Trends in policy, politics, and health care all over the world

Trends in policy, politics, and health care all over the world
The rising trend of healthcare policy and politics is a big worry for the healthcare business right now. A society, state, or country’s healthcare policy is made up of choices and actions that are taken to reach certain healthcare goals. Healthcare policy is becoming more and more focused on making laws that can improve the level of care and keep patients safe in all types of healthcare facilities. The biggest problem with healthcare strategy is that different parts of the government are in charge of carrying it out. There are still a lot of unfinished healthcare bills in the United States, which makes it hard to get care. This paper looks at a specific healthcare policy issue that affects nurses and makes suggestions for how to fix it.

Question of public policy

The nurses’ alertness at the bedside is important for making sure patients are safe, and it depends on a number of things. One of these factors is having the right number of patients so that skills and knowledge can be used to their fullest to improve quality and safety. Nursing staffing ratios and the number of patients a nurse can take care of at once are quality of care problems that have been around for decades, but there are no clear policies to deal with them. (Agency for Healthcare Research and level (AHRQ), 2019) It is clear that having the right number of nurses to patients improves the level of care and has other benefits, such as making healthcare providers happier. In this talk, the nurse-to-patient ratio policy in the state of Georgia is the public policy problem that is important. This plan is about a change in healthcare policy that will lead to a new law in Georgia about the number of patients per nurse. This policy will help decide how many patients nurses can take care of at once in each area, taking into account how sick the patients are and how long their shifts are.

Issue Selection

Safe staffing and the right number of nurses for each patient are important problems not just for Georgians but for the whole country. Inappropriate nurse-to-patient ratios are caused by nurse burnout, lateral violence, and other things that affect work satisfaction. The major reason why this policy issue is important to the state is because staffing ratios have a direct effect on patient safety, quality of care, and access to care. It is known that about five nurses quit their jobs in the first year because they weren’t happy at work. Also, one nurse quits their job in the first two years because they are burned out and there aren’t enough staff to keep them safe (Driscoll et al., 2017). California is the only US state that has set necessary ratios of nurses to patients that must be kept at all times in different units. This shows that well-established rules about the ratio of nurses to patients can help Georgia nurses a lot.

Issue Relevance

Nurses are being asked to take on more responsibility for caring for patients, which can make care less safe. When talking about the number of nurses to patients, the main focus is on making sure patients are safe and can get care when they need it. Statistics show that nurses who are in charge of too many patients are more likely to get stressed out, which can lead to mistakes in care. Research shows that more patients are likely to live if nurses stick to the number of patients to nurses that the hospital requires (Driscoll et al., 2017). When it comes to the problem of how easy it is to get to healthcare services, low staffing ratios make it hard for patients to get the care they need. For instance, nurses who have a lot of patients to care for are less likely to give full health information. This makes it hard to understand how to care for patients, which leads to bad results like higher rates of return. So, the HCAHPS survey results, which are based on how the patient felt, go down, which affects how much money healthcare organizations get back.

The nurses’ ability to keep patients safe depends on how alert they are at the bedside. Appropriate staffing levels can help improve quality by lowering the number of falls, pressure ulcers, and infections caused by medical care. Models that support nurse-to-patient ratio rules show that costs will go down because errors will be less likely and people won’t have to go back to the hospital as often (AHRQ, 2019). Another important reason why this policy needs to be made is the question of taking legal action against medical workers after an accident. Laws about medical registration are often a way to deal with doctors who hurt their patients even if they didn’t mean to. With nurses being held more accountable and facing more punishments, it is more important than ever to set up safe staffing rules.

Financial Impact

In the relative form of legislative sessions, staffing ratios can’t be set without taking into account how the policy will affect money. The law’s passing means that healthcare groups will have to pay to hire new workers. At the moment, the United States spends way too much on health care compared to any other area. Adding more health care workers will cost the government and the people a lot of money. It means that the healthcare industry will have to grow to make room for the new workers, and more programs will have to be set up to train and keep an eye on the actions of healthcare workers. Early study shows that there will be problems with access to health care if more nurses are allowed to work in the field.

