The Registered Nurse Staffing Act
Introduction
In the contemporary society, medical expenses form a big part of the house and family budget. Changes in lifestyles and cultures have resulted in an upsurge of various medical conditions. Increasing population also continues to threaten the capacity of nations and states to offer quality and safe care for their patients. In order for the department of health to ensure that patients get access to quality and safe care, priority has to be placed on the education levels and staffing techniques of the hospital. The nurses are the primary caregivers of any hospital, and thus, their competence and capacity are essential for the type of health care that is provided by a hospital.
For hospitals that lack adequate staffing in terms of education, experience and numbers, challenges of negative patient outcomes tend to be higher. Cardiac arrests, shock, and urinary tract infections are but examples of the negative potential outcomes that result from a decrease in nursing care. The result has been the creation of laws and policy that mandate and guides the staffing process of hospitals to ensure adequacy. Nursing managements play a critical role in the establishment of a balance between all the stakeholders involved. The focus of this paper is in the analysis of The Registered Nurse Staffing Act, its background, use and implications of healthcare (Catalano, 2015).
Background
The Registered Nurse Staffing Act of 2015 was formed to amend the Medicare clause of the Social Security Act with the purpose of ensuring that each hospital that participated in Medicare had established an elaborate staffing plan for nursing services that it provided. The Act stipulates the number of nurses that are required to attend to a given patient in each unit of the hospital. According to the policy, the staffing of a hospital must place its staffing decision on the characteristics of the hospital units as well as those of the patients. The policy articulates the need for forming a committee that focuses on the organization and planning of the staffing procedures. The role of the committee will include the implementation of the policy within the hospital, to provide protection to whistleblowers from discrimination and retaliation and most importantly to set the penalties relating to the violation of the Act (S. 71, 109th Cong. 2005). A committee forms an integral part of the Act, as it ensures the operationalization of the Act. For the success of the staffing regulation to work, a hospital has to come up with this particular committee.
At the backdrop of the development of the legislation was the overwhelming fatigue of healthcare workers, which became a major impediment to the safety of the patients. The staffing practices of the Act would allow for the reduction of work fatigue by the nurses and thus, protect the patients from care malpractice. The satisfaction of the patient is paramount in whatever hospital unit they are in. However, the skills and experiences of the nurses play a critical role in ensuring that patient needs are met. According to various studies conducted in relation to patient safety and satisfaction, the number one factor was the level of staffing, which ensured a lower rate of negative patient outcomes.
The policy also provides a framework that ensures the quality and safe care to patients is not only attained, but maintained at a consistent level. The legislation was introduced to Congress by Lois Capp and went on to be sponsored by seven states. The findings that informed the bill included the importance of professional certification and educational preparation required for hospital jobs. A great deal of time and resources went into understanding the needs of each unit within a hospital. The policy is thus based on a solid understanding of the needs of each unit and the requirements and experiences that a nurse is expected to have if they are to optimize the care they provide to their patients (Catalano, 2015). The intensity, stability and complexity of patients had to be assessed and comprehended before the proper staffing plans and schedules could be developed by a hospital. The most crucial aspect of the legislation involves the investigations, evaluating reports, enforcement provision and the protection of patients. The legal aspects of the legislation provide an elaborate way of dealing with the prosecution of cases related to the violation of the policy.
The policy stipulates the importance of nurses working only in areas that are experienced and trained in. However, awareness on the operationalization and implementation of the policy has to be created among the nurses. They have to understand the services that go with each violation of the policy, how reporting is done, and the procedures that are used in investigating and receiving complaints. The Registered Nurse Safe Staffing proposal has the aim of achieving a staffing approach that does not rely on numbers, but on the needs of the nurses and patients (Myers, 2012). The nursing shortage that continues to haunt most of the hospitals in the United States coupled with the stringent nursing budgets that most hospitals have to work with have caused hospitals to work with fewer nurses.
Stakeholders of the Policy
The implementation of the policy depends on the stakeholders within the healthcare sector for it to succeed. The first group of stakeholders includes the healthcare providers who are directly influenced and impacted by the policy. While the patients may view the staffing process from a perspective of numbers, the healthcare providers have a more technical perception of the accuracy of diagnosis and appropriateness of the quality of care that they will receive. Staffing affects the nurses directly in the sense that their educational standards and experiences are to be scrutinized to ascertain their ability and to adequately meet the needs of the patients. The second group of stakeholders includes the patients who are also the payers within the healthcare setting. The positive outcomes that are intended by the policy are directed towards to this group.
In as much as the patients need the best care and attention, they require it at an affordable cost. The third and most crucial stakeholder of the policy involves the hospital, which is also the employer. The determination of the needs of various patients and the requirements of the healthcare providers is a role that is played by the employer. The hospital has to determine its resources vis-à-vis the needs of the patients and nurses to develop a staffing plan that ensures the optimum benefits for all stakeholders (Catalano, 2015). The probability of conflict arising among the stakeholders can be expected between the patients and employers. For the patients, the goal is to have a wide variety of choice for their health care needs that are specific to their needs which might be unattainable for the employer whose decision is based on a number of factors.
