In the state of Oregon, there are no policies to define and limit the number of patients that a registered nurse may have during his or her shift. There is a critical necessity for a policy change to limit the number of patients a nurse cares for during their shift in any hospital settings. Even through there is a staffing grid at most hospitals, there is not a strict policy for nurse-patient ratios on the medical and surgical floors, especially in step-down units. Because of financial reasons, there are some increased nurse-patient ratios from 1:2 to 1:3 in the intensive care units. In most Oregon hospitals, nurses work twelve-hour shifts. Traditionally there is a “buddy-break system” where a nurse needs to cover another nurse’s patients during his or her rest breaks. This means a nurse needs to watch the buddy’s four or five patients in addition to their own four or five patients. Normally, there are three fifteen minutes breaks and one half-hour break during a twelve-hour shift. Therefore, a nurse may have up to ten patients for one hour and fifteen minutes during a day shift, and a nurse may have up to 12 patients during a night shift. The “buddy-break system” means that a nurse may take their breaks, but it is not mandatory nor guaranteed. There are no current policies in place that the hospital must provide an additional nurse to cover nurse breaks. Thus, any nurse may burn out because of not taking adequate rest breaks. Current research has showed that RN assignments with low nurse-patient ratios could increase better patient outcomes such as reducing hospital-related mortality, falls, skin ulcers and urinary tract infections (Cho, Kim, Yeon, You, & Lee, 2015, p. 1). Therefore, it is a crucial to create a safe nurse staffing policy to improve better outcomes for the patients. California is the state that leads and defines the limitations and minimum numbers of nurse -patient ratios. Massachusetts stipulates the specific law of 1:1 or 1:2 nurse-patient ratios in the ICU ("Nursing Staffing," 2015, p. 1). In Oregon, a nurse-patient ratio should be identified and regulated for the patient’s safety and for nurse’s satisfaction at the work place.
Discuss why you selected this issue. I have been as a bedside nurse for 12 years. During this time, I have learned that nurses have a heavy duty to care for their patients, such as passing oral medications, intravenous medications, changing dressings, drawing labs, taking patients to the bathroom, and paging physicians for their patients as well as sending their patients to procedures. I have experienced and seen many critical situations such as a code blue or bleeding at the time when a nurse is taking care of ten patients. A nurse needs to manage multiple situations and get orders placed during specific events such as this. In a nut shell, this isn’t realistic nor likely to have a good outcome for the patients involved nor for nurse satisfaction. My colleagues and I personally skip our breaks to avoid bad things happening. I have worked in many different settings in Oregon hospitals, and have seen similarities where nurses are not taking breaks. For this reason, a safe and adequate nurse-patient ratio should be in place in Oregon State to protect the patient’s safety and achieve improved hospital outcomes.
Discuss the relevance of the public policy issue to the nursing profession. From the International Journal of Nursing Studies, the authors presented research to support the need to improve nurse staffing. They believe there is a correlation between good environments for the nurses and better patient care as well as better outcomes for the patients. They studied eighty-three hospitals in the UK where the nurses completed online “end of shift diaries” to examine and categorize their daily perceptions of staffing and patient safety. From the results of the online diaries, the nurses reported that lower nurse-patient ratios resulted in less cognitive burnout in the workplace, and in being a better practitioner for their patients. The lower nurse-patient ratios had the positive relationship with patient safety as well. It also indicated an improvement in the nursing bedside performance as a practitioner. Therefore, a lower nurse-patient ratio is associated with a higher perception of patient safety and nurse satisfaction. This study reinforced that adequate nurse staffing would affect the nursing capabilities to deliver safer patient care and to have a safe working environment for the nurses (Louch, O’Hara, Gardner, & O’Connor, 2016).
Other research also supports the premise that adequate staffing levels and low nurse -patient ratios are key factors to achieve the better patient outcomes. The research from the Australasian Emergency Nursing Journal indicated in the acute care settings that higher nurse-patient ratios resulted in negative patient outcomes such as increased medication errors, falls, wound infections, failure to rescue, and higher hospital mortality. Their research also presented that the lower nursing-patient ratios had positive nursing outcomes in term of work exhaustion, workplace satisfaction, and less staffing turnover. The research identified that appropriate nurse staffing numbers may result in good balance for safety, quality, and cost (Wise, Fry, Duffield, Roche, & Buchanan, 2015). In California, there is a mandatory 1:4 of nurse-patient ratios. In Australia, in the State of Victoria, there is a 1:3 mandatory ratio. These mandatory of numbers of nurse-patient ratios improved the rate of rescue and the patient’s recovery time (Wise, Fry, Duffield, Roche, & Buchanan, 2015).
