Running head: HEALTH CARE ISSUE ANALYSIS 1

Health Care Issue Analysis

Angela Purgiel

Ferris State University

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Health Care Issue Analysis

The purpose of this paper is to outline the proposed Federal Safe Staffing and its relevance to

healthcare. Information will be provided on past practices, implications, consequences, key

stakeholders and the proposed legislation. Evidence will be used to support the discussion of this

legislation a long with an interview with the Chief Nursing Officer at a local hospital.
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If you ask a staff nurse what one of the most frustrating obstacles they encounter are, at

some point the issue of staffing would come up. Many nurses are faced with increasing patient

acuities, decreasing staffing ratios, and a nursing shortage. The Federal Safe Staffing Act will be

discussed in the following sections including key stake holder’s specifications of this bill and

why it is important to the field of nursing.

Relevance and Importance to Health Care

Nursing care is an extremely vital aspect of health care system and the Federal Safe

Staffing Act addresses the importance of staffing ratios and its effect on health care. Staffing

ratios and proper nursing care are directly related to safer patient outcomes and increased

satisfaction of the patients (Dorning, 2013). Research shows lower registered nurse (RN) ratios

are associated with increased rates of nonfatal adverse outcomes like “urinary tract infections,

pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue and

30-day mortality” (Stanton, 2004, p3). Research has shown higher staffing levels of RN staffing

levels correlated to lower numbers of patient falls and medication errors (ANA, 2013, May). One

study in the Journal of Health Care Finance reported that “increased nurse staffing did, indeed,

increase operational costs for hospitals; however, it did not decrease the hospitals’ overall

profitability” (Dorning, 2013, p. 4). If hospitals could reduce their proportion of burned-out

nurses to 10% from the 30% that is typical, according to the 2010 University of Pennsylvania

study, hospitals could prevent 4,160 cases a year of the two most common hospital-acquired

infections and save over $41 million (Dorning, 2013, p. 4).

Past Practices Impacting Issue

It has not always been like this, there are several factors that have led to the development

and attempted implementation of this Safe Staffing Act and others like it. “In the early 1990s,
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health care financing and hospital restructuring led to a decrease in licensed caregivers and an

increase in unlicensed caregivers (service aides)” (Tevington, 2011, p. 265). For the sake of

financial benefits, hosptials started replacing nurses with less expensive nurse’s aids. “ At the

same time, managed care requirements led to increased patient acuity and decreased hospital

lengths of stay” (Tevington, 2011, p. 265). Not only was there a decrease in staffing but an

increase in acuity and the burden was felt by the nursing field.

Proposed Legislation

The Federal Safe staffing Act is comprised of several different components. This bill

would require hospitals receiving Medicare funding to establish a staffing committee (comprised

of at least 55% RNs) that would establish adjustable minimum numbers of RNs for each unit.

The bill would allow assignment refusal for any nurse that does not feel adequately trained in the

area being asked to work. It would also require collecting and reporting of data on nursing

services linking acuity and patient outcomes. It would also require public reporting of staffing

information. Any violation of this would enforce a 10,000 fine (H.R. 1821, 2013).

Implications and Consequences

There will be consequences if the Safe Staffing Act is not addressed with the proposed

Legislation. One study found that “hospitals with higher total nurse staffing were significantly

less likely to be categorized in the "consistently high" fall rate group” (Everhart et al., 2014, p. 1)

Another study shows that “higher registered nurse staffing was associated with less hospital

related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other

adverse events” (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007, p. 1). This is also affecting the

turnover rate among nurses, one study suggests that “leaders should implement and evaluate
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strategies that ensure workloads are reasonable and nurse–patient ratios are manageable to

promote retention among all generations of nurses in the acute care hospital workforce”

(Tourangeau, Thomson, Cumming, & Cranley, 2013, p. 473).

Key Stakeholders

There are several key stakeholders regarding the federal safe staffing act. The

American Nurses Association (ANA) has developed a specific website concerning their support

for this issue (H.R. 1821, 2013). Key members of government that support this issue are Senator

Daniel Inouye (D-HI), Representatives Lois Capps (D-CA), and Steven LaTourette (R-OH) who

reintroduced The Federal Safe Staffing Act in Congress for the 2011-12 session (H.R. 1821,

2013). Also another key stakeholder in this issue is the Department for Professional Employees

which has published its support for this issue outlining the importance of safer nurse patient

ratios (Dorning, 2013,).

Political Strategies

Political strategies are very important to the safe staffing act, they are used to help spread

the word and inform nurses about what they can do and why it is important to the profession.

