Category Archives: Laws/Legislation

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

Source: Matthew D McHugh, Linda H Aiken, Douglas M Sloane, Carol Windsor, Clint Douglas, Patsy Yates, The Lancet, Vol. 397, issue 10288, May 22, 2021
(subscription required)

From the summary:
Background
Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. We aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.

Methods
For this prospective panel study, we compared Queensland hospitals subject to the ratio policy (27 intervention hospitals) and those that discharged similar patients but were not subject to ratios (28 comparison hospitals) at two timepoints: before implementation of ratios (baseline) and 2 years after implementation (post-implementation). We used standardised Queensland Hospital Admitted Patient Data, linked with death records, to obtain data on patient characteristics and outcomes (30-day mortality, 7-day readmissions, and length of stay [LOS]) for medical-surgical patients and survey data from 17 010 medical-surgical nurses in the study hospitals before and after policy implementation. Survey data from nurses were used to measure nurse staffing and, after linking with standardised patient data, to estimate the differential change in outcomes between patients in intervention and comparison hospitals, and determine whether nurse staffing changes were related to it.

Findings
We included 231 902 patients (142 986 in intervention hospitals and 88 916 in comparison hospitals) assessed at baseline (2016) and 257 253 patients (160 167 in intervention hospitals and 97 086 in comparison hospitals) assessed in the post-implementation period (2018). After implementation, mortality rates were not significantly higher than at baseline in comparison hospitals (adjusted odds ratio [OR] 1·07, 95% CI 0·97–1·17, p=0·18), but were significantly lower than at baseline in intervention hospitals (0·89, 0·84–0·95, p=0·0003). From baseline to post-implementation, readmissions increased in comparison hospitals (1·06, 1·01–1·12, p=0·015), but not in intervention hospitals (1·00, 0·95–1·04, p=0·92). Although LOS decreased in both groups post-implementation, the reduction was more pronounced in intervention hospitals than in comparison hospitals (adjusted incident rate ratio [IRR] 0·95, 95% CI 0·92–0·99, p=0·010). Staffing changed in hospitals from baseline to post-implementation: of the 36 hospitals with reliable staffing measures, 30 (83%) had more than 4·5 patients per nurse at baseline, with the number decreasing to 21 (58%) post-implementation. The majority of change was at intervention hospitals, and staffing improvements by one patient per nurse produced reductions in mortality (OR 0·93, 95% CI 0·86–0·99, p=0·045), readmissions (0·93, 0·89–0·97, p<0·0001), and LOS (IRR 0·97, 0·94–0·99, p=0·035). In addition to producing better outcomes, the costs avoided due to fewer readmissions and shorter LOS were more than twice the cost of the additional nurse staffing.

Interpretation
Minimum nurse-to-patient ratio policies are a feasible approach to improve nurse staffing and patient outcomes with good return on investment.

Symposium on the upcoming argument in Brnovich v. Democratic National Committee

Source: SCOTUSblog, February 2021

Articles include:
Supreme Court needs to set clear standards for vote-denial claims
By Ilya Shapiro and Stacy Hanson, SCOTUSblog, February 19, 2021

….After the contentious election we just had, this case presents an opportunity to make future elections cleaner and less litigious, with results that inspire greater public confidence. Those salutary outcomes turn not on whether the court upholds the two specific electoral regulations at issue, in Arizona or elsewhere, but on whether it provides a clear framework by which lower courts are to evaluate VRA Section 2 claims….

Voting discrimination is getting worse, not better
By LaShawn Warren, SCOTUSblog, February 18, 2021

Six weeks after the close of an election cycle marred by Republican efforts to exclude Black and Brown voters, the Supreme Court will hear oral argument in a significant voting rights case. For generations, the court has recognized that the heart of America’s vibrant democracy is the right to vote free from discrimination. In Brnovich v. DNC, the court must once more affirm that there is no place for racism in our elections by striking down Arizona’s racially discriminatory voting laws.

Section 2 of the Voting Rights Act: Equal opportunity vs. disparate impact
By Christopher Kieser, SCOTUSblog, February 17, 2021

In the aftermath of the chaos that was the 2020 election-related litigation, it is easy to forget that the Supreme Court is now set to decide the most consequential election law dispute in nearly a decade. At issue in Brnovich v. DNC and Arizona Republican Party v. DNC is nothing less than the future of Section 2 of the Voting Rights Act, the nationwide prohibition of any election regulation that “results in a denial or abridgement of the right of any citizen of the United States to vote on account of race or color.” The court will likely resolve a significant circuit split over whether a disparate racial effect alone renders unlawful an otherwise legitimate state election regulation. In doing so, the court will set the boundaries for future state election laws, and it may even comment on the continuing vitality of disparate-impact liability.

Disenfranchisement: An American Tradition

Source: Julilly Kohler-Hausmann, Dissent, Winter 2021

Invoking the specter of voter fraud to undermine democratic participation is a tactic as old as the United States itself. …. Fair elections require clear regulations and standards, but bureaucratic hurdles inevitably depress participation by disadvantaged groups. And they have often been deliberately constructed—as an appeals court found in 2016—to “target African-Americans with almost surgical precision.” ….

Related:
Dozens of states see new voter suppression proposals
Source: Russell Contreras, Stef W. Kight, Axios, February 10, 2021

There are at least 165 proposals under consideration in 33 states so far this year to restrict future voting access by limiting mail-in ballots, implementing new voter ID requirements and slashing registration options.

