Running head: ANALYSIS OF U.S. HEALTH CARE POLICY: H.

R 2581 1

Analysis of U.S. Healthcare Policy: H.R 2581

Selina Dykes

Grand Canyon University: NSG436

June 30, 2020

ANALYSIS OF U.S. HEALTHCARE POLICY: H.R 2581 2

Analysis of U.S. Healthcare Policy: H.R. 2581

The healthcare field is a diverse and well-known occupation that carries some of the

world’s biggest responsibilities. Among these responsibilities are many errors that can occur and

are often times preventable. Topics such as medication administration errors, fall risks and

documentation discrepancies can all hinder the proper care for a patient. Nurse to patient ratios

have been on a steady incline due to the shortage of healthcare personnel. The H.R. 2581 bill

recognizes the extreme nurse to patient ratios and how to overcome this gap. This paper will

analyze major stakeholders and their influence on the policy, discuss the positive and negative

aspects of the bill, identify legislative, regulatory and financial factors as well as introduce a

proposition to change/ add to the policy.

Summary of H.R. 2581

The healthcare field is constantly evolving with new interventions, medications and

discoveries of new illnesses. While this evolution, the need for personnel within the hospitals are

needed to keep up with these changes, especially nurses. Typically, hospitals are in a nursing

deficit due to the shortage of nurses within the past years. The H.R. policy 2581 expresses its

concerns for the wellbeing of patients as well as nurses. It hopes to implement new standards on

how many nurses can be responsible for at a time. This policy suggests that nurses in different

units should have a predetermined number of patients. For example, the general set up in this

scenario is used to keep patients safe under the care of their nurse and trusting that they will be

provided with the best care. The H.R. 2581 bill suggests that each trauma emergency unit will

have one patient per nurse. Operating rooms will require one patient per nurse. In critical care,

intensive care units, labor and delivery units, acute respiratory care units, coronary care units and

burn units will allow two patients per nurse. The emergency room, pediatric unit, telemetry units,
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antepartum and postpartum units will be allowed three patients per nurse. Additionally, four

patients will be assigned to a nurse in the medical surgical units, intermediate care nursery units

and other specialty care units. Five patients will be given in rehabilitation and skilled nursing

units. Finally, six patients are given to one nurse in postpartum and well-baby nursery units

(Govtrack.us, 2020). These standards are expected to account for the severity of the patient’s

condition and allow the nurse more time to treat their patients correctly without getting burnt out

and putting the patient at harm. With these changes, the outcomes for patients are dramatically

improved.

Major Stakeholders

Stakeholders are a vital part of all change projects and implementing new policies. A

stakeholder is essentially any party that has an interest in a specific organization and the

decisions being made within this organization (ASQ, 2020). This specific policy included

stakeholders such as the government, the hiring manager, nurses and patients. The government is

interested in this bill because they are the ones who determine if the bill passes through the

congress and legislative processes. The hiring manager is a stakeholder because this position is

in charge for hiring more nurses to ease the nursing shortage gap. Nurses play a role as a

stakeholder because they are directly affected by this issue and could benefit from new standards

that allow for burnout to decrease. Lastly, patients are again a direct stakeholder because they are

at risk for the errors that come with nurses having too many patients at a time. Each party is

interested in being attentive to the issue at hand in wanting the best care for each patient. This

cannot happen however if nurses cannot even hold a conversation long enough before another

patient is ringing their call light. To help develop and implement the policy within the institution,

stakeholders can become knowledgeable about the subject and take initiative to request better
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conditions. While it can be difficult to find more nurses to hire in order to help aid this change,

all parties are affected because they are in a position to help create new standards for staffing

plans.

Positive and Negative Aspects

With every proposition, there are positive and negative aspects. These components need

to be analyzed thoroughly in order to determine if the change being made is providing the best

outcome for patients as well as nurses. One pro to implementing new staffing plans include the

decrease risk for burnout. With less patients to care for, nurses will be provided more time to

accurately check medications, properly assess their patients and document correctly and

promptly. One study states, “High nurse-to-patient ratios, greater than 1:4, with each additional

patient added, is associated with a 7% increase in hospital mortality that could be caused by

patient infections, bedsores, pneumonia, cardiac arrest, and accidental death” (Gustan, Patton,

Willis & Coutasse-Hencke, 2018, pg. 11). Mortality rates would be improved with less patients

per nurse in these highly stressful environments. With the mortality rate decreasing, the

organization saves money on further injuries and deaths and can use this money elsewhere in the

hospital. This decreases the amount of stress on nurses to get through all the patients given and

allows for a safer work environment since mistakes are easily made when being rushed.

