Policy, Politics, and Global Trends.

INTRODUCTION For this assessment, you will be required to develop and thoroughly analyze a public policy in order to advocate for one that improves the health of the public and/or the nursing profession globally (local, state, national, or international). To do this, you will reflect on several aspects of being a policy maker within the nursing position. A few things to consider are: • Why did you select the health or nursing profession policy issue? • How does this issue affect nursing practice, healthcare delivery, and health outcomes for individual, families, and/or communities? •

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What are the values and the ethical positions that underpin your perspectives? •Policy, Politics, and Global Trends. What are the criteria you will use to evaluate the success (outcomes) of your proposed policy change? By using both a top-down and a bottom-up approach, you will analyze and bring the nursing perspective to policy makers and stakeholders. Identifying the values and ethical perspectives that underpin your position, you will develop criteria to evaluate the success of your work. This will lead to a created a policy brief that can be sent to decision makers and created a plan to work with an organization/community to promote policy change at the local level. To guide you to your conclusion, using nursing research to support your position is vital. This should include principles of community-based participatory research (CBPR). REQUIREMENTS Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide. Professional Communications is a required aspect to pass this task. Completion of a spell check and grammar check prior to submitting your final work is strongly recommended.Policy, Politics, and Global Trends. You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. Note: Your submission may take the form of an essay, multimedia presentation, etc. Be sure to cover each prompt in sufficient detail and support no matter what form you use. A. Prepare your reflection essay (suggested length of no more than of 3 pages) of the values and ethics of a public policy issue by doing the following: 1. Analyze a health or nursing profession public policy issue that impacts a group of people and requires a policy change. a. Discuss why you selected this public policy issue. Note: If you select a local policy, be sure your discussion reflects how the policy will affect more than a single unit, department, or organization. b. Discuss the relevance of the public policy issue to the health or the nursing profession, using two pieces of academically appropriate literature from the last five years. c. Describe the financial impact of the public policy on an organization or on a community. 2. Analyze how your values impact your position on the public policy issue. a.Policy, Politics, and Global Trends. Discuss the ethical principle (e.g., autonomy, beneficence, non-maleficence, justice) or theory that underpins your perspective. B. Develop a policy brief (suggested length of no more than 6 pages) for the public policy issue discussed in part A in which you do the following: 1. Identify the decision maker (name and title) who will receive the policy brief. a. Explain why the public policy issue requires the decision maker’s attention, using relevant nursing research from the last five years to support your position. 2. Discuss the main challenges of addressing the selected public policy issue. 3. Discuss the primary options and/or interventions for the decision maker, including why they are tangible. 4. Propose a persuasive course of action for the decision maker, including ways to avoid the challenges identified in part B2. 5. Discuss how you will evaluate the success of your policy brief (top-down approach). C. Create a plan (suggested length of no more than 3 pages) for working with an organization or a community to address the public policy issue analyzed in part A by doing the following: 1. Identify an organization or community that has expressed interest in your selected health or nursing profession public policy issue. a. Summarize evidence supporting why the organization or community has expressed interest in the selected public policy issue. 2. Identify three CBPR principles you could use to work with the organization or community to address a policy change for the public policy issue. a. Explain how you could approach and collaborate with the organization or community. b. Discuss how the goal of the community or organization aligns with your goal for the selected public policy issue. c. Discuss the action steps that need to be taken to achieve your goal from part C2b. d. Discuss the possible roles/responsibilities of the community or organization members, including problem-solving and capacity-building roles. e. Discuss key elements of developing a collaborative evaluation plan, using CBPR principles. f. Discuss how you will evaluate the success of your community or organization plan (bottom-up approach).Policy, Politics, and Global Trends. D. Analyze (suggested length of 1 page) the strengths and challenges of the top-down and bottom-up approaches in achieving policy change(s) to support your selected public policy issue by doing the following: 1. Discuss the strengths of each approach to implement change for the selected public policy issue. 2. Discuss the challenges of each approach to implement change for the selected public policy issue. 3. Discuss which approach you would recommend as the most effective to address the selected public policy issue. E. When you use sources, include all in-text citations and references in APA format. Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment. File Restrictions File name may contain only letters, numbers, spaces, and these symbols: ! – _ . * \’ ( ) File size limit: 200 MB File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z

Part A. Reflection essay

The policy issue of concern is nurse staffing, specifically short staffing in the USA. There is a severe shortage of nurse personnel with the associated statistical trends indicating that the concern is expected to worsen over time. The supply of new nurses in the USA falls short of the demand by 203,700 every year as the country can only supply 438,100 new nurses and yet it needs 641,800 nurses every year.Policy, Politics, and Global Trends. The concern is exacerbated by the ageing nursing personnel, financial pressures, and unfavorable working conditions that result in high turnover so that the available nurse numbers are unable to meet the needs due to replacement hiring and occupations growth. The issue has been considered relevant because it has implications for nursing care delivery. The shortages imply that nurse personnel do not have enough time to provide the professional care that is necessary for patients as well as their families (American Association of Colleges of Nursing, 2020).Policy, Politics, and Global Trends.

