Advocacy Through Legislation


Several patients encounter challenges and problems related to medical errors and adverse effects of complications associated with poor staffing ratios. Nurse staffing in health care facilities is critical in determining the quality of health services. Nurse staffing ratios can improve or decrease the level of health care in nursing practice.  Short-staffed institutions increase the workload for the remaining staff in terms of extra shifts. The increase in nurses’ working shifts is directly proportional to the reduction of healthcare quality and an increase in mortality rates. Nurses working longer shifts are prone to stress, burnouts, and workplace injuries.

This affects their ability to provide quality healthcare to patient safety strategies to prevent risks and errors that may cause harm to patients during healthcare provision. Understaffing in health institutions’ critical areas increases the patients’ risks, such as longer hospital stays and an increase in medical errors leading to death (Voss, Mawyer, and Yevchak, 2020).  Low staffing also leads to job dissatisfaction among nurses. Employee satisfaction is critical in healthcare as a conducive work environment increases patient rapports, and ultimately the quality of care.

The idea for Addressing Solution

For years, nurse staffing has been a complex issue for hospitals to manage. With tighter budgets and substantial increases in the number of patients, nurses have been working in situations that endanger both patients and themselves. The failure to recognize the association between registered nurses’ staffing and patient outcomes breeds the need to form policies. The current legislation in Texas; The Texas Safe Hospital Staffing Act enacted in 2002, requires that each medical center organizes a committee on nurse staffing of which 60% must be nurses who provide direct care to patients for more than 50 % of their duty hours. There is an ad hoc committee that is in charge of developing the nurse staffing guidelines and an evaluation plan to improve efficiency (Spetz, 2020). The state law requires hospitals to create this staffing committee to appropriately create a plan that reflects the needs of the patient population. However, the law is ambiguous as it does not outrightly specify the nurse-patient ratios. The continued failure of Congress to enact a federal law designed to correct the ambiguity of nurse staffing ratios is the basis of the advocacy. The legislation is the best course of advocacy as it ensures the practices are legally protected and clearly defined for all nurses resulting in the standardization of hospital measures.

Research the Issue

California is the only state to have passed legislation mandating a specified nurse to patient ratio in 2004. For example, the standard ratio regarding nurses versus patients is 1:5 in medical-surgical units, 1:2 in critical care, and 1:1in the operating room. Nurse staffing ratio regulation allows for flexible nurse staffing plans where registered nurses are empowered to create staffing plans for each specific unit. Nurse staffing levels in hospitals lead to better patient health and improved nurse health and safety. Efficient nurse-patient ratios reduce the length of stay and hospital readmissions due to improved quality of care, ultimately reducing hospitals’ costs (DeNisco, 2019). There is improved patient safety as the quality of patient care increases as the number of patients in nurse care decreases, thus reducing mortality rates.

Nurses’ role is to provide quality healthcare to patients; thus, with the implementation of staffing ratios, registered nurses are provided with a reasonable workload and adequate rest, improving their ability to provide better patient care. In 2018, 62% of registered nurses experienced job burnouts related to overworking leading to job dissatisfaction. One in three nurses leaves the profession within two years of employment as the workplace was no longer safe. Nursing is a physically demanding profession thus coupled with increased overtime; nurses are prone to musculoskeletal injuries.

Stakeholder Support

The nurse staffing movement requires the support of various stakeholders who are charged with ensuring patient safety and establishing a conducive environment for nurses. The stakeholders in support of the legislation include; The American Nurses Association (ANA) and government accrediting agencies. The American Nurses Association (ANA), the national professional organization that advances and protects nurses’ welfare, is a strong advocate for a legislative model where registered nurses are permitted to make staffing plans for each specific unit. With the enactment of nurse staffing ratios, the nurse administrators improve efficiency in assigning duties to nurses limiting the mandatory overtime as they are in charge of work schedules. There is also an increased pool of talent in nursing due to the rising number of nursing graduates and the estimated increase in available nursing jobs (Stadhouders, Kruse, Tanke, Koolman, and Jeurissen, 2019). In California, applications for nursing licenses increased by 60% after the implementation of the law in 2004, and registered nurses’ vacancies reduced by 69% by 2008.

Accrediting agencies such as the Center for Medicare and Medicaid Services (CMS) support the initiative as it is directly proportional to patient outcomes. The agency is charged with the role of ensuring patients are accorded the highest form of patient care thus advocate for higher patient-nurse ratios to deliver quality care. Nurse staffing ratios are precursors for reduced surgical mortality, hospital-acquired infections, and surgical complications.

Stakeholders Opposition

Stakeholders opposed to nursing staffing ratios believe the program does more harm than good. They include; health institutions and lobbyists. The primary weakness of the regulation is that hospitals will be forced to increase the number of registered nurses without receiving increased reimbursement for patient care. An increase in overall costs without corresponding improvement in patient care leads to reduced profit margins.  The hospitals in turn cater to the deficit by laying off other staff such as housekeepers and unlicensed assistive practitioners.

