C159 Policy, Politics, & Global Health Trends Enrico Silvestre Giron Western Governors University

Running head: POLICY, POLITICS, & GLOBAL HEALTH TRENDS 1

C159 Policy, Politics, & Global Health Trends Enrico Silvestre Giron Western Governors UniversitY

POLICY, POLITICS, & GLOBAL HEALTH TRENDS 2 Policy, Politics, & Global Health Trends Considered by many to be “the glue” which allows the hospital to function as a multifaceted organism, nurses are at the forefront and crucial to a hospital’s high-quality care. By providing thorough routine assessments, continuous monitoring for possible deterioration, and timely nursing interventions, nurses “spot errors before they can be launched” (Kuwata, 2017).According to Thomas (2002), nurses are inherently equipped with the ability to “sense apprehensions and act on them,” however, circumstances in the work environment may thwart these uniquely innate abilities possessed by all nurses. For example, safe nurse-to-patient staffing ratios are not consistently maintained and streamlined across the United States—and place many nurse’s careers, patients, and patient outcomes in jeopardy. In California, nurse-to-patient ratios on a Telemetry Unit are 1:4, where other states staff at 1:6 or 1:7. Nurses in other states, such as Arkansas or North Carolina, where there is no safe ratios are not maintained, can attest to the inability to provide the safe and effective level of care they want to, due to the acuity, and number of patients that they must provide care for during their shift.In March of 2010, the Affordable Care Act (ACA) was passed with a goal to protect the United States citizens and their access to healthcare. However, with the passing of the ACA, many healthcare facilities were faced with multiple challenges and forced to comply with new regulatory standards in order to be eligible for compensation of the services provided to each patient. Hospital administration were forced to err on the side of bureaucratic and budgetary functions, instead of the wellbeing of the nurse and patient, by limiting the number of nurses staffed per patient in order to see a markedly increase in profit margins. Consequently, as the number of patients per nurse increased, positive patient outcomes and quality of care provided decreased.

POLICY, POLITICS, & GLOBAL HEALTH TRENDS 3 Public Policy Issue Over the last few decades, as the acuity of each patient admitted to the hospital increased, the cost of healthcare spending and hospital resources also increased. Alternatively, while healthcare costs began to soar, reimbursement rates began to slump. Consequently, in response to the rising costs of healthcare, hospitals began to institute a variety of interventions to decrease costs, including limitations on hospital lengths of stay, restricting certain pharmacological formulary, and progressively increasing patient-to-nurse ratios. Each intervention, particularly of interest, the increase of the patient-to-nurse staffing ratio, potentially undermine not only our nurse’s safety, but also our patient’s safety. To increase the number of patients a single nurse must care for precludes high quality care, and inappropriately puts a hospital’s bureaucratic and budgetary needs before the safety needs of our patients and nurses.Issue selection Throughout the years of my career as both an Emergency Room RN and a Stepdown/Telemetry/Med Surg RN, I have had the privilege to work with many travel nurses from all over the United States. Prior to living and practicing nursing in California, where “safe” patient-to-nurse minimum staffing ratios are not only mandated by law, but also maintained, I practiced in Hawaii, where the laws were not maintained depending on the census on the floor.Through meeting other nurses from around the world, it was surprising to find out how many other states still have not followed or maintained staffing recommendations in suit. In personal communications with multiple travel nurses, many discuss that states such as Arkansas, Massachusetts, North Carolina, and New York, to name a few, have been placed in situations where staffing ratios have been too high to adequately provide high quality nursing care to their patients. With no regard to acuity levels of the patients, or contractual staffing grids, major

POLICY, POLITICS, & GLOBAL HEALTH TRENDS 4 healthcare organizations in these aforementioned states place revenue above the direct staff helping to produce that revenue and the patient population’s healthcare outcomes. It has been determined that a common theme and reason many travel nurses enjoy coming to work in California is the safer staffing ratios. Therefore, all of Hawaii’s healthcare organizations should plan to provide safe staffing ratios to protect nurses and patients for harm or unsafe conditions.Issue relevance To provide high quality, safe, and effective care to patients is not only a requirement, but an expectation of all nurses in the field. Failure to limit the number of patients a nurse must care for without regard for acuity, causes a preclusion of said expectations, and is therefore detrimental to the health and wellbeing of our communities that we took an oath, as nurses, to serve. For example, healthcare organizations that routinely staff 1 nurse to 8 patients have experienced five additional deaths per one-thousand patients seen, versus those organizations that staff 1 nurse to 4 patients (American Medical Association, 2018).According to Curtin (2018), there is readily “available evidence [indicating] that there is a statistically and clinically significant association between RN staffing and adjusted odds ratios of hospital-related mortality, failure to rescue, and other patient outcomes.” Overly saturated medical-surgical floors in the hospital are the focus of many proponents for safe ratio mandated laws. Instituting policies where one nurse can safely and effectively care for a minimum number of patients mandated by law can help improve overall patient outcomes and safety. Maintaining safe patient-to-nurse staffing ratios could thwart a multitude of errors such as: medication errors, falls, pressure associated wounds, detection of life-threatening situations, and even death.Financial impact