Assignment: Topic 3 Creating Change Through Advocacy
Assignment: Topic 3 Creating Change Through Advocacy
Creating Change Through Advocacy
Nurses can advocate change aimed at improving healthcare delivery and advancing the nursing profession. The nursing shortage is a critical issue facing many healthcare organizations and the American health system and requires policy changes at all levels, from institutional to state levels. Studies by Berlin et al (2023) and Zhavoronkova et al. (2022) are categorical that over one in every four nurses intend to leave the profession due to several factors like increased workload, burnout, and stress emanating from poor working conditions. In their article, Costa et al. (2022) recommend policy strategies that stakeholders can use to address the nursing workforce shortage. The essence of this paper is to discuss the nursing shortage issue and demonstrate how legislation can solve it at all levels.
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Problem
In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.
Nursing shortage is a critical problem facing the U.S. healthcare system with existing evidence demonstrating that over 1 in 4 nurses intends to leave the profession over the next three years by 2027. In their recent survey, Berlin et al. (2023) indicate that more than 31% of nurses said they were likely to leave the present role of direct care patient. The figure is higher than 22% who indicated leaving the profession in 2021. The survey also shows that the intent to leave varies based on settings with inpatient registered nurses (RNs) having higher intent to leave rates compared to all RNs. In his article, Peters (2023) asserts that the nursing shortage is a persistent problem that requires effective solutions because of its adverse effects on stakeholders; from nurses to patients. The study notes that increased workload leading to burnout and fatigue, an aging workforce, a rise in care demand due to an aging population, and workplace violence are some of the critical factors influencing the nursing shortage at the organizational and healthcare system levels. The nursing shortage affects nurses, patients, and the healthcare system. For instance, nurse turnover is high for many organizations while patients do not get access to quality care. The nursing shortage threatens to reduce the quality of care and impact efforts focused on increasing access to health for millions of Americans, especially those with chronic diseases. The continuation of the nursing shortage means that organizations and individuals will spend more on healthcare and not have guarantees for quality care provision. Further, the shortage will lead to increased turnover, reduced job satisfaction, and increased susceptibility to errors by the few nurses available in healthcare settings. Further, hospitals will incur high costs in hiring, training, and retaining nurses to deliver quality and accessible care to different types of patients.
Idea for Addressing Solution
In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy.
Addressing the nursing shortage requires efforts based on legislation at the state level for organizations to implement as mandates. An effective strategy at the organizational level is having a proactive retention policy that prioritizes the welfare of nurses and their needs. Such a policy will increase retention rates and job satisfaction levels. Organizations can only adopt such a policy when legal mandates exist on staffing levels through legislation. In their study, Costa et al. (2022) recommend federal and state legal approaches to address the nursing shortage issue. For instance, implementing mandatory maximum patient-to-nurse ratios as a state legal requirement and the Centers for Medicare and Medicaid Services (CMS) establishing hospital safe-staffing ratios at the federal level are policy strategies that can help address the crisis. Through these policy directives, healthcare organizations will develop internal policies and strategies to meet the set legal mandates at the state and federal levels, including innovative ways to recruit and retain nurses. State policies can also entail providing grants for hospitals to develop programs that establish safer and more supporting work environments for nurses to boost retention and job satisfaction which reduce the intent to leave and high nurse turnover rates.
Legislation is the best course for advocacy as it introduces mandatory measures and strategies that healthcare facilities must meet to continue operating. For instance, measures by the CMS on safe-staffing ratios will compel facilities to develop better nursing programs to qualify for reimbursements under value-based care. Further, legislation to eliminate restrictive scope-of-practice regulations will ensure that organizations can hire more nurses within and outside their operational jurisdictions.
Research the Issue
Perform research and compile information for your idea. Present substantive evidence-based findings that support your idea for addressing the problem (research studies, reports, etc.). Include any similar legislation introduced or passed in other states.
Evidence 1
In their article on the nursing shortage issue, the American Association of Colleges of Nursing (AACN) asserts that the current and projected rise in nursing shortage requires effective legislation at the state and federal levels. The association cites a report by the National Council of State Legislatures that profiles various legislative actions states can use and are using to address the problem. These strategies like adapting scope of practice laws and providing financial incentives for preceptors can help address the problem.