Another potential conflict is in relation to the insurance of the patients who depend on the hospital to fund a majority of the healthcare cost. For the caregiver who is also the employer, their priority is on using the most effective ways to offer their service. With the advancement in technology in the field of medicine the caregiver may wish to utilize modern techniques that allow for preventive care, however, this may be out of reach for the patients (Who are the stakeholders in healthcare? 2014). For payers, on the other hand, the most important aspect is to ensure that accurate diagnoses and plans of treatment are based on clear research. They expect the least amount of tests and fewer visits while at the same time having the best diagnosis and care. In a resource-trapped environment where efficiency is paramount, the employer has to ensure that they minimize their cost of operation. The divergent needs between the employer and the patient are in relation to the cost of health care while the patient needs the best care they can get, they also need it at the lowest and most affordable price.
Social and Economic Concerns
The greatest barrier to the implementation of the policy is the additional cost that is required to allow for more staffing. The costs also extend to the repercussions that a hospital has to deal when it comes to the nursing shortage. There is a likelihood of compensatory cuts within the hospital aiming at increasing the ratio of staff to patient. Increased reimbursements are an expected outcome which involves having the idea of experience, skill, and certification in mind. The nurses who will be employed on the basis of their capacity to deal with various patient needs are likely to request for pay increases based on the nature of their job (S. 1132, 114th Cong. 2015). While some experts argue that the extra cost of additional staffing may be reduced by reducing patient deaths and complication, there is the challenge of political interference accruing from the possible financial ramifications. Integrating a plan that incorporates the needs of the patients, availability of nurses, and the costs of implementing the policy is a complex exercise for healthcare department to undertake.
Plan for Implementation
For the policy to be successfully operationalized; the best approach will have to begin from the nursing level to the hospital and federal government. Accountability is the key component of the policy, and as such the passage of the Act by Congress will be followed by the formation of committees by hospitals with the task of accessing the staffing of nurses and the hospital units’ requirements (Vandenhouten, Malakar, Kubsch, Block, and Gallagher-Lepak, 2011). The staffing process will incorporate the number of patients in every unit of the hospital, the requirements of each level of care and the number of staff that additional registered nurses can be pulled from. The technological resources of every hospital will have to be analyzed if adequate staffing is to be attained. For hospitals that offer Medicare, there will be the need for them to release their staffing plans to the public. The primary focus of the policy will be staffing nurses on the basis of their skill and staffing. The idea of floating nurses in areas that they are not adequately trained for will be eliminated despite the number of nurses.
The implementation of the policy provides an elaborate scheme and guideline that has to be followed, failure to which they will be held accountable. The regulations and punishments imposed by the policy are clearly stipulated for nurses, patients and hospitals. Elaborate systems of reporting cases from both the patients and nurses are available to allow ease of litigation and compensation. Protection is a critical element for both patients and nurses who can be discriminated and victimized for reporting cases (S. 1132, 114th Cong. 2015). The issue of staffing has been an issue for decades with numerous presentations being made to the Congress; however, the Safe Staffing Act is one of the closest legislation that has offered a practical solution.
Conclusion
The wellbeing of patients is largely dependent on the staffing of nurses that a hospital has. Quality and proper healthcare can only be attained when the needs of the patients are met adequately. For proper staffing to occur, however, there is a need to take care of the welfare of the nurses who are the primary caregivers to patients. The dynamics of attaining proper patient to nursing ration has been a major challenge for the healthcare fraternity that prompted the formation of an elaborate regulation through the Registered Nurse Staffing Act. The policy has been instrumental in defining the staffing of nurses in various hospitals, and the result has been an overwhelming increase in the quality of health accorded to patients.
Cases of negligence, poor services, and infections during the course of treatment have also been reduced. The quality of healthcare as exhibited by the implementation of the policy is heavily dependent on the number of staff, their skills, and experience in a given hospital. A number of challenges have been singled out within the policy implementation process that require reevaluation if the policy is to be successful. In as much as the policy is aimed at ensuring the best healthcare experience for both the staff and patients, deeper analysis need to be carried out if the implementation is to be achieved.
References
Catalano, J. T. (2015). Nursing now!: Today's issues, tomorrow's trends.
Myers, S. (2012). Patient safety and hospital accreditation: A model for ensuring success. New York: Springer Pub. Co.
Registered Nurse Safe Staffing Act of 2005, S. 71, 109th Cong. (2005).
Registered Nurse Safe Staffing Act, S. 1132, 114th Cong. (2015).
Vandenhouten, C. L., Malakar, C. L., Kubsch, S., Block, D. E., & Gallagher-Lepak, S. (2011). Political participation of registered nurses. Policy, Politics, & Nursing Practice, 1527154411425189.
Who are the stakeholders in healthcare? (2014). Retrieved from http://patientsafetyed.duhs.duke.edu/module_a/introduction/stakeholders.html