These research papers support a need for nurse-patient ratio public policy. This topic is important to improve patient care such as reducing medical errors, lowering hospital inflectional rates and lowering rates of falls in addition to improving nurse satisfaction.
The financial impact of this policy on the State. To create a policy on nurse-patient ratios and hire more nurses, it will impact costs in Oregon State; but, it will benefit the state overall with reduced health care costs. From Heathy Affair Reports, there were 25 percent lower odds of hospitals getting penalized from patient readmission when the hospital had lower nurse to patient ratios. The effect of lower nurse-patient ratios was that the nurses were able to provide more patient care and transfer the knowledge to patients for preventative care and to lower readmission rates (McHugh, Berez, & Small, 2013). Another study showed that the average hospital lost $300,000 each year in nursing turnover every year because of higher nurse-patient ratios. This study also stated that hiring a new nurse costs the hospital around $2,820, but the hospital lost $65, 000 with each nurse lost due to burnout. The study made it clear that nurses were burning out from difficult patient ratios staff turnover ("Safe-staffing ratios," 2016, p. 1). On the surface, it looks like it will cost the state more to hire more nurses, but the benefit is enhanced patient safety, reduced hospital-related mortality, and reduced incidents of falls as well as infections (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013).
Analyze how values impact my position on this issue. I value truth and honesty. I am inspired by both nurses and patients thriving as well as having optimal health. That is why I love to work in the medical field and enjoy helping my patients recover. I want to provide the best patient care for my patients; but, I also want to be honest to my patients. Sometimes I don’t have time to take a break, don’t have a time to drink water, nor have time to eat my meals during my twelve-hour shift. If my colleagues or I tell patients this dilemma, the patients will doubt whether they receive the best care during their hospital stay. This could cause the patient satisfaction scores to significantly drop. As a result, it would affect Medicare reimbursement. I try to protect my hospital’s best reputation for patient care and not tell the truth; but, this challenges my integrity. I believe many nurses in the State of Oregon are dealing with the same controversies and have the same concerns. Because of unsafe staffing and overloaded patient assignments, we truly put our patient safety at risk and our own health in danger.
2.a. Discuss the ethical principle. As I stated, I value truth and honesty, but this dilemma puts patient safety at risk during their hospitalization. I also don’t want to tell patients and their families the truth about being over-worked and overwhelmed in an effort to protect the patient satisfaction ratings for my employer. Because it is a state-wide concern, this situation embodies the ethical principle of non-maleficence. According to the American Nurse Association, non-maleficence means avoiding harm such as injury, infection, or falls. These are some of the worst things to happen to a patient. It is less likely with a lower nurse to patient ratio. ("ANA, Short," 2015, p. 1). A nurse encounters ethical issues every day. To improve this dilemma, their patients may benefit from nurses changing ratio policies within the state. Nurses face the heavy duty of caring for too many patients each day, and try to survive as well as make sure their patients are well-cared for. In this situation, a nurse encounters the ethical issue of not finishing tasks and leaving their patients in harm’s way. For instance, there may not be time to turn a patient every two hour, during a twelve-hour shift. This means that patients may develop wounds or infections. Nurses try their best honestly cannot guarantee the best care all the time, due to prioritizing needs. Therefore, in the State of Oregon, nurse-patient ratios should be mandatory and should limit the number of patients for each nurse.
B. Develop a policy brief.
B1. Identify decision maker. The chair and vice-chair of the Oregon State Legislature, in the House Committee on health care are the decision makers. They are: house representative Mitch Greenlick and house representative Cedric Hayden.
B.1.aThe public policy issue requires the decision maker’s attention.