Besides that, the issue results in nurses feeling like they are not doing enough thus resulting in higher dissatisfaction levels and burnout, situations known as moral distress. It is physically and emotionally draining for the understaffed and overworked nurses who repeatedly feel that they are unable to provide the professional nursing care they think is necessary. In addition, short staffing among nurse personnel has negative implications for patient safety by limiting nursing care penetration thus increasing mortality, morbidity and error rates. Also, it has implications for nurse turnover rates in the health care settings (Rosenberg, 2019). The concern about nurse shortage is extensive and affects the whole country. As a result, there is a need for policy change that would realistically and sustainably improve nurse staffing levels to address the current needs while anticipating future needs (Morris, 2019).Policy, Politics, and Global Trends.

Nurses are the largest single medical profession that is responsible for providing primary care and handling most aspects of patient care. As such, it is not hard to accept that their numbers within the health care environments (specifically ratios) has implications for patient safety and health care quality. In fact, inadequate nurse staffing levels are linked to adverse events such as in-hospital mortality, medication errors, health care related infections, and patient falls. In addition, it can be accepted that adequate nurse staffing levels would improve care outcomes through allowing nurses to spend more time in providing direct care and engaging in interactions with patients and other participants in the health care environment. Insufficient nurse staffing results in the care time being rationed, and this has implications for the occurrence of missed care (Haegdorens, 2019).Policy, Politics, and Global Trends.

Medical facilities are aware of this reality and face it regularly so that they seek to achieve a balance between the number of nurses engaged and workload as influenced by fiscal realities. Medical facilities have typically used a patient classification system to determine how nurse personnel resources are distributed in the units and departments within the facility. The patient classification system uses subjective and objective measures of nursing care dimensions to determine financing. This allows them to develop nurse-to-patient ratios (defined as the proportion of nurses available to each patient) that are used to distribute nurse personnel across the facility. The ratios estimate the number of nurse personnel required based on the number of occupied beds. However, the use of nurse-to-patient ratios is faulted for failing to take into account the care complexities of each department or unit within the facility (Haegdorens, 2019).Policy, Politics, and Global Trends.

The solution identified for the shortcoming is to incorporate patient acuity in developing the nurse-to-patient ratios that are specific to each department and unit. This solution is expected to result in more nurses being engaged, although the numbers would be optimized for the best care and financial outcomes. In addition, international nurse staffing should be facilitated by partnering with international nurse staffing companies thereby acting as a strategic way to build an expert core of nurse staff while limiting disruption and turnover. Policy, Politics, and Global Trends.The international nurses would be engaged for long-term assignments to help stabilize the nurse short staffing issue and mitigate patient care concerns that result from low nurse staffing. Besides that, increasing scholarships would be important for ensuring that more nurses are trained and the local population of nurses is able to meet the existing staffing need. The identified solution would be framed as a federal policy that is applied in all medical facilities across the country (Doenges, Moorhouse&Murr, 2019).Policy, Politics, and Global Trends.

Nurse wages and benefits have typically constituted a substantial proportion of overall costs for medical organizations. Efforts to control costs by medical facilities have addressed this concern by focusing on reducing nurse staffing as a means for increasing costs and reducing profitability. However, the proposed solution would reverse some of these gains. Through engaging more nurses in optimized numbers within a competitive environment is expected to improve outcomes for both nurses and patients without having an adverse effect on financial performance. To be more precise, increasing the number of numbers is expected to lower their workloads so that mortality rates are similarly reduced with overall cost savings being the outcome. In addition, it reduces hospital acquired infections, length of stay, and improves productivity (Doenges, Moorhouse&Murr, 2019).

The issue of short staffing among nurse personnel has ethical implications. The shortage challenges the values of the nursing profession. My personal values are aligned with these principles, and I personally believe that medical personnel must make every effort not to cause harm to patients. The nursing shortage challenges my personal values, as well as the principles of beneficence, non-maleficence and justice.The principle of beneficence is concerned with doing good and the right thing for patients. Policy, Politics, and Global Trends.The principle of non-maleficence is concerned with doing no harm, whether intentional or unintentional. The principle of justice is concerned with ensuring fairness and equitability in nursing care distribution. Short staffing among nurses makes it difficult for them to meet the obligatory conditions of the three principles. The shortage causes nurses to experience job dissatisfaction and emotional distress while limiting their ability to provide quality care to their patients. The nurses are then forced to choose between caring for the needs of their patients or their own welfare. Besides that, nurse personnel must fulfil their assigned daily duties, but the shortage makes this challenging as they are assigned many patients whom they cannot adequately protect from harm or provide the required care for the best outcomes. It is my personal opinion that nurses should not cause harm, and this is best guaranteed through optimized nurse numbers that can offer the required medical care (Perry, Potter &Ostendorf, 2016).Policy, Politics, and Global Trends.

