Politics is a constant changing field, just like the Practice of Nursing but as nurses it is our responsibility and duty to keep up to date with changes being made that will effect our profession. The biggest concern nationwide seems to be the number of patients that a nurse can safely care for and while some states have regulations on that nurse-patient ratio many do not. Pennsylvania is going through a transitional period where two bills are being purposed and both can change the way we provide care. While safe staffing is an issue nationwide it recently became a resolved issue locally at Heritage Valley Beaver.
Other political issues that currently play a part in the nursing world are affordable healthcare, work place violence prevention and mandatory overtime. It is important to educate nursing students and new nurses on the role politics plays in the profession and what resources are available to help them find their voice. State and Local Politics within Nursing The Nurse Practice Act (NPA) is a set of laws enacted by state governments that are in place to protect the general population and ensures the safe practice of nurses.
These laws can differ from state to state and determine things such as educational requirements, licensure, authority and power of Board of Nursing, disciplinary measures and the general standards and scope of nursing practice (Russel, 2012). In 1999, California became the first state to establish by law a minimum registered nurse (RN)-to-patient ratio for hospitals. The final staffing requirements went into effect on January 1st, 2004. Research shows that the California nursing ratios could be associated with lower mortality and better nurse retention (Aiken.. et al, 2010).
After seeing these positive effects other states began to follow suite and began to implement regulations on nurse staffing in the hospital setting. As of now, 14 states have placed regulations to some degree on nurse staffing, Pennsylvania not being one of them. Different states use different methods such as staffing committees, using a designee to develop core staffing plan, some require public reporting to control RN-topatient ratios, but California remains the only state to have laws in place for a required maximum RN-to-patient ratio by unit (American Nurses Association, 2017).
The ratio differs from unit to unit depending on the type of care provided and the severity of the patients needs. For example, in California on the telemetry, pediatric, and the step-down units one RN can care for 3 patients, but in intensive care units or labor and delivery units the number of patients is smaller (PASNAP, 2015). In 2010, Linda H Aiken et al conducted a study surveying 22, 336 RNs in California (CA), Pennsylvania (PA) and New Jersey (NJ) and found that if PA and NJ matched CA’s ratios that PA would have 10. 6% few deaths and NJ would have 13. 9% few deaths.
According to Aiken, RNs in California have reported being able to spend more time with patients, their hospitals have enough staff to provide quality care and miss fewer changes in patient condition. Also California nurses are more likely to stay at their jobs and less likely to report burnout than RNs in New Jersey or Pennsylvania because of staffing regulations. (Aiken, et al, 2010) The results of Aiken’s research were not lost on our Pennsylvania government officials. The Pennsylvania Joint State Government Commission published their report on “Professional Bedside Nursing in Pennsylvania” in June 2015.
The report makes note of the clear evidence in the connection between staffing levels and rates of adverse patient outcomes. The report also highlights the two Government Bills that give recommendations to which approach safe staffing in Pennsylvania facilities (Baker, 2015). The Pennsylvania State Nurses Association advocates their recommendation and urges our lawmakers in Harrisburg to review the report before making a decision. House Bill No. 476 is the first bill mentioned in the report published in 2015 by the Pennsylvania Joint State Government Commission.
This bill will act as an update to the Health Care Facilities Act of 1979. This amendment will, if passed, require hospitals to form a committee made up of equal parts of administrative staff and professional nurse to address facilities individual needs. Once established the committee will then be responsible to devise a nurse staffing standard for each unit of their facility. They would be required to monitor the implementation and concerns related to the plan and convene at least twice a year to review and or update plan.
The board of hospital directors will elect the administrative staff to sit on the committee and the RNs would be anonymously selected by their peers to represent them, and one individual must be familiar with the hospital’s financial budget. The committee consider many factors that will affect staffing such as skill set of the nursing staff and the specific unit, staff skill mix, years of experience, patient census, physical layout of the building and time needed to accomplish patient care tasks.
The committee will also serve as an outlet for nurses to voice their concerns openly about staffing issues. Bill No 476 also will allow patients to request information about a facilities staffing plan to aid in the decision to seek medical care from that facility (Baker, 2015). Senate Bill No 553 was also highlighted in the 2015 report, this bill will update the same 1979 Health Care Facilities Act by providing a set nurse-topatient staffing ratio along with other protections for nurses and patients.
The ratio will be calculated by looking at the number of patients and the number of direct care registered nurses on the unit, other staff such as nurse managers, supervisors, administrators will not affect the ratio. Senate Bill No 553, gives a maximum number of patients that one registered nurse can care for depending on the unit and level of care required (Leach, Brewster, & Teplitz, 2015). This amendment also will allow a RN of refuse an assignment if they feel they do not have the skills or knowledge to complete the task.
The bill will require hospitals to use a classification system that will use a standardized set of criteria to predict the nursing care that will be needed for the individual patient. For example, type and severity of illness, selfcare ability of the patient, and physical layout of the unit will be categories for the criteria. The system will determine the number of RNs needed and other supportive staff to meet the needs for the individual patients. After review of data collected from the patient care system the facilities will develop the staffing plan. Staffing requirements, actual staff, staff mix and the variance between required and actual staffing patterns would need to be documented and posted on the unit for public view on a day-to-day, shift-by-shift basis,” according to report published by the Pennsylvania Joint State Government Commission (2015). A review committee will be developed, they will assess if the system is accurately representing the needs of the patients and the nursing staff, they will also be available to accept input from interested staff on the over all system and the staffing plan.
Hospitals will be subject to penalties and fines if they violate the requirements of the bill (Baker, 2015). With the recent Presidential election there is a possibility for changes to be made to our health care systems at a national level, Bill No 476 and Bill No 553 are encouraging changes to be made on a state level but in the summer of 2016 the nurses union at Heritage Valley Beaver demanded a change be made on a local level.
On July 19th, 2016 the registered nurses at Heritage Valley Beaver went on strike after rejecting the new contract proposed by management. According to SEIU Healthcare PA, who negotiated the contact for the staff, “Management wanted to increase the number of patients for nurses in some parts of the hospital and drastically raise healthcare cost, making care unaffordable for some nurses and their families”(Bhaerman, 2016). Fortunately, a month later an agreement was reached and a new contract has been implemented and will not expire ntil June of 2019 (Myers, 2016). These nurses advocated for safe staffing ratios and affordable healthcare for the staff and their families and by doing so they advocated for the safety of the community and the patients for which they provide care.
The political nursing issues at a state level are very similar to the ones that we see in our local area, as nursing students it is important to be educated on not only the polices and procedures of your facility but on the changes being made in the state and throughout the country. Nurses have the potential to promote the public’s health through active involvement in shaping health and social policies” (Byrd, 2012). Nurses interact with patients on a daily basis, not only can they provide medical care but they can advocate for their patients by educating the government on the medical needs of the population. The Nurse Practice Act has integrated nursing politics into the curriculum of nursing schools and employers encourage new hires to join professional organizations or unions.
There are many reputable associations that nurses can join outside of their facility, such as, at the state level Pennsylvania State Nurses Association, Pennsylvania Association of Staff Nurses & Allied Professionals, and American Nurses Association on an even larger scale. As a nursing student being familiar with these associations can prepare you for some of the political challenges you will face as a registered nurse and they will leave you informed to handle them. “Nurses are advocates for patients and the profession, and in this role nurse generalists should be knowledgeable and active in public policies that affect health” (Byrd, 2012).
