Health policy brief II
Health policy brief II Essay
Health policy brief II Essay
Health policy brief II
Introduction
Health care practitioners have always made the same promise as they take their professional oaths: do no harm. Despite observing this maxim within the professional domain, medical personnel are still prone to the same errors as other humans unintentionally cause harm on some occasions. This is particularly true for nurses who despite being held to a higher standard as they provide primary health care that could have grave implications for the wellness and health of their patients, they still make mistakes. In this case, the unintentional harm caused by the nurse is defined as an adverse event since it is harm that is caused by the nursing care rather than the underlying health care issue. Three subcategories of adverse events can be identified. The first subcategory is adverse events caused by negligence whereby the nursing care falls short of the expected standards. The second subcategory is ameliorable adverse events that are not preventable but the harm can be reduced through deliberate approaches. The third category is preventable adverse events that occur owing to failure or error in applying accepted prevention strategies (Huff, Kline& Peterson, 2015). Health policy brief II Essay
Adverse events are a serious concern for the health care industry because more than 140,000 patients die from their occurrence annually. The concern has subtle links with nurse-to-patient ratios whereby it is noted that low nurse populations are associated with higher incidences of adverse events. The implication is that increasing the number of nurses can reduce the occurrence of adverse events. The industry can use all the help that it can get to reduce preventable adverse events from occurring, including policy reforms that establish legislative mandates for nurse staffing standards that optimize nurse-to-patient ratios to ensure patient safety and quality of carein nurse-patient interactions. This cultural shift coupled with reducing pathogen bioburden, facilitating patient communication, and helping track medicine management can work to reduce adverse events in nursing care (Huff, Kline & Peterson, 2015; Office of Inspector General, US Department of Health and Human Services, 2019). This paper will discuss nurse staffing legislation as a patient-safety intervention and the legislative interventionnecessary to support efforts to reduce adverse events in nursing care. Health policy brief II Essay
Discussion
Adverse events are an acknowledged source of concern in health care since they are resultant from health care process across a range of procedures and conditions. In fact, approximately 10% of all patients report at least one adverse event, with 51% of adverse events being preventable thus justifying intervention efforts (Schwendimann et al., 2018). In addition to the significant impact on patient mortality and morbidity, adverse events increase the cost of health care from longer stays in medical facilities (Rafter et al., 2015). In this case, medical facilities have identified this concern and implemented strategies they deem appropriate to address these issue. For that matter, patient safety improvement interventions have been applied through actions, behavior, procedures, structures, strategies, and practices to mitigate or prevent unintended harm to patients (Tollefson et al., 2019). Black (2016) comprehensively discusses some of the health campaigns implemented as interventions. Firstly, it notes that medical facilities apply screening and early identification strategies to identify the factors that place patients at risk. Secondly, conducting comprehensive interdisciplinary assessments when risks are identified, particularly among geriatric patients. Finally, effectively communicating with stakeholders and ensuring that there is collaboration between medical personnel in nursing care provision. This is based on the understanding that all stakeholders have a shared role in preventing the occurrence of adverse events (Black, 2016). Health policy brief II Essay
In addition to interventions by medical facilities, the legislature recognizes the magnitude of the issue and had proposed safe staffing as a legislative intervention. Introduced as The Safe Staffing for Nurse and Patient Safety Act of 2018 in the US Congress (H.R. 5052) and Senate (S. 2446), the legislation seeks to have Medicare-participating medical facilities to form committees to determine optimal nurse-to-patient ratios for each unit. At least 55% of the committee members must be direct care nurses working at the facility. The legislation seeks to amend title XVIII of the Social Security Act with the intention of protecting patients by establishing safe nurse staffing levels that would benefit the medical facilities, nurses and patients through reducing costly readmissions, nurse turnover and adverse health events. Sponsored by Rep. Dave Joyce (R-OH) and Sen. Jeff Merkley (D-OR), and co-sponsored by Rep. Suzanne Bonamici (D-OR-1), Rep. TulsiGabbard (D-HI-2) and Rep. Suzan K. DelBene (D-WA-1), the legislation passed the Senate and House owing to its clinical and economic merits. However, the legislation was not enacted at the end of the 115th Congress, resulting in it being cleared from the legislative agenda (American Nurses Association, 2018; GovTrack, 2019).Health policy brief II Essay