By extension, passing rules about the number of nurses to patients can help healthcare organizations’ finances. Better numbers of nurses to patients will cut down on hospital-acquired infections, readmissions, and length of stay in the hospital. The health care organizations will save a lot of money if the above bad results happen less often. Second, it costs a lot to replace a nurse, especially when there are a lot of them leaving their jobs. Costs to replace one nurse are expected to be $82,000, but good safe staffing laws can save the organization that much money (Brooks et al., 2019). Lastly, Medicare and Medicaid Service payments have a big impact on the financial health of healthcare organizations today. Better nurse-to-patient ratios can have a good effect on HCAHPS scores and help healthcare organizations get more money.

Personal Values

Values are goals and ideas that guide behavior and help people decide what to do. Nursing is based on morals and principles that guide how patients are cared for every day. First of all, I am guided by the values of quality and safety, which means that I believe in giving people the best care possible. These values should be shown through good relationships, good decisions, and good actions that lead to good patient results. Advocating for safe staffing rules will make sure that quality and safety go up. My second value is ethics, which says that healthcare services should be given in an honest, private, and open way. I really think that if Georgia has the right number of nurses for each patient, the quality of care will go up and healthcare workers will be happier. I plan to work with policymakers and colleagues to make the nursing industry better for this generation and the next. I will do this by emphasizing teamwork and working with people from other fields. Lastly, I believe in caring for people in a way that is kind and important. Without safe staffing rules, it will be hard for nurses to care for patients in a way that meets all of their needs.

Ethical Idea or Principle

Ethical ideas and principles help nurses know how to treat patients in a way that is acceptable. The moral principle of non-maleficence is what makes me back the new law. (American Nurses Association (ANA), 2015) When giving care, nurses must ask themselves if they are doing anything that could hurt the patient, either by doing something or by not doing something. When there aren’t any safe staffing rules in place and a lot of patients need to be cared for, these mistakes happen a lot. Inadequate nurse-to-patient levels can lead to things like medication mistakes, not being able to meet a patient’s needs, and giving the wrong amount of care. For nurses to do their jobs safely, they need to take care of the right number of patients, as suggested in this policy brief.

Maker of decisions

The suggested policy will be sent to Dr. Darell Thompson, who is the head of the Georgia Board of Nursing.

Explanation

The suggested policy needs the attention of the president of the Georgia Board of Nursing for more than one reason. The right number of nurses to patients has been a problem in the US for a long time, and even though it has caught the attention of a powerful leader, it is still a problem. Federal law 42CFR 482.23(b) says that hospitals that are approved by the CMS must always have enough nurses on staff (Brooks et al., 2019). The law also says that each department must have the right number of supervisors and workers. Georgia is one of the places in the US that doesn’t have any rules about the right number of nurses to patients. Since these rules are made by the state government, the person making the decision is in a good situation to push for the new change.

Several professional groups, like the American Nurses Association (ANA) and the Agency for Healthcare Research and Quality (AHRQ), agree that safe nursing hiring plans need to be made. (Paulsen, 2018) These groups have pushed for hiring levels that are flexible and take into account the severity of the patient as well as other things like the use of technology. The main reason for the above support is that the right number of nurses to patients can lead to better care for patients and lower healthcare costs. For example, safe hiring improves safety by lowering the number of HAIs, pressure sores, patient falls, and hospital readmissions (McHugh et al., 2020). When there are enough nurses on hand, patients are checked on regularly and any necessary steps are done right away to prevent bad things from happening.

There are many campaigns going on right now that back the idea that there should be more registered nurses for each patient. The National Nurses United (NNU) national effort for safe RN-to-patient staffing ratios is one of the most important ones. These moves show how important safe staffing is for making sure patients are happy. The HCAHPS scores rely on how well patients are cared for, and when there are enough staff, the quality of care is often better. Aside from making patients happy, safe staffing can make healthcare workers happier by keeping them from getting tired and burned out (Paulsen, 2018). Because the numbers aren’t right, nurses have to work long hours in stressful situations.

In recent years, policy changes have caused the cost of health care in the US to go up. Even though changes like the Affordable Care Act (ACA) have been made, healthcare costs are still going up. (Pollack et al., 2018) says that in 2018, the US government spent about $3.6 trillion on health care. Making sure there are enough nurses for the number of patients in a hospital or clinic can help lower some healthcare costs in different ways. When there are enough workers, problems like people coming back to the hospital and having to stay longer in the hospital can be avoided. The health care workers can evaluate patients and give them full care, which can keep costs down.

