Nurse staffing legislation: Empirical evidence and policy analysis

Abstract

Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient‐centric lens, three state‐level nurse staffing policies (mandated nurse‐to‐patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.

Improving hospital nurse staffing during the pandemic: Implementation of the 2019 Fund for Health Care Staff in Belgium

“…Even monitoring and public transparency is not pursued, despite that the effects of public reporting in some regions have been shown to be favourable (but less pronounced than mandated patient-to-nurse ratios). [46] , [47] , [48] Therefore, it is remarkably that this easily implementable policy option was not adopted in Belgium, especially because it was possible to extract patient-to-nurse ratios automatically from the B-NMDS until 2017 [ 15 , 49 ] when this registration was stopped under the pretext to reduce hospitals’ administrative burden. It is unclear why hospital associations are against its re-instalment (e.g.…”

“…The Belgian reform includes some elements of safe staffing policies identified abroad. [48] As in most safe staffing policies, ward managers are not included in the staffing standards. [15] This would increase time for ward managers to take up their management and leadership responsibilities which is essential to improve the work environment of nurses.…”

Nursing policy and practice in Mongolia: Issues and the way forward

“…Policy analysis, a systematic, iterative comparative evaluation of existing or proposed policies rather than research was used (Bartmess et al., 2021). Policy analysis aims to address societal problems of interest from a policy perspective, investigate fundamental reasons for those problems, and determine the best ways to solve the problems (Bartmess et al., 2021). The corresponding recommendations are followed to bridge the gaps between existing policies and proposed policies (Bartmess et al., 2021).…”

“…Policy analysis aims to address societal problems of interest from a policy perspective, investigate fundamental reasons for those problems, and determine the best ways to solve the problems (Bartmess et al., 2021). The corresponding recommendations are followed to bridge the gaps between existing policies and proposed policies (Bartmess et al., 2021).…”

“…( Note : a new WHO Global Strategic Directions for Nursing and Midwifery 2021−2025 was released on April, 2021; WHO, 2021a). Policy analysis is mainly conducted by literature reviews (and/or key informant interviews) (Bartmess et al., 2021; Joarder et al., 2021). We conducted literature reviews through iterative debriefings, discussions, and virtual consensus meetings (approximately once a week) via Zoom from November 2020 to August 2021.…”