Part B. Policy brief

The policy issue (short staffing in nursing) as well as the proposed solution would be presented to Senator Lamar Alexander (Rep-TN), the chairman of the US Senate Committee on Health, Education, Labor and Pensions. The proposed policy solution requires the attention of Sen. Alexander since his committee is charged with comprehensively studying and reviewing matters relating to health and reporting them to the rest of the senate. The committee has a broad jurisdictional responsibility over health care issues at the federal level. Besides that, Sen. Alexander is a senator has the opportunity to propose new policies for legislative consideration. He can use the opportunity to present the proposed health policy to the senate and help with drumming up support for favorable legislation. Besides that, he is among the few number of legislators who can introduce legislation. This is important since anyone can write a bill to be introduced to the Senate and Congress, but only legislators can introduce legislation (Pierce & Smith, 2014).Policy, Politics, and Global Trends.

Addressing the issue of nurse short staffing in the USA presents five challenges. The first challenge is nurse retirements and ageing workforce. As significant number of nurses are ageing and are being forced into retirement without adequate numbers of qualified nurses to replace them. Like the ageing population that they serve, nurse personnel are also ageing with 33% of the workforce expected to retire within the next 15 years. This number includes the nurse personnel who serve patients as well as the faculty members who train new nurses so that enrolment limitation is expected. The second challenge is the increasing need of nursing services. Advances in medical technologies have resulted in a significant number of Americans living for longer and requiring medical care in old age. Many health concerns that were previously terminal are now survivable for the long-term, and offering them nursing care places a strain on the available workforce. As the American population ages, there need for nursing services increases. This concern is confounded by the fact that geriatric populations do not typically have a single morbidity, and will typically have multiple co-morbidities and diagnosis (Murray, 2017). The third challenge is nurse burnout. Some of the nurses graduate from education programs, start working in understaffed environments and realize that it is stressful and the profession is not what they envisioned. This causes some nurses to experience burnout so that they opt to leave the profession.Policy, Politics, and Global Trends. The fourth challenge is regional imbalance. Although there is an overall nurse shortage in the USA, the reality is that some facilities have adequate number of nurses while others have surpluses. The shortage amounts vary across regions and presenting a federal legislation that standardizes staffing ratios across the country would result in some facilities reducing the number of nurses they have thereby resulting in reduced care quality. The final challenge is the financial implications. Every nurse hired comes at a cost. Although there is a desire to ensure that every patient has a dedicated nurse, there financial reality is that this is not feasible as personnel attract costs that would rise as more personnel are hired without necessarily increasing incomes thereby reducing profits (Murray, 2017).Policy, Politics, and Global Trends.

A multimodal solution has been identified as appropriate for addressing the issue of nurse short staffing. The proposed solution has three aspects. The first aspect is to match nurse-to-patient ratios with patient acuity levels for each department. The patient acuity system helps in organizing nurse placement so that patients who have greater nursing needs are assigned to more skilled and experienced nurses. Policy, Politics, and Global Trends.The system more accurately calculates the number of nurses and working hours needed in a given care situation to ensure a targeted outcome. This is a tangible solution since it ensures that the available nurses are more efficiently and effectively allocated to work responsibilities for the best care outcomes. The second aspect is partnering with international nurse staffing companies to hire nurses from out of the country. This helps with expanding the scope of the area in which nurses are hired from so that the country has a larger pool of available nurses from which to hire personnel. This is a tangible solution since a nurse shortage in the USA does not necessarily imply that there is a nurse shortage across the world (Burton & Ludwig, 2015). Besides that, the USA offers attractive employment opportunities when compared to others countries and the USA government can leverage this by making it easier for professional nurses seeking to work in the USA. The third aspect is increasing scholarships and financial aids for nurses so that more people are motivated to train as nurses thereby increasing the number of qualified nurses across the country. More qualified nurses would be expected to logically pursue a nursing career and practice as nurses thereby helping to ease the existing personnel shortage. This is a tangible solution since it would act as a motivation for persons with a desire to pursue a nursing career to have training opportunities and qualifications to practice (Murray, 2017).Policy, Politics, and Global Trends.

This proposed multimodal solution is considered appropriate since it addresses the nurse short staffing issue from different perspectives. This solution combines the specific advantages of each of the three modes by designing an innovative solution specific to the actual situation in the USA. The first solution ensures that nurses are assigned to the specific locations where they are required so that patients with greater needs have more attention from nurses than those with fewer needs. The second solution increases the hiring pool without compromising the nurses’ quality as it allows the country to hire more nurses from foreign countries. The third solution ensures offers a more sustainable solution as it ensures that the country is able to meet nurse staffing needs using local resources (Peate& Wild, 2018).Policy, Politics, and Global Trends.

