WRITE a 750 word paper; using the two (2) articles: Abood (2007) and Aikan et al., (2010), and your textbook assigned chapter readings; as references.
1) WRITE a 750 word paper; using the two (2) articles: Abood (2007) and Aikan et al., (2010), and your textbook assigned chapter readings; as references. See the Nursing Student Writing Guidelines Checklist for paper requirements and answer the following questions:a) After reading Aikan, et al (2010) on staffing ratios, you have decided that you want your state’s legislature to pass similar legislation mandates on nurse-patient ratios.?b) RECOMMENDED: REVIEW Chapter 11: The nurse as advocate. In K.K. Blais& J.S. Hayes (2010) Professional nursing practice: Concepts and perspectives (6th ed.). Upper Saddle River, NJ: Prentice Hall. ?c) Using all of these references, develop your plan for influencing votes of legislators on nurse-patient ratios.?d) Paper title: Mandating Nurse-Patient Ratios.RESEARCH ARTICLEImplications of the California NurseStaffing Mandate for Other StatesLinda H. Aiken, Douglas M. Sloane, Jeannie P. Cimiotti,Sean P. Clarke, Linda Flynn, Jean Ann Seago, Joanne Spetz,and Herbert L. SmithObjectives.To determine whether nurse staffing in California hospitals, wherestate-mandated minimum nurse-to-patient ratios are in effect, differs from two stateswithout legislation and whether those differences are associated with nurse and patientoutcomes.Data Sources.Primary survey data from 22,336 hospital staff nurses in California,Pennsylvania, and New Jersey in 2006 and state hospital discharge databases.Study Design.Nurse workloads are compared across the three states and we examinehow nurse and patient outcomes, including patient mortality and failure-to-rescue, areaffected by the differences in nurse workloads across the hospitals in these states.Principal Findings.California hospital nurses cared for one less patient on averagethan nurses in the other states and two fewer patients on medical and surgical units.Lower ratios are associated with significantly lower mortality. When nurses’ workloadswere in line with California-mandated ratios in all three states, nurses’ burnout and jobdissatisfaction were lower, and nurses reported consistently better quality of care.Conclusions.Hospital nurse staffing ratios mandated in California are associated withlower mortality and nurse outcomes predictive of better nurse retention in Californiaand in other states where they occur.Key Words.Nurse staffing, California nurse ratiosIn 2004, California became the first state to implement minimum nurse-to-patient staffing requirements in acute care hospitals (Coffman, Seago,and Spetz 2002; Spetz 2004).As of September 2009, 14 states and the District of Columbia had enac-ted nurse staffing legislation and/or adopted regulations addressing nursestaffing and another 17 states had introduced legislation (American NursesAssociation 2009). California remainstheonlystateto have enacted minimumnurse staffing requirements, and as the amount of legislative and regulatoryrHealth Research and Educational TrustDOI: 10.1111/j.1475-6773.2010.01114.x1Health Services Researchactivity suggests, there is widespread interest in what can be learned fromCalifornia’s example.For two decades, nurses have reported that there are not enough nursesin hospitals to provide high-quality care (Aiken and Mullinix 1987; Aiken,Sochalski, and Anderson 1996; Aiken et al. 2001). In response to these con-cerns, Congress, in 1993, requested an Institute of Medicine (IOM) study ofthe adequacy of nurse staffing in hospitals and nursing homes. The IOMreport concluded that there was insufficient evidence to support specific nursestaffing ratios in hospitals and called for additional research (Wunderlich,Sloan, and Davis 1996). Since then, the evidence supporting an associationbetween nurse staffing and better patient outcomes has grown. We reported in2002 that each patient added to nurses’ workloads was associated with a 7percent increase in mortality following common surgeries, and that nurseburnout and job dissatisfaction, precursors of voluntary turnover, also in-creased significantly as nurses’ workloads increased (Aiken et al. 2002). Rep-lications in Canada, England, and Belgium produced similar findings as didother studies in the United States (Aiken, Clarke, and Sloane 2002; Needle-man et al. 2002; Estabrooks et al. 2005; Rafferty et al. 2007; Tourangeau et al.2007; van den Heede et al. 2009). A meta-analysis of 90 studies commissionedby the Agency for Healthcare Research and Quality (AHRQ) subsequentlyconcluded that there is an evident association between nurse staffing andpatient outcomes (Kane et al. 2007).Registered nurse (RN) staffing in California