Evidence 2
In their article in the Center for American Progress (CAP), Zhavoronkova et al. (2023) recommend bold and robust policies aimed at addressing the nursing shortage issues to increase access to safe, and high-quality nursing care services. The report emphasizes the importance of coordinated policy measures by both state and federal governments in the United States to address the issue. As such, legislation advocacy remains the most effective approach to addressing the nursing shortage problem.
Evidence 3
California was the first state to implement mandatory nurse-to-patient ratios in the country. Consequently, its hospitals and other healthcare facilities were able to meet the staffing standards. Due to a better work environment and less restrictive scope of practice laws, more nurses flocked to the state leading to better patient care as patients received nearly three more hours of nursing care per day compared to states that did not have the minimum or mandatory nursing levels (Dierkes et al., 2022). As such, the evidence from California demonstrates the efficacy of legislation mandates and advocacy in addressing the nursing shortage issue.
Stakeholder Support
Discuss the stakeholders who would support the proposed idea and explain why they would be in support.
Stakeholder(s) Supporting 1 Nurses would support the proposed intervention since they are the most affected and suffer adversely. Nursing shortage causes long working hours making nurses susceptible to errors, fatigue, and burnout as well as poor patient outcomes (Costa et al., 2022). Therefore, nurses will support the proposed idea because it will lead to increased job satisfaction and help them overcome burnout, fatigue, and more workload.
Stakeholder(s) Supporting 2 Patients will support the proposed idea as they require access to better care and quality interventions. Patients need more nursing care time since nurses are the primary contact between them and the healthcare system. The nursing shortage reduces access to care and patients will support the idea to increase their interactions with nurses for better outcomes.
Stakeholder (s) Supporting 3 Physicians and other healthcare providers will support the idea. They will cite the adverse effects of nursing shortage like increased workload, adverse events, and a rise in operational costs for the health system and organizations.
Stakeholder Opposition
Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.
Stakeholder(s) Opposed 1 Healthcare organizations and their shareholders may oppose the proposed idea because it increases regulatory requirements and mandates. For instance, the cost implications related to the implementation may lead to opposition by these entities. Therefore, presenting a cost-benefit analysis would be critical to enlighten them and ensure they adopt the proposed solution.
Stakeholder(s) Opposed 2 Legislators and state governments may also oppose the proposed approach since it requires more laws and budgetary allocations. However, presenting the legislators with the projected benefits of the proposed solution, and innovative approaches can reduce possible resistance. Again, ensuring that legislators develop policies focused on increasing access to care will be imperative.
Financial Incentives/Costs
In no more than 250 words, summarize the financial impact of the issue and the idea (added costs, cost savings, increased revenue, etc.). Provide support (may include references from the “Research Your Issue” section).
The proposed idea has better financial incentives for healthcare organizations as stressed by existing studies and independent analysis. Healthcare facilities implementing the proposed idea will benefit from CMS reimbursement as they stand to offer quality care and attain better patient outcomes. The value-based care model by CMS emphasizes quality over quantity. Therefore, the facility will get reimbursed for services offered to patients due to sufficient nursing staff levels. Hospitals will also save on costs attributed to recruitment and nurse turnover. Hospitals spend about $16736 every year on every nurse who leaves (Muir et al., 2022). Therefore, hospitals lose billions of dollars every year due to nursing shortages. These costs are associated with turnover and recruiting new nurses. Therefore, by adopting the proposed idea in addressing the nursing shortage, hospitals will reduce and avoid unnecessary costs and invest such in employee development and better services. Moron et al. (2020) demonstrate in their study that hospitals can save up to $1.8 million every year by implementing programs aimed at solving the nursing shortage issue.
Legislature: Information Needed and Process for Proposal
Discuss how to advocate for your proposal using legislation. Include the following:
Provide the name and complete contact information for the legislator.
