Currently, there is no law that stipulates the maximum number of hours that nurses should work. The Fair Labor Standards Act which governs labor relations at the federal level lacks any provisions that set the maximum number of working hours in any profession. The state of Missouri has not enacted any such laws either. The Missouri Department of Labor states that “there is no minimum or maximum number of hours an employee may be scheduled or asked to work” (MO DOL, n.d). The lack of these laws should be blamed for nurse fatigue, burnout and negligence. The nurses are basically left at the mercy of hospital administrators who may require them to work for very long hours. It is important to note that 15 states have already enacted laws which set the maximum hours that nurses should work (Bae & Yoon, 2014).
Fatigue and burnout are among the challenges that nurses in the US grapple with. These challenges result from the fact that the demand for nurses far exceeds their supply. When they are fatigued, the capacity of nurses to deliver safe and effective care is compromised. In fact, a nurse who is fatigued is likely to cause harm to patients. The nurse could then be the subject of a malpractice suit that a patient who has suffered harm files. It appears that nurses are being punished for factors that are out of their control. They make mistakes because they are fatigued. They are fatigued because they work long hours. They work long hours because there is a nursing shortage. There is need for Congress to enact a law that requires all medical facilities in the country to set the maximum number of hours beyond which no work should work.
Delegate your assignment to our experts and they will do the rest.
I chose to discuss the need for a law that stipulates the maximum working hours for nurses because of first-hand experiences and encounters that I have had with colleagues. I understand that there are thousands of nurses who are placed in 16-hour back-to-back shifts. This means that after working for 16 hours, a nurse is expected to be at her station only 8 hours later. This severely limits their social life and denies them adequate rest, thereby hindering their capacity to deliver.
The long working hours that nurses endure is a public policy issue that needs to be fixed with urgency. This issue has also been the subject of scholarly investigation. Various scholars have examined how long-working hours hamper the effective and efficient delivery of care and the adverse impacts that this issue has on the wellbeing of nurses.
Amy Witkoski and her colleagues are among the scholars who have explored the impacts of long working hours. In an article that they authored, they observe that when nurses are made to work long hours, they suffer burnout. They add that nurses are not the only parties who suffer. Patients also endure suffering. Amy and her team state that “as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients’ dissatisfaction with care increased” (Witkoski, Sloane & Aiken, 2012). Essentially, Amy and her team are making it clear that the long working hours harm both nurses and their patients.
Amy and her colleagues are not the only scholars who have investigated the impacts of long working hours. Claire Caruso also added her voice to this issue. After examining how shiftwork and long working hours affects nurses, she concluded that all the effects are adverse (Caruso, 2014). She found that when nurses work in shifts and for long hours, they face the risk of injury and obesity. She adds that the performance of the nurses is impaired and that they are exposed to the risk of chronic illnesses (Caruso, 2014). Moreover, the long working hours increase the likelihood of the nurses causing harm to their patients and others.
Describe the financial impact of the public policy on an organization or on a community.
Every year, hundreds of nurses face malpractice suits. These suits are very costly. The nurses and the facilities that they work for incur huge costs in legal expenses and settlement (Zhao et al., 2011). If these costs are to come down, urgent legislative intervention must be launched. Creating a law that shields nurses from working long hours would dramatically reduce the incidences of malpractice thereby lowering making malpractice suits less common. However, the law will also force medical facilities to hire more nurses so that they are able to maintain the same level of service delivery. Hiring nurses will be a costly undertaking.
Analyze how your values impact your position on the public policy issue.
The need to respect the rights and safeguard the welfare of patients is one of the values that define my perspectives. I feel that if nurses are to effectively deliver care, they must be shielded against harm. I also think that all measures should be exhausted to secure the health of patients. It is my strong belief in the importance of protecting patients and nurses that has driven me to call for a law that stipulates the maximum work hours for nurses.
Discuss the ethical principle (e.g., autonomy, beneficence, non-maleficence, justice) or theory that underpins your perspective.
Fairness, justice and non-maleficence are among the ethical principles that govern the actions of nurses (Wheeler, 2013). It is vital for nurses and hospital administrators to uphold justice and fairness in their dealings with all stakeholders. It is particularly important for nurses to apply these principles when engaging with patients. It has been pointed out above that long working hours expose nurses to cause harm. This goes against the principle of non-maleficence. It is my desire to see these principles upheld that is pushing me to challenge the country’s legislators to enact laws limiting working hours for nurses.