Additionally, holistic care is better achieved by the understanding of each patient rather than just

treating the disease. Another positive aspect of this bill is the decreased wait time for each

patient. With less patients to care for, nurses can quickly attend to their patients’ needs rather

than having to push aside less severe cases.

Because this policy has not been implemented as of yet, there are things to improve. One

of the negative aspects of this bill is that hospitals will need to hire more nurses to close the ratio
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gap. This is not only difficult because there is a nursing shortage, but it is also expensive. Some

organizations are not capable of hiring more personnel which can halt the progression of this

policy. Furthermore, if more nurses are not hired, patients will have to wait for longer periods of

time to be seen and cared for. This can put the patients more at risk for mortality and further

injuries by trying to do things themselves.

Factors That Impact Nursing Practice and Equitable Delivery

Different factors such as legislative financial and regulatory all play different roles in

implementing new policies. The legislative factor is composed of the government process of

passing a bill that needs to be approved by the Senate and House of Representatives followed by

approval from the president. Once this has been completed, the bill is turned into a law. The

current bill was introduced on May 8th, 2019 and as of now, the H.R. 2581 bill is in the first stage

of the legislative process. By having to go through all these steps, it does take a long time to

complete a new implementation such as this one which can affect the nursing practices because it

hinders nurses from decreasing their ratios or having the right to do so. Financially, by having an

increased number of patients per nurse is cheaper short term because more patients are being

seen as well as not paying for excess nurses. Although this seems to be the cheaper option, long

term progress begins by decreasing the number of patients because it ultimately causes decreased

mortality rates and reinjury visits. Regulatory factors determine the current standards that the

staff upholds. If the bill were to pass all processes, nurses need to keep up the standard of work

and uphold all the methods being presented. This means assessing patients further, taking more

time to accurately check medication administration techniques and becoming more useful to

patients when in need of things such as using the restroom. This will in turn increase the quality

of care for patients and ultimately prevent burnout for nurses.

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Proposed Alteration to the Policy

The proposed H.R. 2581 bill is comprised of many positive perspectives and

interventions however, there is room for alterations to this bill in order to further the success

rates of nursing care. One thing that was mentioned before was some units were supposedly

allowed only one patient or even just two in intensive care units among others. Although this is a

great idea, this would be difficult to implement because natural disasters and mass traumas occur

on unexpected days. Not only would nurses be stressed because of the influx of new patients at

once, but they would also be unfamiliar with the routine of taking care of more than one patient.

This is not a realistic ratio because it limits the number of patients being seen as well as does not

actively prepare the nurses for things such as natural disasters. Further analysis could be done in

order to determine the repercussions of these ratios because although they sound great, they can

work against the initial problem and cultivate a bigger issue. Additionally, analysis needs to be

done for areas that cannot sustain the recommendations of this bill due to the lack of resources

and personnel available.

Conclusion

The nursing career is one of the most difficult yet rewarding occupations. Although there

are many great qualities that this career possesses, there is always room for improvement and

exploring different methods to improve patient outcomes. By analyzing the H.R. 2581 bill, it has

been displayed that nurse to patient ratios are controllable and can be altered to help with these

improvements. By analyzing different financial, legislative, regulatory, positive and negative

factors, this bill has the potential to benefit many lives. This bill works to decrease the number of

patients a nurse cares for in hopes of bettering patient outcomes. Because this career is based

upon adaptability, it is vital that research continues to improve treatment methods and techniques
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used in the clinical setting. With the implementation of decreased nurse to patient ratios, patients

will receive better quality of care and nurses will benefit from less burnout rates.
ANALYSIS OF U.S. HEALTHCARE POLICY: H.R 2581 8

References

ASQ. (2020). What are stakeholders. Retrieved from https://asq.org/quality-

resources/stakeholders

GovTrack.us. (2020). H.R. 2581 — 116th Congress: Nurse staffing standards for hospital Patient

safety and quality care act of 2019. Retrieved from

https://www.govtrack.us/congress/bills/116/hr2581

Gustan, Patton, Willis & Coutasse-Hencke. (2018). Burnout syndrome and nurse-to-patient

ration in the workplace. Marshall University. Retrieved from

https://mds.marshall.edu/cgi/viewcontent.cgi?

referer=https://www.google.com/&httpsredir=1&article=1196&context=mgmt_faculty