Current staffing levels for nurses appears to be inadequate to effectively deliver high quality care to the patient. The staffing levels may also contribute to recent increase in adverse medical events, due to the nurse not having the necessary time to devote to each individual patient. Policy should therefore be enacted to ensure that the nurse has all the required tools to safely care for each patient. This report presents the pathway for Formulating, Legislating, and Implementing reform at the federal level.
The intertwining relationship between the public and private sector entities, which are involved in facilitating U.S. Healthcare delivery, must work concomitantly to generate any substantial policy changes. Due to an inherent importance to have government oversight, the policy formulation, legislation, and implementation process, requires great effort from stakeholders such as; interest groups, lobbyists, and citizens. In order to initiate and formulate changes in healthcare delivery, respective state and federal governments will typically have a high level of involvement, along with primary stakeholders. Additionally, the policy making process for healthcare changes will almost always take place in a wide arena that incorporates public and private settings. Media scrutiny, as well as election cycles/congressional mapping should also be considered during the formulation stage and legislation phases. In order to assess all the attributes involved with initiating and implementing policy change, a scenario will be presented in which a need to balance the current ratio of patients to registered nurses in hospitals, will be considered.
Prior to the formulation of Health Policy, a stakeholder must almost always present a need that change must be implemented (Abood, 2007). It is unlikely that any single arm of the government will enact policy, unless prodded by some outside force. Modern health policy will also pose very complex legal, ethical, and social questions (Gostin, 1995). Once a stakeholder presents a problem, the formulation of policy will then ensue. With respect to my policy to increase the number of registered nurses, I would begin by highlighting the major stakeholders. The groups which would be behind a legislative push of this nature would be; the American Nurses Association (ANA), the American Health Care Association, and the American Academy of Nursing. The ultimate stakeholders would be the registered nurse (RN) and the patient. However, there will be many groups that would “weigh in” on such a significant policy issue. Formulation of a policy which governs the patient to nurse ratio on the federal level would have to be taken up by one of the three branches of government (Gostin, 1995). The initial questions that will be posed by policy makers (i.e. government representatives) would be: what would be a sound health policy? How should this policy be assessed? and, how can data be generated and made available to policy makers? The formulation of policy will likely consider all of these questions and interests groups will also present information to policy makers, in order to impact their decisions. Interest groups must highlight the fact that the costs associated with adverse medical events are significantly higher, due to the fact that hospitals have tried to run facilities with less full-time staffed nurses (ANA, 2011). Any policy that is formulated must generate Mandatory Hospital Nurse to Staffing Ratio’s (ANA, 2011).
THE ISSUE OF NURSE SHORTAGES – Legislation
As previously stated, the legislative process must begin within one of the three branches of government. The House of Representatives is likely to be the best place for issuing permanent legislation as the Judiciary and Executive Branches may not enact broad sweeping policy changes (Gostin, 1995). Interest groups must play a significant role in pushing legislation within this body. The many voices and ideas within the house will function to remove or retract many initial considerations, crafted within the formulation phase. The two phases of Formulation, and Legislation will intertwine. Individuals with contrasting points-of-view that may sink the legislation should be targeted in a strategic fashion. Stakeholders must hold each representative responsible, with respect to their own district and the U.S as a whole. Stakeholders should ensure that the legislative process occurs on a public stage so that each member is held accountable. Election cycles should also be considered, due to the fact that there are many periods where legislation may not proceed due to inactivity and campaigning. Support must be given in the terms of financial contribution to the elections of representatives that will ensure safe passage of favorable policy (Sigma Theta Tau, 2000). This support must also be conducted in a manner that is compliant with all applicable state and federal finance laws. The legislative approval process will require that elected members are in favor and will support the policy.
After signing by the executive branch of the government, a law that produces such a major change will require extensive financing and time to implement correctly. A certain minimum level of federal funding should be provided in order to ensure that hospitals have the required resources to hire additional staff members. Time limits should also be set in place, as there is no real way that facilities may; hire, train, and develop internally approved standard operating procedures within any short period of time. Implementation should also occur at the state level. At this level state bodies may have the necessary oversight to ensure compliance to acceptable implementation.
The process of Formulating, Legislating, and Implementing such a major policy change will be highlighted extensively by the media. Although the major stakeholders will be the nurse and the patient, private/public sector groups will be affected financially by such a sweeping law. Due to this observation individuals pushing this change will require extensive fiscal and public support to stand up to key groups that will not want any changes. Timing to introduce formulated policies into the legislative body also should consider election cycles and public desires to address change. Once the law has been approved implementation must occur on a small and controlled scale. The most effective way to ensure that a transition is smooth is perhaps to delegate tasks to state and local city governments.