News & Research

Policy in Healthcare: How Laws Influence Your Ability to Care For Patients

EveryNurse Staff
Last Updated: 05/18/2019

Nurses are at the forefront of every aspect of American life, whether it is on the floor of a hospital, teaching at a college or university, or working in a law office, nurses are leading the way. Most people decide to enter the nursing profession because they want to enhance the lives of other people. Nurses have a deep desire to fix things, and they identify, assess, and resolve issues every day. There are some issues however that nurses are still having problems with that many say interfere with their ability to provide appropriate and effective patient care. Nurses are sounding the alarm, but you have to wonder who’s listening. Here is a look at one law with a huge influence on healthcare, which actually interferes with the ability of nurses to properly care for their patients.

Staffing Ratios

Nurses in hospitals and other medical facilities are in a constant uproar over how their institution deals with staffing. Nurses are having to deal with the daily plight of working with a lean core of nursing and ancillary staff during their shifts. Lean staffing is a systemic problem, and there are reasons it is so pervasive in facilities across the country.

You can ask any nurse working on the floor of a hospital or in a long term care facility what their biggest issue is in terms of their job, and they will tell you that there is not enough coverage during their shifts. You can ask any hospital CEO or nursing home administrator about the nurse to patient ratios in their facilities, and they will say they meet regulatory and state-mandated standards. So who is right? The answer is simple, they both are. The way the laws are written in regard to patient care acuity systems and their management plays a major role in why staffing is an issue that never seems to get resolved.

As nurses, our mind is constantly geared towards patient care, while hospitals and other health care facilities continue to prioritize profit over the value of patient care. MACRA is attempting to change this through its concerted efforts to place more of an emphasis on the patient experience by making it a determining factor in Medicare reimbursements. Even with MACRA and the provisions in the Affordable Care Act which also addresses the issue of better patient experiences, there is still the issue of the laws which govern the current patient care model in the United States.

Trick or Treat

The Federal Regulation 42 Code of Federal Regulations (42CFR 482.23) was established to ensure that hospitals and long term institutions of health care who are certified to participate in Medicare maintain appropriate numbers of nursing staff to include licensed registered nurses, LPN’s, LVN’s and other ancillary staff to administer safe, effective and skilled nursing care to patients. This Federal standard sounds good, however, it serves as an impediment to nurses and other members of the health care team.

The language in 42 CFT 482.23 at first glance, appears to offer a little something for everyone. In theory, the regulation should satisfy nurses and others who are in the direct line of patient care, and it should also benefit the CEO’s, CFO’s and Administrators of medical facilities, however, the language in 42 CFT 482.23 is so vague, nursing teams and patients are consistently getting the short end of the stick in terms of how care is delivered and when it is received. In theory, 42 CFT 482.23 should mandate what the appropriate numbers should be in terms of nurse-to-patient ratios but it doesn’t.

The reason there is so much confusion in regard to what appropriate staffing numbers should be is that the regulation as it is written leaves it to each state to determine their own ratios. In the United States, there are some states with 5/15 nurse-patient ratios and then there are others with a mandate of 3/15. This is dangerous and poses extreme risks in terms of patient safety on dumping ground floors like Medical-Surgical units, and specialty floors like Labor and Delivery.

Friends in High Places Versus Effective Nursing Practice

The current reality is that those who are responsible for the operation of hospitals and other health facilities determine what works best for their facilities within the confines of their state’s mandate. Many of the people who make these decisions are business people who have no background in medicine or health care. The other issue is, the majority of the people who serve on state boards of health are appointees who serve at the pleasure of the administration that appointed them. Take the state of Texas, for example, Governor Rick Perry appointed several people to his State Board of Health who did not have a medical background.

You have to consider this, there is no incentive for facilities to increase the number of nursing staff they hire as long as the language in regulations like 42 CFT 482.23 remains the same. Federal regulations that fail to identify what safe staffing numbers are will continue to place patients at risk, and nurses will continue to work with the added stress of making a career-ending mistake because appointees will always do what is best for the agenda of the person who appointed them. By the same token, the CEO’s and Administrators of hospitals and long term care facilities will always choose to do what is best for their bottom lines.

Read and Follow Up

All is not lost in the fight for better staffing numbers. Every nurse has the power to do something to raise awareness of the issue. You can read up on the issues, and you can also do a little research to find out what laws have been passed in your state regarding staffing in medical facilities. You can also attend your county health board meetings, and visit your lawmakers in your state’s legislature. Writing letters and making phone calls to legislative decision-makers are also effective measures you can take to help the ANA, SEIU, and other organizations who have been pushing for years to make improvements to regulations like 42 CET 48.23. Together nurses can make a difference by staying active and educating themselves on the laws and policies that govern the profession.