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Policy Action Plan

Emily Rittenhouse

Delaware Technical Community College

NUR 420 Nursing Policy

Ms. Tammy Brown

December 3, 2023
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Policy Action Plan

One of the most rewarding aspects of being a nurse is the opportunity to help people to

achieve better health. The nursing practice is guided by policies that affect the working

environment and patients. As nurses, it is vital to be involved in policy development to see the

change needed to provide better patient care. Establishing safe nurse-to-patient ratios is an area

that necessitates nurse advocacy to provide better quality care and a healthy working

environment. This paper will explore nurses' role in highlighting health policy issues, the

financial impact this issue has on healthcare delivery, vulnerable populations affected by this

issue, and a policy action plan.

Background

It is essential for nurses to bring attention to health policy issues that are identified at the

bedside and through the nursing practice. Nursing practice is guided by Nursing Regulatory

Bodies in each of the states to manage the nursing practice, and each of these areas has the Nurse

Practice Act to establish what nurses are allowed to do (About U.S. Nursing Regulatory Bodies,

n.d.). Many healthcare issues, such as nurse-to-patient ratios, will start as a bill introduced by the

House of Representatives or Senate (Mason et al., 2021). In this case, a bill was introduced by

the House of Representatives called H. R. 2530 Nursing Staffing Standards for Patient Safety

and Quality Care Act of 2023 (H.R.2530 - Nurse Staffing Standards for Hospital Patient Safety

and Quality Care Act of 2023, 2023). The goal of this bill is to ensure a safe number of nurses to

patients mandated that hospitals and organizations must abide by and gives the nurse freedom to

decline an unsafe assignment if adequate staffing is not maintained (H.R.2530 - Nurse Staffing

Standards for Hospital Patient Safety and Quality Care Act of 2023, 2023). As this bill is still in
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the introductory phase, it will have to go through committees, subcommittees, negotiations

between the House and the Senate, and reach the President (Mason et al., 2021).

Role of the Nurse

Nursing associations, such as the American Nurses Association, and other nurses are

actively involved in promoting this bill and imploring Congress to pass it. The American Nurses

Association applauds the bill for receiving much-needed recognition and urges that change needs

to come across the nation with nurses leading the change (American Nurses Association Supports

the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, 2023). Castillo

(2023) states that nurses are making a stand to have this bill enacted and verifies that it has

already worked in California. Nurses must advocate and voice their experiences and

consequences of unsafe staffing to legislative bodies to gain support and attention to this issue

(The Consequences of Unsafe Staffing, 2023). Nurses are encouraged to be active through

politics in that they may run for an elected position, participate in voting, and educate those

making decisions about the issues identified in health care, such as safe patient ratios (Mason et

al., 2023).

Financial Impacts

Having adequate nurse-to-patient ratios not only has an effect on the nurses and patients

but also the overall financial status of a hospital or an organization. There is a push for

organizations to make changes to improve an organization's finances while providing quality

patient care (Akinleye et al., 2019). There is a connection between safe staffing and improved

patient outcomes and financial status. One article discusses that organizations that decide to

decrease the number of nurses to save money negatively impact the overall hospital finances as
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well as patient safety and outcomes (Chen et al., 2019). There are several factors that unsafe

staffing and nurse-to-patient ratios have in regard to hospital finances. When nurses are burned

out or feel unsafe or supported and decide to leave, this high turnover impacts the hospital

budget as well as the costs of having to hire new nurses to fill the positions of those leaving (The

Consequences of Unsafe Staffing, 2023). A hospital is noted to lose around $52,000 for a nurse

during nursing turnover (The Consequences of Unsafe Staffing, 2023). Clark and Donaldson

(2018) noted that hospital finances are to be increased in organizations that have unfavorable

patient care outcomes. Unfavorable outcomes can present as falls, errors in relation to

medication administration, hospital-acquired infections, and even death related to inadequate

nurses to perform patient care ((The Consequences of Unsafe Staffing, 2023). These outcomes

become costly for a hospital.

Vulnerable Populations

Vulnerable populations for the issue of unsafe nurse-to-patient ratios include nurses and

patients. Castillo (2023) discusses how having an inadequate number of nurses for patients can

result in patient mortality, delays of care, and injuries including pressure ulcers. Another source

discusses that patients are at an increased risk of mortality by 7% for every additional patient that

is added to a nurse's workload (The Consequences of Unsafe Staffing, 2023). Unsafe ratios result

in more patients being readmitted and staying in the hospital longer, as well as an increased risk

for adverse events (The Consequences of Unsafe Staffing, 2023). Nurses who work in inadequate

staffing ratios are more likely to suffer from burnout, anxiety, depression, physical injuries, and

cardiovascular disease (The Consequences of Unsafe Staffing, 2023). It is also noted that nurses
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in these conditions are more likely to experience a needle-stick injury, rush patient care,

experience verbal abuse, and medication errors (The Consequences of Unsafe Staffing, 2023).

