| Course | DNP 820 Health Policy and Advocacy |
|---|---|
| Module | Module 8 |
| Paper type | Policy analysis paper |
| Length | About 1,007 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | DNP |
| Updated | September 2026 |
Free sample paper for DNP 820 Module 8
Ratios, Committees or Both? A Policy Analysis of Hospital Nurse Staffing Regulation for a Composite State
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP 820: Health Policy and Advocacy
Instructor Name
Month Day, Year
Ratios, Committees or Both? A Policy Analysis of Hospital Nurse Staffing Regulation for a Composite State
Few health policy questions matter more to nurses than how many patients each nurse cares for. After the pandemic, many states considered legislation to regulate hospital nurse staffing, and the approaches differ sharply. This paper analyzes the options for a composite state whose legislature has asked its health committee for a recommendation. It defines the problem, sets criteria, describes four options, weighs the evidence for each against the criteria, and recommends an approach.
The Problem
In the composite state, registered nurses on hospital medical-surgical units report caring for an average of 5.6 patients on day shifts and more at night, with wide variation among hospitals. Research shows why this matters. Surveying over 22,000 nurses in three states, researchers found that, nurses in California, the state with mandated ratios, cared for fewer patients than nurses in two comparison states, and lower patient loads were associated with lower patient mortality and less burnout (Aiken et al., 2010). A more recent study of Illinois hospitals found that each additional patient per nurse on medical-surgical units was associated with 16% higher odds of 30-day mortality and longer stays, and estimated that staffing at four patients per nurse would have prevented more than 1,595 deaths and saved over $117 million in a year (Lasater et al., 2021).
Criteria
The options are judged against five criteria: likely effect on patient outcomes, likely effect on actual registered nurse staffing, cost to hospitals and the state, flexibility to account for differences in patients and hospitals, and political and administrative feasibility.
The Options
States have taken several approaches. As of January 2024, seven states had staffing ratio laws for at least one hospital unit, eight required nurse staffing committees, eleven required staffing plans, and one, Idaho, had banned minimum staffing requirements (Krishnamurthy et al., 2024). The four options for the composite state are: first, fixed minimum nurse-to-patient ratios by unit type, as in California; second, hospital staffing committees with at least half direct-care nurses that develop annual staffing plans; third, public reporting of actual staffing by unit and shift; and fourth, a hybrid combining committees and public reporting with enforceable minimum ratios for medical-surgical units.
Weighing the Evidence
Ratios have the strongest evidence of changing staffing. A national study using 16 years of hospital data found that, compared with states without staffing legislation, the state with mandated ratios saw registered nurse hours rise by about one hour per patient day, while states that chose staffing committees or public disclosure of staffing showed no significant difference in registered nurse hours (Han et al., 2021). Evidence on outcomes is favorable but more mixed. California hospitals increased staffing more than comparison hospitals, and the gains were greatest where staffing had been lowest before the law, and failure to rescue fell in some hospitals, but other quality measures showed no change and one type of infection increased in some hospitals (Mark et al., 2013). Cross-sectional studies consistently link lower patient loads to lower mortality.
Ratios score well on staffing and outcomes but poorly on cost and flexibility: hospitals must hire, and rural hospitals may struggle to recruit. Committees score well on flexibility and feasibility but poorly on actual staffing change. Public reporting is cheap and increases transparency but, on its own, did not raise registered nurse hours. The hybrid combines the enforcement that changes staffing with the flexibility and transparency of the other approaches, at moderate cost.
The Politics
The state hospital association opposes ratios, citing cost and workforce shortages, and supports committees. The nurses' union supports ratios. The state nurses association supports a hybrid. Rural legislators worry about hospital closures. A hybrid that phases in ratios for medical-surgical units over three years, with a hardship waiver process for small rural hospitals tied to workforce funding, addresses the most serious objection while preserving enforcement.
Costs and Financing
Cost is the strongest objection to ratios and deserves a direct answer. Moving medical-surgical units from an average of 5.6 to 4.0 patients per nurse would require substantial additional registered nurse hours, and the cost would fall hardest on hospitals with thin margins. Some of that cost would be offset: better staffing is associated with shorter stays, fewer adverse events and lower turnover, which reduces spending on temporary staff, and the Illinois study estimated large savings from fewer deaths and shorter stays at a four-to-one ratio. Offsets will not cover the full cost for every hospital, however, which is why the recommendation phases the requirement and pairs it with workforce funding.
The state can finance its share through several mechanisms: targeted Medicaid rate increases for hospitals that meet staffing standards, grants for rural hospitals to recruit and retain nurses, and expanded capacity in nursing programs so that the supply of nurses grows with demand. Linking public funding to staffing performance also gives the state influence beyond enforcement penalties.
Recommendation
The health committee should recommend the hybrid option: require every hospital to have a staffing committee with at least half direct-care registered nurses that sets annual staffing plans for all units; require quarterly public reporting of actual staffing by unit and shift; and establish an enforceable minimum of one registered nurse to five patients on medical-surgical units, phased to one to four over three years, with limited, time-bound waivers for rural hospitals that demonstrate recruitment efforts. The recommendation should be paired with funding for nursing education and rural workforce incentives, and with an evaluation requirement so the legislature can review the effects on staffing, patient outcomes and hospital finances after five years.
