Best hospital teams in the country have been affected by nurse stress and burnout. Increased patient care responsibilities, long shifts, and time demand are major attributive causes of nurse stress burnout. Though the problem has risen to epidemic levels and almost turning into an accepted norm, nurses can de-stress and maintain a healthy mental state. A nurse that has stress burn out will show characteristics such as exhaustion, being alienated and coupled with reduced work performance (Cherry &Jacob, 2017). Experts have come up with various techniques to help handle and minimize nurse burnout. The methods include art therapy, yoga, and relaxation techniques. However, documentation processes and technologies are not enough to manage nurse stress burnout. Coworkers in the nursing department and supervisors need to provide support for to affected nurses to alleviate nurse stress nurses that are bogged down by stress also need to check on their social relationships to help them keep track of their emotions, thoughts, and moods (Roux & Halstead, 2018). Increased cases of nurse burnout in hospitals, has made the government and all stakeholders in the health department come up with legislative issues to address the problem.
The current regulatory issue under debate to reduce nurse burnout revolves around the topic of safe-staffing ratios. Legislators argue that implementing minimum nurse-to-patient staffing ratios will be beneficial to both nurse and patients (Mark et al., 2013). Safe staffing ratios are a critical factor in determining the quality of care that hospitals will provide and the nature of patient outcomes. Nurses are an integral part of the health care system, and adequate staffing is key to ensuring nurse retention and patient care. Inadequate staffing drives nurse from the profession, and as a result, the life of patient will become endangered. Nurses in California reported dissatisfaction in their jobs thus prompting the state to implement minimum nurse-to-patient staffing ratio in 2004. Before the implementation of the policy, the number of in-patient deaths had also increased within 30 days of hospital admission (Roux & Halstead, 2018).
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The legislation is under debate because of numerous reasons. Inadequate staffing in hospitals causes a nurse to work long hours thus affecting their health by increasing the risk of musculoskeletal disorders, depression, and cardiovascular diseases (Mark et al., 2013) . A research study conducted by medical care in 2012 showed that emotional exhaustion among nurses is caused by long working shifts which thus causing "high burnout." Other reviews from Centers from Medicare and Medicaid Services found that hospitals that were understaffed had higher cases of heart failure, electrolyte imbalances, and respiratory infection. Hospitals with understaffed nurses will have reduced time for registered nurse per patient thereby increasing the probability of poor outcomes in patients. Patients will have increased case of skin trauma, weight loss, and pressure ulcers.
The ongoing legislation debate has both positive and negative outcomes. People who will benefit most from the legislation are nurses and patients. Nurses will be in a position to achieve job satisfaction as a result of reduced workload which in turn reduces stress burn out. Therefore, nurses will be in a position to provide quality services to patients and discharge their duties with professionalism (Roux& Halstead, 2018). Patients will reap maximum benefits from the legislation because they will be a position to receive and quality medical care. However, hospitals and employers will be held responsible if they fail to adhere to safe-staffing regulations. Employers will be held accountable for the mental and physical well-being of nurses. Nurses will be able to recover claims if there is an existing causal relationship between personal injury and employment. Claims usually filed by nurses are physical/mental and mental/physical claims. Employers are therefore forced to heavily invest heavily in developing preventive approaches stipulated in the legislation to reduce work-induced stress and shield themselves from recovery claims. Safe-staffing will thus, increase operational costs of employers hence affecting their profitability. However, the staffing regulation can affect employers positively. Adopting the mandated safe-staffing ratios will lead to an increase in nurse retention and additional costs associated with hiring supplemental nurses will reduce (Cherry & Jacob, 2017).
Though safe-staffing regulation has brought positive change in the healthcare system, there are a lot of socioeconomic, political, cultural, and ethical issues surrounding the topic. Nurses need to change the culture of the profession and transform healthcare service. The nursing profession has to adopt a culture of speaking out when something is not right. There is also a need to use hard evidence to and local professional judgment to determine the right experience to handle medical situations. The American society is multicultural and therefore, patients needs will be met when nurses are made up of diverse teams with better experience to better patient outcomes. Having a team of nurses from diverse ethnicity will help in achieving equality in the representation of all demographics. People argue that safe-staffing is ethical as it aims at minimizing harm to both patients and nurses. It is not ethical for employers to have an excuse that safe-staffing is making them lose money and yet understaffing proves to be harmful to people (Mark, et al., 2013) . Services that harm people are not good and there should be no excuse for unsafe staffing. Political issues on safe staffing are whether the government is enforcing the regulations. It is difficult to ascertain whether employers are complying with the regulations because there is little compliance monitoring and reporting. Socioeconomic issues on safe-staffing are on whether all hospitals have the capability of following the regulations. Inequalities in geographical distribution of nurses make it difficult for all hospitals to comply with the regulations. Larger and well-funded hospitals have the ability to employ more nurses to meet the required nurse-to-patient ratio. Less funded hospitals in rural areas have a hard time in employing more nurses and meeting the required ratio stipulated in the regulation.