hospitals increased sub-stantially following the passage of the legislation and implementation of theregulations (Donaldson et al. 2005; Bolton et al. 2007; Spetz et al. 2009).Whether the increase in nurses is associated with improved outcomes hasbeen more difficult to determine. Researchers were unable to detect an impactAddress correspondence to Linda H. Aiken, R.N., Ph.D., F.A.A.N., Center for Health Outcomesand Policy Research, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104-4217;e-mail: laiken@nursing.upenn.edu. Douglas M. Sloane, Ph.D., is with the Center for Health Out-comes and Policy Research, University of Pennsylvania, School of Nursing, Philadelphia, PA.Jeannie P. Cimiotti, R.N., D.N.Sc., is with the Center for Health Outcomes and Policy Research,University of Pennsylvania, Philadelphia, PA. Sean P. Clarke, R.N., Ph.D., F.A.A.N., is with theLawrence S. Bloomberg Faculty of Nursing, University of Toronto, University Health Network,Toronto, ON, Canada. Linda Flynn, Ph.D., R.N., is with the School of Nursing, University ofMaryland, Baltimore, MD. Jean Ann Seago, Ph.D., R.N., F.A.A.N., is with the School of Nursing,University of California, San Francisco, 2 Koret Way, San Francisco, CA. Joanne Spetz, Ph.D., iswith the School of Nursing, University of California, San Francisco, UCSF Laurel Heights, CA.Herbert L. Smith, Ph.D., is with the Department of Sociology, Population Studies Center, Centerfor Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA.2 HSR: Health Services Researchxx:xxof improved nurse staffing on falls or hospital-acquired pressure ulcers (Don-aldson et al. 2005; Bolton et al. 2007), but research findings in general on theassociation between hospital nurse staffing and falls and pressure ulcers havebeen inconsistent in the literature (Lake and Cheung 2006). While not relatedto the impact of the legislation on patient outcomes, Mark, Harless, and Spetz(2009) found that wage growth for RNs in California after implementation ofmandated minimum nurse staffing increased more than RN wage growth inother states; the researchers could not rule out alternative explanations for thewage increases including the impact of the nurse shortage.Research by Sochalski et al. (2008) using data before implementation ofmandated minimum ratios offers a glimpse of the possible impact on patientoutcomes. During the study period between 1993 and 2001, when RN levelsrose by roughly 1.2 percent per year, they found that more RN hours perpatient day were associated with lower mortality for patients with acute myo-cardial infarction. They also found, as would be expected, that mortality re-ductions associated with increased nurse staffing were greatest for hospitalsthat began with the worst staffing ratios. If this result can be replicated whenhospital outcome data become available for the years following implemen-tation, many would conclude the legislation produced a desirable outcome.The California Department of Health undertook a multiyear process todetermine the minimum ratios to be mandated based upon research and otherfactors. The California mandates can be viewed as a benchmark against whichto compare hospitals within California and between California and otherstates. We compare patient-to-nurse ratios in California hospitals with similarratios in New Jersey and Pennsylvania hospitals, states without nurse staffinglegislation at the time of the study, and compare associated outcomes. Wereport findings from California nurses about the impact of the legislation onfactors affecting the quality of hospital care. We examine potential unintendedconsequences of the legislation: whether RNs in California perceive thatnursing skill mix in hospitals has been negatively affected by increased em-ployment of licensed vocational nurses (LVNs), and whether non-nurse an-cillary support services have been reduced——two issues that were concerns atthe outset of the legislation (Coffman, Seago, and Spetz 2002). We comparethe outcomes for nurses and indicators of quality of care across hospitals in allthree states according to the proportion of nurses with workloads consistentwith the benchmarks derived from the California-mandated ratios. Finally, wecompare patient outcomes——30-day inpatient mortality and failure-to-rescue(FTR)——across hospitals in which nurses care for fewer and more patientseach. This provides an estimate of the possible impact on nurse retention,Implications of the California Nurse Staffing 3
"You need a similar assignment done from scratch? Our qualified writers will help you with a guaranteed AI-free & plagiarism-free A+ quality paper, Confidentiality, Timely delivery & Livechat/phone Support.
Discount Code: CIPD30
Click ORDER NOW..