A Manager’s Guide to Free Speech and Social Media in the Public Workplace: An Analysis of the Lower Courts’ Recent Application of Pickering

Source: Adam M. Brewer, Public Personnel Management, OnlineFirst, Published September 4, 2020
(subscription required)

From the abstract:
Public organizations are experiencing a burgeoning of workplace challenges involving employee use of social media. Comments, images, or videos ranging from racist remarks, to calls to violence, simple criticism of one’s organization, to full on whistle blowing significantly challenge public organizations’ policies for addressing speech that creates discord in the workplace. With the blurring of lines between personal and professional lives, these challenges create uncertainty for public organizations regarding how to maintain the efficient operation of the workplace, deal with the social and political fallout of such instances, and manage organizational liability. This article performs content analysis on 33 federal lower court opinions involving speech/social media workplace issues. The study analyzes the manner in which the lower courts apply free speech precedent on contemporary workplace speech cases. The findings suggest that patterns emerge from the opinions providing key insights for public managers regarding how to better manage these complex issues.

The War on Whistleblowers

Source: Nancy M. Modesitt, University of Pennsylvania Journal of Law & Public Affairs, Volume 6 (Forthcoming), Date Written: September 2020

From the abstract:
In the last few decades, Congress has passed a variety of statutes to improve legal protections for federal employee-whistleblowers, with the dual goals of promoting disclosure of wrongdoing and prohibiting retaliation against whistleblowers. However, these statutes and goals are being undermined in the current administration. This Article argues that President Trump’s administration has conducted multi-faceted attacks against federal employee-whistleblowers in order to deter disclosure of the administration’s wrongdoing. Since these efforts began, there has been a decrease in whistleblower disclosures of wrongdoing in the federal government. In order to stop this trend, immediate action is needed, including amending federal laws to reduce the possibility of retaliation by administration officials against whistleblowers, increasing funding and staffing at the federal agencies tasked with protecting whistleblowers and adjudicating their retaliation claims, and promoting greater outreach by Congressional committees to federal employees within agencies over which such committees have oversight authority. If these steps are not taken, there is a significant risk that the culture of promoting whistleblowing that has been cultivated within the federal government will collapse, leaving the American public in the dark about future misconduct within the Executive branch of the government – not just in this administration, but also in future ones.

COVID-19 Occupational Licensure Policy Responses

Source: Council of State Governments, 2020

While occupational licensing regulations provide certain public health and safety safeguards, the increased health care demands imposed by COVID-19 have compelled states to evaluate which regulations may impede response efforts.

In response, states have implemented executive orders/proclamations, legislation and administrative rulings that temporarily amend certain regulations to increase the supply of health care workers, lessen administrative burdens and comply with social distancing measures.

While many of these actions were made during the onset of the COVID-19 state of emergency and exist only temporarily, states may consider additional policy actions that may be needed in the event of subsequent rises in COVID-19 cases and future health emergencies.

The following information presents a collection of state actions, categorized by policy themes and types, to assist states with developing response plans.

National data release sheds light on past polling place changes

Source: Carrie Levine, Pratheek Rebala, Matt Vasilogambros, Center for Public Integrity and Stateline, September 29, 2020

The first installment of a new national data release that will help journalists and researchers analyze polling place accessibility was released Tuesday as part of an investigative series, Barriers to the Ballot Box, from The Center for Public Integrity and Stateline. The data, posted to Github, includes polling place locations and addresses for 30 states for the 2012, 2014, 2016 and 2018 general elections, and is aimed at aiding reporting and research on the impact that polling place closures and changes could have on the 2020 election. Data for additional states will be added in the coming weeks.

Polling place reductions and changes can lower turnout by creating confusion and barriers for voters, potentially disenfranchising them. There is no national public dataset of polling place locations and addresses for past federal elections.

…The polling place location information, now in a usable data format, standardized and available to the public, can be used to track the movement and consolidation of polling places. Combined with other data, such as voter file data, it can shed new light on which voters were affected by the changes. …

…U.S. elections are administered by thousands of separate jurisdictions. Every state has different laws and deadlines governing voting, which can include unique requirements for polling places. Local authorities typically choose them based on a variety of factors.

Public Integrity and Stateline filed and tracked roughly 1,200 records requests to assemble the polling place location data.

In 12 states — Alabama, California, Georgia, Idaho, Kansas, Minnesota, Missouri, New Mexico, New York, Tennessee, Texas and Wyoming — data had to be obtained county by county for at least one of those elections….

What Is ALEC? Learn About the Organization Writing Your State Laws

Source: Sophie Hayssen, Teen Vogue, September 25, 2020

The American Legislative Exchange Commission writes “model legislation” that detractors say “sustains corporate power.”

….ALEC has existed for decades, but spent most of its life in the shadows, cultivating a reputation as a conservative organizational powerhouse. On its website, ALEC describes itself as a “nonpartisan” organization “of state legislators dedicated to the principles of limited government, free markets, and federalism.” Though that description may appear staid at first glance, its detractors argue that ALEC is central to some of the most profound shifts in American politics over the last several decades. Groups like Dream Defenders and the Center for Constitutional Rights, have accused it of resembling a “shadow-state apparatus” and promoting “legislation that sustains corporate power.”

Here’s what you need to know about the controversial organization…..