Healthcare Reform and the Future of Nursing, Research Paper Example

Informal Presentation

After reviewing a number of journal articles, national and international newspapers, and some recently-published books, it appears that healthcare in the United States is experiencing unparalleled growth and change, due in part to President Obama’s Patient Protection and Affordable Care Act (PPACA) which was signed into law on March 23, 2010 as a way to help reform America’s healthcare industry. As might be anticipated, the profession of nursing is also experiencing unparalleled change, due mostly to the aging of the Baby Boomer generation or those born between 1946 and 1961. The oldest members of this group of Americans (estimated at around 80 million) are now over the age of 65, a situation that has place a huge burden on the US healthcare system, especially concerning Medicare and Medicaid. Thus, the need for well-educated and experienced nurses is also growing, along with the need for new types of health care-related facilities and entities, such as accountable care organizations (ACO), medical homes, and nurse-managed health care clinics.

One area that will not be affected by change in the health care arena is the continuum of nursing care, a concept “involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity” of patient care. This continuum which ideally endures from birth to death includes seven basic services–extended care, such as in a nursing home or hospice; acute hospital care; ambulatory care; home care; outreach and wellness; and housing. In addition, this continuum involves four basic

mechanisms–planning and management; care coordination; case-based financing; and the application of integrated computerized information systems (Young, Clark, Kansky, & Pupo, 2014).

As to the new types of health care facilities and entities that will emerge in the future (in fact, some are already in operation), three are of great importance to the profession of nursing–accountable care organizations or ACOs, medical homes, and nurse-managed health care clinics. The first involves “groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care” to patients on Medicare. This type of approach helps to ensure that “patients, especially the chronically ill, get the right care at the right time” with the goal being to avoid “unnecessary duplication of services” and the prevention of medical errors, thus saving money and time (Accountable Care Organizations, 2015).

The second is the medical home which focuses upon the health care needs of children, the elderly, and others who require round-the-clock care and treatment. In essence, the medical home (sometimes the home of the patient) is the base of operations for a patient’s medical care and treatment, as sort of private hospice if the patient is terminally ill. This sort of arrangement is generally between the patient, his/her family, and the health care provider, such as a physician or in many cases, a professional nurse who might live on-site as the primary caregiver.

The third is the nurse-managed health care clinic which in 2015 can be found in many metropolitan areas and rural settings. This is perhaps the fastest-growing health care entity, due to the fact that they are primarily operated by Advanced Practice Registered Nurses (APRNs) and other professional nurse practitioners. They are also staffed by an “interdisciplinary team of healthcare providers that may include physicians, social workers, public health nurses, therapists,” and mental health professionals (Nurse-Managed Health Clinics, 2014).

Feedback Summary

At my department at a local hospital (ICU), I approached three of my fellow nursing colleagues and asked them what they thought of the future of nursing in the United States and the current trends related to health care reform. Basically, all three agreed with the findings presented in this short paper. For example, although none of them had ever been employed at an ACO or accountable care organization, they were intrigued by the idea of working alongside a group of professionals like physicians, nurse specialists, and other health care providers that volunteer their time and expertise to help others who may not be able to afford high quality health care at a local hospital or clinic or who are on Medicare or Medicaid. They also liked the idea of attempting to lower duplication services, such as diagnosing an illness in a patient who has already been diagnosed for the same illness. They also liked the idea of lowering medical errors which unfortunately ended the career of a nurse that worked at a local hospital several years ago and who was good friends with one of the nurses.

One of the nurses was quite familiar with medical homes, due to having been employed in one several years ago before her current position at a local hospital as a Advanced Practice Nurse or APN. Her basic impression was good all around since this particular medical home was the private residence of the patient, a young girl with a rare congenital disorder. This nurse was employed by the mother as the primary caregiver of her daughter. This nurse also informed me that my research my right on target because it was an arrangement between the patient, her family (in this case, her mother), and the health care provider, being the nurse who lived part-time at the premises for about four years until the young girl’s condition deteriorated to the point of requiring a long stay in the hospital.

