Bill S.864 National Nursing Shortage Reform and Patient Advocacy Act
The National Nursing Shortage Reform and Patient Advocacy Act bill creates requirements for the acute care facilities to provide registered nurses based on the increased patients’ acuity as long as the minimum nurse-to-patient ratios are met all the time. Direct care registered nurses are mandated to act in the exclusive interest of their patients, and possess the right to be patient advocates. The bill seeks to address a number of policy issues such as the growing nationwide shortage of direct-care registered nurses in hospitals, provide minimum standards for patient protection, such as safe staffing ratios, for both the long-term and short-term acute care in America, protect direct care registered nurses as patient advocates, create education grants for registered nurses and also provide living stipends to retain and recruit direct-care registered nurses. The bill also aims at creating a hospital service environment that will attract new registered nurses and provide the foundation for the eventual restoration of the direct care registered nurses workforce.
Additionally, the bill aims to establish legally protected, clear defined and enforceable rights and duties to direct-care registered nurses as patient advocates. The whistleblower protections accorded by the bill encourage the registered nurses, patients and other healthcare workers to notify private accreditation entities and the government of any instances of unsafe conditions for patients that will significantly improve the welfare, health and safety of the patients. The bill takes note of the essential staffing principle in the acute-care hospital settings that must mainly be based on the acuity and needs of individual patients, the severity of the conditions, types of services needed and the complexity that surrounds the provision of those services.
The issue of nurse-staffing has always been a complex issue but it has taken renewed importance over the years. The issue of patient staffing ratios and nursing care took national importance with the release of the Institute of Medicine Report (IOM) report that focused on the evaluation of nurse staffing and the safety of patients (Longest, 2010). The nurse-patient ratio issue has gained prominence in the recent years due to the fact that patients have become more informed, the higher acuity levels, the budgetary issues related to the cutbacks on healthcare and the aging of the nursing workforce. The appropriate way to manage the registered nurses can and should handle have prompted lively debates over the years. Nurses are always dedicated to the safety of their patients and always work hard to ensure positive patient outcomes. In order to achieve this goal, the nurse-to-patient ratios must be reasonable and attainable (Longest, 2010). The emphasis has always been the financial viability of the hospital institution, adequate registered nurse staffing, positive patient outcomes as well as keeping up with the advancement in technology (Mason, Leavitt & Chaffee, 2014; Vincent, 2010). The impact of restructuring healthcare on safe care patient standards prompted the historic enactment of California Safe Staffing Law that established the first specific, minimum and direct-care-registered nurse-to-patient ratios by clinical units for the acute-care hospitals. This move prompted other states to consider passing staffing legislations to implement the mandated staffing ratios, take use of patient acuity levels to determine the staffing needs and develop staffing committees (Jacobi, Watson & Restuccia, 2011). The historic enactment of the law has prompted the introduction of pieces of legislation by the National Nurses United aimed at improving and expanding patient protection standards and the expansion of nursing care.
The National Nursing Shortage Reform and Patient Advocacy Act was introduced to the Congress and sought to amend the existing Public Health Service Act. The bill requires the healthcare facilities to implement a staffing plan that included a minimum direct care registered nurse-to-patient ratio by each unit, significant adjustments to the minimum ratio under the convenient circumstances and the compliance with the minimum registered practical requirements for nurse staffing (Patel & Rushefsky, 2014).. The bill requires the secretary of Health and Human services to develop a national acuity tool that will establish the requirements for nurse staffing above the minimum ratios. The bill gives a nurse the right to act an advocate for the patient through the initiation of actions that would be aimed at improving healthcare or change the activities or decisions that are against the wishes or interest of the patient. Also, it gives a patient an opportunity to make a rightful decision about the quality of healthcare that was being provided at the healthcare facility. The bill also gives the registered nurses the right to refuse an assignment if they thought it violated the minimum ratios and if the nurse is not prepared through training, education or experience to accomplish the assignment without compromising patient safety or putting at risk his or her license. Additionally, it sought to prohibit the hospital from taking any action in instances where a nurse refused the assignment for reasons stated above. The hospital was also prohibited from discriminating against any patient or employee. The bill included stipends that were to be provided for the registered nurse for their education needs and also sought to expand the nurse retention program through preceptorship and mentorship projects. The National Shortage Reform and patient Advocacy Act was introduced in a previous section of Congress on April 16th 2013 but was not enacted. It was sponsored by Barbara Boxer, a junior Senator from California.
There have been aggressive efforts by the nursing unions to push for nurse-to-patient ratios by exerting political pressure on state legislatures and through collective bargaining (Mason, Leavitt & Chaffee, 2014). Until now, California is the only State in America that has passed a legislation mandating a certain number of nurses for an individual patient. The common purpose of the National Nursing Shortage and Patient Advocacy Act was to ensure that there are a fixed number of nurses for a patient and how the ratios would be established. Apart from establishing the minimum direct-care registered nurse-to-patient ratios, the bill required hospitals to establish nurse staffing plans and provide whistleblower protections to both the nurses and the patients.