Because nurses play significant and important roles in health care, the nurse staffing concern becomes an important issue in caregiving workplaces to achieve adequate recovery and satisfaction. There are three important concerns and problems with this issue. First of all, from the International Journal of Nursing Studies, research shows that a lack of nursing staff can cause medical errors, care undone, and patient injuries. This research studied 65 hospitals and indicates a statistically significant increase in falls with higher nurse to patient ratios. The data also shows adverse events as a result of nurse shortages and mandatory overtime. The research also found a significant link to nurse ratios with safe care (Cho et al., 2016). The other study found significance with high nurse-patient ratios in increasing hospital-related pressure ulcer rates and falls with injuries (Liu et al., 2015). Second, there is an inverse relationship found between nurse staffing and patient deaths while in the hospital. In a 30-day study of 26,516 nurses and 422,730 patients, the patient mortality rate increased seven percent when nurses took on responsibility for one extra patient. The study also found that the mortality rate of patients dropped 30% when nurses cared for six patients rather than eight. Therefore, more patients assigned to staff nurses results in higher patient mortality (Aiken et al., 2014). Third, there is a correlation between nurse staffing ratios and nurse job satisfaction. There are better outcomes with less patients assigned to nurse’s care. There are also less work-related injuries associated with less patients. In California, after their mandatory minimum laws were passed, there were 55% fewer job injuries and illnesses per 10, 000 nurses each year. This is 31% less than the expected rates of injury (Leigh, Markis, Loslf, & Romano, 2015, p. 1). These research numbers indicate that there is also a result of lower fees for work compensation insurance and legal fees as well as law suits. Mandatory laws in California also reduced the training fees to find other nurses for replacing the injured nurses. In addition, research from the International Journal of Research in Medical Sciences found that poor staffing results in nurse burnout, high turnover, work place injuries and poorer patient care. There were more positive patients’ outcomes and a better perception of the working environment for nurses with lower patient ratios. This study found that nurses were more satisfied with their job in lower patient ratio workplaces (Koy, Yuniband, Angsurich, & Fisher, 2015). Therefore, these three concerns are supported by resent researches and are appropriate for public policy changes in Oregon. This public policy aims at nurse staffing issues to protect the nurses and patients.
B.2. Discuss the main challenge of addressing the selected public policy issue. The biggest challenge to this policy will be hospital administrators who will not like nor want to pay the extra money to hire more nurses when this policy is proposed. They will state that there is no strong data nor evidence regarding staff ratios and safety. Because the money for hiring nurses comes from the hospital budgets, the administers need to clearly understand that the evidence is there to support this policy change. The need to be shown the hard facts regarding staff ratios and correlations to infections and mortality. They also need to be shown the correlation between patient satisfaction scores and nurse to patient ratios. The administrators need to see enough data to prove that there will be a reduction in staff turnover, nurse injuries, and total costs for the hospitals. The administrators also need to see enough data to understand how their reimbursement rates can be increased from Medicare due to less re-admissions, sentinel events, falls, and preventable events.
B,3. Discuss the primary options and interventions for the decision maker.
There are three options for the chair and vice chair. The first option is for law makers to do nothing. This is the worst scenario because retired baby boomers are the fastest-growing population in Oregon. They will need more nursing care, and it is safe to assume that many of them vote in elections. So, the law-makers are at risk for not acting quickly on this policy change. Also, there are many baby boomer nurses in Oregon who may burn out and leave their employer before the expected retirement age of 65. This will result in an even worse shortage of skilled nurses. The second option, is to have a Champion for increasing nurse staffing in the hospitals. This Champion may be chosen in several units in the hospital. I recommend to start at the Oregon State Hospital, which is the mental health hospital. This hospital has the highest rates of nurse injuries, staff vacancies, and highest turnover in Oregon. With dedication, this will be a win-win situation for the hospital’s public relations and reputation. The hospital Champion can publish with results in local and national media. However, this may take up to a year to achieve good results. So, I recommend the third option, to support and pass this public policy proposal into a law. The law will state that there will be a mandatory hospital nurse-patient ratio of one nurse to four patients per shift, on medical and surgical units. This option is tangible because the evidence-based studies and research have approved and supported the positive outcomes for both patients and nurses. If this policy passes, it will be easy to import nurses from other states once they learn that Oregon has a better nurse to patient ratio. This also is the greatest option for residents in Oregon. They will benefit from the safer care, lower mortality, and less complications. Nurses will make less medical errors, suffer fewer injuries and will be more satisfied their working environments. The hospitals will save the total costs from medical errors, hospital-related infections and readmission, as well as increased patient and nurse satisfaction scores.
B.4. Propose a persuasive course of action for the decision maker.
