NURS 6226 Week 1 Policy Process Analysis Example

From Part of the Job to a Bill on the Clerk's Desk: Workplace Violence Against Nurses in the Policy Process

Student Name

College of Nursing, Walden University

NURS 6226: Introduction to Healthcare Policy

Instructor Name

Month Day, Year

From Part of the Job to a Bill on the Clerk's Desk: Workplace Violence Against Nurses in the Policy Process

Introduction

In a composite state, emergency and behavioral health nurses have long been shoved, bitten, spat on and threatened by patients and visitors. Many of these events were entered in hospital incident systems, and few led to any change. This paper traces how the issue moved from an accepted part of the work to a filed bill, and where it stands in the process now.

Problem Identification

The issue sat outside policy for years because of how it was classified. An assault by a confused or agitated patient was treated as patient behavior, a clinical matter to be managed with de-escalation and sedation, rather than as a workplace hazard to be prevented. Nurses themselves often did not file formal reports: in one hospital system, 88% of workers who said they had experienced violence in the past year had not documented it in the incident system, although many had told a supervisor informally (Arnetz et al., 2015). Underreporting kept the problem out of sight of anyone with the power to change it. In the United States more broadly, health care workers face high rates of workplace violence, much of it from patients, and much of it never reported (Phillips, 2016).

Agenda Setting

The shift came from two sources. The state nurses association surveyed its members and published the results, giving legislators a count of assaults that incident systems had not captured, told in nurses' own words. Federal injury data from the Bureau of Labor Statistics, showing that health care workers suffer a disproportionate share of workplace violence injuries, gave the issue credibility beyond anecdote. Using the three streams described by Kingdon (2011), the problem stream was now defined as a workplace hazard, a policy proposal was available from other states' laws, and a political stream opened when two widely reported assaults on emergency nurses coincided with a health committee chair willing to take up the issue.

The Federal Gap

Part of the reason the issue landed with the state is that federal law offers no binding standard. The Occupational Safety and Health Administration publishes guidelines for preventing workplace violence in health care and social service settings, recommending management commitment, worksite analysis, hazard prevention, training and recordkeeping, but the guidelines are voluntary (Occupational Safety and Health Administration [OSHA], 2016). Without a federal rule, states that want enforceable requirements must write their own.

Formulation and the Stages Ahead

The issue is now at formulation. A bill has been filed with two main parts: a felony enhancement for assaulting a health care worker, and a requirement that hospitals adopt workplace violence prevention plans. It has been referred to the house health committee. The stages ahead are committee consideration and markup, floor votes in both chambers, the governor's decision to sign or veto, implementation through the health department's rulemaking, and eventually evaluation. The appendix maps these stages and names the actors expected at each: the nurses association and hospital association at committee, the health department at rulemaking, and hospital committees and frontline nurses at implementation.

Appendix: Process Map

Problem identification (years before filing): nurses, unit managers, incident systems. Agenda setting (last two years): state nurses association, media, health committee chair. Formulation (now): bill sponsors, committee counsel, drafting office. Adoption (next session): committees, both chambers, governor. Implementation (after enactment): health department, hospitals. Evaluation (later): health department reports, researchers, nurses association.

References

Arnetz, J. E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M. J., Russell, J., & Essenmacher, L. (2015). Underreporting of workplace violence: Comparison of self-report and actual documentation of hospital incidents. Workplace Health & Safety, 63(5), 200-210. https://doi.org/10.1177/2165079915574684

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (Updated 2nd ed.). Longman.

Occupational Safety and Health Administration. (2016). Guidelines for preventing workplace violence for healthcare and social service workers (OSHA 3148-06R).

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374(17), 1661-1669. https://doi.org/10.1056/NEJMra1501998