There are two pending legislations concerning preventable adverse events. The first legislation is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 (H.R.2581). Sponsored by Representative Janice Schakowsky and introduced into the 116th Congress on 8th May 2019, the bill seeks to amend the Public Health Service Act by establishing the nurse staffing standards that would ensure patient safety and quality of care in medical facilities. In fact, it seeks to determine the minimum nurse-to-patient rations that should be observed for every health care purpose, and how this requirement would be enforced. Currently, the bill is before the Energy and Commerce, and Ways and Means Congress Committees where discussions are ongoing on the issues relevant to the two committees (Library of Congress, 2019). The second legislation is the Registered Nurse Safe Staffing Act (H.R. 1821 and S. 2353), a federal legislation that is applicable to Medicare-participating medical facilities that requires these facilities to establish a committee that would create appropriate staffing plans based on staff experience, patient acuity and other relevant factors. At least 55% of the committee must be comprised of registered nurses (Working Nurse, 2019). Health policy brief II Essay
ORDER A PLAGIARISM- FREE PAPER NOW
The proposed plan for addressing adverse events in nursing care is to develop new legislation that would be discussed and enacted. The new legislation would present federal guidelines mandating nurse-to-patient ratios based on the medical facility’s capacity. The legislation is based on the awareness that nurse staffing has an effect on the quality of care and patient safety with appropriate staffing protecting patients from adverse events and lowering the risk of mortality. Unlike The Safe Staffing for Nurse and Patient Safety Act of 2018 that empowers nursing personnel to determine the variable and unique needs of their patients to ensure quality and safe nursing care outcomes, the proposed legislation would set up, empower and fund an independent federal agency to present and regularly update staffing models that present minimum nurse-to-patient ratios for all medical facility units and health care scenarios. The federal agency would focus on optimizing the number of medical personnel and professions (including nurses) to reduce the opportunities for errors. Some of the federal agency’s responsibilities would include changes to the use of nursing agency staff and overtime, shift patterns, staff allocation models, education preparation of medical personnel, skill mix (proportions of experiences, expertise, qualification levels and grades), and staffing levels (American Nurses Association, 2018;Stanhope & Lancaster, 2014).Health policy brief II Essay
Mandating minimum nurse-to-patient ratios has implications for adverse events. This has been seen in the State of California where safe staffing legislation has results in improved care outcomes and reduction in procedural mistakes so that fewer patient get sick in medical facilities, more patients recover and fewer patients suffer from complications that required them to be re-hospitalized (National Nurses United, 2019). There is a need to acknowledge that this legislation presents some cost concerns. The legislation would impose steep fiscal costs on medical facilities by minimizing their involvement in staffing decisions. To be more precise, the legislation would require medical facilities to spend more on hiring more personnel and increasing benefits and salaries to attract enough personnel. Still, the high initial cost could be considered an investment since it would be associated with cost savings from addressing adverse events (Cherry & Jacob, 2013).Health policy brief II Essay