Describe the steps needed to present this to your legislator. I would send an email to the representative expressing my intention to meet her and present the proposed idea. Upon getting an appointment, I will prepare the proposal by ensuring that it contains the latest data and critical facts on the nursing shortage. I will present the proposal through a prepared PowerPoint to capture the magnitude of the problem and also visually demonstrate to the representative the benefits of the proposed idea or solution.
Interprofessional Collaboration in the Legislative Arena
In no more than 250 words, discuss the role interprofessional collaboration plays in advocacy through legislation.
Inter-professional collaboration plays a fundamental role in advocacy through legislation. Firstly, it ensures that providers come together and bring diverse knowledge, skills, and perspectives to advocate a policy position to address the nursing shortage problem. Secondly, inter-professional collaboration in this arena is essential as it illustrates a collective approach or pursuit of a common goal and interests for nurses encountering shortage and its adverse effects. As stated by Campbell et al. (2020) healthcare advocacy is a component of social advocacy aimed at improving behavioral approaches to issues affecting individuals and society. The study notes the importance of peer-based advocacy to raise awareness in healthcare settings among different providers and patient populations. Thirdly, inter-professional collaboration improves communication and ensures that providers have a shared approach to the identified health issues like nursing shortage (Girard et al., 2020). Inter-professional collaboration eliminates fragmented sharing of information and enhances decision-making as well as effective implementation of suggested or recommended strategies to address the problem.
Leadership Competencies and Styles
The American Organization of Nurse Executives (AONE) has identified leadership competencies relevant for nurse leaders to guide practice within the health care system. Describe two leadership competencies identified by the AONE that would also be necessary for a nurse to advocate for the legislative solution you have proposed. Discuss how the theory of servant leadership supports these competencies. This section should be addressed in no more than 250 words.
The two leadership competencies relevant to nurse advocacy for the proposed legislative solution as advanced by the American Organization of Nurse Executives (AONE) are communication and relationship management and possessing adept knowledge of the healthcare environment. Nurses should possess effective communication and relationship management attributes to promote a collaborative approach to the problem through the proposed solution. Nurses should be effective listeners and communicators, and leverage their leadership skills in influencing a shared decision-making approach (Pawar et al., 2021). Nurses should have sufficient knowledge of the healthcare system; from clinical practice to healthcare delivery models, healthcare policy, and patient safety. Through this knowledge, nurses can influence key decisions by providing balanced and critical information for decision-makers.
The servant leadership model supports these competencies as nurses acquire them to serve others, especially patients and colleagues. Nurses should prioritize strategies that benefit patients, colleagues, and the organization as opposed to themselves. The servant leadership model will ensure that nurses voice the concerns affecting the profession and their impact on quality patient care (Morse & Warshawsky, 2021). Nurses as patient advocates must focus on serving others and improving care delivery through deliberate policy strategies at the organizational level, including programs and initiatives to address the nursing shortage.
Christian Principles and Nursing Advocacy
In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.
The Christian worldview principles support legislative advocacy in healthcare due to the benefits it stands to offer to patients and the health populations. At the core of the proposed solution is to increase access to quality care while also addressing nurses’ welfare, especially factors leading to turnover. The policy advocacy strategies to address the nursing shortage aim at engaging in activities that promote the greater common good of the majority as patients suffer the distress associated with diseases like chronic conditions. Therefore, the Christian worldview principles of love and kindness, inclusiveness, and positive perception of others because of their inherent dignity as human beings created in God’s image support nursing advocacy. The sick are a vulnerable population irrespective of their gender, sexual orientation, race, culture, and even religion. As patient advocates, nurses should aim at ensuring collective benefits for all irrespective of their backgrounds. Again, nurses should have a common approach for the benefit of all healthcare professionals. The Christian worldview principles also hold those involved in advocacy to focus on virtues like respect, honesty, trust, and transparency when making decisions (Mintert et al., 2020). As advocates, nurses engage in efforts to promote positive health outcomes for all populations and individuals without any bias based on aspects like race, gender, and any demographic factor.
Conclusion
Advocacy is an essential aspect of addressing the nursing shortage that continues to threaten access to quality care, especially for vulnerable populations. Having increased legislation on nursing staff levels and ratios will help reduce and eliminate the current nursing shortage as such mandates will compel organizations to develop better strategies to retain their nursing workforce. The proposed idea aligns with required nursing competencies and provides financial incentives that include long-term savings for healthcare organizations and providers.
