Health Policy Brief (one-page leave behind) Assignment. Please follow the instructions, sample and rubric.

References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nursing staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of American Medical

Association. 288(16), 1987-1993. doi: 10.1001/jama.288.16.1987 Cole, A. (2014). Higher nurse to patient ratios on stroke units could cut one death in 25, research shows. British Medical Journal, 349, 5260. doi: 10.1136/bmj.g5260 Daleen, A. P. (2010). Nursing staffing and patient outcomes in critical care: a concise review. Critical Care Medicine, 38(7), 1521-1528. doi: 10.1097/CCM.0b013e3181e47888 Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munvombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-

sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22. Doi: https://doi- org.proxy.lib.odu.edu/10.1177%2F1474515117721561

Gutsan, E., Patton, J., Willis, W. K., & Coustasse, A. (2018, April). Burnout syndrome and nurse-to-patient ratio in the workplace. Retrieved from https://mds.marshall.edu/cgi/viewcontent.cgi?article=1196&context=mgmt_faculty

H.R. 2581, 116th Cong. (May 8, 2019) (enacted).

What does this bill support?

• Establishing requirements for staffing of RN’s providing direct patient care in hospitals in the U.S. in the next 2 years/4 years for rural areas (1 patient/nurse in trauma units, 1 patient/nurse in OR, 2 patients/nurse in CCU, 3 patients/nurse in ER, 4 patients/nurse in Med/Surg, 5 patients/nurse in rehab/skilled care, and 6 patients/nurse (3 couples) in post-partum and well-baby nurseries

• Nurses displaying competence while providing direct patient care within their scope of practice (inclusive of relief staff and not including staff who do not provide direct patient care and/or area not RN’s)

• No mandatory overtime to meet requirements • Staffing committees composed of 50% RN’s with at least 1 RN from each unit

Background: • Shortage of bedside nurses in the U.S. is attributed to nurse burnout – “a chronic response to work-related stress

comprising three components or dimensions: emotional exhaustion, depersonalization, and personal accomplishment” (Gutsan, Patton, Willis, & Coustasse, 2018)

• Regulated nurse to patient ratios will decrease burnout resulting in retention of direct-care nurses. Retention of nurses will result in continuity of care, therefore improving quality and safety of patient care.

Evidence: • 40% of nurses working more than 12 hours per shift and over 40 hours per week are three times more likely to make an error

(Daleen, 2010) • 7% increased mortality rate of patients for every additional patient added to a nurses workload over four patients on a

surgical ward, increases to 14% & 31% when ratios are 6:1 & 8:1 (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002) • Aiken et al. (2002) also found that nurses with high patient ratios are twice as likely to experience burn out and job

dissatisfaction, leaving within a year • Cole (2014) found that increasing nurse-to-patient ratios may prevent 1 in 25 deaths on stroke units • 79% of patients are less likely to experience pneumonia, as well as a 31% reduction risk for decubitus ulcers with higher

nurse to patient ratios (Driscoll, Grant, Carroll, Dalton, Deaton, Jones, Lehwaldt, McKee, Munyombwe, & Astin, 2018) • Driscoll et al. (2018) found that every additional patient per nurse, patients are 22% less likely to experience excellent to

good quality care and 35% more likely to experience a longer than expected hospital stay

Recommendations:

• Contact your legislators, committee members, representatives, and governor to support this bill. • Keep track of this bill’s progress at www.congress.gov • VOTE!!!

H . R . 2 5 8 1 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of

2019

References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nursing staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of American Medical

Association. 288(16), 1987-1993. doi: 10.1001/jama.288.16.1987 Cole, A. (2014). Higher nurse to patient ratios on stroke units could cut one death in 25, research shows. British Medical Journal, 349, 5260. doi: 10.1136/bmj.g5260 Daleen, A. P. (2010). Nursing staffing and patient outcomes in critical care: a concise review. Critical Care Medicine, 38(7), 1521-1528. doi: 10.1097/CCM.0b013e3181e47888 Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munvombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-

sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22. Doi: https://doi- org.proxy.lib.odu.edu/10.1177%2F1474515117721561

Gutsan, E., Patton, J., Willis, W. K., & Coustasse, A. (2018, April). Burnout syndrome and nurse-to-patient ratio in the workplace. Retrieved from https://mds.marshall.edu/cgi/viewcontent.cgi?article=1196&context=mgmt_faculty

H.R. 2581, 116th Cong. (May 8, 2019) (enacted).

Lost points in these areas

1. Recommendations are somewhat vague. Clearer and more directive recommendations will help guide the legislator’s next steps.

2. Visual appearance, the small font size limits ease of readability, impacting the potential appeal of the message.