It has been pointed out that to improve patient safety and the quality of healthcare, a change is needed to be observed at the following levels of healthcare: the experience of the patients, the nursing units, organizational practices and the environments of policy, regulation, accreditation and payment (Mason, Leavitt & Chaffee, 2014). As a result, the bills key stakeholders include the patients, nurses, hospitals, accreditation institutions, the nursing unions, health insurance cover institutions and the government. The bill mainly focuses on patients’ safety and quality of healthcare provided to them. Consequently, the nurses and patients become the most important stakeholder in the bill. Shortage in the nursing workforce has been observed in all parts of the country and this has affected the quality of healthcare provided and the safety of the patients. In addressing this issue, the bill advocates for the increasing of the nurse-to-patient ratios to enable the attainment of better healthcare services. The under-staffing problem has seen nurses being overworked and also performing tasks that they are not trained to perform or lack experience in (Mason, Leavitt & Chaffee, 2014). The bill empowers the nurses to refuse tasks that they are unqualified in and also empowers them to be advocates for the patients in ensuring that all conditions point to quality healthcare. Furthermore, the nurses are provided an opportunity to advance their education and training so as to address the nursing shortage issue. The patients form the other key stakeholders of the bill. The overall aim of the bill is the provision of quality healthcare through adequate nurse-to-patient ratios and better hospital conditions for provision of healthcare services. The needs of the patient are the focus of the bill, and hence form a key stakeholder. The patients are also empowered to point out to accreditation institutions and the government the conditions that would affect the delivery of quality healthcare.
Hospital administrators form another key stakeholder of the bill (Longest, 2010). Under the bill, hospitals are required to develop and maintain a nurse staffing plan which has been developed in conjunction with the registered nurses working in that hospital. In certain instances where applicable, the hospital are required use the input of collective bargaining that is representative of the nurses. The bill also establishes the minimum direct care registered nurse-to-patient ratio for different hospital units, with exemption of the hospital emergency units. Hospitals are required to maintain records of the registered nurse-to-patient ratio at each hospital unit and make the report available. Furthermore, the hospitals are prohibited from taking any action against a nurse who has refused an assignment due to lack of experience or lack of qualifications. Violations to this directive would result into penalties. Hospital administrators are key stakeholders in that they are the implementers of a large proportion of the bill in relation to nursing ratios and quality of healthcare. Healthcare accreditation institutions also form part of key stakeholders in that they ensure compliance with all the requirements of the bill and take relevant actions in relation to any cases of violations by the hospitals. The Nursing organizations form part off the stakeholders in that they push for collective bargaining agreements that are representative of the registered nurses in the country (Longest, 2010). These organizations also ensure that all rights accorded to the nurses are met by all nurses in all hospital organizations. The government is the final stakeholder in that it is the policy maker and ensures the enforcement of the policy. The Department of Health and Human Services is charged with ensuring the direct care registered nurse-to-patient ratios and compliance of all hospital organizations.
The nursing workforce represents the largest workforce in the healthcare workforce. Registered and unregistered nurses account for about 54% of all the United States healthcare workers. Registered nurses alone, account for 23% of the healthcare workforce; which is the largest portion of the workforce in the healthcare environment. Registered nurses offer their services to patients in virtually all units of the hospital setting including long-term care facilities, emergency units, trauma, physicians and clinics offices and other workplace settings. Consequently, nurses have an integral part in the healthcare system. Adequate nurse staffing is needed to ensure quality healthcare to all patients and also ensure nurse retention (Longest, 2010). Inadequate nurse staffing, on the other hand, endangers the health of patients and endangers the nursing profession. The problem of under-staffing of nurses intensifies with the older nurses aging and nearing retirement, and the increasing demand for healthcare services (Mason, Leavitt & Chaffee, 2014).
Over the years, the problem of under-staffing has been observed in the country which has created a problem of shortage of nurses. Under-staffing in most hospitals has also seen the problems of mandatory overtime and extended working hours and fatigue observed among nurses; all of which contribute to low quality healthcare services and outcomes (Mason, Leavitt & Chaffee, 2014). Patient safety is a vital and essential aspect of healthcare quality (Vincent, 2010). Many healthcare providers today in the United States face many challenges in the healthcare environment as they try to keep patients healthy and safe. Recent statistics indicate that the shortage of nurses is one of the most important challenges facing patient safety (Longest, 2010). Shortage of nurses has led to high turnover for nurses in healthcare organizations, lack of motivation among them, overworking and less productivity among the direct care registered nurses. Consequently, a number of attempts have been made to ensure that the nursing ratios have been increased to curb this growing problem. The National Nursing Shortage Reform and Patient Advocacy Act address the nursing shortage problem by increasing the ratios of nurse-to-patient and also ensure patient safety through patient advocacy.