The multimodal solution also helps with avoiding the five challenges previously identified. The first challenge is nurse retirements and ageing workforce. The multimodal solution helps with addressing this challenge by presenting nurses to meet the current and future demands thereby replacing the nurses leaving the workforce. The second solution offers a ready and existing supply of nurses. The second challenge is the increasing need of nursing services. The multimodal solution helps with addressing this challenge by ensuring that adequate number of qualified nurses are available to meet the increasing needs. The second and third solutions ensure that the country has access to qualified nurses from the international arena to meet the existing demand, and is able to train more nurses to meet future demand (Murray, 2017).Policy, Politics, and Global Trends. The third challenge is nurse burnout. The first solution helps with addressing this challenge by ensuring the fair and equitable distribution of nurse resources to patients so that responsibilities and roles are matched with capabilities and personnel availability. This ensures that nurses are assigned to area where they are most needed. The fourth challenge is regional imbalance. The second solution helps in addressing this challenge by hiring nurses from out of the country. Unlike nurses hired from within the USA, nurses hired from foreign countries are not expected to have positing preferences so that they are able to address the needs of understaffed areas. The final challenge is the financial implications of getting more nurses to address the shortage. The first solution helps in addressing this challenge by assigning nurses based on patient acuity so that the cases that need the greatest attention similarly get the greatest attention while those that need the least attention get the least attention. This helps with matching incomes with expenditure and improving profit levels as the available nurse personnel are redistributed without necessarily having to hire additional nurses (Murray, 2017).Policy, Politics, and Global Trends.

The policy brief is intended as a concise summary of the policy options for dealing with the issue of nurse short staffing in the USA with recommendations on the best solution. The policy brief is intended for review by a senator who is anticipated to frame the presented multimodal solution as a bill for legislative discussions and eventual enactment as a legislation. The success of the policy brief will be evaluated based on how it proceeds through the legislative process. The first measure of success is the presentation as a bill for legislative discussion in the Senate and Congress. The second measure of success is public discussions about the policy issue and proposed solution as well as opinions of lobbyists and other stakeholders. The final measure of success is the proposed solution being enacted into law (Murray, 2017).Policy, Politics, and Global Trends.

Part C. Plan to address the public policy issue

The American Association of Colleges of Nursing (AACN) has expressed interest in the issue of nurse short staffing in the USA. This is an organization that was formed in 1969 and currently represents 840 nursing schools across the USA. The membership includes more than 45,000 faculty members and more than 543,000 students. It is the national voice of academic nurses and works to establish quality standards for nursing education, promotes public support for professional nursing practice, research and education, influences the nursing profession to improve health care, and aids nursing schools in implementing the quality standards for nursing education. The programs ran by AACN include nurse certification, accreditation, leadership development, health policy advocacy, and curriculum standards. The organization’s interest in addressing the issue of nurse short staffing stems from a need to improve nursing practice by improving opportunities for nursing education. This would allow the organization to secure sustained federal support for nursing practice and education, shape legislative policies affecting nursing education, and ensuring that nursing students have continuing financial assistance (American Association of Colleges of Nursing, 2020). Besides that, the AACN is aware of the issue and is currently working with other stakeholder to increase attention to the issue.Policy, Politics, and Global Trends. In addition, the organization is leveraging its resources to form collaborations, identify strategies and shape legislation to address the issue. In addition, the organization is concerned with keeping other stakeholders abreast of the issue by developing fact sheets and other sources of information (American Association of Colleges of Nursing, 2019).Policy, Politics, and Global Trends.

Three community-based participatory research (CBPR) principles will be applied to work with AACN. The first principle is building on the organization’s strengths and resources to ensure that nursing schools support the proposed solution and lobby for its application. The second principle is focusing on the relevance of the issue and solution. It acknowledges that a sustainable solution for addressing the issue is increasing the number of nurses, and this is best achieved by ensuring that prospective nurses have more training opportunities. The third principle is commitment to sustainability and the long-term process. The issue of nurse short staffing is present and expected to worsen. This calls for an immediate solution (hiring foreign nurses) and a more sustainable solution for the long term (training more nurses and acuity-based assignments).Policy, Politics, and Global Trends.

The AACN would be approached for collaboration through coalescing the available information on the issue. This helps with informing on the issue and highlighting its seriousness. In addition, prospective solutions would be presented and evaluated for feasibility. Besides that, a proposal would be presented for a collaborative committee to be set up with the focus in policy advocacy to address the issue (Peate& Wild, 2018). The goal of AACN is to improve nursing education and practice. This goal is aligned with the policy change since it allows the organization to be involved in improving nursing practice and education opportunities.Policy, Politics, and Global Trends.

Three action steps will be applied to ensure that AACN supports the policy change proposal. The first step is communicating with the organization on the policy issue, concerns and possible solutions. The second step is garnering support from other stakeholders by convincing them about the need for the policy change. The third step is preparing a report that coalesces the opinions of stakeholders with the best solution (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

The partnership with AACN will be managed through a committee with three members. The first member is the policy initiator with the other two members being representatives from AACN. The committee will have three responsibilities. The first responsibility is to present a formal document detailing the policy change to justify the proposed change. The second responsibility is to conduct and facilitate workshops with other stakeholders to collect their opinions on the proposed policy change. The third responsibility is to present a revised policy change document that incorporates the opinions of the stakeholders (Patton, Zalon&Ludwick, 2015).

