" (Allen 2008) This means that nursing educators are also a key stakeholder. Other stakeholders include healthcare facility administrators, corporate trustees and public office holders, who will often have entangled or competing interests relating to the profitability of operations and the political expediency of policy orientation. This will also be true of the various professional advocacy groups, nursing associations and lobby groups that will vie for influence in the discussion on any legislation relating to the nursing shortage.

Policy Objective:

A primary policy objective is to endorse any legislation that would aggressively enforce better recruitment of nursing students, better training of existing nurses, improvements in working conditions for nurses and mandated nurse-to-patient ratios. These objectives are underscored by evidence of the opportunities to save lives facilitated by mandated ratios. According to the text by Health Services Research (HSR) (2010), "key findings of the study reportedly include that 10-13% 'fewer surgical patients in New Jersey and Pennsylvania would die if hospitals in those states had as many nurses as California law requires.' Specifically, the study indicates that the ratios could have saved the lives of 468 additional patients during 2005 and 2006 in the two states." (HSR 2010)

Policy Options and Alternatives:

There are several policy options that are currently under consideration in Congress and the outcome of the implementation or adoption of these bills could be a significant improvement of nurse to patient ratios. Among them, S. 992, proposed initially in 2011 by the 112th Congress of the United States calls for "a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes." (GovTrack1 2011) Sponsored by Democratic Senator Barbara Boxer of California, the bill was aimed at bringing stronger regulatory pressure upon healthcare facilities and managed care complexes to ensure that staffing ratios were commensurate to the number of available beds and inpatients.

That this bill is currently under consideration is a testament to the perceived importance of such legislation where its sponsor and supporters are concerned. This is because this is an identical bill to one previously introduced by Senator Boxer in 2009. To the point, a second bill correlated to the proposal, S. 1031, would be suspended previously. According to GovTrack.us, "this bill never became law. This bill was proposed in a previous session of Congress. Sessions of Congress last two years, and at the end of each session all proposed bills and resolutions that haven't passed are cleared from the books. Members often reintroduce bills that did not come up for debate under a new number in the next session." (GovTrack 2009)

The legislative importance of this issue is underscored by the bill subsequently introduced by Representative Janice Schakowsky to the 112th Congress. H.R. 2187, called "Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011," is designed to institute mandatory nurse-to-patient ratios that would require hospitals to maintain adequate staffing quotas. The nature of the bill is such that there is a significant demand for continued debate and revision. GovTrack.us reports that "the bill at this stage is intended to "go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee." (GovTrack2 2011)

It is hoped that the pending legislation will make greater headway in establishing federal mandates on staffing ratios. According to Berkowitz, "staffing ratios have been mandated in some states through legislative action as a solution to inadequate nurse staffing an concerns aobut the quality and safety of patient care." (Berkowitz 2012) However, the text goes on to note that mixed expectations have greeted this state level legislation, causing some concern about the implications of a federal mandate on the same order. Certainly, it does strike the researcher here as reasonable that government intervention would be appropriate to bring greater regulatory consistency to healthcare staffing the consequent quality of health outcomes. However, Berkowitz warns that many healthcare facility administrators and enterprisers have argued that this imposed upon their...

To the point, Berkowitz reports that in addition to legislative efforts mandating hospitals to maintain ratios more conducive to quality care outcomes, there are ways to improve staffing ratios that do not require regulatory imposition. Here, Berkowitz indicates, "Buerhaus (2009) has imposed several non-regulatory solutions to safe staffing including improving hospital work environments, incentives to hospitals for high quality care and a focused effort on reducing the nursing shortage." (Berkowitz 2012)
Evaluation of Objectives:

The recommendation above from Berkowitz helps to drive consideration on the objectives central to H.R. 2187. Namely, there is an objective to find ways of improving nurse capabilities to help improve their efficiency in the face of shortages. This is supplementary to the chief objective identified in S. 992 and restated in H.R. 2187 which would define and subsequently mandate the optimal staffing ratio. In their article, Lin & Liang indicate that "educational reform focusing upon standardized, higher level nursing education using a military model, appropriate staff ratio laws derived from the outcomes literature, and recurrent training incorporating policy-making powers can result in nurse empowerment and improved patient safety." (Lin & Liang 2007) These recommendations help point to the feasibility of the primary objective of H.R. 2187, which is to find ways of reducing gaps between need and availability of nursing. The higher emphasis on education on new nurses and the incorporate of mandated staff ratios speaks to the objective of improving both abilities and availabilities of nurses.

Results of Analysis:

The analysis provided above suggests beyond a reasonable doubt that there is a need to engage policy action that would mandate better staffing ratios throughout the U.S. healthcare industry. In spite of the likely protestations from such stakeholders as managed healthcare corporations and their political advocates and lobby groups, the patient population and nurse population would benefit incalculably from meaningful and uncompromising legislation aimed at improving working conditions for nurses, ramping up recruitment efforts for prospective nurse professionals and altering training and procedural orientation in hospitals to improve both working experiences and health outcomes.

Works Cited:

Allan, L. (2008). The nursing shortage continues as faculty shortage grows. Nursing Economics, 26(1), 35-40.

Berkowitz, B. (2012). The Policy Process. .

Cullen, E.; Ranji, U. & Salganicoff, A. (2010). Addressing the Nursing Shortage. Kaiseredu.org.

GovTrack. (2010). S. 1031: National Nursing Shortage Reform and Patient Advocacy Act. govTrack.us.

GovTrack1. (2011). S. 992: National Nursing Shortage Reform and Patient Advocacy Act. govTrack.us.

GovTrack2. (2011). H.R. 2187: Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011. govTrack.us.

Greis, J. & Duda, L. (2010). The National Nursing Shortage: Is Mandatory Nurse-to-Patient Staffing Ratio Legislation the Solution? Lexis Nexis.

Health Services Research (HSR). (2010). More Nurses, Less Death. Truth About Nursing.org.

Leavitt, J.K.; Mason, D.J. & Whelan, E. (2012). Political Analysis and Strategies. .

Lin, L. & Liang, B.A. (2007). Addressing the Nursing Work Environment to Promote Patient Safety. Nursing Forum, 42(1), 20-30.

Perin, M. (2008). Houston nursing shortage in critical condition, study shows. Houston Business Journal.

Roberson, J. (2010). Texas, hospitals work to address nurse shortage. Dallas News.

Texas Center for Nursing Workforce Studies (TCNWS). (2006). The Economic Impact of the Nursing Shortage. Texas Department of State Health Services.

Appendix A:

Matrix Scorecard for Policy Initiatives Mandating Nurse-Patient Ratios:

S. 992

H.R. 2187

Criteria:

Mandatory quotas

Political support

Flexibility to include nurse training improvements

Flexibility to include incentives for Nurse Educators

Flexibility to improve Nursing Working Conditions

Score for Bill