The biggest challenge is the hospital administrators who don’t want to pay any more money to increase the nursing staff. Therefore, the strong evidence-based approach will help the decision makers to approve of this new policy and pass the policy into a law. I think it would be a benefit for all of the stakeholders to invite two Californian hospital administrators up to make a presentation. I think a CEO of one hospital and a CFO of another hospital will be able to address all of the concerns and answer all of the questions. I suggest that two representatives come from both a public and a private hospital from California. They can present their ideas in a public hearing and address the pros and cons of patient ratios before and after the California law was enacted. Their presentation and capabilities will influence the decision makers to agree with this policy change and may hopefully guide the administrators towards acceptance. In addition, one of the big hospital CEOs in Oregon will be another important perspective, if they present the evidence of higher nurse ratios associated with turnover, injury, low satisfaction, and patient incidents. The negative side of things can also be persuasive.
B.5. Discuss how you will evaluate the success of your policy brief. First, the success of this process will be evaluated by a score on a 0 to 5 scale. The score of 5 will be most successful, and reach the goal. A score of 0 means no one is interested in this new policy nor supports it. A score of 1 will mean the chair and vice-chair accept a proposal and agree to sponsor this bill. The score of 2 means the proposal is reviewed and voted on by the committee. A score of 3 means, that adjustments are made to make this proposal a bill as well as go to the State House for voting. The score of 4 will mean a few adjustments will be made by the Senate, that there is minimal opposition, and that the bill passes. The score of 5 will be the best result. This means that the bill goes to the governor and it has been signed into a new law. After this bill is passed and implemented to law, I assume that the news will announce this policy to the public with either a positive or negative spin. For instance, the Oregon Business Journal or Business Review may have a negative response towards the law whereas the local public broadcasting may have a more positive perspective on this new law. I hope that passing this nurse-patient ratio law will cheer and astonish all nurses and patients in Oregon. However, the general public may not see any immediate changes in the medical settings until several months have passed. Once this law goes into effect, we want to see long-term success for nurses as well as patients. I believe that many hospitals will study and analyze how successful this law will be. They will want to know if there are safer and better outcomes for patients and nurses in Oregon. Initially, the new law will increase costs, but hopefully the total costs will start to decline after the law is put into action. All of the positive results, which have been seen in California, are shown in evidence-based studies. Eventually, this law may pass in every state in the United States. This is just like the “smoke-free” law for public places, which also started in California. To implement a new law, like this nurse ratio proposal, the goal is to benefit people’s health overall.
C. Create a plan for working with an organization to address the public policy issue.
C.1. Identify an organization that has expressed interest on the policy. The organization I will address is the Oregon Nurse Association, ONA, which has over 12,500 nurses as members in Oregon and is an integral organization of the American Nurse Association, ANA.
C.1.a. Summarize evidence supporting why the organization has expressed interest in this policy. Although ONA doesn’t represent all nurses in Oregon, every nurse of the 30, 330 nurses in Oregon will benefit from ONA action, such as annually increasing hourly payment once or twice based on years of working. ONA’s headquarters are located at the city of Tigard and has branches in every other city. Additionally, there are representatives who work in local hospitals. ONA implements the changes and acts in response to the challenges for all nurses in practice, labor and politics. ONA’s mission as an organization is to facilitate higher standards of nursing and create a higher quality health care for all people ("History & Mission," 2017, p. 36). The ONA also advocates for Oregon nurses and leads these nurses in maintaining their benefits and rights. The ONA supported the Oregon Health & Science University’s nurses and won the case to resume their 0.75 FTE with whole medical benefits for the next three years in addition to renewing their contract with increasing hourly payment twice a year. This victory brings a higher satisfaction rate at the work place for nurses ("Agreement between ONA & OHSU," 2017). At the ONA convention meeting, ONA discussed with other hospital representatives critical issues, such as staffing and ethics. At this convention, the staffing committee increased transparency to empower the State Legislative to consider and implement a new safe staffing law ("Oregon’s nurse staffing law," 2014, p. 1). ONA not only leads and supports Oregon nurses in improving their performance, but also negotiates with the State to have a law for a safe, positive working environment and better health care outcomes.
C.2 Identify three CBRP principles you could use to work with the organization to address a policy change for the public policy issue. To comply with ONA’s mission, I will use community based participation study principles; I will build on strength and resources within the community, facilitate collaboration and equitable partnerships in all phases of research, and ensure a long-term commitment (Minkler, Vasque, Chang, & Miller, 2016, p. 13). Creating a partnership and building strength with ONA, like with Oregon Health & Science University, is one possible instance that I could facilitate a new policy for the state. ONA collaborates and starts out with its members in a cooperated and organized manner. The organization’s success will be a result of its long and consistent commitment in this long-term research project.