The AACN would be engaged in leveraging its resources to garner support from policy makers for the proposed policy change. AACN has an extensive membership that includes nursing schools, faculty members and nursing students. In addition, it has links with other nursing organizations. These resources can be leveraged to gain support for the policy change while ensuring that it is framed in a manner the represents the best interests of the stakeholders (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

Three CBPR principles were identified as necessary for working with the AACN collaboratively and they form the core feature of the evaluation plan. The first principle is building on the organization’s strengths and resources to ensure that nursing schools support the proposed solution and lobby for its application. This principle will be evaluated by keeping track of the number of nursing schools and other organizations that support the policy change. The second principle is focusing on the relevance of the issue and solution. This principle will be evaluated by tracing changes in training opportunities for nurses as well as changes in numbers of nurses. The third principle is commitment to sustainability and the long-term process. This principle will be evaluated by keeping track of the changes in numbers of foreign nurses hired to work in the country, number of nurses trained, and use of acuity-based systems.Policy, Politics, and Global Trends.

The organization plan is based on three steps as previously identified. The first step is communicating with the organization on the policy issue, concerns and possible solutions. This step will be evaluated based on feedback from the organization. The second step is garnering support from other stakeholders by convincing them about the need for the policy change. This step will be evaluated based on changes in support levels from other stakeholders. The third step is preparing a report that coalesces the opinions of stakeholders with the best solution. This step will be evaluated based on opinions from stakeholders on whether the report includes their opinions (Patton, Zalon&Ludwick, 2015).

Part D. Challenges of top-down and bottom-up approaches

The top-down and bottom-up approaches have different strengths. The top-down approach has two strengths. The first strength is fast achievement of goals as tasks are streamlined. The second strength is focused use of resources as there is the process of making decisions is shortened. The bottom-up approach has two strengths. The first strength is that stakeholders have greater buy in as they are involved in all steps. The second strength is that stakeholders have greater awareness of the policy change (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

The two approaches have different challenges. The top-down approach has two challenges. The first challenge is low acceptance from stakeholders as there is limited input. The second challenge is low support from stakeholders as they are not involved in framing the policy change. The bottom-up approach has two challenges. The first challenge is that it takes long to apply as opinions are collected from the different stakeholders. The second challenge is that it adds to the duties of the stakeholders as they take much time and resources collecting opinions from stakeholders (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

Of the two approaches, the bottom-up approach presents the best option. Although this approach requires more resources and time, it ensures that the policy solution has much support from the stakeholders. This is unlike the top-down approach that could face opposition from other stakeholders who feel that they were not consulted and opinions disregarded (Patton, Zalon&Ludwick, 2015). As such, the bottom-up approach offers the best option for managing the policy change.

The policy issue of concern is nurse staffing, specifically short staffing in the USA. There is a severe shortage of nurse personnel with the associated statistical trends indicating that the concern is expected to worsen over time. The supply of new nurses in the USA falls short of the demand by 203,700 every year as the country can only supply 438,100 new nurses and yet it needs 641,800 nurses every year. The concern is exacerbated by the ageing nursing personnel, financial pressures, and unfavorable working conditions that result in high turnover so that the available nurse numbers are unable to meet the needs due to replacement hiring and occupations growth. The issue has been considered relevant because it has implications for nursing care delivery. The shortages imply that nurse personnel do not have enough time to provide the professional care that is necessary for patients as well as their families (American Association of Colleges of Nursing, 2020).Policy, Politics, and Global Trends.

Besides that, the issue results in nurses feeling like they are not doing enough thus resulting in higher dissatisfaction levels and burnout, situations known as moral distress. It is physically and emotionally draining for the understaffed and overworked nurses who repeatedly feel that they are unable to provide the professional nursing care they think is necessary. In addition, short staffing among nurse personnel has negative implications for patient safety by limiting nursing care penetration thus increasing mortality, morbidity and error rates. Also, it has implications for nurse turnover rates in the health care settings (Rosenberg, 2019). The concern about nurse shortage is extensive and affects the whole country. As a result, there is a need for policy change that would realistically and sustainably improve nurse staffing levels to address the current needs while anticipating future needs (Morris, 2019).Policy, Politics, and Global Trends.

Nurses are the largest single medical profession that is responsible for providing primary care and handling most aspects of patient care. As such, it is not hard to accept that their numbers within the health care environments (specifically ratios) has implications for patient safety and health care quality. In fact, inadequate nurse staffing levels are linked to adverse events such as in-hospital mortality, medication errors, health care related infections, and patient falls. In addition, it can be accepted that adequate nurse staffing levels would improve care outcomes through allowing nurses to spend more time in providing direct care and engaging in interactions with patients and other participants in the health care environment. Insufficient nurse staffing results in the care time being rationed, and this has implications for the occurrence of missed care (Haegdorens, 2019).Policy, Politics, and Global Trends.