In Georgia, the state government is in charge of making laws and rules for the healthcare system, which is called healthcare policy. Dr. Darren Thompson is the head of the board that makes rules for nurses in the state. I think that because of his power, he is in a good place to change policy in the chosen area. Thompson is the only nurse practitioner on the board, and he can push for a change in state policy on the number of nurses to patients because of his knowledge. As a member of the National Council of State Boards of Nursing Advanced Practice, he can have an effect on the policy by asking nurses and boards all over the country to back it.

Challenges

Safe ratios of RNs to patients have been shown to save lives, but RNs fight every day with not having enough staff. The main thing stopping all states from passing the rules is the money they will cost. If the new rule is passed, it will be necessary to hire a lot of nurses to meet the needs of the growing number of patients. The nurse-to-patient ratio strategy hasn’t gotten enough votes in Georgia during the legislative process because of the state’s financial problems.

The second thing that could go wrong with this new strategy is when groups with different goals get involved in politics. The people who make the policies are not the same people who pass the rules in Congress. Also, there aren’t many nurses in those jobs who can help other politicians understand how bad the problem is. Because of this problem, the healthcare bills about hiring haven’t been able to grow up. Last but not least, the lack of good nursing leadership has also made it hard to see through many healthcare policy problems today. It looks like California is the only state in the US with clear rules about the number of nurses to patients. With strong nursing leadership, good choices can be made to make it possible for laws to be passed that could help solve nurses’ problems.

Options/Interventions

When the policy proposal is given to the person making the choice, they can choose from three options. The first thing that could be done about the policy problem is nothing. The president of the Georgia Board of Nursing could decide to reject the proposal for political reasons or because there isn’t enough evidence to back it. For example, in past nursing strikes, the number of nurses to patients was brought up, but nothing good came of it. Based on what has happened in the past, the person making the choice might think that the new idea is a waste of time. If the plan isn’t accepted, nurses will still have to deal with a lot of patients during their shifts, which can be hard. Because of this, perks like better care quality and happier healthcare workers will not be realized.

The second choice the policymaker could make is to accept the policy plan with some changes or compromises. The person who makes the choice is a registered nurse who has a lot of experience with nursing and nursing policy. If you choose this choice, you will have to change the new policy issue in order to get the attention of other lawmakers and maybe get good results. For example, the person making the policy might think about which hospital units, like the emergency room, urgent care unit, and surgical unit, need the policy change the most. Laws about how many people should be working in these areas will be the first step before the whole nurse-to-patient ratio problem is solved.

The third choice for the person making the decision is to accept the policy plan, back it, and move it forward through the change process. Darell Thompson is in charge of the Georgia Nursing Board, which is in charge of nursing problems in the state. This will be the best choice because the state has finally passed long-awaited laws about safe staffing. If this policy is passed, it will be a big step toward making sure patients are safe and getting better care in the state.

What to do next

The main problem with dealing with this policy issue at the state level is that the new law’s financial needs mean that different groups have different political goals. Most politicians don’t understand the problem with health care, so they need to learn more about the topic of nurse staffing. The best way to convince people will be to get nurse educators, researchers, and policy analysts together to talk about how important the problem is. The nurse educator will tell the decision-makers about safe staffing and how the lack of a policy on the subject has led to bad results for patients. The nurse researcher will talk about the lack of health care workers in the state and the bad things that happen when there aren’t enough nurses for each patient. The policy researcher will then talk about how much money the new law will cost, how important it is, and what benefits it might have for nurses, patients, and the state. Professional groups like NNU, which can provide leadership and direction during the change process, is another way that can be helpful.

Policy Brief Does Well

The suggested policy change will help patients, healthcare providers, and the government, both in the way it is done and in the way it turns out. The first thing that will determine the success of the policy change is whether or not the person making the choice agrees with the new policy. If the policy is passed, it will show that the state wants to improve health care through the political process. Second, the policy’s success will be clear when it goes through the committee stage and is heard by the state. If congress agrees to the change in the number of nurses to patients, it will be a big win for the nurses in Georgia. At this point, it means that only the governor will be able to decide whether or not to go ahead with the plan.

As part of the plan to back the policy change, professional organizations like NNU would be asked to take the lead. These groups have the power to change the way policy is made because they speak for the people. If professional nursing groups in Georgia work together to back the new law, it will be a big win for the new change. After the new policy becomes law, it will be looked at to see how well it works in the long run. Success will be measured by how long it lasts and how well it improves the health and safety of patients. For example, if the nursing team gives better care a year after the policy change, the patient satisfaction numbers should go through the roof.

