Nurse Practitioner Role Expansion, Term Paper Example

ABSTRACT

This paper examines the role of the Advanced Nurse Practitioner and considers whether sufficient scope exists to expand the role in order to alleviate the pressures placed upon Doctors. It is questioned whether the Affordable Care Act (ACA) introduction will be a catalyst in driving this consideration forward.  The paper is divided into four elements: (1) Introduction – Providing background information (2) Literature Review – Examining existing research and literature produced to date (3) The Affordable Care Act – Defining the act, its objectives and the different dimensions that support the expansion of the ANP roles (4) Conclusion – Provision of a summary of the key points.

INTRODUCTION

There is no doubt about the intense pressures placed upon both Doctors and Nurses in hospital settings.  This being compounded by the shortage of Doctors to meet the demand for adequate patient care.  This has raised the question as to whether the Advanced Practice Nurse should have a more expanded role in order to alleviate the pressures placed upon the Doctors.  This being having sufficient independence from the Doctors in order to address the less critical issues.

The forthcoming introduction of the ‘Affordable Care Act’ in a few years may be the ideal opportunity to address these questions and consider revised roles for the more advanced nursing professionals.  One of the key issues relates to whether this will enhance patient care or prove to be a detrimental step and reduce the quality of services provided to patients.  There will be a number of important policy issues that will have to be addressed including that of : (i) Legal considerations (ii) Ethical Considerations (iii) Both Doctors and Nurses medical opinion on the viability of such an initiative (iv) Patient input.

LITERATURE REVIEW

In some regards we are dealing with a futuristic concept, based upon the introduction of the Affordable Care Act (ACA). However, the shortage of available Doctors in the medical profession is a present day issue.  A number of journal articles focus upon the provisions of the Affordable Care Act (ACA) in terms of what this is intended to achieve i.e. emphasis on preventative medicines and clinical care, promotion of wellness at work and the strengthening of communities, the promotion of healthcare through numerous policies.  It is in the latter statement that the role of Nurses can be more carefully examined.  (Sebelius).

Another important issue that ACA addresses is the increased pressure placed upon the system by the accelerated number of patients requiring medical support; particularly amongst the younger population. This will provide added stressors on both the Doctors and Nurses. (Manchikanti).

The concept of expanding the roles of the Advanced Practice Nurse (APN) is not a new concept. Considerable debate and discussion has been taking place since 1997 and there are numerous medical articles that discuss the merits and demerits of same.  (Safreit).  One area that has been identified where APN’s could take a more proactive role is in family care and the delicate issue of dealing with sexual problems and diseases.  This has historically proved to be a communications barrier for both Doctors and Nurses alike. (Merryn Gott).

AFFORDABLE CARE ACT (ACA)

Relevance to the Nursing Practitioner

The ACA has amongst its aims to improve the overall efficiency and organization of the medical profession.  This is based upon the imbalance between patient demand and the shortage in supply of both nurses and  Doctors to meet future needs.  The lack of Doctors and specialists is likely to place the bulk of the pressure on the nursing profession “National Sample Surveys of Registered Nurses shows that increasing losses from the active workforce, stagnant wages, and low levels of job satisfaction pose major impediments to bolstering supply” (Sochalski).

If the model is to change and increased expectations are to be placed upon the nursing profession then the system needs to find more monies in support of training needs, salary improvements, increasing job satisfaction and improving environmental and social conditions in order to attract more nurses into the profession.

Impact of key stakeholders on policy

One of the key stakeholders of ACA is that of the Insurance Companies who would expand the range of health insurance coverage based upon a more efficient system being in place. Previous attempts have met with little success. This has focused around the concept of Health Insurance Exchanges and the attempt to improve healthcare coverage. These have been placed at the centre of ACA reform policies. (Jost).

Other key stakeholders would be Doctors professional bodies like the American Medical Association (AMA) and the American Association of Physicians and Surgeons (AAPS). These bodies would wish to ensure that the professional integrity of Doctors is retained and not diluted by delegating non-essential duties to Advanced Practitioner Nurses.  This also delves into the Code of Conduct and Ethical Canons of the Doctors in terms of their duties  and responsibility for professional care.

Different Dimensions of the Policy

Ethics – There has been considerable controversy over the ethics of President Obama’s Affordable Care Act (ACA).  It has been questioned whether the ACA is an equitable Act that helps to provide affordable health care to all concerned.  The Republicans have criticised this and stated that if elected they would seek to immediately repeal this Act.  The aim is to provide pressure on the Insurance Companies to have more comprehensive health insurance available to all.  Although this is an 8 year plan it has been criticised as having goals that are not compatible to realistic goal attainment. A far more comprehensive reform of the health system is required that has broader dimensions. (Cochran)

Cultural –  It is estimated that some 47 million residents of the USA are without health insurance.  As employees continue to try and shift the burden to individuals, the trend is set to increase.  As such, this creates a vicious circle where the average Americans continue to struggle with escalating health costs and adequate coverage.  The most successful of all the health care programs, i.e. Medicare is under increasing attack for lack about the service provision.  This particularly impacting the over 65 group that rely on Medicare for health support.  The question posed is  – are  all individuals entitled to healthcare?

Reasons against automatic health entitlement –   Universal healthcare systems fail, and both Canada and the UK are cited as examples.  For example:

• more than 1 million Canadians cannot find a family doctor;
• only 5% of surgery patients in the USA must wait for more than four months for a procedure, as compared to 36% in the UK;
• In mortality rates, the USA is the highest incidence of prostate cancer, but the lowest incidence of death.

