The Safe Staffing for Quality Care Act 2015
Background
The passing of the Affordable Care Act (2010) is overhauling the healthcare delivery system, with an emphasis on creating a value-based healthcare system that will increase the public 's access to high quality and cost effective health care. The Affordable Care Act (2010) developed new initiatives that provide incentives and penalties for healthcare organizations, based on the organization’s ability to meet specific quality and safety indicators (ANA, 2015).
Nurses are at the heart of the health care delivery system, and are a health care organization’s most valuable assets (ANA, 2015). Nurses make up the largest profession in the health care system, and are the primary source providing direct patient care. Health care administrators are challenging nurses with enormously high, extremely unsafe nurse to patient ratios and presenting unrealistic and unattainable expectations. The increased emphasis on value based health care, requires optimal nurse staffing to achieve positive clinical and economic outcomes (ANA, 2015).
The Safe Staffing for Quality Care Act 2015
The Safe Staffing for Quality Care Act (2015), Assembly bill number A8580A and Senate bill number S.782 is an amendment to the Public Health Law in New York State. This amendment would require acute care facilities and subacute facilities to establish specific nurse-to-patient ratios in all nursing units. If enacted this bill would set minimum staffing requirements, based on the specific needs of the census, and nursing workforce. Health care organizations would be required to submit an annual staffing plan to the New York State Department of Health (ANA, 2015).
Sponsorship
The Safe Staffing For Quality Care Act (20...
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...inistrators do not fully understand the need for change regarding nurse staffing. High nurse to patient ratios require nurses to hesitantly cut corners in order to get the job done as best as possible. Health care administrators are not concerned until there is a bad outcomes (Robbins, 2015). The focus on value based healthcare, increases the emphasis on cutting costs to protect the organization’s bottom line (Robbins, 2015).
Next Steps
The future of The Safe Staffing for Quality Care Act (2015), the safety of the patient population, and the safety of the nursing profession hangs in the balance of the the Senate Heath Committee. The bipartisan support and the fact that the primary sponsor of this bill in the senate is the Chairman of the Senate Health Committee, and the strong evidence based research presented should not meet much resistance (NYSNA, 2015)
In the case of nurse staffing, the more nurses there are the better outcome of patient safety. When there enough staff to handle the number of patients, there is a better quality of care that can be provided. The nurses would be able to focus on the patients, monitor the conditions closely, performs assessments as they should, and administer medications on time. There will be a reduction in errors, patient complications, mortality, nurse fatigue and nurse burnout (Curtan, 2016). While improving patient satisfaction and nurse job satisfaction. This allows the principle of non-maleficence, do no harm, to be carried out correctly. A study mentioned in Scientific America showed that after California passed a law in 2014 to regulate hospital staffing and set a minimum of nurse to patient ratios, there was an improvement in patient care. Including lower rates of post-surgery infection, falls and other micro emergencies in hospitals (Jacobson,
The Affordable Care Act seeks to reduce health care costs by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Accountable Care Organizations (ACOs) make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up (CMS, 2014). An estimated 14 percent of the U.S. population is now being served by an ACO (CMS, 2014).
The problem, as defined for my argument research paper, is that to cut costs, hospitals have been steadily increasing the number of patients nurses must care for. In many areas it's not uncommon for one nurse to have to assess, give medications to, and manage the care of as many as 12 patients. This puts tremendous strain on nurses. Many of the studies I have seen in my research indicate that a high ration of patients to nurses increases the rate of death or other poor outcomes for patients. It also leads to increased nurse burnout and higher turnover, though at this point I believe my paper will focus on patient outcomes.
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
On April 17th 2013, Senator Barbara Boxer (California) introduced a federal bill that is aimed to reduce nursing shortages by establishing a minimum nurse-to-patient ration in hospitals. She is also ordering whistleblowing protection for nurses who report quality-of-care violations. The law requires that every hospital implement a written hospital-wide staffing plan that will guide the assignments to...
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
O’Daniel, M., & A.H., R. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2637/
It is clear that statewide mandated nurse-to patient ratios result in drastic financial changes for every hospital impacted. Hospitals often have to compensate for hiring more nurses by laying off support staff. Mandated ratios also result in an increase in holding time in emergency rooms . (Douglas,
Patient’s safety will be compromised because increase of patient to nurse ratio will lead to mistakes in delivering quality care. In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a metanalysis and found that “shortage of registered nurses, in combination with increased workload, poses a potential threat to the quality of care… increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stay.” Intense workload, stress, and dissatisfaction in one’s profession can lead to health problems. Researchers found that maintaining and improving a healthy work environment will facilitate safety, quality healthcare and promote a desirable professional avenue.
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
This article is a comprehensive look at staffing on hospital units. It used a survey to look at characteristics of how the units were staffed – not just ratio, but the experience and education level of the nurses. It evaluated several different categories of hospital facilities – public versus private, academic medical centers versus HMO-affiliated medical centers, and city versus rural. It is a good source because it shows what some of the staffing levels were before the status quo of the ratio legislation passed in California. It’s main limitation as a source is that it doesn’t supply any information about patient outcomes.
Over the last few decades, various laws have been established with the main purpose of making the system equal and more efficient for all. The U.S. hospital system has become more complex and less efficient due to significant political and monetary interference along with the passage of these laws. The most recent amongst those laws is the Affordable Care Act (ACA), which was signed into legislation by President Obama in 2010. Various provisions in the ACA includes universal health insurance coverage, significant changes in the payment for health services and changes in the health care organization delivery and workforce policy. Thus, ACA has a significant influence on the current U.S. healthcare system.
The purpose of this paper is to address the issue of nursing staffing ratios in the healthcare industry. This has always been a primary issue, and it continues to grow as the population rate increases throughout the years. According to Shakelle (2013), in an early study of 232,432 surgical discharges from several Pennsylvania hospitals, 4,535 patients (2%) died within 30 days of hospitalization. Shakelle (2014) also noted that during the study, there was a difference between 4:1 and 8:1 patient to nurse ratios which translates to approximately 1000 deaths for a group of that size. This issue can be significantly affected in a positive manner by increasing the nurse to patient ratio, which would result in more nurses to spread the work load of the nurses more evenly to provide better coverage and in turn result in better care of patients and a decrease in the mortality rates.
Bedside nurses want to change staffing levels to assure that they have enough time to both keep up with the constantly evolving health care and to provide safe patient care. Yet, healthcare employers consider that reducing nurse patient ratio is an unnecessary expense that has not been proven to improve quality of patient care (Unruh, 2008). Employers emphasize that raising nursing staffing level is not cost-effective. In fact, in accordance with ANA’s report (2013), a study, in the Journal of Health Care Finance, confirmed that reducing patient-nurse ratios increased hospital costs, but did not lower their profitability. Higher hospital costs were attributed to wages and benefits allocated to newly hired nurses. Yet, according to Cimiotti et.al (20112), it is more costly for hospitals to not invest money on nursing.
To briefly summarize, the report acts to identify nurses as an important faction in enabling access to high quality, affordable health care. This was supported by the development of four fundamental recommend...