B. Develop a policy brief (suggested length of no more than 6 pages) for the public policy issue discussed in part A in which you do the following:
1. Identify the decision maker (name and title) who will receive the policy brief.
This policy brief will be presented to Claire McCaskill. She is the current senior Senator representing the state of Missouri. Claire has been selected because of her record and her commitment to tackling various challenges that are ailing the American healthcare system. She has fought to reduce the cost of prescription drugs, campaigned to tackle the opioid crisis and fought hard to allow Americans in rural areas to access quality care (“Improving Healthcare”, n.d). Given her record, it is expected that she will support the calls for a law limiting the number of working hours for nurses.
Explain why the public policy issue requires the decision maker’s attention, using relevant nursing research from the last five years to support your position.
Upon receiving the brief, Senator McCaskill should move with speed to table a bill in Congress. The issue of long working hours has plagued nurses in the US for a very long time. In many hospitals across the US, nurses are made to work for extremely long hours. The long hours that they work for leave them so exhausted that they are unable to effectively deliver care. Furthermore, since they are fatigued, the nurses are more likely to cause accidents and harm their patients. The long working hours also deny the nurses a social life and make it difficult for them to attend to personal matters. Essentially, long working hours reduce nurses to people who spend all their lives attending to the needs of others while their own welfare is neglected. If Senator McCaskill truly wishes to protect nurses and patients, she should rally her colleagues to enact the law limiting working hours for nurses.
2. Discuss the main challenges of addressing the selected public policy issue.
The enactment of a law that sets the maximum working hours for nurses will be fraught with challenges. Opposition from hospitals is among these challenges. Hospitals are forced to make their nurses to work for long hours because of the nurse shortage (Witkoski, Sloane & Aiken, 2012). If the law is passed, the hospitals will struggle in their efforts to deliver care. Those who feel that it is not the mandate of Congress to dictate how hospitals should conduct their affairs are also likely to protest against the enactment of the law.
Gaining bipartisan support for the law is another challenge that will be encountered. The US Congress is notorious for being so divided that it is unable to enact laws (Abutaleb, 2017). For example, the Congress has been unable to repeal Obamacare owing to the lack of bipartisan support. There are many other issues that Congress is unable to agree on. While there are strong arguments in favor of the passing of a law that limits working hours for nurses, it would not be surprising if Congress fails to pass the law.
3. Discuss the primary options and/or interventions for the decision maker, including why they are tangible.
As noted in an earlier discussion, 15 states have already enacted laws that limit the number of hours that nurses should work. These states provide lessons for a federal law. As she pursues the law which will limit working hours for nurses, Senator McCaskill has two options available to her. One of these options is including a provision in the law which would grant nurses the right to refuse to comply with commands that they should work overtime. A number of states have already included this provision in their laws (Bae & Yoon, 2014). This provision has been shown to be effective in significantly reducing the length of time that nurses work. This means that granting nurses the right to refuse to work overtime is a viable option that Senator McCaskill can pursue.
The option identified above is not the only one that Senator McCaskill can pursue. In addition to this option, the Senator may include a provision which expressly state that nurses must not work above a certain number of hours. Some of the 15 states referred to earlier have already implemented this option and have registered remarkable success (Bae & Yoon, 2014). This is what makes this a viable option that Senator McCaskill should pursue aggressively.
4. Propose a persuasive course of action for the decision maker, including ways to avoid the challenges identified in part B2.
Given that the US Congress is very slow in passing laws, it is expected that the law recommended above will encounter hurdles in its journey towards enactment. It is recommended that Senator McCaskill should begin with a bill in which she outlines the basic provisions of the law. She should then proceed to rally support from her colleagues. She should rely on the testimonies of nurses who work long hours, suffer poor health and whose capacity to deliver safe and effective care is compromised. This will allow McCaskill to gain bipartisan support for the law. It has been predicted that the initiative will face strong opposition from hospitals which fear that the law will hamper their capacity to deliver care. Since the concerns of the hospitals are valid, McCaskill should point out the many benefits that the hospitals are set to gain once the law is passed. For example, limiting nurse working hours improves their performance and significantly reduces incidences of negligence (Bae & Yoon, 2014).
5. Discuss how you will evaluate the success of your policy brief (top-down approach).
The enactment of the law mentioned above will not mark the end of the initiative to address the problem of long working hours. It is also important to monitor the implementation of the law to ensure that it is successful. Gaining full support from Congress and the Executive is one of the metrics that can be used to assess the success of the policy. If Congress and other leaders in government throw their full weight behind the policy, this can be interpreted as success.
C. Create a plan (suggested length of no more than 3 pages) for working with an organization or a community to address the public policy issue analyzed in part A by doing the following:
1. Identify an organization or community that has expressed interest in your selected health or nursing profession public policy issue.
The American Nurses Association is among the groups that have demonstrated their desire to reduce the number of hours that nurses work.
Summarize evidence supporting why the organization or community has expressed interest in the selected public policy issue.
