Healthcare: Quality Nursing in the California State - Essay Example

? Quality Nursing Quality Nursing Over the years, the nursing profession in the United s has had numerous controversies as pertains what is the expected standard in the nature and type of work carried out by the nurses. This controversy has led to the formulation and implementation of various legislative rules that govern and protect the rights and duties of nurses, particularly on the working environment and the nurse-to-patient ratios. Since nurse-to-patient ratios are one of the most controversial topics in healthcare today, various pressure groups and nurse associations have been established over the years to lobby for the rights of Registered nurses in the U.S.A. The history of the staffing requirements of hospitals in California dates back to the year 1999 when the then governor Gray Davis signed assembly bill 394 into law. This bill required the California Department of health services to adopt stipulated regulations that established the minimum nurse to patient ratios in hospitals. This came as a response to the numerous concerns raised about patient safety as the dynamics of healthcare became more complex and hence resulting into a shortage of nurses in the late 1990s (Donaldson and Shapiro, 2010). The minimum staffing requirements set in place aimed to improve the quality of healthcare and patient safety as well as aiming to retain and acquire more nurses by improving the conditions of their working environment. As required by the law, the California Department of Health Services requires hospitals that provide acute care to maintain the minimum nurse to patient ratios. The stipulated ratios vary by unit ranging from 1:1 ratio in operating rooms, and 1:2 intensive care units, neonatal intensive units and critical care, as well as in post-anesthesia recovery and labor delivery. Further, the ratio is 1:4 in ante-partum and post-partum, emergency room and pediatric care and the emergency rooms. Its 1:6 on psychiatric units. In general, regular hospital units have a 1:5 ratio (Aiken et.al. 2010). In the subsequent years after the California law took effect, nurses became very optimistic about the stipulated ratios. According to the California Nurses Association, the ratio law has been a large success as demonstrated by a large increase in the number of registered nurses licensed in California. Moreover, there has been a reduction in the rate of nurse turnover as a result of better job satisfaction. In addition, it has been observed to improve patient safety and hence helped to save more lives and provided nurses with a platform to advocate for their patients (Cook et.al. 2012). However, in spite of these positive observations, hospitals are still not convinced especially in the absence of tangible evidence that the ratios set out actually improve the care provided by the nurses and reduce errors. A study conducted in 2002, two years before the law was implemented provided shocking findings. It showed that when a nurse is assigned four patients under his/her care, the risk of patient death rises by 7% for each additional patient assigned. The legislation which was signed into law in 1999 took effect on 1st January 2004 giving hospitals five years to implement the required changes. Contrary to the positive expectations after implementation, various problems that make the implementation process difficult to implement have been observed. A key limitation being that it requires continuous compliance with the ratio which means that the number of patients under the care of each nurse should not exceed the stipulated number at any one point in time during their shifts in any particular unit. So if a nurse has to use a restroom, then the law provides for him to reassign his/her patients to another nurse. Despite these minor setbacks in the implementation process, the requirements set out by the legislation have been observed to have a positive effect on the working environment of the nurses. This positive effect can be demonstrated by the increase in the number of registered nurses and a decrease in the turnover of currently licensed nurses. In this time and age many patients demand quality healthcare. By increasing the number of registered nurses the standards of the quality of healthcare provided has also improved. Various studies conducted have shown that the state mandated nurse staffing requirements reduce workloads leading to lower mortality among patients and greater satisfaction among nurses. Citing various evidence provided by researchers and scholarly articles, heavy patient workloads for nurses have been greatly associated with detrimental patient results and very low job satisfaction for nurses. This link between patient outcomes and the implication for nurses has been addressed greatly by the implementation of the law hence leading to high competence among licensed nurses as a result of a conducive working environment that has resulted from the stipulation of the minimum staffing requirements. Even with laws in place to govern the rights and duties of nurses, nursing still remains one of the most challenging professions as nurses are expected to work long hours caring for severely ill patients. Many professionals have argued that in order to alleviate job related fatigue and dissatisfaction and reduce the workload among nurses while still improving the safety of patients, there should be more nurses working in hospitals per patient. This is what has made the issue of staffing requirements in hospitals a major controversial topic to date with different classes of people having different opinions on the nurse to patient ratios. For example, the nurses and associated pressure groups feel that the implementation of the minimum staffing requirements have a positive impact on the quality of their work and patient safety while healthcare organizations see the lack of conclusive evidence to show that the stipulated ratios improve the general working conditions and patient safety in the respective healthcare centers. The controversies to date have led to a recent introduction of the National Nursing Shortage Reforms and Patient Advocacy Act which was introduced in April 2013 by Senator Barbra Boxer which is a bill that establishes the requirements of acute healthcare centers to provide registered nurses based on the severity of the patients conditions provided that the minimum staffing requirements are met at all times. In my opinion, the introduction of the legislation that provides for minimum staffing requirements in healthcare facilities has contributed greatly to the improvement in the general healthcare and patient safety conditions over the years since implementation. The stipulation of the nurse to patient ratios has been observed to have a positive impact on the safety of the patients as well as the well-being of the nurses themselves. The ratios introduced mean that the workloads among nurses is reduced and hence worth, improved job satisfaction among the nurses. The positive results from the implementation of the legislation also has a few negative implications such as the difficulty in implementation of the law in the various hospitals due to certain unavoidable factors such as lack of sufficient funds to hire enough nurses to meet the minimum staff requirements which have been catered for by the government through provision of grants to meet the state mandated requirement. In conclusion, I think that the legislatively mandated nurse-to-patient ratios are an effective way to manage the nursing workloads and there is a positive response to the mandated ratios in California which is depicted by the increase in licensed registered nurses and also the adoption of the minimum staffing requirements by other states. Thus the implementation of the law over the years has been a major success. Works Cited Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., ... & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health services research, 45(4), 904-921. Cook, A., Gaynor, M., Stephens Jr, M., & Taylor, L. (2012). The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California's minimum staffing regulation. Journal of health economics, 31(2), 340-348. Donaldson, N., & Shapiro, S. (2010). Impact of California mandated acute care hospital nurse staffing ratios: A literature synthesis. Policy, Politics, & Nursing Practice, 11(3), 184-201. Read More