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1 Article Analysis Name Institution Course Instructor Date

2 Article Analysis The article chosen for this paper is "Patient Safety: Time for Federally Mandated Registered Nurse to Patient Ratios" by Anders (2021), published in Nursing Forum, volume 56, issue 4. The rationale for selecting this article is the ongoing debate on the optimal nurse-to- patient ratios in healthcare settings. To ensure patients receive optimal outcomes, medical caretakers must prioritize safeguarding the wellness of their patient population as well as preserving excellence in treatment. Achieving such objectives hinge on securing an adequately staffed workforce, a decisive element in any successful implementation strategy aimed toward ensuring optimal health outcomes. The focal point of the article involves examining the topic surrounding national governance on quantifying a proportional number of healthcare individuals assigned per patient in America's medical structure. Anders argues that federally mandated ratios would enhance patient safety and improve the quality of care delivered to patients. The author reviews previous studies that support the implementation of mandated ratios, indicating the positive outcomes of reducing adverse events, lowering mortality rates, and improving patient satisfaction (Anders, 2021). However, Anders acknowledges the potential challenges of implementing such regulations, including the cost implications, resistance from healthcare organizations, and potential unintended consequences. The author proposes a phased approach to the implementation of nurse-to-patient ratios, allowing for sufficient time to adjust and address any challenges. The Nursing Forum journal is a peer-reviewed publication that focuses on promoting discussion, research, and innovation in nursing practice. The nursing journal is revered for its substantial influence on the development of healthcare education, application, and analysis. The article's publication in Nursing Forum indicates the significance of the topic and the need to

3 address the nurse-to-patient ratio issue in healthcare settings. The objective of this essay is to assess arguments made in the article while investigating potential advantages and obstacles associated with federally mandated nurse-to-patient ratios. Pertinent literature related to the topic will be examined, analyzing how the nurse workforce can affect patient results as well as considering possible implications linked to implementing federal guidelines on staffing levels. The conclusions drawn from this paper will offer useful information into both pros and cons surrounding mandatory ratio enforcement at a national level - ultimately resulting in recommendations for future research endeavors along with policy-making initiatives. Critical thinking The article by Anders (2021) stimulated critical thinking by addressing the crucial issue of nurse-to-patient ratios in healthcare settings. The author provides evidence-based arguments to support the implementation of federally mandated ratios and also acknowledges the potential challenges of such regulations. The article's central argument stimulated my critical thinking by raising important questions about the effectiveness of nurse staffing on patient outcomes and the potential implications of federal regulations on staffing. A crucial element of the written piece is its discourse pertaining to how nurse staffing can affect patient outcomes (Anders, 2021). Numerous studies have been referenced by the author that substantiate a favorable connection between reduced ratios of nurses to patients and enhanced outcomes for the latter. The discovery at hand incites pressing inquiries on the contribution made by registered nurse count in guaranteeing favorable patient consequences and prospective repercussions faced if staff falls short of sufficiency, endangering both safety and quality of care (Anders, 2021). Moreover, the piece furnishes an intricate outlook regarding plausible merits and hindrances of governmentally prescribed proportions between nurses and patients. The author acknowledges that implementing

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4 such regulations may be met with resistance from healthcare organizations and also raises concerns about the potential cost implications and unintended consequences. These considerations stimulate critical thinking about the practicality of implementing federally mandated ratios and the potential limitations of such regulations. Provided New Learning The article by Anders (2021) provided new learning on the importance of nurse staffing in healthcare settings and the potential benefits and challenges of federally mandated nurse-to- patient ratios. The article accentuates the import of staffing quantities in guaranteeing safety for patients and quality of service while presenting logical arguments grounded in evidence to validate the adoption of federally enforced proportions. The article also provided new learning on the potential challenges of implementing such regulations. The author discusses the potential resistance from healthcare organizations and the cost implications of federally mandated ratios, raising awareness of the practical challenges of implementing such regulations. Additionally, the author proposes a phased approach to the implementation of mandated ratios, providing new learning on the potential benefits of a gradual approach to regulatory change. Moreover, the article provided new learning on the potential unintended consequences of federally mandated ratios. The writer concedes that modifications to regulations could lead to inadvertent outcomes, resulting in a rise in work pressure for nursing professionals. The author emphasizes the necessity of thoughtful contemplation when weighing potential restrictions and their ramifications. The acquisition of knowledge in this subject incites recognition of the significance of overseeing modifications to rules that affect medical services, which accentuates continuous analysis and consideration. Reflective Feelings

