Nursing Shortage Reform Act: Evaluation, Analysis, Revision
This paper examines the National Nursing Shortage Reform and Patient Advocacy Act (S.739), introduced in the U.S. Senate in April 2013 to address the growing public health nursing shortage. The paper traces the Act through three critical stages of the policy process: evaluation, analysis, and revision. It discusses why the bill stalled in committee, why similar predecessor bills failed in 2009 and 2011, and what structural and political obstacles—particularly hospital opposition to mandatory nurse-to-patient staffing ratios—make passage unlikely. The paper concludes that while adequate nurse staffing is essential for patient safety, rigid numerical mandates may lack the flexibility needed to reflect real-world hospital conditions.
- Introduction: The Nursing Shortage Crisis and Legislative Response: Context for nursing shortage and S.739 introduction
- Evaluation of the Act: Legislative pathway and committee referral process
- Analysis of the Act's Prospects: Hospital opposition and low passage probability
- Revision Challenges and Legislative Obstacles: Why meaningful revision is structurally difficult
- Conclusion: Staffing value weighed against legislative realism
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What makes this paper effective
- The paper clearly maps a real piece of legislation onto the three formal stages of the policy process (evaluation, analysis, revision), giving the abstract framework concrete meaning.
- It demonstrates balanced critical thinking by acknowledging both the merits of the Act and the legitimate reasons — hospital complexity, skill-mix concerns, prior legislative failures — that undermine its passage.
- The conclusion avoids a simplistic verdict, instead connecting the bill's likely failure to the inherent difficulty of legislating flexible operational decisions in healthcare settings.
Key academic technique demonstrated
The paper uses legislative history as evidence — citing predecessor bills that died in committee in 2009 and 2011 — to build a pattern-based argument about the Act's prospects. This use of analogous precedent to support a predictive claim is a strong technique for policy analysis writing at the undergraduate level.
Structure breakdown
The paper follows a tightly organized four-part structure: an introduction that situates the Act within the broader nursing shortage crisis, followed by dedicated sections on evaluation, analysis, and revision that mirror the formal stages of the policy process. The conclusion synthesizes the findings by weighing patient safety needs against legislative and operational realities. Each section builds on the last, making the argument cumulative and easy to follow.
Introduction: The Nursing Shortage Crisis and Legislative Response
The National Nursing Shortage Reform and Patient Advocacy Act was designed to address the public health workforce shortage, particularly where nurses are concerned. It is no secret that nurses are leaving the profession in record numbers, and as they do, it becomes increasingly difficult to replace them with others willing to do the same type of work (Buerhaus & Retchin, 2013; Iglehart, 2013). Because of widespread retirements and pervasive burnout, the gap between the number of nurses needed and those available continues to widen (Negron & Cohen, 2013). The central question is how the Act becomes a policy so that it can provide meaningful help to a struggling public health workforce.
In order for the Act to become a policy, it must first be evaluated. The Act discussed here was introduced in 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 of the Act
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 possible chance of clearing the Senate when it is voted on. It must also pass the House, and only then can it have a chance of becoming law. So many bills fail in the House or Senate because they are not acceptable to both chambers, or because riders and other attached measures prevent them from advancing. The Act will be evaluated for all of these factors.
The legislation is based on prior measures that required better nurse-to-patient staffing ratios and focuses on the same core 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 nominally about nurses, it is fundamentally about patients — 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 of the Act's Prospects
After thorough evaluation, the Act moves into the analysis stage, where anything that could prevent it from advancing is discussed and addressed (Iglehart, 2013). If serious problems that could stop the Act from progressing are identified in this stage, they can be caught and adjusted. Factors that allow the policy to meet its objectives also have to be considered, in order to determine the overall strength of the policy. Currently, the policy remains with the committee to which it was assigned in April of 2013 (S.739, 2014). The government's bill tracker indicates a 0% chance of passage as originally introduced. However, that figure addresses only the bill in its original form; work continues in committee to improve its chances.
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 maintain these ratios, potentially costing hospitals funding and other resources that are critical to their operations (Iglehart, 2013). With that in mind, hospitals oppose such bills because they force different staffing plans than those currently in place and impose requirements based solely on numerical formulas (Buerhaus & Retchin, 2013). This makes many hospitals uncomfortable and likely explains why similar bills introduced in 2009 and 2011 died in committee without advancing through Congress (Buerhaus & Retchin, 2013). Those bills failed to attract co-sponsors, backing, or funding. The current Act has one co-sponsor, but it is clear that the analysis phase has dragged on and that the Act is largely stalled — likely to die without being put to a Senate vote.
Conclusion
There is real value in providing patients with enough nurses to care for them safely and properly (Buerhaus & Retchin, 2013). However, passing a bill that requires a particular number of nurses on a shift regardless of circumstances may not be the most realistic way to protect patients. Through the evaluation, analysis, and revision process, the Act under consideration demonstrates that it leaves little flexibility. Hospitals, on the other hand, must be flexible environments (Negron & Cohen, 2013). They often change rapidly, and they must be allowed to operate in ways that provide the greatest value to the greatest number of patients (Buerhaus & Retchin, 2013).
More nurses would seem to provide that value, but there is also the issue of quality over quantity. A smaller number of well-trained nurses could likely accomplish more than a larger number of poorly trained nurses, which would undermine the argument that a specific numerical staffing threshold is necessary for proper patient care. That is just one of the reasons the Act will likely remain unsuccessful.
References
Buerhaus, P. I., & Retchin, S. M. (2013). The dormant National Health Care Workforce Commission needs congressional funding to fulfill its promise. Health Affairs, 32(11), 2021–2024.
Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners — risks and rewards. New England Journal of Medicine, 368(20), 1935–1941.
Negron, B., & Cohen, E. (2013). Back to the future: A standardized approach to delivering effective nursing care. Nurse Leader, 11(2), 52–56.
S.739 (2014). Congress.gov. Retrieved from https://beta.congress.gov/bill/113th-congress/senate-bill/739
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