The National Nursing Shortage Reform and Patient Advocacy Act builds on the success of the historic California legislation that sets minimum nurse-to-patient-ratios and extends the same minimum standards to the hospitals that participate in Medicaid and Medicare (Patel & Rushefsky, 2014). If enacted, the legislation would have a number of benefits in terms of improving the health and well-being of the citizens of United States. The legislation’s direct care registered nurse-to-patient ratios will save many lives, improve quality of healthcare and outcomes and enhance patient safety. For a long time, the country has grappled with the shortage of registered nurses in the country, but with the new ratios, hospital will be adequately staffed. This will lead to high quality healthcare services and healthcare outcomes. There would be limited cases of errors hence patient safety would be enhanced. The bill will also promote nurse retention in the hospital environments which would mean better outcomes for patients. The emphasis on the unit level nurse staffing level requirements would greatly promote the quality of healthcare and enhance patient safety all over the country. Previously, the registered nurses were required to perform tasks in different units within the healthcare environments, but with the new legislation, there would be adequate registered nations per each unit of the organization. The whistleblower protections would point out the potential dangers in the health care environment hence promoting quality healthcare and patient safety. Further, the investment in the education, training and mentorship of nurses would ensure better healthcare services which would promote the well-being of Americans.
The bill proposes a number of reforms that will ensure patient safety and quality of healthcare. Given the thorny issue of nursing shortage and the emphasis on quality healthcare, the bill has slowly gained popularity since its second introduction on March 15th 2015. The bill has the backing of the National Nurses United, American Federation of State, County and Municipal Employees (AFSCME) and the California Nurses Association. Since the passage of the historic act in California, many states have followed suit in trying to adopt the same. The historic bill in California has seen reduced errors in healthcare provision, nurse retention and better healthcare services among other benefits. It is obvious that the country is facing a shortage of nurses which has crippled the healthcare industry. The urgent need of reforms will likely lead to a passage of the bill as it promises reforms to key areas in the healthcare environment that greatly affect patient safety and quality healthcare (Mason, Leavitt & Chaffee, 2014). However, it may not sail smoothly as it may receive opposition from a number of quarters such as the hospital administrators who will cite the fact the bill strips off their powers for nurse staffing. Hospital administrators always hire staff based on their needs and their financial capacities, but the bill proposes ratios per unit in the hospitals. This would be a key area that will be a subject heated debates. Also, the bill targets the entire nation, which is a very expansive scope. The bill is most likely to function in States rather than the entire nation. This might be a potential pitfall.
The healthcare environment has changed vastly over the last few decades (Huston, 2014). The rising patient needs and the higher acuity levels have prompted a shift in the traditional nurses’ roles. Today, nurses have to be trained and vastly knowledgeable in the current environment (Huston, 2014; Vincent, 2010). A well-educated nursing workforce leads to better patient outcomes and quality of healthcare. With the bills emphasis on the training, education and mentorship, registered nurses have a role to ensure that they take advantage of these opportunities to become more skilled and knowledgeable. This will not only be in accordance to the legislation but also be a means to achieve patient safety and quality healthcare. Education and training is not only confined to nurses alone but the other healthcare services as well. The bill’s effectiveness would be evaluated according to the outcomes and quality of services provided. Hence, it is important for the nurses to become better patient advocates and take up the education, training and mentorship opportunities (Huston, 2014).
References
Abraham, D. C. (2011). Reforming Nursing with Information Systems and Technology. Internet Resource.
Congress, (2015). S.864 - National Nursing Shortage Reform and Patient Advocacy Act. Congress.Gov. Retrieved from https://www.congress.gov/bill/114th-congress/senate-bill/864
Huston, C. J. (2014). Professional issues in nursing: Challenges & opportunities. Baltimore, MD ; Philadelphia, PA : Wolters Kluwer Health.
Jacobi, J. V., Watson, S. D., & Restuccia, R. (2011). Implementing Health Reform at the State Level: Access and Care for Vulnerable Populations. The Journal of Law, Medicine & Ethics, 39, 69-72.
Longest, B. B. (2010). Health policymaking in the United States. Chicago: Health Administration Press.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2014). Policy & Politics in Nursing and Health Care (6th edition). St Louis, MO: Elsevier Health Saunders.
Patel, K., & Rushefsky, M. E. (2014). Healthcare politics and policy in America. Armonk, New York : M.E. Sharpe.
Vincent, C. (2010). Patient Safety. New York, NY: John Wiley & Sons.