All three of these nurses do have some experience in working at nurse-managed health care clinics, such as found in small cities and towns across the country and usually supported financially by the state governments via some type of state-based medical program for poor and indigent citizens. All three of the nurses also acknowledged that this type of medical facility is quickly becoming standard practice in most US states. Also, all three of these nurses are Advanced Practice Registered Nurses and generally found working in one of these health care facilities as pleasant and conducive to learning more about their profession and how nurses can work together to achieve some amazing results.

All three of the nurses also agreed wholeheartedly that today in 2015 is a great time to be a professional nurse, due in part to President Obama’s recent health care reforms which will provide much-needed health care to more than thirty million Americans who previously did not have health care coverage. Although some may look at this as socialized medicine as they have in Canada and the European Union, the impact of this program (sometimes called Obamacare) will be quite significant for America and its hard-working professional nurses.

According to the National Academy of Sciences in Washington, DC, the profession of nursing “represents the largest sector of the health professions with more than 3 million registered nurses in the United States.” Thus, we must ask a very pertinent question–what roles can nurses assume in order to help address the increasing demand for safe, high-quality, and effective health care services? One of the answers is nurse-managed health clinics which can provide primary care, “care coordination and transitional care, prevention and wellness, and the prevention of adverse events” (The Future of Nursing, 2011, p. xi).

The overall importance of nurse-managed health clinics cannot be too overstated, something that the three nurses that took part in this paper would certainly agree with without hesitation. One of them does have experience as a primary care physician (PCP) or in this instance, a primary care nurse (PCN). As noted by the Institute of Medicine, nurse-led primary care in the near future will be “accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” In addition, nurse-led primary care will act as the first contact entity related to each new health care need. It will also provide “long-term person-focused care, comprehensive care for most health needs, and coordinated care when it must be sought elsewhere” (The Future of Nursing, 2011, p. 2.7).

Interestingly, the three nurses mentioned so far in this paper are fully aware of the statistics related to the current status of nursing in the United States. For example, there are an estimated 400,000 primary care providers working in the United States today in 2015. Out of this number, about 287,000 are physicians or MDs with about 83,000 as nurse practitioners (The Future of Nursing, 2011, p. 6.2).

As might be suspected, the number of nurse practitioners is steadily increasing in the US, while the number of medical students entering primary care continues to decline. What these figures indicate is that professional nurses will be assuming the roles usually relegated for physicians in the near future. Also, it appears that professional nurses will not be gainfully employed as the majority in large urban cities but instead in small rural areas. This is supported by more statistics which demonstrate that “65 million Americans live in areas that are officially identified as primary care shortage areas” with only one out of ten physicians practicing in those areas (The Future of Nursing, 2011, p. 6.2).

Taken together, all three of the nurses agree that the future of their profession is bright and full of the unexpected. They also agree that accountable care organizations, medical homes, and nurse-managed health care clinics are the wave of the future, and that health reform as exemplified by President Obama’s Affordable Care Act is urgently needed, due to the fact that America’s elderly population continues to expand which in the near future will place a huge burden on not only our economic system but also our social health care system which revolves around the idea that every American deserves high-quality and effective health care.

References

Accountable care organizations (ACOs): General information. (2015). Centers for Medicare and Medicaid Services. Retrieved from http://innovation.cms.gov/initiatives/aco

Nurse-managed health clinics: Increasing access to primary care and educating the healthcare workforce. (2014). American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/government-affairs/FY13NMHCs.pdf

The future of nursing: Leading change, advancing health. (2011). Washington, DC: The National Academies Press. Retrieved from http://www.thefutureofnursing.org/sites/default/files/Future%20of%20Nursing%20Report_0.pdf

Young, B., Clark, C., Kansky, J., and Pupo, E. (2014). Definition: Continuum of care. Retrieved from http://www.himss.org/ResourceLibrary/genResourceDetailPDF.aspx?ItemNumber=30272