Medical facilities are aware of this reality and face it regularly so that they seek to achieve a balance between the number of nurses engaged and workload as influenced by fiscal realities. Medical facilities have typically used a patient classification system to determine how nurse personnel resources are distributed in the units and departments within the facility. The patient classification system uses subjective and objective measures of nursing care dimensions to determine financing. This allows them to develop nurse-to-patient ratios (defined as the proportion of nurses available to each patient) that are used to distribute nurse personnel across the facility. The ratios estimate the number of nurse personnel required based on the number of occupied beds. However, the use of nurse-to-patient ratios is faulted for failing to take into account the care complexities of each department or unit within the facility (Haegdorens, 2019).Policy, Politics, and Global Trends.

The solution identified for the shortcoming is to incorporate patient acuity in developing the nurse-to-patient ratios that are specific to each department and unit. This solution is expected to result in more nurses being engaged, although the numbers would be optimized for the best care and financial outcomes. In addition, international nurse staffing should be facilitated by partnering with international nurse staffing companies thereby acting as a strategic way to build an expert core of nurse staff while limiting disruption and turnover. The international nurses would be engaged for long-term assignments to help stabilize the nurse short staffing issue and mitigate patient care concerns that result from low nurse staffing. Besides that, increasing scholarships would be important for ensuring that more nurses are trained and the local population of nurses is able to meet the existing staffing need. The identified solution would be framed as a federal policy that is applied in all medical facilities across the country. This solution has financial implications by requiring that more nurse be hired so that more money is spent on paying them without necessarily increasing the associated incomes (Doenges, Moorhouse&Murr, 2019).Policy, Politics, and Global Trends.

The issue of short staffing among nurse personnel has ethical implications. The shortage challenges the values of the nursing profession, particularly the principles of beneficence, non-maleficence and justice. The principle of beneficence is concerned with doing good and the right thing for patients. The principle of non-maleficence is concerned with doing no harm, whether intentional or unintentional. The principle of justice is concerned with ensuring fairness and equitability in nursing care distribution.Policy, Politics, and Global Trends. Short staffing among nurses makes it difficult for them to meet the obligatory conditions of the three principles. The shortage causes nurses to experience job dissatisfaction and emotional distress while limiting their ability to provide quality care to their patients. The nurses are then forced to choose between caring for the needs of their patients or their own welfare. Besides that, nurse personnel must fulfil their assigned daily duties, but the shortage makes this challenging as they are assigned many patients whom they cannot adequately protect from harm or provide the required care for the best outcomes (Perry, Potter &Ostendorf, 2016).Policy, Politics, and Global Trends.

Part B. Policy brief

The policy issue (short staffing in nursing) as well as the proposed solution would be presented to Senator Lamar Alexander (Rep-TN), the chairman of the US Senate Committee on Health, Education, Labor and Pensions. The proposed policy solution requires the attention of Sen. Alexander since his committee is charged with comprehensively studying and reviewing matters relating to health and reporting them to the rest of the senate. The committee has a broad jurisdictional responsibility over health care issues at the federal level. Policy, Politics, and Global Trends.Besides that, Sen. Alexander is a senator has the opportunity to propose new policies for legislative consideration. He can use the opportunity to present the proposed health policy to the senate and help with drumming up support for favorable legislation. Besides that, he is among the few number of legislators who can introduce legislation. This is important since anyone can write a bill to be introduced to the Senate and Congress, but only legislators can introduce legislation (Pierce & Smith, 2014).Policy, Politics, and Global Trends.

Addressing the issue of nurse short staffing in the USA presents five challenges. The first challenge is nurse retirements and ageing workforce. As significant number of nurses are ageing and are being forced into retirement without adequate numbers of qualified nurses to replace them. Like the ageing population that they serve, nurse personnel are also ageing with 33% of the workforce expected to retire within the next 15 years. This number includes the nurse personnel who serve patients as well as the faculty members who train new nurses so that enrolment limitation is expected. Policy, Politics, and Global Trends.The second challenge is the increasing need of nursing services. Advances in medical technologies have resulted in a significant number of Americans living for longer and requiring medical care in old age. Many health concerns that were previously terminal are now survivable for the long-term, and offering them nursing care places a strain on the available workforce. As the American population ages, there need for nursing services increases. This concern is confounded by the fact that geriatric populations do not typically have a single morbidity, and will typically have multiple co-morbidities and diagnosis (Murray, 2017). The third challenge is nurse burnout. Some of the nurses graduate from education programs, start working in understaffed environments and realize that it is stressful and the profession is not what they envisioned. This causes some nurses to experience burnout so that they opt to leave the profession. The fourth challenge is regional imbalance. Although there is an overall nurse shortage in the USA, the reality is that some facilities have adequate number of nurses while others have surpluses. The shortage amounts vary across regions and presenting a federal legislation that standardizes staffing ratios across the country would result in some facilities reducing the number of nurses they have thereby resulting in reduced care quality. The final challenge is the financial implications. Every nurse hired comes at a cost. Although there is a desire to ensure that every patient has a dedicated nurse, there financial reality is that this is not feasible as personnel attract costs that would rise as more personnel are hired without necessarily increasing incomes thereby reducing profits (Murray, 2017).Policy, Politics, and Global Trends.

