Analyzing Healthcare Regulations and Impact on Nursing Practice

This essay discusses the impact of current healthcare laws and regulations in Massachusetts on nursing practice, specifically focusing on nurse staffing legislation passed in 2014. The legislation mandates specific nurse-to-patient ratios in ICUs and emphasizes the development of acuity tools for standardized staffing levels and quality indicators for public reporting. The paper also examines the influence of value-based purchasing programs, promoted by the Centers for Medicare & Medicaid Services (CMS), on the quality of care provided. It highlights the direct relationship between optimal nurse staffing and reduced mortality rates, as well as the potential for enhanced medical costs and patient-centered care resulting from the implementation of the legislation. The essay concludes that the legislation serves as a national experiment to improve care delivery for patients with chronic illnesses.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
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Author Note:

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Consider the current laws and regulations that affect healthcare operations in your state.
How do these regulations impact nursing practice? How do current healthcare finance
regulations, specifically value-based purchasing, impact the quality of care that is provided?
The healthcare industry has been identified as the most dynamic industry which is
continually subjected to diverse patient needs and novel therapeutic inventions. In order to
promote effective care and improve the quality of service delivery, every year healthcare laws
and regulations are revised. This paper intends to discuss the legislation on nurse staffing in
Massachusetts and the implication of the legislation on nursing practice. The legislation was
passed on June 30th, in the year 2014 by the Masachusetts Governor Deval Patrick as he
signed the Bill H.4228 where it required hospitals to staff ICUs according to 1:1 or 1:2 nurse
to patient ratio (Nursingcenter.com, 2019). The legislation was a compromise between the
Massachusetts Nurses Association that represented a proportion of the state’s Nurses as well
as the Massachusetts Hospital Association. The Masachusetts Hospital Administration voiced
against the mandatory staffing ratio law that was proposed by the MNA in the ballot that was
one of the agenda in the November 2014 elections. The present scenario suggests that
Masachusetts is the second state that is in need of mandatory nurse staffing ratio within the
intensive care unit so as to avoid adverse medical events. The legislation involves two
integral aspects that need attention. The first being the need to develop an acuity tool in order
to standardize staffing levels and the second to establish a minimum to 3 quality indicator
items to monitor public reporting within hospitals (McHugh, Berez & Small, 2013). It can
hence be mentioned that the two elements mentioned above present a relative flexible
approach to the stringent mandatory staffing legislation and ideally takes into consideration
the elements of patient acuity, outcome of nursing care as well as nurse staffing care.
A number of research studies have indicated the presence of a direct relationship
between optimal nurse staffing and a massive reduction in the rate of unexpected mortality

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and length of stay within the hospital (Chen et al., 2013; Shindul-Rothschild et al., 2017).
Further, the value based purchasing program, an initiative promoted by the Centers for
Medicare & Medicaid Services (CMS) sheds light on the benefit accrued by the Affordable
Care Act (Shindul-Rothschild et al., 2017). The CMS typically retains the portion of the
hospital’s reimbursement and only on submission of the metrics, the reimbursement is
adjusted on the basis of the quality of services offered by the hospital to the patient. It should
further be noted that hospitals across Massachusetts are a part of the VBP program on a
mandatory basis. This explains the reason why the National Quality Forum Indicators that are
used by the CMS might be chosen as the quality criteria by the healthcare organizations
across Massachusetts. In this context, the nurse staffing ratio would directly be related to the
patient outcome.
Therefore, it can be mentioned that the legislation on nurse staffing has a significant
implication to the nursing profession. The legislation serves as a national experiment that
would ideally indicate the level of improvement in the care delivery process that could help
in serving patients with chronic illness in an effective manner. Also, it can be commented that
the implementation of the legislation would lead to an enhanced medical cost pertaining to
patient priority and stretched duration for the provision of patient-centred care.

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References:
Chen, L. M., Birkmeyer, J. D., Saint, S., & Jha, A. K. (2013). Hospitalist staffing and patient
satisfaction in the national Medicare population. Journal of hospital medicine, 8(3),
126-131.
McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals with higher nurse staffing had
lower odds of readmissions penalties than hospitals with lower staffing. Health
Affairs, 32(10), 1740-1747.
Nursingcenter.com (2019). Massachusetts New Nurse Staffing Law. [online]
Nursingcenter.com. Available at: https://www.nursingcenter.com/journalarticle?
Article_ID=2620058&Journal_ID=54024&Issue_ID=2620057 [Accessed 10 Mar.
2019].
Shindul-Rothschild, J., Read, C. Y., Stamp, K. D., & Flanagan, J. (2017). Nurse staffing and
hospital characteristics predictive of time to diagnostic evaluation for patients in the
emergency department. Journal of Emergency Nursing, 43(2), 138-144.