5 Feelings Evoked While Reading the Article Reading by Anders (2021) evoked various feelings, including concern, frustration, and hope. The discourse centered on the influence of nurse staffing on patient outcomes, revealing apprehensions concerning perilous repercussions that may arise from understaffed facilities and emphasizing action as an imperative to guarantee optimum levels of safety for patients. In accordance with the author's statement, numerous pieces of research elucidate a favorable association between diminished nurse-to-patient ratios and boosted patient results. This raises apprehension towards the prospective aftermaths of deficient labor-force thresholds. Furthermore, the discussion on the potential challenges of implementing federally mandated nurse-to-patient ratios was frustrating, highlighting the resistance from healthcare organizations and the potential cost implications of regulatory changes. However, the article's proposal for a phased approach to implementation provides hope for future action, evoking a sense of optimism that regulatory changes may be possible. Feelings Upon Conclusion of The Article Upon perusing the piece, my senses were invigorated, and I experienced an impetus to engage in activity regarding the proportion of nurses to patients. The persuasive arguments in the article, based on factual analysis, have broadened my knowledge concerning the possible dangers of insufficient staffing levels as well as made me realize that it is crucial to ensure patient safety and quality care through actions taken. Moreover, discussing potential advantages along with obstacles faced when enforcing federally mandated ratios offered valuable information leading towards decision-making around regulatory changes implementation suited for practical purposes. The article's proposal for a phased approach to implementation also provided motivation for future action, evoking a sense of optimism that regulatory changes may be

6 possible with careful planning and evaluation. The article has universally prioritized the subject of patient safety and quality healthcare, which has inspired a deep urgency to take responsibility regarding the crucial issue of assigning nurses to every individual in care. Effect On Motivation and Future Actions The article has had a significant effect on my motivation and future actions regarding the topic of nurse-to-patient ratios. Addressing the issue of suboptimal staffing levels and recognizing that decreased nurse-to-patient ratios lead to improved patient outcomes is an urgent matter, as indicated by ongoing discussions on potential risks. The article's proposal for a phased approach to implementation has also provided insight into the practical considerations of regulatory change and the need for careful planning and evaluation. The article, on the whole, has inspired me to make an impact regarding nurse-to-patient ratios. This could include advocating for modifications in staffing practices at my place of work or participating in public discourse surrounding this matter. Additionally, the article has highlighted the importance of ongoing research and evaluation of the impact of regulatory changes on healthcare systems. As a healthcare professional, this article has deepened my understanding of the significance of staffing levels in ensuring patient safety and quality of care and has motivated me to take action to improve patient outcomes. Application To Course Student Learning Outcomes (CSLOS) Match Of The Article To CSLOS Anders (2021) matches several of the Course Student Learning Outcomes (CSLOs) related to nursing practice, research, and leadership. Specifically, the article aligns with CSLOs 1, 3, 4, 5, and 6 by discussing the integration of nursing, social, economic, and political theories to promote culturally competent nursing care of individuals, families, and communities. It also

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7 highlights the importance of evidence-based practices, the use of technology to promote safe and effective nursing care, and the impact of historical and current issues in healthcare policy, finance, and regulation on the delivery of culturally competent care. Best Matched CSLO And Discussion The CSLO that best matches the article is CSLO 5, which discusses the influence of historical and current issues in healthcare, policy, finance, regulatory environments, and professional nursing on culturally competent care of individuals, families, and communities. Anders' (2021) article presents a comprehensive examination of how the volume of personnel affects both patient safety and quality health care, bringing to light past and existing problems resulting in subpar proportions between nurses servicing patients within medical facilities. Frowde et al. (2020) deliberate on the monetary and supervisory hurdles that have obstructed the execution of nationally ordered proportionalities between nurses and patients while concurrently presenting knowledge into conceivable benefits as well as challenges related to alterations in regulations. Furthermore, the article emphasizes the importance of advocacy and collaboration in addressing the issue of nurse staffing, which aligns with CSLO 5's focus on understanding and addressing the impact of policy and regulation on nursing practice. The article's proposal for a phased approach to implementation also reflects the need for strategic planning and collaboration to overcome the challenges of regulatory change and promote culturally competent nursing care (Schill & Caxaj, 2019). Anders (2021) provides an extensive examination of probable repercussions that nurse-to-patient ratios have on patient safety as well as therapy excellence. It brings to light both historical and contemporary dilemmas which are responsible for insufficiencies in staffing levels within healthcare facilities. The article's emphasis on advocacy,