Recently, the American Nurses Association (ANA) released a statement in which it expressed its interest in improving nurse and patient welfare through policies that limit nursing work hours. In the statement, the ANA acknowledged that there is a link between working hours and the performance of nurses (Brown, 2014). The longer a nurse works, the more their performance suffers. The ANA also pointed out that long working hours increase “likelihood of errors”, is responsible for “diminished problem solving, slower reaction time” (Brown, 2014). This statement is clear evidence that the ANA wishes to pursue any intervention that promises to address the issue of nurse fatigue. Limiting work hours is one of these interventions.
2. Identify three CBPR principles you could use to work with the organization or community to address a policy change for the public policy issue.
Community-based participatory research (CBPR) has allowed the medical community to make gains in involving the community in its programs. Some of the key principles that guide CBPR include encouraging community participation, capacity building and seeking to deliver benefits to all parties (“Community-Based Participatory”, n.d). These are the principles that will be relied on when bringing the community on board. The community will be encouraged to offer its views regarding the impacts of long nurse working hours and how this issue can be addressed. The policy that results from this process will seek to deliver benefits for the community, patients and the medical community. Moreover, effort will be committed to ensuring that the community is fully informed as part of capacity building.
Explain how you could approach and collaborate with the organization or community.
The American Nurses Association seeks to enhance the welfare of the members of nursing profession. This mission means that it will be easy to gain the support of the organization. In my effort to collaborate with the organization, I will engage its leadership. I will remind the leaders of the mission of the organization and the plight of nurses who are forced to work long hours. I will also urge the leaders to support me in my quest for safer hospitals. This organization also has thousands of nurses as its members. This presents a unique opportunity to reach out to the very people whose lives will be transformed once the law comes into effect. I will work with some of the nurses who are members of the organization to push it to support the law. Once the organization hears the horror and anguish that nurses suffer as they are made to work for long hours, it will simply have to support the law. My interactions with the organization will take a collaborative approach. I will challenge the organization to use its strong voice and vast resources to respond to the plight of nurses.
b. Discuss how the goal of the community or organization aligns with your goal for the selected public policy issue.
In an earlier discussion, the American Nurses Association is among the organizations that have expressed interest in reducing the number of nurse work hours. The main mission of this organization is to “advance the nursing profession by fostering high-standards of nursing practice, promoting the economic and general welfare of nurses in the workplace” (“American Nurses Association”, n.d). My goal in pursuing the law discussed above is to improve the welfare of nurses while safeguarding the interests of patients. It is clear that my goal is in line with the mission and goals of the American Nurses Association.
Discuss the action steps that need to be taken to achieve your goal from part C2b.
The achievement of the goal outlined above will go a long way in improving the welfare of nurses and patients. To achieve this goal, I will embark on a journey to gain an in-depth understanding of the experiences of nurses and patients. I will create a report in which I detail these experiences. I will then present the report to Senator McCaskill. The report will also include insights from the American Nurses Association, scholars and experts regarding the adverse impacts that long working hours have on patients and nurses.
Discuss the possible roles/responsibilities of the community or organization members, including problem-solving and capacity-building roles.
I understand that it will be nearly impossible to achieve the goal of improving patient and nurse welfare alone. It is for this reason that I will rely on the support of the American Nurses Association and the community of nurses. I will charge the ANA with the mandate of providing expert opinion and developing solutions to the problems encountered during the enactment of the law that will limit nurse working hours. I will also work with the ANA to educate the community on the importance of the law. The law, in part, intends to force a quicker solution towards nursing shortage, which is the underlying cause of the problem in question. Walker (2017) provides various alternatives to dealing with nursing shortage. She noted that health organizations should promote career advancement, for instance through clinical ladders, which allow nurses to graduate from one level to the next. This would not allow room for hiring of more nurses, but also help promote retention thereby combating nursing shortage at both ends (Walker, 2014). The ANA should set up policies that emphasize on career advancement through, for instance, providing a flexible checklist to health institutions, which they could use to determine those that are eligible for career advancement.
Senator McCaskill has been identified as the official that I will work with to persuade Congress to implement the law. Her main role will be to engage her fellow members of Congress to support the law. I expect that she will aggressively support the law and point out the numerous benefits that it will present upon enactment. Another key responsibility that Senator McCaskill will be performing is challenging other interested parties to throw their weight behind the proposed law. For example, she could reach out to the Executive to set aside funding that will allow hospitals to implement the law with ease. Notably, Everhart et al. (2013) identified a close relationship between staffing levels and a health institution’s financial performance. This intensifies the role and responsibility of the government to ensure that there is sufficient funding in health institutions. With sufficient funding, hospitals will be able to build their capacity when it comes to providing nursing services through hiring qualified nurses, thereby reducing shortage and the lengthy working hours.