Getting support from legislators for the proposed legislation will require lobbying and advocacy efforts. Lobbying involves asking the legislators to introduce the legislation for discussion in the Congress and Senate, and support it. Advocacy involves informing legislators how the proposed legislation affect the constituents. In this case, five approaches have been identified as appropriate for influencing legislators. The first approach is to hold individual briefings and meetings with strategically positioned legislators. In planning for the meetings and briefings, it is necessary to identify an appropriate time and location, and information that would interest the legislator. The second approach is to use telephone calls and letters that clearly state the legislative objective, reasons for supporting it, and potential concerns. The third approach is public hearings that involve substantive formal deliberations between key stakeholders who include legislators. The fourth approach is public discussions that involve informal public debates. The final approach is public forms that involves the stakeholders who support and oppose the legislation to a neutral location where they can raise discussions on their points (Marquis& Huston, 2017). Any legislative opposition would be addressed by presenting comprehensive information on the merits of the legislation, and how it positively affects their constituents. In addition, any concerns that the legislators have will be identified and substantively addressed through providing the required information or amending the proposed legislation to incorporate the concerns (Marquis & Huston, 2017).Health policy brief II Essay
Conclusion
One must accept that despite the best efforts and being held to a higher standard, it is not uncommon for nurses to be unintentionally involved in adverse events. In addition, one must acknowledge that adverse events are a source of concern since approximately 10% of all patients report at least one adverse event resulting in more than 140,000 patients dying annually. Legislative efforts to address the issue of adverse events through presenting The Safe Staffing for Nurse and Patient Safety Act of 2018 were derailed when the legislation was not enacted on time. Still, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 and Registered Nurse Safe Staffing Act are currently being discussed as legislative interventions. To support these legislation, the proposal is presented that an independent federal agency be set up with legislative support to determine minimum nurse-to-patient ratios that reduce the opportunities for adverse events. Advocacy and lobbying would then be used to garner support from legislators for the proposed legislation.Health policy brief II Essay
References
American Nurses Association (2018). ANA applauds nurse staffing legislation. Retrieved from https://www.nursingworld.org/news/news-releases/2018/ana-applauds-nurse-staffing-legislation/
Black, B. (2016). Professional nursing-e-book: concepts & challenges. New York, NY: Elsevier Health Sciences.
Cherry, B. & Jacob, S. (2013). Contemporary nursing, issues, trends, & management (6thed.). Amsterdam: Elsevier Health Sciences.
GovTrack (2019). H.R. 5052 (115th): Safe Staffing for Nurse and Patient Safety Act of 2018. Retrieved from https://www.govtrack.us/congress/bills/115/hr5052
Huff, R., Kline, M. & Peterson, D. (2015). Health promotion in multicultural populations: a handbook for practitioners and students (3rded.). Thousand Oaks, CA: SAGE Publications, Inc.
Library of Congress (2019). H.R.2581 – Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019. Retrieved https://www.congress.gov/bill/116th-congress/house-bill/2581/text
National Nurses United (2019). RNs Applaud Reintroduction of Federal Safe Staffing Bills Mandating Nurse-to-Patient Ratios. Retrieved from https://www.nationalnursesunited.org/press/rns-applaud-reintroduction-federal-safe-staffing-bills-mandating-nurse-patient-ratios
Office of Inspector General, US Department of Health and Human Services (2019). Spotlight on… adverse events. Retrieved from https://oig.hhs.gov/newsroom/spotlight/2012/adverse.asp
Rafter, N., Hickey, A., Condell, S., Conroy, R., O’Connor, P., Vaughan, D. & Williams, D. (2015). Adverse events in healthcare: learning from mistakes. QJM: An International Journal of Medicine, 108(4), 273-277. DOI: 10.1093/qjmed/hcu145
Schwendimann, R., Blatter, C., Dhaini, S., Simon, M. &Ausserhofer, D. (2018). The occurrence, types, consequences and preventability of in-hospital adverse events – a scoping review. BMC Health Services Research, 18(Article number 521). DOI: 10.1186/s12913-018-3335-z. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3335-z#citeas
Stanhope, M. & Lancaster, J. (2014). Public health nursing: population-centered health care in the community (8thed.). Maryland Heights, MO: Elsevier/Mosby.
Tollefson, J., Tambree, K., Jelly, E. & Watson, G. (2019). Essential clinical skills: enrolled nurses (4thed.). South Melbourne: Cengage Learning Australia.
Working Nurse (2019). New legislation that impacts nursing. Retrieved from https://www.workingnurse.com/articles/New-Legislation-That-Impacts-Nursing.Health policy brief II Essay