Medicare has created health savings accounts, i.e. HSA’s and these have helped individuals to gain  a savings account for small medical expenses.

There also remains, the financial are nationalized health system.  The reality is, there is no free national health care system.  You would need to be paid for by increased taxation or spending cuts in other key areas i.e. defence education etc. as such government intervention in a national health system would lead to a decrease in patient flexibility.  Equally, the government mandated procedures may result in a reduction of Dr. flexibility, and therefore reduce patient care.  Government maintained central health care records may also lead to a breach of patient confidentiality.  Both Canada and the UK, demonstrate a poor track record in central health care administration.

There may also be an escalation in the practice of  lawsuits, as universal healthcare, may expose the government to legal liability costs.  This in turn would have to be paid for by either increased taxes or cuts in expenditure; hence the vicious circle.  Also, patients are likely to be less responsible with their drug costs, if you’re free on a nationalized health service.  The results of this would cause costs to escalate several times higher than current levels.  Finally, like any Social Security, if healthcare is free.  It will be taken as a social right, and once instigated.  It will be almost impossible to review, should it get out of control. (Boot)

Reasons for automatic entitlement – The number of uninsured American citizens has increased to over 45 million people.  The escalating costs of health coverage is made health care become unaffordable for both individuals and businesses in the USA.  Companies already facing tough economic conditions are pushing back by transferring the cost from the companies to individuals.  It is considered that a centralized medical database would be easier for doctors and nurses to administer.  By the introduction of free medical services.  Patients are more likely to practice preventative medicine and inquire about potential problems more expensive medical tree becomes a necessity.  Also, those patients with pre-existing conditions should be able to get health coverage.

The USA is the only industrialized nation that is not guaranteeing health care is an automatic entitlement of its citizenship.  United States spends at least 40% more per capita on healthcare than any other country with universal healthcare system.  It has been estimated that a single payer universal health care system would save between hundred to $200 billion in one year alone.  These figures, even after factoring in all the uninsured and increasing health care benefits.  The cost of health care in Canada as a percent of GNP has reduced since 1971, when the system was first implemented.  In the US costs of increased despite having a stronger economy in Canada.

America cannot afford to have its working populace unable to afford adequate health coverage.  America already has the highest levels of obesity, diabetes, cancer and heart disease in the world.  As such, the American people paid the price for this with sickness, time off work, lost income and loss leisure time with family and friends.  As such universal healthcare is the only viable means of ensuring everybody is treated in an equitable manner and afforded human rights proper medical coverage.  Those countries with universal health coverage have demonstrated more concerned about human welfare and conservative citizens.

It is considered that there is a moral obligation to provide a citizen with universal health coverage.  The single universal health care system is the health care payment system and not be considered a free care system.  Polls in the USA have indicated that between 60 to 75% of Americans like to see a universal healthcare system adopted.  The current situation of the US healthcare system is ranked as the lowest of any industrialized nation.

CONCLUSIONS

Getting the right balance

There are many  different representational points of view as to whether individuals are automatically entitled to healthcare.  On the one hand, many consider that healthcare is a human right and should be provided to all citizens regardless of race, creed or monetary status.  The other viewpoint is that health care is a privilege and should be earnt by responsible citizens through contribution to society.  This has been defined as those people who are employed and pay taxes or contribute financially to society in some other form.  In the United Kingdom and Canada the concept of a universal health system was decided by the electorate.  Perhaps ultimately in the United States, a similar situation will take place i.e., the people will decide on the most suitable system to be adopted moving forward.

The arguments against adoption of the Universal healthcare system are equally convincing.  The concept of government intervention and running a state health system as opposed to the more entrepreneurial approach of the private sector is a persuasive argument.  In the United Kingdom, the national health service — NHS, has been the subject of considerable criticism in terms of sustaining good medical practice and retention of key staff i.e., consultants, doctors and nurses many of which departed to the private sector of the US healthcare system, where they received higher remuneration and improved medical facilities.  The NHS has also been the victim of financial cuts from UK government spending policies.  It is this argument that the anti-lobby put forward in terms of nationalizing the US healthcare system.  That is to say it is feared a government controlled nationalized health system would be greatly inferior to that of a private sector run system that is considered to be much more accountable from a business perspective.

References

Boot, MAX. “ObamaCare and American Power.” Wall Street Journal (2010).

Cochran, James E. Sabin and David. “Confronting Trade-Offs In Health Care: Harvard Pilgrim Health Care’s Organizational Ethics Program.” Health Affairs Vol 26(4) (2007): 1129-1134.

Jost, T.S. Health Insurance Exchanges and the Affordable Care Act: Key policy issues. Academic Report. Washington DC: Washington and Lee University Law School, 2010.

Manchikanti, L Carraway, D Parr, A.T. Fellows, B Hirsch, J.A. “Patient Protectiion and Affordable Care Act of 2010: Reforming the Health care for the new decade.” Pain Physician (2011): 36-67.

Merryn Gott. ““Opening a can of worms”: GP and practice nurse barriers to talking about sexual health in primary care.” Family Practice Vol 21(5) (2004): 528-536.

Safreit, B.J. “Health care dollars and regulatory sense: The role of Advanced Practice Nursing.” Yale Journal of Regulation (1992): 419-434.

Sebelius, H.K. Koh K.G. “Promoting prevention through the affordable care act.” New England Journal of Medicine (2010): 1296-1299.

Sochalski, Julie. “Nursing Shortage Redux: Turning The Corner On An Enduring Problem.” Health Affairs Vol 31 (9) (2012): 157-164.