Known community or group

The National Nurses United (NNU) and other healthcare groups in the US work on the problem of registered nurse staffing ratios. The group has been around since 2009 and is made up of people who are registered in the United States. It is the most active group, and it gives nurses who are in unions a chance to be heard.

Brief Description of Expressed Interest

Registered nurses in the US have been raising concerns about the number of nurses to patients for almost 20 years. NNU backs laws that would improve the number of nurses to patients in all states. In their article “RN Staffing Ratios,” the group talks about how setting minimum RN-to-patient ratios can save lives and make it easier for patients to get care (NNU, n.d.). Patients are at risk when there aren’t enough workers because it leads to mistakes, illness, and death. The group gives a link to the California law that says how many nurses are needed for how many patients in each nursing unit. The group also gives the suggested federal RN-to-patient safe staffing ratios, which show the right ratios for each of 24 nursing units. The safe staffing law was passed in California after a three-year process because people were interested in the policy problem.

CBPR Principles

To work well with Nurses United, the following CBPR concepts will be taken into account:

CBPR encourages partnerships that are fair and work well together at all stages of research. It also includes a process of empowering people and sharing power.
CBPR combines study and action in a way that helps everyone.
CBPR encourages a process that takes a long time and a commitment to sustainability.

Approach and Working Together

The National Nurses United is made up of more than 170,000 nurses from all over the country, including some from Georgia. To get the organization’s support, I’ll convince the regional reps to talk about the new policy change with the NNU presidents. I will send a long email that explains why the law is important and how it will help the nurses in Georgia. Once the organization agrees to be involved, a meeting will be set up to talk about the policy in detail and explain what each member’s part is. The National Nurses United works to make sure that its members have good joint bargaining representatives and that nurses’ economic and professional interests are looked after. Because of this, members will need to work together to make sure their skills and knowledge are used to push for the new policy change. To encourage collaborative care, people will talk to each other regularly through phone calls, emails, and one-on-one talks.

Alignment of Goals

Registered nurses in the United States have a say through National Nurses United. The group has done amazing things that have helped shape the nursing field. For example, NNU has set up more than 6,500 RNS in Florida, Louisiana, Nevada, Texas, and Illinois. It has also pushed for important national laws, like the nurse-to-patient ratio bill that became law in California. These things make NNU a trustworthy group that can push for changes in the nursing field. One of the suggested policy’s goals is to help direct care nurses and patients all over the U.S. (NNU, n.d.). This is also one of NNU’s goals. Also, NNU gives direct care RNs and patients more of a say in public policy, like making sure safe nurse-to-patient ratios and patient protection rights are put in place in Congress and every state. These goals are in line with the new policy change, which aims to make staffing safer through lobbying.

Steps to Take

Different steps will be taken to help get the nurse-to-patient ratios policy put into place as part of the new plan. In the first step, a team or group will be chosen to help reach out to key stakeholders. The second step will be to get in touch with nurse educators, researchers, and policy analysts and ask them to help explain the new change to other lawmakers. At the convenience of the person making the choice, a meeting will be set up to talk about the policy issue and how it affects the nursing profession. The newly formed committee will call out to the NNU representatives in each region to ask for the union’s help in changing the policy. Lastly, the full plan will be given to the person who makes decisions so that the change can be made officially.

Parts to play and jobs to do

During the process of changing the policy, the members of National Nurses United will be in charge of building up their skills and finding solutions to problems. First, the organization will give the policymakers the nurse educator who will teach them why this problem is important to nurses and the public. The best person to talk about the problems that have been seen because there is no nurse-to-patient ratio strategy will be a licensed nurse practitioner. The second job of NNU members is to persuade the person making the choice to think about whether or not to accept the policy change. The presidents of the unions, Deborah Burger, Zenei Triunfo-Cortez, and Jean Ross, will be convinced to get the person making the choice to agree with the policy. With the help of these leaders, the job of building capacity will be filled, and resources will be pulled to support the new law.

Important Parts of an Evaluation Plan

The new plan to change policy will be judged by the CBPR concepts listed above. The first CBPR concept (Israel et al., 2010) says that partnerships should be fair and based on collaboration at all stages of research, including phases of empowerment and power-sharing. Whether or not the plan works will depend on how well the policy change process shows teamwork and a diverse approach. The plan’s success will depend on how well the chosen group, NNU members, and decision makers work together and attend meetings.