A multimodal solution has been identified as appropriate for addressing the issue of nurse short staffing. The proposed solution has three aspects. The first aspect is to match nurse-to-patient ratios with patient acuity levels for each department. The patient acuity system helps in organizing nurse placement so that patients who have greater nursing needs are assigned to more skilled and experienced nurses. The system more accurately calculates the number of nurses and working hours needed in a given care situation to ensure a targeted outcome. This is a tangible solution since it ensures that the available nurses are more efficiently and effectively allocated to work responsibilities for the best care outcomes. Policy, Politics, and Global Trends.The second aspect is partnering with international nurse staffing companies to hire nurses from out of the country. This helps with expanding the scope of the area in which nurses are hired from so that the country has a larger pool of available nurses from which to hire personnel. This is a tangible solution since a nurse shortage in the USA does not necessarily imply that there is a nurse shortage across the world (Burton & Ludwig, 2015). Besides that, the USA offers attractive employment opportunities when compared to others countries and the USA government can leverage this by making it easier for professional nurses seeking to work in the USA. The third aspect is increasing scholarships and financial aids for nurses so that more people are motivated to train as nurses thereby increasing the number of qualified nurses across the country. More qualified nurses would be expected to logically pursue a nursing career and practice as nurses thereby helping to ease the existing personnel shortage. This is a tangible solution since it would act as a motivation for persons with a desire to pursue a nursing career to have training opportunities and qualifications to practice (Murray, 2017).Policy, Politics, and Global Trends.

This proposed multimodal solution is considered appropriate since it addresses the nurse short staffing issue from different perspectives. This solution combines the specific advantages of each of the three modes by designing an innovative solution specific to the actual situation in the USA. The first solution ensures that nurses are assigned to the specific locations where they are required so that patients with greater needs have more attention from nurses than those with fewer needs. The second solution increases the hiring pool without compromising the nurses’ quality as it allows the country to hire more nurses from foreign countries. The third solution ensures offers a more sustainable solution as it ensures that the country is able to meet nurse staffing needs using local resources (Peate& Wild, 2018).Policy, Politics, and Global Trends.

The multimodal solution also helps with avoiding the five challenges previously identified. The first challenge is nurse retirements and ageing workforce. The multimodal solution helps with addressing this challenge by presenting nurses to meet the current and future demands thereby replacing the nurses leaving the workforce. The second solution offers a ready and existing supply of nurses. The second challenge is the increasing need of nursing services. The multimodal solution helps with addressing this challenge by ensuring that adequate number of qualified nurses are available to meet the increasing needs. The second and third solutions ensure that the country has access to qualified nurses from the international arena to meet the existing demand, and is able to train more nurses to meet future demand (Murray, 2017). The third challenge is nurse burnout. The first solution helps with addressing this challenge by ensuring the fair and equitable distribution of nurse resources to patients so that responsibilities and roles are matched with capabilities and personnel availability. This ensures that nurses are assigned to area where they are most needed. The fourth challenge is regional imbalance. The second solution helps in addressing this challenge by hiring nurses from out of the country. Unlike nurses hired from within the USA, nurses hired from foreign countries are not expected to have positing preferences so that they are able to address the needs of understaffed areas. The final challenge is the financial implications of getting more nurses to address the shortage. The first solution helps in addressing this challenge by assigning nurses based on patient acuity so that the cases that need the greatest attention similarly get the greatest attention while those that need the least attention get the least attention. This helps with matching incomes with expenditure and improving profit levels as the available nurse personnel are redistributed without necessarily having to hire additional nurses (Murray, 2017).Policy, Politics, and Global Trends.

The policy brief is intended as a concise summary of the policy options for dealing with the issue of nurse short staffing in the USA with recommendations on the best solution. The policy brief is intended for review by a senator who is anticipated to frame the presented multimodal solution as a bill for legislative discussions and eventual enactment as a legislation. The success of the policy brief will be evaluated based on how it proceeds through the legislative process. The first measure of success is the presentation as a bill for legislative discussion in the Senate and Congress. The second measure of success is public discussions about the policy issue and proposed solution as well as opinions of lobbyists and other stakeholders. The final measure of success is the proposed solution being enacted into law (Murray, 2017).Policy, Politics, and Global Trends.

