Today’s healthcare is in a constant state of change, with regulations directly impacting a patient’s ability to receive healthcare and preventive care. The spiraling cost of healthcare leaves many Americans unable to afford insurance or access proper health care. Health care delivery systems aim at universal access to health care services and implementing cost-effective services that meet pre-established standards of quality. The American Nurses Association (ANA), the national professional organization that advances and protects nurses’ welfare, is a strong advocate for a legislative model where registered nurses are permitted to make staffing plans for each specific unit.
Nurse Staffing Ratios
For years, nurse staffing has been a complex issue for hospitals to manage. With tighter budgets and substantial increases in the number of patients, nurses have been working in situations that endanger both patients and themselves. Laws have been proposed in the U.S. requiring minimum staffing levels for nurses in hospitals to improve patient health and safety. This led to the introduction of Senate Bill 1357 and House Bill 2581, known as the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019, in Congress in May 2019 (Spetz, 2020). The bill aims at amending the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals. The regulation allows for flexible nurse staffing plans where registered nurses are empowered to create staffing plans for each specific unit through hospital committees.
Effect on Nursing Practice
Nurse staffing in health care facilities is critical in determining the quality of health services. Nurse staffing ratios can improve or decrease the level of health care in nursing practice. Short-staffed institutions increase the workload for the remaining staff in terms of extra shifts. The increase in nurses’ working shifts is directly proportional to the reduction of healthcare quality and an increase in mortality rates (Voss, Mawyer, and Yevchak, 2020). Nurses working longer shifts are prone to stress, burnouts, and workplace injuries. This affects their ability to provide quality healthcare to patient safety strategies to prevent risks and errors that may cause harm to patients during healthcare provision. Understaffing in health institutions’ critical areas increases the patients’ risks, such as longer hospital stays and an increase in medical errors leading to death. Low staffing also leads to job dissatisfaction among nurses. Employee satisfaction is critical in healthcare as a conducive work environment increases patient rapports, and ultimately the quality of care.
Higher nurse staffing levels in hospitals lead to better patient health and improved nurse health and safety. Efficient nurse-patient ratios reduce the length of stay and hospital readmissions due to improved quality of care, ultimately reducing hospitals’ costs. There is improved patient safety as the quality of patient care increases as the number of patients in nurse care decreases, thus reducing mortality rates. Nurses’ role is to provide quality healthcare to patients; thus, with the implementation of staffing ratios, registered nurses are provided with a reasonable workload and adequate rest, improving their ability to provide better patient care.
Quality measures and pay for performance
Quality measures and value-based performance pay are critical in providing financial assistance to health care providers. Pay for performance refers to a health care system where providers are reimbursed by payers based on a value-based model. The model assesses whether pre-established quality measures and efficiency have been met. The physicians receive compensation for providing quality patient results rather than the number of services provided, thus reducing costs. Compensation reflects health care providers’ performance on specified quality metrics. This payment approach’s primary objective is to enhance the quality, efficiency, and value of health care. Pay for performance is designated to improve health care by improving results and lowering costs. The effect of pay for performance on health care providers depends on the efficiency of obtaining proper diagnosis and prognosis of the patient, leading to improved patient outcomes.
The improvement is relative to the enactment of quality measures using data to assess hospitals and health systems based on specified quality standards. They serve as benchmarks that help hospitals measure resource utilization, such as providing effective patient-focused care. The North American health care system defines and measures the quality of care through structure measures, process measures, and outcome measures. Structure measures are attributes related to material sources and human resources, including access patients’ have to care, electronic systems, and overall patient experience (Grabowski, Stevenson, Caudry, O’Malley, Green, Doherty, and Frank, 2017). Process measures evaluate the methods by which care is provided. The primary focus of process measures is the hospital’s ability to diagnose and manage the illness, including appropriateness of treatment and resulting complications. Health care organizations employ quality measures specific to their institution. Process measures reports are initiated by third-party organizations such as Centers for Medicare and Medicaid Services (CMS) and the National Association for Healthcare Quality (NAHQ). Patients use the reports to compare the quality of facilities and health plans and chose the best available option. Outcome measures refer to the impact of physicians’ interventions on the health of patients. The measures gauge the care process results and include; surgical mortality, hospital-acquired infections, and surgical complications.