Policy Action Plan

Safe nurse-to-patient ratios necessitate an action plan for the improvement of policy. The

plan to improve staffing is two-fold over the next ninety days. First, nurses are to be involved in

advocating in their hospitals and organizations for safe nurse-to-patient ratios and a healthy work

environment. The goal for this first plan is to decrease nurse burnout and increase organizational

support for the nursing profession, resulting in a healthy and safe work environment. Nurses are

encouraged to join committees and professional organizations to gain support from other nurses

and advocate for patient care issues (Mason et al., 2021). When nurses are actively engaged in

patient advocacy, policy-making, and collaboration through councils and committees, there is a

decreased incidence of burnout and increased retention (Brooks Carthon et al., 2019). According

to the ICN's updated code of ethics, nurses are called to be involved in the decision-development

process, and organizations are to aid their nursing staff in their overall health (Stievano &

Tschudin, 2021). Second, nurses are to be involved in advocating for policy development in their

governments. Policies and guidelines regulate the nursing practice, and nurses are experiencing

issues in patient care due to inadequate staffing. It is vital to discuss with policymakers the

importance of requiring reporting of staffing levels and a safe standard of nurse-to-patient ratios

(de Cordova et al., 2019). Castillo (2023) urges nurses to plead with Congress to enact H.R. 2530

to ensure safe staffing ratios in order to provide a better future.

The goal would be to highlight the consequences for patients, nurses, and organizations

experience with inadequate nurse staffing in order to gain a minimum safe nurse-to-patient ratio.
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California is the only state to have a policy in regard to safe nurse-to-patient ratios, and there

have already been improvements in patient and staff safety (Leigh, 2015). On a small scale, this

would happen in Delaware, just as it was started in California, but ultimately, the goal would be

to make it a universal policy for safe staffing. Mason et al. (2021) encourage nurses to be active

advocates politically through professional organizations to promote issues in all areas, including

national, local, and state levels. The American Nurses Association is very active in being part of

federal and state changes toward safe staffing (American Nurses Association, 2022). Nurses need

to be a part of the change and advocate for the change they want to see in their work

environments and with their patients. The best way to promote change is to voice experiences

and issues to those who are in control of changes. Through advocacy, nurses are responsible for

being a voice for safety issues, such as safe nurse-to-patient ratios, and can be instrumental in

policy development.
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References

About U.S. Nursing Regulatory Bodies. (n.d.). NCSBN.

https://www.ncsbn.org/nursing-regulation/about-nursing-regulatory-bodies.page#:~:text=

More%20than%20100%20years%20ago

Akinleye, D. D., McNutt, L.-A., Lazariu, V., & McLaughlin, C. C. (2019). Correlation between

hospital finances and quality and safety of patient care. PLoS One, 14(8).

https://doi.org/10.1371/journal.pone.0219124

American Nurses Association. (2022). Nurse staffing advocacy. ANA.

https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/

American Nurses Association Supports the Nurse Staffing Standards for Hospital Patient Safety

and Quality Care Act. (2023, November 1). American Nurses Association.

https://www.nursingworld.org/news/news-releases/2023/american-nurses-association-sup

ports-the-nurse-staffing-standards-for-hospital-patient-safety-and-quality-care-act/

Brooks Carthon, J. M., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders,

A. M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019).

Association of Nurse Engagement and Nurse Staffing on Patient Safety. Journal of

Nursing Care Quality, 34(1), 40–46. https://doi.org/10.1097/NCQ.0000000000000334

Castillo, B. (2023). A message to Congress. National Nurse, 119(2), 13.

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Chen, Y.-C., Guo, Y.-L. L., Chin, W.-S., Cheng, N.-Y., Ho, J.-J., & Shiao, J. S.-C. (2019).

Patient–Nurse Ratio Is Related to Nurses’ Intention to Leave Their Job through

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Mediating Factors of Burnout and Job Dissatisfaction. International Journal of

Environmental Research and Public Health, 16(23).

https://doi.org/10.3390/ijerph16234801

de Cordova, P. B., Rogowski, J., Riman, K. A., & McHugh, M. D. (2019). Effects of public

reporting legislation of nurse staffing: A trend analysis. Policy, Politics, & Nursing

Practice, 20(2), 92–104. https://doi.org/10.1177/1527154419832112

H.R.2530 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023.

(2023). Congress.gov.

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Mason, D., Dickson, E., McLemore, M., & Perez, G., (2021). Policy and Politics in Nursing

Healthcare, 8th Edition. Elsevier.

Leigh, J. P. (2015). California’s Nurse-to-Patient Ratio Law Reduced Nurse Injuries by More

Than 30 Percent. Economic Policy Institute.

https://www.epi.org/blog/californias-nurse-to-patient-ratio-law-reduced-nurse-injuries-by

-more-than-30-percent/

Stievano, A., & Tschudin, V. (2021). The ICN code of ethics for nurses: A time for revision.

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The Consequences of Unsafe Staffing. (2023). Alaska Nurse, 74(1), 8–10.

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