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Policy Briefing Document

Policy Briefing Document

Part One – Process of Legislation

The safe staffing ratios legislation, A.B. 394, was prompted by notable nursing supply shortages affecting California. Prior to the legislation, research evidence had identified nursing shortages and low staffing levels in primary and acute care settings in California and other states like New York (Dracup & Bryan-Brown, 1998). California also had an issue with health facilities employing unregistered and unlicensed nurses, which risked the quality and safety of care provided. The nursing shortage experienced in the time before the legislation had been enacted, evidence showed that most hospitals, especially in emergency rooms, were overcrowded (Coffman & Spetz, 1999), which is noted to have also led to some patients being diverted to other hospitals (Coffman & Spetz, 1999). The unbalanced supply of nurses amid high demand for healthcare services also resulted in the available nursing staff being overloaded with work, suffering burnout, and poor nursing care delivered. Notably, low nurse staffing levels are a risk factor for missed nursing care and poor patient outcomes (Rosenberg & Mechcatie, 2019).

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The legislation was proposed by the registered nurses of California following the issues of poor levels of nursing staff. Through the California Nurses Association (CNA), the registered nurses of California prepared the legislation and passed it to the Californian legislature for debate. The CNA sponsored and lobbied other nursing unions and other healthcare advocacy groups to push for the passage and enactment of the legislation. The legislative process took a while, from when the basic idea was proposed to when it was put into effect. The law was passed by the California Legislature in 1999 and signed into law by the governor. However, it was fully implemented in 2004, five years later. The major critical elements of the legislation that were passed include the mandates for specific nurse-to-patient staffing ratios in hospitals, nursing homes, clinics, and units, as well provisions for reporting and enforcement to ensure compliance with the established ratios as well provisions for reporting and enforcement to ensure compliance with the established ratios. (Spetz et al., 2009).

Part Two – Outcome of Legislation

Available research evidence supports the A.B. 394 take that mandated ratios improve nurse turnover rates and patient outcomes. For instance, a study by Spetz et al. (2009) linked mandated nurse-to-patient staffing ratios to reduced nurse strain and burnout with lower turnover intentions and improved quality of care. Recent studies, such as studies by Pang et al. (2020), related nursing rations as a factor for nurses’ depression, poor quality of life, as well as increased turnover intentions, while Yun and Yu (2021) note increasing nursing supply hence adequate staffing as an intervention that significantly reduces nurse burnout and job dissatisfaction leading to decreased turnover intentions and rates. On the other hand, evidence from research such as that presented by Aiken et al. (2018) and Carthon et al. (2019) indicates that adequate nurse supplies lead to increased staff engagement with an impact on the safety of care delivered and the satisfaction of patients with the nursing care.

Recommendations for Nursing Leader’s Support on Similar Legislation

The evidence so far supports safe nursing ratios legislation in California. My nursing leader should support and work with other nurse leaders to push for similar legislation in all states across the U.S. The pros of this recommendation are that; working with other nurse leaders with other nurse leaders will increase their lobbying powers and influence to make similar legislation universal in the U.S. Additionally, as evidenced by mandated nursing ratios in California (Spetz et al., 2009), it will help address the current issue of nursing shortages in the U.S. However, pushing for similar legislation for all states may not be possible due to the lack of universal funding across states, as well as the rigidity of mandated nursing ratios may lead to unfair nursing staff distributions across some states to variations in patient acuity and demand for healthcare in other units and states.


Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M., & Griffiths, P. (2018). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 8(1).

Carthon, J. M. B., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A. M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Association of nurse engagement and nurse staffing on patient safety. Journal of Nursing Care Quality, 34(1).

Coffman, J., & Spetz, J. (1999). Maintaining an adequate supply of RNs in California. Journal of Nursing Scholarship, 31(4).

Dracup, K., & Bryan-Brown, C. W. (1998). One more critical care nursing shortage. In American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses (Vol. 7, Issue 2).

Pang, Y., Dan, H., Jung, H., Bae, N., & Kim, O. (2020). Depressive symptoms, professional quality of life and turnover intention in Korean nurses. International Nursing Review, 67(3).

Rosenberg, K., & Mechcatie, E. (2019). Low RN staffing levels are linked to missed care. In The American journal of nursing (Vol. 119, Issue 1).

Spetz, J., Chapman, S., Herrera, C., Kaiser, J., Seago, J. a, & Dower, C. (2009). Assessing the impact of California’s nurse staffing ratios on hospitals and patient care. California Health Care Foundation, Feb.

Yun, M. R., & Yu, B. (2021). Strategies for reducing hospital nurse turnover in South Korea: Nurses’ perceptions and suggestions. Journal of Nursing Management, 29(5).


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Policy Briefing Document

Policy Briefing Document

Explain the process of policy-making in healthcare delivery.

Student Success Criteria
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Your nursing leader has asked you to provide her with information regarding the legislation on California’s nursing union-negotiated staffing ratios. You will prepare a policy briefing document that details the process and outcome associated with this piece of legislation. Your nursing leader will use this briefing document to guide her decision on whether this is a good policy to support in your state.

Prepare a policy briefing document that:

Part One – Process of Legislation

Explains the critical concern(s) that prompted this legislation, who proposed the issue, as well as who drafted and sponsored this legislation.
Describes how long the process took and the steps taken from the initial idea to legislation implementation as well as the critical elements of the legislation that was passed.
Part Two – Outcome of Legislation

Answers the following questions:
Does the research support that mandated ratios improved nurse turnover rates?
Does the research support that mandated ratios improve patient outcomes?
Discusses recommendations on whether your nursing leader should support working with other nurse leaders on similar legislation.
Examine at least two pros and two cons for your recommendation based on research.
Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the policy briefing document.

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