Conclusion
Evidence links lower patient loads to better outcomes, and fixed ratios are the approach most clearly shown to raise registered nurse staffing, while committees and reporting alone are not. Ratios alone, however, raise cost and flexibility concerns, especially for rural hospitals. A hybrid that combines enforceable, phased medical-surgical minimums with committees, public reporting, workforce support and evaluation offers the best balance for the composite state, and it gives nurses a structured voice in staffing decisions.
References
Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J., & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. https://doi.org/10.1111/j.1475-6773.2010.01114.x
Han, X., Pittman, P., & Barnow, B. (2021). Alternative approaches to ensuring adequate nurse staffing: The effect of state legislation on hospital nurse staffing. Medical Care, 59(Suppl. 5), S463-S470. https://doi.org/10.1097/MLR.0000000000001614
Krishnamurthy, N., Mukherjee, N., Cohen, B., Mazor, M., & Appel, J. M. (2024). Hospital nurse staffing legislation: Mixed approaches in some states, while others have no requirements. Health Affairs, 43(8), 1172-1179. https://doi.org/10.1377/hlthaff.2023.01521
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: An observational study. BMJ Open, 11(12), Article e052899. https://doi.org/10.1136/bmjopen-2021-052899
Mark, B. A., Harless, D. W., Spetz, J., Reiter, K. L., & Pink, G. H. (2013). California's minimum nurse staffing legislation: Results from a natural experiment. Health Services Research, 48(2, Pt. 1), 435-454. https://doi.org/10.1111/j.1475-6773.2012.01465.x
DNP 820 Module 8 instructions, in plain terms
Aspen does not share the final DNP 820 prompt outside the course, so the sample leans on the catalog description of economic, financial and political factors in care delivery, policy reform and advocacy. A closing policy analysis usually asks you to define a problem, set criteria, compare policy options with evidence, consider politics and costs, and recommend one course of action. Check whether your prompt fixes the number of options, asks for a specific framework such as Bardach's eightfold path, or requires a presentation. Confirm the length and source count, and whether earlier module work can be reused, because some instructors expect this paper to build directly on the problem you chose in Module 1.
How this DNP 820 Module 8 example is built
Eight headings divide roughly 1,005 words. The problem section states the staffing problem with its evidence on patient outcomes. The criteria section lists five: effect on outcomes, cost, feasibility, political support and equity. The options section describes four approaches. Weighing the evidence compares them with specific studies, including where the evidence is mixed. The politics section identifies supporters, opponents and likely compromises. Costs and financing estimate who pays. The recommendation section proposes a specific, phased policy with evaluation, and the conclusion restates why. Each option is judged against the same five criteria, so the reader can follow the comparison without having to reconstruct it from scattered paragraphs.
Where the marks sit in the DNP 820 Module 8 rubric
The rubric for a final policy analysis gives most weight to the comparison of options and the quality of the recommendation. This paper earns those points by applying the same criteria to every option and by citing specific evidence for each judgment, and the margin notes mark where mixed evidence is handled honestly. The politics and cost sections show feasibility thinking, which graders often score under analysis. A phased recommendation with evaluation built in shows mature judgment. Because this is the course's final paper, integration of earlier topics adds synthesis points. Organization follows the classic structure of a policy analysis. APA credit depends on five correctly cited sources and consistent formatting from the title page on.
Common DNP 820 Module 8 mistakes, and how to avoid them
Students often choose their preferred policy first and then build the analysis to support it, which graders notice. Set criteria and apply them to every option, including ones you reject. Another common mistake is using different evidence standards for different options, citing strong studies for your choice and anecdotes against the others. Papers also skip costs and politics, but a recommendation that ignores who pays or who votes is incomplete. Some students list options that are variations of one idea; make the options genuinely different. Finally, make the recommendation specific: say what the law or rule would require, when it would start and how its effects would be measured, so that a reader could act on it.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 820 Module 8 questions, answered
What does DNP 820 Module 8 usually ask for?
Aspen's DNP 820 description centers on critiquing policy and advocating for reform, so a complete policy analysis with options and a recommendation is a typical final assignment. Check your classroom for the prompt.
Do nurse staffing committees increase staffing?
A national study found that states legislating staffing committees or public reporting alone showed no significant difference in registered nurse hours, while the state with mandated ratios saw an increase.
How should a policy analysis be structured?
Define the problem, set evaluation criteria, describe options, weigh evidence for each against the criteria, consider politics and feasibility, and make a specific recommendation.
Where can I find a free DNP 820 Module 8 sample paper?
This page has the complete policy analysis of hospital nurse staffing regulation, from its title page and eight sections to the references, with margin notes, all readable at no cost. If your final paper covers a different problem, send the prompt through the form for a custom version.
How should a DNP 820 Module 8 policy analysis be organized?
A common structure is problem, criteria, options, analysis of options against criteria, politics and costs, and a recommendation. Bardach's eightfold path follows a similar logic. This example uses that order so each judgment can be traced back to evidence.