nurses with unlicensed health workers. By 1996, nursing the staff budget was cut to 27 percent. Meanwhile, the number of patient complaints has significantly increased; in two years, according to American Hospital Association survey, 35 percent of patients received care that was below standards (Massachusetts Nurses Association, 2017). Since then, the Safe Staffing bill was filed to Congress multiple times. California was the first state to enforce minimum nurse-to-patient staffing ratios in 2004 with the primary goal to improve the quality of the provided care.
Later, studies showed the effectiveness of the legislation: nurses of California experienced less burnout, and less dissatisfaction with jobs compared to other states. Moreover, California reported fewer surgical deaths, more infrequent occurrences of pressure ulcers, acute care hospitalizations, urinary tract infections in patients and more (Department for professional employees, 2016). Although the legislation failed within a year, today, 14 states have enacted the safe staffing legislation following the analogical requirements. They include Oregon, Texas, Illinois, Ohio, Washington, Nevada and Connecticut and others.
American Nurses Association – one of the major stakeholders of the bill actively provided continuous support for the bill because it promoted patient safety and cared for nurses. ANA (2017) strongly believes that “Identifying and maintaining the appropriate number and mix of nursing staff is critical to the delivery of quality patient care” (para.1). Florida Hospital Association – is the biggest association in the state that actively advocates legislations on behalf of health care facilities, opposing this bill. The clear explanation for opposition is not provided, however budget and feasibility could be some of the influencing factors.
Proponents of the bill emphasized the relevance of this issue. They believed it was critical to improve patient safety and protect nurses from overworking and eventually quitting this profession. Opponents, on the other hand, believed that changing nursing staffing ratios would not improve death rates or patient satisfaction. One of the disadvantages of this legislation is that it would impose a great financial pressure on hospitals. Nevertheless, a substantial body of research showed otherwise.
The bill would positively impact the overall performance of nurses as it would appropriately regulate the working schedule, and ensure nurse’s workload is adequately distributed. The safety and quality of nursing care would increase because registered nurses would effectively use their education and experience in the proper units. Effective nursing care would not only improve readmissions, patient satisfaction and decrease mortality rate but could also solve human resources problems, such as nurse turnover and nurse retention as well as increase the revenue of a healthcare facility.
Because of adequate workload, and less pressure to work overtime, nurses will have the motivation to work and stay in the profession. Thus, passing and enacting such bills as safe staffing directly impacts the practice of every nurse in the country. Therefore, for a nurse it is important to communicate with local or national legislators and policymakers, provide support and information about health care, and participate in the development of policies using the professional network. Some steps to take action include contacting a representative of a state, writing a letter to the Congress, or influencing public opinion by talking about health care issues on public meetings, and conferences.
Staffing Ratios in Health Care Facilities bill proposed to improve the staffing plan by nursing education and experience and other important factors. This legislation was proven to be effective in improving the overall nursing practice experience, the quality of nursing care, which resulted in fewer mortality rates, and nurse retention across the states that enacted this legislation. In Florida, this bill would encourage nurses to work harder and seek for education opportunities.
Aiken, L. H., Sloane, D.M., Bruyneel, L.,Van den Heede, K., Griffiths, P., Busse, R.,… Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824 – 1830.
American Nurses Association. (2017). Safe staffing. Web.
Massachusetts Nurses Association. (2017). Safe RN staffing legislation fact sheet and historical timeline. Web.
McHugh, M., Rochman, M. F., Sloane, D.M., Berg, R.A., Mancini, M.E., Nadkarni, V.M., … Aiken, L.H. (2016). Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Medical Care, 54(1), 74-80.
Neuraz, A., Guérin, C., Payet, C., Polazzi, S., Aubrun, F., Dailler, F.,… Duclos, A. (2015). Patient mortality is associated with staff resources and workload in the ICU: A multicenter observational study. Critical Care Medicine, 43(8), 1587-1594. Web.
Department for professional employees. (2016). Safe-staffing ration: Benefiting nurses and patients. Web.
Staffing Ratios in Health Care Facilities, H.B. 187 (2016).