Policies and Evaluation

Policy Process: Evaluation, Analysis and Revision The National Nursing Shortage Reform and Patient Advocacy Act was designed to address the public health workforce shortage that is seen, especially where nurses are concerned. It is no secret that nurses are leaving the profession in record numbers, and as they do that it is becoming more and more difficult to replace them with others who want to do the same type of work (Buerhaus & Retchin, 2013; Iglehart, 2013).

Because of all the nurses retiring, and so many of them experiencing burnout, the gap between the number of needed nurses and those who are available continues to widen (Negron & Cohen, 2013). The issue here is how that Act becomes a policy, so it can provide more help to a public health workforce that is struggling. In order for the Act to become a policy, it must first be evaluated. The Act discussed here was introduced to the Senate in April of 2013, and has been read twice (S.739, 2014).

It was then referred to the Committee on Health, Education, Labor, and Pensions (S.739, 2014). Since then, no further action has been taken on it. Evaluation The lack of action in Congress does not mean that nothing is happening to the Act. The Act must go through a process to help ensure it is ready to be passed, and to have the highest chance of getting through the Senate when it is voted on.

Then it must also pass the House, and only then can it have a chance of becoming law. So many bills "die" in the House or the Senate because they are not acceptable to both sides of Congress, or because they have riders or other bills attached to them that stop them from going through. The Act will be evaluated for all of these things. It is based on legislation that required better nurse-to-patient staffing ratios, and focuses on that same type of issue (Buerhaus & Retchin, 2013).

There are too many patients and not enough nurses to safely and properly care for them (Buerhaus & Retchin, 2013). While the Act is about nurses, it is actually about patients, in that it is designed to bring more nurses into the field to care for all the patients who are already there and who will be there in the future (Buerhaus & Retchin, 2013).

Analysis After the thorough evaluation the Act receives, it will then be moved into the analysis stage, where anything that could prevent it from moving forward will be discussed and acknowledged (Iglehart, 2013). If there were serious problems that could stop the Act from advancing, they could be caught in the analysis stage and adjusted. Factors that allow the policy to meet objectives also have to be considered, in order to determine the overall strength of the policy.

Currently, the policy is still with the committee to which it was assigned in April of 2013 (S.739, 2014). The government's bill tracker site shows that it has a 0% chance of being passed. However, that addresses its chances when it comes to how it was originally introduced. Work is being done on the Act in committee to provide it with a better chance of passing. An analysis of the Act shows that it would require strict patient to nurse ratios throughout all hospitals (Buerhaus & Retchin, 2013).

There would be consequences for those who did not keep these ratios, and that could cost these hospitals funding and other needs items that would be very important to them (Iglehart, 2013). With that in mind, hospitals oppose these kinds of bills, because they force the hospitals into different staffing plans than they currently have, and impose upon them something that is based only on a numbers game (Buerhaus & Retchin, 2013).

This makes many hospitals uncomfortable, and is likely why similar bills introduced in 2009 and 2011 died in committee and did not advance through Congress (Buerhaus & Retchin, 2013). The bills failed to attract co-sponsors, backing, or funding. The current Act has one co-sponsor, but it is clear that the analysis phase is taking a long time and that the Act itself is mostly sitting, where it will also likely die without being put to a Senate vote.

Revision Once a policy has been analyzed properly, there are often revisions that have to be made to it. These can help to protect the most important parts of the policy, while making changes that would allow the policy to go forward in a slightly different form. The key is to make sure the policy's main and most important areas remain the same and go through. However, there are often a number of incidentals that can be changed around, added, removed, or adjusted.

This is the focus of the revision process. With the Act in question, revision is difficult. The main points of the Act are that hospitals are required to have specific numbers of nurses on a shift based on the number of current patients (Negron & Cohen, 2013; S.739, 2014). While that may sound like an excellent way to do business, hospital staffing is much more complicated than that (Iglehart, 2013). There are issues regarding the qualifications and skill levels of the nurses, the conditions of the patients, and a number of other factors.

Unless those are all addressed, it is not possible to state how much nurses really should be on a particular shift (Buerhaus & Retchin, 2013). The revision process of the Act, therefore, is complicated. Too many changes will negate what the Act is trying to do. Not making enough changes will mean that the Act will not go through, because similar bills have been extremely unsuccessful in the past.

Revising a bill in order to make sure it goes through the Senate and/or the House is often very difficult, and a number of bills end up dead because they cannot be changed enough to be acceptable without losing their essential meaning. The Act is likely going to be one such bill, where hospitals will not agree to staffing requirements so there are not going to be any backers to help the bill go through (Buerhaus & Retchin, 2013).

With two other unsuccessful attempts already behind it, the likelihood of the Act being revised enough to make real changes and still be passed.