C.2.a. How would you could approach and collaborate. I have contacted my regional ONA representative, Mrs. Julie Kettler, and she is very knowledgeable and responsible. She responds to my calls and emails in a timely matter. I will email my proposal to her and express my plan with supportive data from the evidence-based studies and researches, and follow up by setting appointments with her through either a telephone call or an in-person meeting. Her role at ONA will help me to recruit her peers to be in my group, and together we will all be able propel my proposal into action. I will ask Mrs. Kettler to introduce me to her peers from ONA-NU-PAC (Nurse Unite Political Action Committee) which is a non-partisan group of people that consists of the director of government relation, a political organizer, lobbyists, lawyers, a regulatory nursing staff, and health specialists. Both of us will present my proposal with strong supportive evidence-based studies to the group of ONA-UN-PAC. Then as a team, we will work together to present the critical nursing staffing issue and pursue it to a law. I will ask Mrs. Kettler to lead this group and have a monthly meeting for this project.
C.2.b. Goal alignment. ONA’s evident goal as an organization is to “lead all nurses and professions for improvement of health and availabilities of health care service ("History & Mission," 2017, p. 1). Their vision is aligned with mine, which is to improve the quality of patient care and to have an optimal working environment for nurses. This will create the opportunity for ONA to stay at the front line and respond to these challenges and improve these conditions for the nurses in the state of Oregon.
C.2.c. Discuss the action steps that need to be taken to achieve you goal. The initial step is for me to call and email my regional representative, request a return call or personal meeting, and present my proposal and goals during our conversation in order to persuade her to let me present with her to the ONA-NU-PAC. Moreover, as a community group, we will collaborate from there on out to obtain access to the chair and vice chair to endorse our policy. We will also go to ONA yearly conventions, ONA staffing meetings, and other hospitals to present our goal, simultaneously collecting data to enrich the data we already have that supports our policy change. Once everything has been refined through the process of research studies and collaboration, the ONA-NU-PAC will make a meeting with the two chairs, who are essentially the decision makers, of Oregon State Legislature, House Committee on Health Care. We will persuade and convince these two chairs to aid our policy proposal.
C.2.d. Discuss the possible roles/responsibilities of the community or organization members. An important role in this group is the regional representative, who has worked for ONA for over 20 years and had the most important role in helping nurses during OHSU’s nurse contract negotiation. She will be my facilitator to help me set up the initial meeting, monthly meeting, and town house meeting. I will deliver our plan by serving as a messenger, speaking to each group member personally. In spite of the regional representative, the most important role would be the lobbyists, who have strong relationships with law makers and better access to Oregon State legislature. They will present our proposal to the law makers and convince them of the importance of this policy. Lobbyists have potential and skills best suited for public relations, and will be the best resource to solve and get past the obstacles, ultimately being the key to persuading the law makers of our objective. The next very important role is the political organizer, who is very experienced on Legislature ballot champions. She will push this proposal to the State, convincing them to pass the policy. She is also the right person to notify the public about our proposal and put in contact with social medias like the local news television reports and newspapers. She will also make sure that the new reporters and journalists will be present in hospital meetings, at town hall meetings, and at public hearings. Moreover, the regulatory staff will be the facilitators and messengers responsible for contacting social medias and hospitals, spreading word of our plan and proposal. Their job will also consist of bringing the input from the public back to our group. Overall, every member in our group will work hard and complete the tasks that their roles consist of in order to push this proposal to law.
C.2.e. Discuss key elements of developing a collaborative evaluation plan, using CBPR principle. The CBPR principle we will select to facilitate my proposal to become a law is to use a community based anticipation study group. We will use many skillful and resourceful members from ONA-NU-PAC during this process. It will be considered a success if I see our members embrace this principle on building on strength and resources within the community. If the ONA-NU-PAC team and I collaborate in making adjustments based off of the research and align the agreements without biases, then this process will be victorious as it expedites equitable partnership in all phases of this project. By consistently working toward our long-term goal together and keeping true commitment to our purpose, we will reach the achievement of completing this long term this project. If we are successful in reaching our goal, we will continue to be pioneers for our purpose once the policy is supported, and our roles may rotate when this policy becomes a bill and, with confidence, a law. We will continue to influence the public and legislature, mostly relying on the lobbyists midst this phase.