References
American Association of Colleges of Nursing (AACN) (2024 May). Nursing Shortage Fact Sheet. https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage
Berlin, G., Burns, F., Lapointe, M., Essick, C. & Murphy, M. (2023 May 5). Nursing in 2023: How hospitals are confronting shortages. https://www.mckinsey.com/industries/healthcare/our-insights/nursing-in-2023
Campbell, A., Deshpande, S., Rundle-Thiele, S., & West, T. (2024). Social advocacy: A conceptual model to extend post-intervention effectiveness. Journal of strategic marketing, 32(2): 216-229. https://doi.org/10.1080/0965254X.2023.2179653
Costa, D. K., & Friese, C. R. (2022). Policy strategies for addressing current threats to the US nursing workforce. New England journal of medicine, 386(26): 2454-2456. DOI: 10.1056/NEJMp2202662
Dierkes, A., Do, D., Morin, H., Rochman, M., Sloane, D., & McHugh, M. (2022). The impact of California’s staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis. Nursing outlook, 70(2): 219-227. DOI:https://doi.org/10.1016/j.outlook.2021.09.007
Girard, V. W., Moore, E. S., Kessler, L. P., Perry, D., & Cannon, Y. (2020). An Interprofessional Approach to Teaching Advocacy Skills: Lessons from an Academic Medical-Legal Partnership. Journal of legal medicine, 40(2): 265–278. https://doi.org/10.1080/01947648.2020.1819485
Mintert, J., Tran, A. G. T. T., & Kurpius, S. (2020). Religious and/or Spiritual Social Justice Advocacy: Guidance From the Multicultural and Social Justice Counseling Competencies. Counseling and values, 65(1): 2–14. https://doi.org/10.1002/cvj.12119
Moran, D., Wu, A. W., Connors, C., Chappidi, M. R., Sreedhara, S. K., Selter, J. H., & Padula, W. V. (2020). Cost-Benefit Analysis of a Support Program for Nursing Staff. Journal of patient safety, 16(4): e250. https://doi.org/10.1097/PTS.0000000000000376
Morse, V., & Warshawsky, N. E. (2021). Nurse Leader Competencies: Today and Tomorrow. Nursing administration quarterly, 45(1): 65–70. https://doi.org/10.1097/NAQ.0000000000000453
Muir, K. J., Wanchek, T. N., Lobo, J. M., & Keim-Malpass, J. (2022). Evaluating the Costs of Nurse Burnout-Attributed Turnover: A Markov Modeling Approach. Journal of patient safety, 18(4): 351. https://doi.org/10.1097/PTS.0000000000000920
Pawar, A., Sudan, K., Satini, S., & Sunarsi, D. (2020). Organizational Servant Leadership. International journal of educational administration, management, and leadership, 63–76. https://doi.org/10.51629/ijeamal.v1i2.8
Peters, M. (2023). Time to solve persistent, pernicious, and widespread nursing workforce shortages. International nursing review, 70(2): 247-253. https://doi.org/10.1111/inr.12837
Suran, M. (2023). Overworked and understaffed, more than 1 in 4 US nurses say they plan to leave the profession. JAMA, 330(16):1512-1514. doi:10.1001/jama.2023.10055
Zhavoronkova, M., Custer, B. D., Neal, A., Schweitzer, J. & Bombardieri, M. (2022 May 23). How To Ease the Nursing Shortage in America. https://www.americanprogress.org/article/how-to-ease-the-nursing-shortage-in-america/
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The purpose of this assignment is to identify a problem or concern in your organization, local community, or state in which change can occur through advocacy and legislation.
Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.
Identify a problem or concern in your organization, local community, or state. Examples of problems relevant to nursing include, but are not limited to, title “nurse” protection, sharps injury prevention, nursing shortage, nurse well-being, valuation of nursing services, etc. Research the issue you selected and use the attached “Creating Change Through Advocacy” template to complete this assignment.
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