In my experience as a registered nurse in a hospital in Texas, nurse to patient ratios have become a major dilemma. As a result of a shortage of nurses, many nurses (including me) have found themselves in assignments that are not exactly “safe,” and definitely not providing the best care for patients. Having worked in the intensive care unit (ICU) for two years, I experienced this first hand. Being short staffed on a nightly basis caused nurses to be assigned to take care of multiple critically ill patients considered a 1:1 (one nurse to one patient). As expected, patients considered 1-1 are the most ill in the unit and need a nurse who was not preoccupied with another patient. In Texas no law exists that mandates any kind of nurse staffing ratio to protect our patients. According to the American Nurses Association, “California is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. Massachusetts passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient” (2015). The nursing shortage is relevant in today’s practice and affects a large number of patients and nurses daily. Now, the conceptual model I devised will be applied to solving a critical issue that affects in-hospital patient care – nurse staffing ratios.
The first step of my conceptual model is “issue identification and background”. It is important to deliver the issue with thorough background information that clearly illustrate the need for the issue to be addressed. Background information must include the fact that the nurse staffing ratio is an umbrella issue as other problems result from nurse staffing shortages. Sending the message that nurse staffing ratios can lead to medical errors, and affect patient satisfaction scores, nurse burnout, etc., and draws attention to the need for a solution rather than a desire. “Targeting key stakeholders” is the next step in the conceptual model. It is imperative for the team to reach out to interest groups and committees at this point to allow for proper development of the issue, and thus, an effective health policy. Stakeholder coalitions provide structure to the agenda and exert an enormous influence on shaping the policy (Mason et al., 2016). Once stakeholders have been established the team begins policy formation. During policy formation, the nurses present their knowledge and expertise on the issue.
Throughout this stage, nurses and other members of the health care team will be involved in brainstorming possible solutions. Their ideas are presented at each level of government, which leads into the next step, implementation. At the implementation stage of the conceptual model, the legislative branch passes the law to the executive branch. When the rule making has been finalized the policy will published for 60 days in the daily Federal Register to receive public comment. The modification and feedback stage follows implementation. To gain feedback and develop modifications, the team conducts a retrospective study analyzing the outcomes that attributed to the health policy. All previous points will be revisited, and topics can be revised and adjusted as appropriate. If the results have concluded that the policy impacted the nursing shortage issue positively, health policy would have made it to the “production” stage. If this stage is reached, the health policy is then placed into action.
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The political involvement or nurses at all levels of government are essential for successful health policy production that enhances health care and provides exceptional care to all patients. Through sufficient formulation of health policies, we can strive towards the health care that our patients deserve.
