Legislative Process and California

¶ … Nurse Staffing Levels Through a Legislative Process Despite arguments from critics who argue that mandated nurse staff levels will adversely affect the skill mix of nurses, the experiences of states that have implemented this solution clearly indicate that this alternative represents a timely approach to a nationwide issue. To determine the facts, this paper reviews the literature to identify the respective pros and cons of mandating nurse staffing through a legislative process, followed by a discussion concerning whether public reporting would be effective in achieving safe levels of staffing.

Finally, a summary of the research and important findings concerning the pros and cons of mandating nurse staffing levels through a legislative process are presented in the conclusion. Review and Discussion Today, the low nurse-to-patient staffing levels in many states has been found to be threatening the quality of health care services and adversely affecting job satisfaction and morale levels of professional nursing staff (Glazer & Alexandre, 2009).

Notwithstanding the growing body of evidence concerning the inextricable relationship between inadequate nurse staff levels and adverse clinical outcomes for patients, just a few states in the United States currently use a legislative process to establish minimum nurse-to-patient ratios (Furillo & Mcewen, 2012). Furthermore, the few states that do have a legislative process in place to establish these minimum nurse-to-patient ratios only apply them to certain care settings in tertiary health care facilities (e.g., intensive care units or operating suites) (Furillo & Mcewen, 2012).

According to the National Bargaining Director for National Nurses United and the President of California Nurses Association and Vice President of National Nurses United, "Legislators remain reluctant to require hospitals and health systems to hire more nurses, particularly with ongoing shortages in many areas" (Furillo & Mcewen, 2012, para. 4).

A recent initiative implemented by the California Department of Health Services in response to California Assembly Bill 394 which mandated minimum nurse-to-patient staffing ratios depending on the clinical setting (e.g., 1:1 in operating rooms and 1:6 on psychiatric units) has proven highly effective in improving job satisfaction levels for nursing staff while simultaneously reducing nursing workloads and patient mortality levels (Furillo & Mcewen, 2012).

Moreover, the skill mix of nurses practicing in California tertiary health care facilities has not been adversely affected by this initiative in spite of warnings from the opponents of the legislation (Furillo & Mcewen, 2012). In addition, a comparison of patient outcomes with states such as Pennsylvania and New Jersey which do not use a legislative process to establish nurse-to-patient staffing ratios showed that California experienced significantly better clinical outcomes following the implementation of this initiative.

With respect to the issue concerning whether public reporting would be effective in achieving safe levels of staffing or not, the California legislation specifically requires that health care providers maintain accurate records of staffing levels as well as a patient acuity classification system that serves to ensure the transparency of nurse-to-patient ratios (Furillo & Mcewen, 2012). Conclusion The research was consistent in showing a direct relationship.