I have the outlines ready. It needs to be developed according to what is already written and the comments between parenthesis. It needs foot notes for each and every citation. I have several sources, but extra ones may be needed or used.
The outlines are as following:
INCREASING PATIENT SAFETY AND DECREASING NURSE LIABILITY WITH MANDATORY NURSE-PATIENT RATIOS REGULATIONS
Abstract
California’ Assembly Bill 394 of 1990 is the precursor of mandatory nurse-patient ratios regulation. Similar initiatives in other states have not succeeded. Supporting and opposing arguments have been raised. Support arguments include the alignment of this regulatory measure with the Tenth Amendment of the United States Constitution and related state laws, improved patient safety and reduced nurse’s liability, greater job satisfaction, and retention of nurses, and naturally, cost savings in the long term. Opposing arguments cover the flaws in the language of the law, lack of empirical evidence linking mandatory nurse-patient ratios regulation with patient care outcomes, limited flexibility in staffing management, and uncertainties, added costs and existence of better alternatives. The case history of California’s Assembly Bill 394 has shown positive effects, but there are also weaknesses. This paper will argue the strong opposition to mandatory nurse-patient ratios regulation, supporting arguments weigh more. State enactment of laws mandating nurse-patient ratios in healthcare facilities is timely and practical. Improvements on the weaknesses of California’s bill will reinforce and lead to the achievement of better outcomes from this regulatory measure.
I need to mention: (Legislation developed in California and the proposed legislation in some states was strongly supported by the nursing unions.
A- Is this more about improving patient safety and quality?
B- Is it more about improving the terms and conditions of employment by nurses?
C- Can be about both?
Part I: INTRODUCTION
Mandatory nurse-patient ratios regulation is not new. California passed Assembly Bill 394 in 1999, which mandated minimum nurse-patient ratio in hospitals. Implementation of the bill required healthcare providers to comply with the minimum nurse-patient ratio for different hospital care units. Several states have also attempted to enact similar laws, such as Massachusetts and Florida. California remains the only state that mandates nurse-patient ratios in hospitals. Legislative (Specify Florida statute or regulations.)
initiatives on this matter have failed in the past years, but now is the time for all states to pass law on this regulatory measure. Regulating nurse-patient ratios in hospitals would increase patient safety and decrease nurse’s liability for medical errors that are the result of too many patients assigned to one nurse. (Needs support contentions with specific data and statistics.)
Other positive outcomes have also been linked to mandatory nurse-patient ratios in hospitals.
Part II: BACKGROUNDStrong concerns of healthcare service providers have over cost control have resulted in reduction of nursing staff in the past years. As a result, a consequence of cost saving measures, many service providers have reduced their staff. In some hospitals, a nurse cares for 15 patients on his or her own at one time . Many medical errors, as well as, and burnout have been associated with high nurse-patient ratio in hospitals. Recently, this increased shortage in nursing, in face of patient advocacy for better quality of health services has made the issue of cost control in the healthcare sector a much complex issue for medical providers to deal with.
A- Debate over the enactment of laws proving mandatory nurse-patient ratios have intensified.
B- One side of the debate is advocacy for enactment of laws on mandatory nurse-patient ratios in al states.
C- The other side of the debate is skepticism over the effectiveness of laws on mandatory nurse-patient ratios in addressing the complex healthcare issues and advocacy for alternatives to this solution.
Part III: ADVOCACY FOR MANDATORY NURSE-PATIENT RATIOS REGULATION
Mandating nurse-patient ratios regulation is consistent which provisions of the Constitution and state laws. It finds support from the Tenth Amendment, which empowers states to enact laws to protect citizens. (How the Tenth Amendment affects or empowers this specific issue?)
A- Mandatory nurse-patient ratios improve safety and will result in reduced nurse’s liability.
B- Mandatory nurse-patient ratios improve patient safety and increase job satisfaction and retention of nurses in hospitals.
C- Mandatory nurse-patient ratios may involve additional cost in hiring more nurses, but it will likely save costs associated with liability for medical errors associated with the increased workload nurses are facing in today’s medical environment.(needs to support these arguments with statics and data to show strength)
Part IV: OPPOSITION ON MANDATORY NURSE-PATIENT RATIOS REGULATION
Laws on mandatory nurse-patient ratios regulation are faulty and unworkable. (Why state legislatures or regulators, hospital providers, and others have been reluctant to adopt the regulations on nurse-patient ratios?)
There is limited information on the effectiveness of achieving targeted objectives on enforcing legal provisions due to poor compliance monitoring and reporting .
A- Reduction in patient-nurse ratios and increase time has been reported. There is limited evidence of the impact of nurse-patient regulations on quality of patient care .
B- Mandatory nurse-patient ratios regulation debilitates flexibility in staffing management decisions.
C- Direct and indirect costs of enacting mandatory nurse-patient ratios regulation are uncertain. (Needs support these arguments with statics and data to show strength)
Part V: CONCLUSION AND ARGUMENT SUMMARY
California’s Assembly Bill 394 of 1999 is the precursor of the mandatory nurse-patient ratios regulations. Similar initiatives in other states have not flourished. Supporting and opposing arguments have been raised. An analysis of provisions of this bill provides a deeper understanding of the need for such a law and staffing regulation works not only to help reduce liability for medical errors, but such laws will promote better health care for patients. The paper discussed the identification of positive outcomes and modalities which work with issues with language of the law and its implementation that limits the achievement of empirical evidence linking regulatory practice with patient safety and reduction in nurse’s liability.
(What others think about this topic? and what other solutions could be applied on this issue? Is protection of public health and safety a function of state government or it could be a federal solution?)
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