C.2.f. Discuss how you will evaluate the success of your organization plan. A checklist is a good way to evaluate the advancement of this process. The aim of the checklist is to check-off each step, starting from the beginning of this process – such as my initial call, email, and meeting with the reprehensive – to the return calls and emails, presentations, the presenting of evidence to ONA-NU-PAC, meetings with lobbyists, town house meetings, conventions, attending ONA-NU-PAC meetings, gaining supports of the two co-chairs, and getting sponsored by them. This will be helpful and track any obstacles that occur. If I find there to be any obstacles, I will solve the problem by making some realistic adjustments to push this proposal forward. This adjustment will be made with an algorithm: if not this, then that. By going forward this process, though it may not result in the way as expected, the checks and balances put in place will be, at the very least, enough to address the items that haven’t been checked off. We will set up goals at the three-month mark, six-month mark, and at the end of the year. In first three months, the main objectives will be to have already presented to ONA-UN-PAC and to be prepared to give the presentation to the chair and vice chair. In following three months, if either we or the lobbyists have presented to the two chairs and our members of ONA-UN-PAC are informed of our goal to be invited to participate, then our sixth-month goal will be achieved and we can move towards our final goal. By the end of the year, we will be successful if we have collaborated with everyone and worked hard to push the bill to pass, ultimately making our policy a law. After becoming a law, the hospitals in Oregon will take long time, perhaps two or more years, to develop a staffing and financial plan suited for this new law. Fortunately, some of members of ONA-UN-PAC committee are part of the staffing committees at the hospitals. They will become facilitators in helping the hospitals fulfill the new law, working toward putting the “Go Live Date” in the hospital events calendar. As a result, we will see an effective outcome, including the increase of patient and nurse satisfaction, fewer injuries, and less infections in the hospitals.
D. analyze the strengths and challenges of the top to down and bottom-up approaches in achieving policy issue.
1. Discuss the strengths of each approach to implement change for the selected public policy issue. The strength of the top-to-down approach is that ONA will concentrated on using their resources with a clear and consistent goal in mind, and will not utilize everyone from the community all at once. This will benefit ONA because then the organization won’t have to pay for unnecessary expenses and logistical resources at the beginning of the process. The bottom-to-up approach will benefit the organization as well; there will be high visibility during the early stages of the operation, creating an ample drive towards achieving our goal, and benefits already have been taken note of at the first phase of our implementation.
2. Discuss the challenges of each approach to implement change for the selected public policy issue. During the first phases, the top-down approach will be limited, for the process is very precise and much more defined. Furthermore, foreseen benefits of the top-down approach will not appear instantly, but instead will take some time to develop and come forth. It is possible that during this waiting period, a lot of time will be wasted. On the contrary, using the bottom-up approach has the potential of creating a challenge if the organization and plan have to be altered later in the future. This might also serve as an obstacle because this approach doesn’t follow a strict business process, but instead may follow existing patterns that are more dissipative ("Top-down and Bottom-up," 2013).
3. Discuss which approach you would recommend as the most effective to address the selected public policy issue. I think the bottom-up approach will be most effective in turning my proposal into a law. I would also have to use the community-based theory of CBPR during this process. With this approach, the proposal will have a quicker response from a variety of social medias, including the evening news, town hall meetings, and ONA conventions. The members of ONA-UN-PAC will go to different cities to meet new people and explain to them the importance of this new policy. Politicians will engage more when all of the voices of these communities combined advocate for this new policy and demonstrate its urgency. This will force the organization and law makers to investigate the effectiveness and benefits of this new policy. In terms of activism, it wouldn’t be shocking if nurses and other community members organize a peaceful demonstration to express the urgent need for safety among nurses and patients. An example of this would be a march in front of the State Capitol, which resides in Salem. If something of this sort occurs, reporters and journalists will be there, spreading the voices and opinions of the nurses to the public. An event like this will push the two chairs of the House Committee on Health Care to meet with our representatives about moving towards implementing a new policy.
In conclusion, there are a variety of ways to go about achieving more appropriate patient staffing. However, the overloaded nursing working force and raised numbers of the aged population are critical issues that must be addressed. If this policy passes and becomes a law, then I know that Oregonians will obtain the great Health Care benefits, ultimately influencing each resident of Oregon in a positive way.