Hospitals are of the notion that nurse staffing ratios lead to a shortage of nurses forcing facilities to close down. There has been a growing need for the increment of registered nurses in hospitals due to increased acuity of patients and reduced length of stay thus with the implementation of the law, nurse shortage is inevitable. Hospitals offer a dynamic environment with endless possibilities thus planning is flexible. Components such as patient acuity and patient workflow affect decisions on appropriate time regarding nurse staffing. The impact of the mandated staffing ratio is the increased wait time for patients in need of assistance in the emergency departments and other units in the hospital (Senek, Robertson, Ryan, King, Wood, and Tod, 2020).  Hospitals may be forced to turn away patients as they will have to shut down some of the units due to the rigid regulations.  Lobbyists argue that the one size doesn’t fit all referring to California ratios. Patient needs vary among hospitals and nursing shifts thus flexibility is required to meet the ever-changing patient’s demands.

Financial Incentives

Healthcare facilities are graded based on their quality of performance; thus, the better the care, the higher the compensation rates through pay for performance package. Pay for performance refers to a health care system where providers are reimbursed by payers by assessing treatment on a value-based model. Hospitals are rewarded for quality performance while penalized for subpar performance. Nurse staffing ratios improve is relative to the improvement of patient care and outcome. This leads to improved reimbursement packages increasing revenue for hospitals. The added costs are related to talent acquisition where health facilities are forced to absorb a sizeable number of nurses into the workforce leading to an increased wage bill. Imposing ratios would add to the cost of healthcare which would be passed to patients in the form of higher health care costs.


Colin Zachary Allred, a member of the democratic party is the current U.S Representative from Texas 32nd congressional district. His contact address is 328, Cannon House Office Building in Washington DC.  I would present this to the legislator through a memo lobbying for his support on the issue. I would write a memo articulating the arguments for and against and an unbiased conclusion indicating my position on the matter. The legislator introduces the bill to the house when in session. The first reading of the bill is done and referred to a committee with jurisdiction in healthcare (Hertel-Fernandez, Mildenberger, and Stokes, 2019). The committee members research, discuss and make alterations to the bill and tables it to a subcommittee for comprehensive analysis. The subcommittee studies the bill, make necessary changes, and sends it back to the committee for approval. The committee sends the bill to the House for consideration. The bill is debated in the House. The deliberations and amendments of the bill are done in the second reading. The bill is read the third time and put to a vote where members either pass or reject the bill. The passed bill is presented to the president to sign or veto the bill.

Christian Worldview

The principles of a Christian worldview lend support to legislative advocacy in healthcare without bias by supporting access to healthcare for ethnic minorities and poor families. The Christian worldview believes that all human beings are equal and should not be subjected to prejudice. Men and women in key positions should strive to assist the poor to access critical health services by treating them with dignity. This is reflected by the willingness of legislators to vote for bills that help in addressing health inequalities. Inequality in healthcare prevents some populations from accessing quality health services (Rieg, Newbanks, and Sprunger, 2018). Justice regarding treating individuals as equals without contempt is also a critical perceptive in the Christian worldview principle of the world without bias. All individuals are created equal in the image of God thus none is special. Christians should employ fairness in aligning with laws that limit discrimination and safeguard the affected population.




DeNisco, S. M. (2019). Advanced practice nursing. Jones & Bartlett Learning.

Hertel-Fernandez, A., Mildenberger, M., & Stokes, L. C. (2019). Legislative staff and representation in Congress. American Political Science Review, 113(1), 1-18.

Rieg, L. S., Newbanks, R. S., & Sprunger, R. (2018). Caring from a Christian worldview: Exploring nurses’ source of caring, faith practices, and view of nursing. Journal of Christian Nursing, 35(3), 168-173.

Senek, M., Robertson, S., Ryan, T., King, R., Wood, E., & Todd, A. (2020). The association between care left undone and temporary Nursing staff ratios in acute settings: a cross-sectional survey of registered nurses. BMC Health Services Research, 20(1), 1-8.

Spetz, J. (2020). Nurse staffing ratios: Policy options. Policy & Politics in Nursing and Health Care-E-Book, 452.

Stadhouders, N., Kruse, F., Tanke, M., Koolman, X., & Jeurissen, P. (2019). Effective healthcare cost-containment policies: a systematic review. Health Policy, 123(1), 71-79.

Voss, E., Mawyer, K., & Yevchak, A. (2020). NURS 230: Nursing Staffing Ratios.


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Advocacy Through Legislation . (2022, February 20). The Studypool . Retrieved June 06, 2023, from
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