Part C. Plan to address the public policy issue

The American Association of Colleges of Nursing (AACN) has expressed interest in the issue of nurse short staffing in the USA. This is an organization that was formed in 1969 and currently represents 840 nursing schools across the USA. The membership includes more than 45,000 faculty members and more than 543,000 students. It is the national voice of academic nurses and works to establish quality standards for nursing education, promotes public support for professional nursing practice, research and education, influences the nursing profession to improve health care, and aids nursing schools in implementing the quality standards for nursing education. Policy, Politics, and Global Trends.The programs ran by AACN include nurse certification, accreditation, leadership development, health policy advocacy, and curriculum standards. The organization’s interest in addressing the issue of nurse short staffing stems from a need to improve nursing practice by improving opportunities for nursing education. This would allow the organization to secure sustained federal support for nursing practice and education, shape legislative policies affecting nursing education, and ensuring that nursing students have continuing financial assistance (American Association of Colleges of Nursing, 2020). Besides that, the AACN is aware of the issue and is currently working with other stakeholder to increase attention to the issue. In addition, the organization is leveraging its resources to form collaborations, identify strategies and shape legislation to address the issue. In addition, the organization is concerned with keeping other stakeholders abreast of the issue by developing fact sheets and other sources of information (American Association of Colleges of Nursing, 2019).Policy, Politics, and Global Trends.

Three community-based participatory research (CBPR) principles will be applied to work with AACN. The first principle is building on the organization’s strengths and resources to ensure that nursing schools support the proposed solution and lobby for its application. The second principle is focusing on the relevance of the issue and solution. It acknowledges that a sustainable solution for addressing the issue is increasing the number of nurses, and this is best achieved by ensuring that prospective nurses have more training opportunities. The third principle is commitment to sustainability and the long-term process. The issue of nurse short staffing is present and expected to worsen. This calls for an immediate solution (hiring foreign nurses) and a more sustainable solution for the long term (training more nurses and acuity-based assignments).Policy, Politics, and Global Trends.

The AACN would be approached for collaboration through coalescing the available information on the issue. This helps with informing on the issue and highlighting its seriousness. In addition, prospective solutions would be presented and evaluated for feasibility. Besides that, a proposal would be presented for a collaborative committee to be set up with the focus in policy advocacy to address the issue (Peate& Wild, 2018). The goal of AACN is to improve nursing education and practice. This goal is aligned with the policy change since it allows the organization to be involved in improving nursing practice and education opportunities.Policy, Politics, and Global Trends.

Three action steps will be applied to ensure that AACN supports the policy change proposal. The first step is communicating with the organization on the policy issue, concerns and possible solutions. The second step is garnering support from other stakeholders by convincing them about the need for the policy change. The third step is preparing a report that coalesces the opinions of stakeholders with the best solution (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

The AACN would be engaged in leveraging its resources to garner support from policy makers for the proposed policy change. AACN has an extensive membership that includes nursing schools, faculty members and nursing students. In addition, it has links with other nursing organizations. These resources can be leveraged to gain support for the policy change while ensuring that it is framed in a manner the represents the best interests of the stakeholders (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

Three CBPR principles were identified as necessary for working with the AACN collaboratively and they form the core feature of the evaluation plan. The first principle is building on the organization’s strengths and resources to ensure that nursing schools support the proposed solution and lobby for its application. This principle will be evaluated by keeping track of the number of nursing schools and other organizations that support the policy change. The second principle is focusing on the relevance of the issue and solution. This principle will be evaluated by tracing changes in training opportunities for nurses as well as changes in numbers of nurses. The third principle is commitment to sustainability and the long-term process. This principle will be evaluated by keeping track of the changes in numbers of foreign nurses hired to work in the country, number of nurses trained, and use of acuity-based systems.Policy, Politics, and Global Trends.

The organization plan is based on three steps as previously identified. The first step is communicating with the organization on the policy issue, concerns and possible solutions. This step will be evaluated based on feedback from the organization. The second step is garnering support from other stakeholders by convincing them about the need for the policy change. This step will be evaluated based on changes in support levels from other stakeholders. The third step is preparing a report that coalesces the opinions of stakeholders with the best solution. This step will be evaluated based on opinions from stakeholders on whether the report includes their opinions (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

Part D. Challenges of top-down and bottom-up approaches

The top-down and bottom-up approaches have different strengths. The top-down approach has two strengths. The first strength is fast achievement of goals as tasks are streamlined. The second strength is focused use of resources as there is the process of making decisions is shortened. The bottom-up approach has two strengths. The first strength is that stakeholders have greater buy in as they are involved in all steps. The second strength is that stakeholders have greater awareness of the policy change (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

The two approaches have different challenges. The top-down approach has two challenges. The first challenge is low acceptance from stakeholders as there is limited input. The second challenge is low support from stakeholders as they are not involved in framing the policy change. The bottom-up approach has two challenges. The first challenge is that it takes long to apply as opinions are collected from the different stakeholders. The second challenge is that it adds to the duties of the stakeholders as they take much time and resources collecting opinions from stakeholders (Patton, Zalon&Ludwick, 2015).Policy, Politics, and Global Trends.

Of the two approaches, the bottom-up approach presents the best option. Although this approach requires more resources and time, it ensures that the policy solution has much support from the stakeholders. This is unlike the top-down approach that could face opposition from other stakeholders who feel that they were not consulted and opinions disregarded (Patton, Zalon&Ludwick, 2015). As such, the bottom-up approach offers the best option for managing the policy change.Policy, Politics, and Global Trends.