Legislation In Nursing

THE NURSE'S ROLE OF ADVOCACY IN HEALTHCARE

Why is the legislative process relevant in the field of Nursing? Legislation, as a whole, is responsible for shaping and molding the health care policies in America. It takes a large body to influence a change in our current health care system. We, as Nurses advocates in health care, have this ability – through our skillfulness, positions, and our numbers. This paper will describe the legislative process which includes four key elements – bills, committees, Senate, House, and Presidential decision making. Additionally, the topic of Nurse-to-Patient ratios will be investigated.

PART ONE

LEGISLATIVE PROCESS

In the United States, 1 in 44 women voters is a nurse, 1 in 100 adults is a nurse and there

are 10,000 nurses per congressional district ("Health Care Policy: The Nurse's Crucial Role"). This statistic is powerful, as it shows that a large body of American Nurses could influence the U.S. health care system. The legislative process begins with an idea. Firstly, a representative promotes a bill ("The Legislative Process," n.d.). The bill is a document used for most legislation, whether indefinite or short-term. This bill is then assigned to a committee to be analyzed. If released by the committee, the bill is placed on a calendar to be voted on, disputed, or amended. If the bill passes by a simple majority rule of 218 out of 435, the bill moves onto Senate to be reviewed ("The Legislative Process," n.d.). In the Senate, the bill is designated to move to another committee, who decides if the bill is terminated, or moved onwards. Another simple majority is designated to pass the bill which is 51 to 100. Lastly, a conference committee composed of House and Senate members decide on a final draft of the bill and then the Government Printing Office prints the amended bill in a practice called “enrolling” ("The Legislative Process," n.d.). This final bill is introduced to the President who then has 10 days to decide on signing or discontinuing the bill ("The Legislative Process," n.d.).
PART TWO
ANALYSIS OF POLITICAL ISSUES
The topic of nurse-to-patient ratios seems to be a big controversy in modern America. There are positives and negatives in regards to higher patient ratios. On a business/managerial point of view, less nursing staff and more patients being cared for is a profitable concept. The less capital that the hospital needs to pay employees, plus the payment (of a higher influx of patients) to the hospital, equals better financial outcomes overall for the hospital or institution on the business side of things. Conversely, higher patient-to-nurse ratios can be significantly dangerous for the patient, staff, and even for the hospital.
Leadership and team collaboration plays a large part when discussing increased patient-to-nurse ratios.

To be a successful nurse, these qualities need to be achieved: being competent in an advanced skill-set, collaborating with all parts of the health care team effectively, and most of all – doing the best that she/he can for the patient for their desired outcome. These factors are vital for success. Nurses who abide by the vision, the corresponding goals, and the plan to implement and measure progression of the patient is required for better outcomes (American Nurses Association, p. 55) Also, treating colleagues with respect while engaging in teamwork together to have safer outcomes for the patient is vital to success (American Nurses Association, p. 56). Although ratios are high right now in central Ohio hospitals, the whole healthcare team works together to do the best they can with the resources that are available to

them.
A study from several Pennsylvania hospitals shows that from 232,342 surgical discharges, 4,535 patients (2%) died within 30 days of their stay in the hospital.

The investigators of this study approximated that the difference between 4:1 and 8:1 patient-nurse ratios may be approximately 1,000 deaths in a bracket of this size (Shekelle, MD, PhD, 2013). The increase of Nurses to patients being cared for will lead to decreased illness and death rates based on a theory that increased attention to patients is the major factor (Shekelle, MD, PhD, 2013). Another study shows the positive effect of changing Nurse staffing ratios. In 2004, a California law required minimum nurse-patient ratios in acute care hospitals. This act mandated patient-nurse staffing proportions of 5:1 for medical-surgical units, 4:1 for pediatric units, and 2:1 for ICU’s. The study was followed two years later, where patient satisfaction levels improved, patient outcomes were significantly enhanced, and overall, nurses were more satisfied in their

position.
STUDENT’S OPINION ON POLITICAL ISSUES
As an Emergency Room nurse, I believe that nurse-to-patient ratios should decrease for the ultimate goal of increased patient safety country-wide. My opinion is based from the belief that safety is compromised when there is not enough staff to adequately care for the patients. Patients have not survived during the most critical time of their lives due to the inadequacy of enough nursing staff. Future patient deaths could be prevented solely on this problem. Increasing nursing ratios could prevent future medication errors due to dashing from patient to patient. Also, satisfaction scores of patients and families with their stay would increase. Currently where I work, there is high amount of patients that are re-admitted for the same morbidities. If there were decreased nurse-to-patient ratios, more patients would be properly educated on their disease during discharge which can prevent future hospital stays due to knowledge increase. The nurse would be less rushed to move onto the next patient that needs to be seen. Instead, he/she could spend more time with the patient explaining medication instructions, dietary restrictions, and follow up appointments with primary care. This theory alone could prevent unnecessary hospital stays.
Alternatively, looking at the Nurse’s side of this change, it would be very positive for mental health, physical health, and overall satisfaction with one’s job position. In my experience, I feel physically depleted after a twelve hour shift with low staff and large amount of high acuity patients. It’s exhausting mentally and physically when there isn’t enough help and you feel as if you could haven’t done enough. When you’re resuscitating a patient for two hours in the trauma bay while the whole ED is completely full and then finally get to check on your other four patients, your heart drops. Because you know that they will already be dissatisfied with their care due to the patient feeling that their nurse is neglecting them. In my opinion, this is a major country-wide problem that needs fixed.
In conclusion, legislation is essential for changes in health care policies in America. The legislative process which includes four key elements – bills, committees, Senate, House, and Presidential decision making. Lastly, nurse-to-patient ratios as described have positives and negatives in the health care field. In my background in nursing, I believe that decreasing nurse-to-patient ratios would prevent future unnecessary deaths and hospital stays.