Understandably, nurse shortage, which explains the current long working hours nurses are subjected to, leads to various risks associated with the wellbeing of these nurses. As the problem of nursing shortage cannot be solved immediately, there is a need for other short-term alternatives, which can help alleviate some of the challenges that nurses face among which are stress, fatigue and burnout. Roberts and Grubb (2014) proposed integration of person-focused strategies, which are designed to help nurses enhance their ability to manage stress at the individual level. Additionally, considerable attention should be focused on organization-based strategies, which eliminate stressful working conditions. With such a recommendation, it becomes clear that the society needs to create an atmosphere favorable for nurses such that they feel less pressure both at work and at home. As an example, the community could set up associations that help nurses with their duties at home in order to reduce the bulk of work they have to do once they get off work. These associations could be funded by the government as well as donors who understand the risk of having overworked nurses as this undermines the quality of care given. Therefore just as nurses take care of community members in the hospital, the community should also set up measures to help nurses until the issue of nursing shortages is resolved. The outcome of these measures would be reduction and prevention of stress both at the workplace and at home among nurses.
Moreover, the ANA should place stringent measures towards nurse-patient ratios. According to Holdren, Paul, & Coustasse (2015), “ As of 2011, California is the only state that has passed legislation requiring exact patient-to-nurse ratios,” (p. 4). The ratios were that, for instance, four to one patient-to-nurse in pediatrics, three to one in both labor and delivery, as well as two to one in intensive care units. These ratios should not be adopted in one state alone and it becomes the mandate of the ANA to ensure that all other states consider the significance of these ratios in promoting quality of care given. It should work with relevant agencies to ensure that these measures are implement across the country, imposing penalties on states that do not comply. This does not only provide room for capacity building in hospitals, but also alleviates the problem at hand. The less the number of patients a nurse attends, the more effective the care given, hence improving the country’s overall healthcare.
The issue above is of importance to decision makers as it is associated with a chain of other issues, which need to be solved. Long working hours lead to turnover, which in turn is associated with nurse burnout, stress, fatigue, and job satisfaction. Other interrelated issues are such as low quality of care across the country following nursing shortage, which means lack of competent personnel to provide the level of care needed. Therefore, these issues intensify the need for a solution to the problem identified above (Cox, Willis & Coustasse, 2014). The ANA bears considerable responsibility to ensure that measures are put in place to combat the issue.
Discuss key elements of developing a collaborative evaluation plan, using CBPR principles.
As noted earlier, CBPR recognizes the value and importance of community partnerships. These partnerships can be used to evaluate the policy. Seeking feedback from all concerned stakeholders and building the capacity of the stakeholders are the key CBPR principles that will be used to evaluate the policy. The enactment and the successful implementation of the law will require a collaborative approach. The American Nurses Association will work together with Senator McCaskill to ensure the full implementation of the law. Senator McCaskill’s success will be measured based on the level of support that she gets for the law. If a majority of the members of Congress support the law, this will be an indication of success. Discuss how you will evaluate the success of your community or organization plan (bottom-up approach).
The key bottom-up evaluation criterion that can be used involves analyzing the changes that occur following the implementation of the policy. For example, if after hospitals have adopted the policy it is observe that there has been a decline in nurse fatigue, incidences of negligence and an overall improvement in levels of patient satisfaction, this will mean that the policy has been successful . Getting all hospitals to implement the provisions of the law is another key metric that will be used to evaluate it once it has been rolled out. The law will be considered successful if all hospitals agree to limit the number of hours that their nurses work.
D. Analyze (suggested length of 1 page) the strengths and challenges of the top-down and bottom-up approaches in achieving policy change(s) to support your selected public policy issue by doing the following:
1. Discuss the strengths of each approach to implement change for the selected public policy issue.
The main strength of the top-bottom approach is that it allows leaders to exploit their experience, resources and connections to push for change. For example, Senator McCaskill can use her position to highlight the plight of nurses and convince Congress to take action. The other advantage is that this approach allows resources to trickle down to the bottom. The bottom-up approach also has advantages. One of these is that this approach allows individuals who are familiar with the issue to take charge. For instance, nurses who are most affected can share their experiences and help to create solutions.
2. Discuss the challenges of each approach to implement change for the selected public policy issue.
The bottom-up and the top-down approaches also present challenges. The former approach could be ineffective since the parties who take charge lack the authority and resources needed to push for far-reaching reforms. On the other hand, the main challenge that plagues the top-bottom approach is that the leaders who provide direction may lack the first-hand experience and insight needed to fully understand the issue and develop solutions that work.
3. Discuss which approach you would recommend as the most effective to address the selected public policy issue.
I recommend the bottom-up approach. This is because this approach benefits from the input of low-ranking individuals who have a deep understanding of the problems that nurses grapple with. They are then able to create solutions that are effective.
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