One of the things the ANA did was set up a website allowing nurses to retrieve information

regarding the Safe Staffing Act ("Safe Staffing," 2014, p. 1). The American Association of

Critical Care Nurses (AACN) published information on this topic via one of their links titled

Position Statements ("ANA Applauds," n.d.). The Department of Professional Employees has

produced a document regarding this bill outlining the importance of safe staffing and provides

articles and research studies supporting this topic (Dorning, 2013).

Interview with Organization Leader

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One of the key stakeholders in my organization is Shawn Ulriech, who is the Chief

Nursing Officer at my organization. We discussed how prepared Spectrum Health is regarding

the demands of increased staffing needs. This year alone my organization has enacted two

different staffing plans to meet the needs of increasing nursing care demands. One program

required nurses and nursing assistants to commit to an extra 16 hours of working time in a three

month period. Nurses would be paid time and half for their commitment on top of any overtime

pay that occurs. We also have an established acuity system hospital wide that is updated every 12

hours to ensure staffing ratios increase or decrease with the changing of the actual patient

acuities. Shawn explained that “in general, I oppose any legislation that mandates staffing

numbers” Her reasoning for that is “we don’t need more governmental involvement in the

operations of the hospital and I truly believe that hospitals will work toward providing the best

care”. This can be done “with value based purchasing and many other types of payer incentives,

hospitals must provide a standard of care or suffer financially”. Finally, “standard of care is

contingent upon nursing” (S. Ulriech, personal communication, March 16, 2014).

Conclusion

There have been many studies that show the correlation between adequate nursing care

and better outcomes for patients. Many hospital organizations may at first fear that increasing the

number of nurses would cause an increase in the cost to the organization. However studies are

also showing that the initial investment will be outweighed by the decrease in the cost of hospital

acquired illness. It also shows that keeping experienced nurses in your organization can reduce

nurse turnover rates and in turn reduces cost to the organization leading to safer patient

outcomes. Overall, this bill offers great solutions to the workplace environment and will ensure
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safer patient outcomes, increase in patient satisfaction, and increase in a nurse’s overall job

satisfaction.
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References

ANA Applauds Federal Legislation to Mandate Safe Nurse-to-Patient Ratios. (n.d.). Retrieved

from http://www.aacn.org/wd/practice/content/nurse-staffing-ratio.pcms?menu=practice

Dorning, J. (2013). SAFE-STAFFING RATIOS: BENEFITING NURSES AND PATIENTS.

Retrieved from http://dpeaflcio.org/wp-content/uploads/Safe-Staffing-Ratios-2013.pdf

Everhart, D., Schumacher, J. R., Ducan, R. P., Hall, A. G., Neff, D. F., & Shorr, R. I. (2014,

February 21). Determinants of hospital fall rate trajectory groups: A longitudinal

assessment of nurse staffing and organizational characteristics. Health Care Management

Review, 1-7. http://dx.doi.org/10.1097/HMR.0000000000000013

H.R.1821 - Registered Nurse Safe Staffing Act of 2013. (2013). Retrieved March 16, 2014, from

http://beta.congress.gov/bill/113th-congress/house-bill/1821/text

Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2007). Nurse staffing and

quality of patient care. , evidence report/technology assesment. Retrieved from http://0-

www.ncbi.nlm.nih.gov.libcat.ferris.edu/books/NBK38315/

Safe Staffing Saves Lives. (2014). Retrieved from

http://www.safestaffingsaveslives.org/WhatCanYouDo/default.aspx

Serratt, T. (2013, October). California’s nurse-to-patient ratios, part 2. The Journal of Nursing

Administration, 43, 549-553. http://dx.doi.org/10.1097/NNA.0b013e3182a3e906

Stanton, M. K. (2004, March ). Hospital Nurse Staffing and Quality of Care. Research In Action,

14(14), 1-12. Retrieved from

http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.pdf
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Tevington, P. (2011, September-October). Mandatory Nurse-Patient Ratios. MedSurg Nursing,

20, 265-268. Retrieved from http://www.amsn.org/sites/default/files/documents/practice-

resources/healthy-work-environment/resources/MSNJ_Tevington_20_05.pdf

Tourangeau, A., Thomson, H., Cumming, G., & Cranley, L. (2013). Generation-specific

incentives and disincentives for nurses to remain employed in acute care hospitals.

Journal of Nursing Management, 473-482. Retrieved from http://0-

onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1111/j.1365-2834.2012.01424.x/pdf