(Israel et al., 2010) The second CBPR principle talks about how study and action should be balanced to help all partners. During the talks, the nurse researcher, who is a member of NNU, will be in charge of giving facts about how staff shortages in healthcare are affecting patients. If the policy is accepted by the person making the decision, it will show that there is a balance between study and action. Israel et al. (2010) describe the third CBPR concept as a commitment to long-term processes and sustainability. Whether or not the plan works will depend on how well the lawmakers and the implementation team work together. Also, for the policy change to work, the members of the NNU will have to show that they are vigilant and committed.

Plan for the organization

Short-term and long-term measures will be used to figure out how well the business plan is working. First of all, the policy will be accepted if there is good coordination of training events for policymakers. Coordination of events during routine follow-up, such as people going to meetings, will show how well the plan is working. Another way the plan will work is if the idea becomes a law in Georgia about the number of nurses to patients. Concerning the long-term success, the new strategy should show within a year that HCAHPS scores have gone up because of better quality.

How Strong Each Method Is

The top-down method is when choices are made by the most powerful people. This method is good because it takes less time to change how groups make decisions (McDermott et al., 2015). Second, it’s easy to figure out if the plan worked or not because everything is planned out. In the bottom-up method, decisions are made at the lower levels before the manager makes the final choice. (McDermott et al., 2015) It is clear that the method is good because it lets employees take part in making decisions. It has also been seen that the bottom-up method makes it easy to adjust to new changes. These two ways were used to change the rules mentioned above. The top-down approach is when the person making the choice is directly involved. The bottom-up approach is when the health care organization is involved.

Problems with each method

The top-down method makes it hard for employees to be involved in decision making. (McDermott et al., 2015) say that when this method is used, communication should be very clear and that changing information can cause action plans to fail. On the other hand, the bottom-up method takes more time because it involves everyone in the decision-making process. The many steps that go into making policies can also make it hard to evaluate plans.

The Best Way to Do It

The best way to deal with the nurse-to-patient ratio strategy is to work from the top down. Policy making is a complicated process that needs clear lines of communication and advocacy. This can only be done with a top-down method. If the bottom-up method is used, meetings, the submission of reports, and the evaluation of projects can be delayed, which can cause the change process to fail.

References
Agency for Healthcare Research and Quality. (2019). Nursing and patient safety. https://psnet.ahrq.gov/primer/nursing-and-patient-safety

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks. org. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/

Brooks Carthon, J. M., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A. M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Association of nurse engagement and nurse staffing on patient safety. Journal of Nursing Care Quality, 34(1), 40–46. https://doi.org/10.1097/NCQ.0000000000000334

Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., … & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22. https://doi.org/10.1177/1474515117721561

Israel, B. A., Coombe, C. M., Cheezum, R. R., Schulz, A. J., McGranaghan, R. J., Lichtenstein, R., … & Burris, A. (2010). Community-based participatory research: A capacity-building approach for policy advocacy aimed at eliminating health disparities. American Journal of Public Health, 100(11), 2094-2102. https://doi.org/10.2105/AJPH.2009.170506

McDermott, A. M., Hamel, L. M., Steel, D., Flood, P. C., & Mkee, L. (2015). Hybrid healthcare governance for improvement? Combining top‐down and bottom‐up approaches to public sector regulation. Public Administration, 93(2), 324-344. https://doi.org/10.1111/padm.12118

McHugh, M. D., Aiken, L. H., Windsor, C., Douglas, C., & Yates, P. (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: An observational study. BMJ Open, 10(9), e036264. https://doi.org/10.1136/bmjopen-2019-036264

National Nurses United. (n.d.). RN staffing ratios: A necessary solution to the patient safety crisis in U.S. hospitals. https://www.nationalnursesunited.org/sites/default/files/nnu/graphics/documents/Ratios-ANecessarySolutiontothePatientSafetyCrisisinUSHospitals.pdf

Paulsen R. A. (2018). Taking nurse staffing research to the unit level. Nursing Management, 49(7), 42–48. https://doi.org/10.1097/01.NUMA.0000538915.53159.b5

Pollack Porter, K. M., Rutkow, L., & McGinty, E. E. (2018). The importance of policy change for addressing public health problems. Public Health Reports, 133(1_suppl), 9S-14S. https://doi.org/10.1177/0033354918788880

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