8 collaboration, and strategic planning aligns with CSLO 5's focus on understanding and addressing the impact of policy and regulation on nursing practice, providing valuable insights into the importance of cultural competence in nursing care. Application To Practice Area and Professional Development The article by Anders (2021) provides valuable insights that will enhance my current and future clinical practice and professional development. As a nurse working on a medical-surgical floor with four rooms designated for palliative patients, the article's focus on nurse-to-patient ratios is particularly relevant to my practice area. In my current practice, the article's emphasis on the importance of adequate staffing levels highlights the need to prioritize patient safety and quality of care. Through the incorporation of ratios directed by the government, I can warrant that every patient obtains the adequate attention and care they merit, despite their illness or severity (Young et al., 2020). The augmentation of patient results is not a solitary benefit, as it simultaneously diminishes the likelihood of exhaustion and attrition among nurses. Such an effect would then generate an environment conducive to enduring contentment within work- related contexts. Concerning the sphere of occupational growth, the article accentuates the significance of promoting change and enhancing patient outcomes through means such as backing advocacy and team effort. By engaging in advocacy initiatives and collaborating with other healthcare professionals, I can promote cultural competence in nursing care and advance the nursing profession. Moreover, the article underscores a focus on practices that are grounded in empirical evidence and highlights technological advancements as instruments for integrating current research findings and cutting-edge resources into my profession to foster safe care delivery with optimal outcomes.

9 As for my future clinical practice, the article's insights will be invaluable in navigating the rapidly changing healthcare landscape. The emphasis on regulatory change and strategic planning underscores the need for nurses to stay informed and engaged in policy and regulatory issues, both at the local and national levels. By advocating for the implementation of nurse-to- patient ratios and other evidence-based practices, I can ensure that I am providing the highest level of care possible and contributing to the advancement of the nursing profession. Furthermore, the article's focus on cultural competence and patient-centered care aligns with my values as a nurse and underscores the importance of empathy and compassion in nursing practice. By embracing these values and incorporating them into my practice, I can promote a patient-centered approach that values diversity, promotes equity, and recognizes the unique needs and experiences of each patient. By prioritizing patient safety, embracing cultural competence, and engaging in advocacy and collaboration, I can promote positive patient outcomes, advance the nursing profession, and contribute to a more sustainable and fulfilling work environment. Future Action Plan Based on the critical analysis and reflection on the article, my future action plan aims to advocate for the implementation of federally mandated registered nurse-to-patient ratios in my workplace. The goal of this plan is to improve patient safety and quality of care by ensuring adequate staffing levels and workload distribution among nurses. The following action steps will be taken to achieve this goal within six months: Research Conducting extensive research on the evidence-based benefits of implementing federally mandated registered nurse-to-patient ratios in healthcare settings is crucial to this goal (McHugh

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10 et al., 2021). I will also gather data on the current staffing levels and patient outcomes in my workplace. Collaboration I will collaborate with other nurses and healthcare professionals to create a comprehensive proposal for implementing registered nurse-to-patient ratios in my workplace. The present proposal shall delineate the potential advantages, expenses, and foreseen consequences of implementing this particular regulation. Professional Correspondence I will write a formal letter to the nursing leadership team in my workplace to propose the implementation of registered nurse-to-patient ratios. Contained in this missive shall be a synopsis of the proposition, advantages substantiated by empirical evidence, and an entreaty directed at nursing administration to get behind said undertaking. Presentation In a proficient and compelling manner, I will illustrate the proposition to the nursing administration crew during my presentation. Throughout it all, utilizing persuasive tactics that advantageously underscore how this policy would enhance operations while also addressing potential dilemmas or misgivings are key goals of mine. Evaluation After the proposal has been presented, I will evaluate the response of the nursing leadership team and gather feedback. Nolan and Owen (2021) state that in the case that consent is granted, one should be responsible for collaborating with our crew and promoting the directive while overseeing its progress throughout time.