Parties involved in safe-staffing issues are those concerned with the healthcare system. Stakeholders include organizations such as the American Nurse Association's (ANA), Department of health in state government, employers in the healthcare sector, individual nurses, and patient. The ANA is responsible for looking into the welfare of its members by ensuring that nurses work in environments that are favorable, safe and conducive for both mental and physical well-being (Buchan et al., 2015) . State government enacts safe-staffing regulation that all employers are expected to follow to better the service delivery in the health sector. Nurses, on the other hand, are required to provide quality services and be professional in their work to meet the need of patients effectively. Patients are the major stakeholders in safe-staffing regulations. Policies on safe-staffing focus on ensuring that the needs of patients seeking medical care are met.
Professional healthcare organizations such as ANA have extended support toward Registered Nurse Safe Staffing Act which was introduced in the house in 2015. Medicare hospitals are required to implement the staffing plans by developing coordination with the nurses. ANA has also funded nursing quality feasibility studies to document the quality of nursing care in hospital settings. Organizations such as the Californian Nursing Outcomes Coalition (CalNOC) functions a regional nursing quality database to analyze the association of safe staffing and improved quality and safety of patient care. Several politicians have also expressed their interest in the importance of safe-staffing. National Nursing Shortage Reform and Patient Act introduced by Senator Barbara Boxer in 2015 amended the Public Health Service Act. The bill aims in establishing direct care registered nurse-to-patient staffing ratio in all hospitals. The America Federation of Government Employees, National Nurses United has endorsed the Nurse Staffing Standards for Patient Safety and Quality Care Act. The bill restricts mandatory registered nurse (RN) overtime in times emergency (Buchan et al., 2015).
States that have implemented safe-staffing regulations have seen rapid improvements in the nursing profession. Implementation of the mandated staffing ratios has led to a significant reduction in nurse workload. Reduction in workload has reduced nurse stress and burnout which in turn increased the level and quality of work performance (Roux & Halstead, 2018). Nurses have become more satisfied with their jobs, and hospitals have been able to witness a high retention rate of nurses. Hospitals have been able to save money that could have been wasted in recruiting and hiring other nurses to fill the gaps left by nurses who decide to quit employment as a result of work exhaustion. Surgical patient mortality has also declined after the implementation of lower and safe-staffing ratios. Patients can get personalized and quality care which improves their outcomes.
Disparities that exist in the healthcare sector include minority distrust in the healthcare system and internalized, institutional, and individual racism of healthcare workers. The role of nurses in bridging existing disparities in healthcare involves enhancing care coordination and quality of care for minorities. Providing access to quality care can be done through medical home models and integrated care systems. Nurses should also maintain neutrality when dealing with patients to avoid bias and increase patient confidence (Buchan et al., 2015) . Nurses should also ensure that they are culturally competent and able to communicate effectively with people of different races and ethnicity. Health care systems have to enact policies guaranteeing that hiring of staff is conducted in such a way that minorities and people with disabilities are equally represented. Hospitals should establish anti-discrimination policies in the work environment to ensure that each patient can access quality services.
References
Buchan, J., Twigg, D., Dussault, G., Duffield, C., & Stone, P. W. (2015). Policies to sustain the nursing workforce: an international perspective. International nursing review , 62 (2), 162-170.
Cherry, B. and Jacob, S.R. (2017). Contemporary Nursing: Issues, Trends, & Management, 7 th edition. Cherry, B. and Jacob, S.R. Editors. St. Louis, MI.: Elsevier: ISBN: 978-0-323-39022-4. Units 1 & 2.
Mark, B. A., Harless, D. W., Spetz, J., Reiter, K. L., & Pink, G. H. (2013). California's minimum nurse staffing legislation: results from a natural experiment. Health services research , 48 (2pt1), 435-454.
Roux, G. & Halstead, J.A. (2018). Issues and Trends in Nursing: Practice, policy, and leadership. 2 nd Edition. Roux, G. & Halstead, J.A. Editors. Burlington, MA: Jones & Bartlett Learning. ISBN 9781284104899.