Nurses’ role and responsibility are to educate patients on reducing the prevalence of preventable diseases during the hospital stay. Nurses promote professionalism through person-centered care services and patient satisfaction and outcome. Healthcare facilities are graded based on their quality of performance; thus, the better the care, the higher the patient admission rate and ultimately higher compensation rates. Medicare awards facilities for delivering quality care with improved reimbursement packages. Nurses also help patients make informed choices of the care they receive through elaborate care plans.
Nurses Leadership and Management
Nursing leadership and management refer to the roles of nursing professionals who direct nursing departments by providing patient care and overseeing medical processes’ organizational structure. Nurse leaders focus on setting and upholding standards regarding the organization’s mission and long-term goals. The leaders ensure that staff upholds standards that represent the whole organization and are actively involved in policy setting. Nurse leaders ensure regulatory compliance, set policies, and discharge planning (Wei, Roberts, Strickler, and Corbett, 2019). The role of leaders regarding nurse staffing ratios is that of advocacy. The leader ensures that top-level management is aware of staff discrepancies regarding staffing, increasing the employees to the standard ratio. The nurse leader is responsible for ensuring that the employees are compensated adequately for salaries and overtime pay.
Nurse managers bridge the gap between patient care and administrative roles, thus provide guidance and support to their staff by addressing staffing ratio issues. Nurse managers are responsible for supervising nursing staff, thus oversee budgetary decisions, patient care, and work schedules; thus, overtime and shifts are under their control. Nurse managers should strive to implement a flexible schedule to achieve optimal care quality and patient outcomes by maintaining optimal staffing levels. Nurse managers are involved in the day to day operations, thus should be engaged in identifying the appropriate number and mix of nursing staff by matching the patients’ needs and staff experience. Nurse managers also educate staff on care standards to improve patient outcomes and facility ratings.
Emerging trends in nursing practices are influenced by the change in policies to improve patient outcomes and reduce associated costs. Two emerging trends in nursing comprise improved holistic care and integration of technological advancement in practice. The holistic nursing practice identifies the patient’s needs and initiates strategies that recognize the patient physical, spiritual, emotional, and mental strengths and weaknesses (Jin and Yi, 2019). Holistic care provides exceptional care to an individual patient as a whole. Collaborating with patients in the treatment process leads to better health outcomes and overall greater patient satisfaction. Holistic care also takes into account social and cultural differences. The philosophy ensures care for all parts of the patient, thus improving patient outcomes. The value-based nursing approach seeks to provide a positive patient experience since payment, and delivery models are based on quality instead of volume.
An increase in access to technology, such as electronic health records, is one of the critical trends in nursing practice. Electronic health records (EHRs) refer to the digitalized patients’ records, which improve the transfer of information between medical providers, thus better managing patients’ whole health. EHRs improve patient care by increasing the accuracy of medical records and making data easily accessible. Inflexible staffing ratios lead to overworked staff, thus increasing the probability of mistakes. Improved technology decreases the chance of human error as routine procedures are simplified.
Grabowski, D. C., Stevenson, D. G., Caudry, D. J., O’Malley, A. J., Green, L. H., Doherty, J. A., & Frank, R. G. (2017). The impact of nursing home pay‐for‐performance on quality and medicare spending: results from the nursing home value‐based purchasing demonstration. Health services research, 52(4), 1387-1408.
Jin, J., & Yi, Y. J. (2019). Patient safety competency and the new nursing care delivery model. Journal of nursing management, 27(6), 1167-1175.
Spetz, J. (2020). Nurse staffing ratios: Policy options. Policy & Politics in Nursing and Health Care-E-Book, 452.
Voss, E., Mawyer, K., & Yevchak, A. (2020). NURS 230: Nursing Staffing Ratios.
Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management, 27(4), 681-687.
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