11 With the implementation of this strategic course, my objective is to make an impactful contribution toward advancing patient safety and enhancing the quality of care within our organization. I also aim to enhance my leadership skills, advocacy for patient safety, and professional development as a nurse. Conclusion In conclusion, the article "Patient safety time for federally mandated registered nurse-to- patient Ratios" by Anders (2021) has provided valuable insights into the importance of nurse-to- patient ratios and their impact on patient safety. Upon thorough inspection and examination of the article, it has been brought to light that satisfactory staffing levels in conjunction with fitting ratios between nurses and patients are imperative when considering the provision of secure and superior-quality patient care. The article stimulated critical thinking and provided new learning opportunities, particularly in the areas of healthcare policy, patient safety, and advocacy. Furthermore, the piece elicited a plethora of sentiments, including exasperation and apprehension regarding the well-being of individuals under care, especially when considering the existing dearth of nursing staff. The article also aligns with several of the course student learning outcomes, particularly in regard to cultural competence, evidence-based practice, and professional values. Furthermore, the article provides practical applications for current and future clinical practice, particularly in regard to enhancing patient safety through adequate staffing and appropriate nurse-to-patient ratios. Given the circumstances, the suggested initiative blueprint is geared towards bolstering vocational refinement and fostering advances in patient care safety by means of advocacy tactics and involvement with nursing factions at a professional level. Through the proposed action plan, a feasible and realistic goal has been set, and professional correspondence has been identified as an essential component of the plan.

12 References Anders, R. L. (2021). Patient safety time for federally mandated registered nurse-to-patient ratios. Nursing Forum , 56 (4). https://doi.org/10.1111/nuf.12625 Frowde, R., Dove, E. S., & Laurie, G. T. (2020). Fail to Prepare, and You Prepare to Fail: the Human Rights Consequences of the UK Government's Inaction during the COVID-19 Pandemic. Asian Bioethics Review , 12 (4), 459–480. https://doi.org/10.1007/s41649-020- 00151-1 McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet , 397 (10288), 1905–1913. https://doi.org/10.1016/S0140-6736(21)00768-6 Nolan, H., & Owen, K. (2021). A qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education. BMC Medical Education , 21 (1). https://doi.org/10.1186/s12909-021-02726-4 Schill, K., & Caxaj, S. (2019). Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliative Care , 18 (1). https://doi.org/10.1186/s12904-019-0404-y Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., & Tierney, K. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry , 20 (1), 1–27. https://doi.org/10.1186/s12888-020-02707-9

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13 Professional Correspondence Dear Dr. Anders, I hope this letter finds you well. I am writing to express my appreciation for your recent article, "Patient Safety Time for Federally Mandated Registered Nurse to Patient Ratios," published in Nursing Forum. Your article provided a comprehensive and insightful analysis of the need for federally mandated RN-to-patient ratios and their impact on patient safety. It has stimulated my critical thinking and provided me with new knowledge, skills, and awareness regarding patient safety and nursing advocacy. In my registered nurse capacity, I have the privilege of working with those designated for palliative care in a medical-surgical unit. From this perspective comes first-hand knowledge of how appropriate staffing and safely managed ratios between patient and nurse can make an immense difference. Your article highlighted the alarming statistics of adverse patient outcomes and the negative impact on nurses' well-being in situations with inadequate staffing. I appreciate your efforts to raise awareness and advocate for safer nurse-to-patient ratios. Your article aligns with the focus area of quality and safety, which is a critical aspect of nursing practice. Furthermore, it underscores the urgency for implementing an empirical practice that is crucial to foster nursing care that guarantees safety and efficacy. I am committed to incorporating this new knowledge and awareness into my clinical practice and advocating for safe nurse-to-patient ratios. From studying your article, I have created a strategic personal goal to advocate for safe nurse-to-patient ratios in my workplace as well as to support legislation for federally mandated ratios. Through initiating discussions with my nurse manager and colleagues, participating in nursing associations, and reaching out to my local representatives, I believe I will achieve it in the next six months.

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