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Current Healthcare Reform and the Future of Nursing

  • Current Healthcare Reform and the Future of Nursing


    Health Reform: What Do These Laws Mean for Nursing?

    As you probably recall in 2010, president Obama signed two pieces of health reform legislation into law, the patient protection and Affordable Care Act and the Health Care Education and Reconciliation Act. These laws instituted complex changes in healthcare coverage. delivery, payment, and education to ensure access to health care.


    What do these laws mean for nursing?


    The laws recognize that nurses are needed to increase access to primary care and other health services. They call for nursing organizations and leaders to work with states to revise practice laws and regulations to expand the scope of nursing practice, specifically for advanced practice nurses.


    Provisions for Expanded Health Care

    Provisions in the laws authorize maternal, infant, and early childhood visitation programs and funding

    for nurse-driven care models. such as health clinics managed by nurses. These programs require an expanded healthcare workforce to meet the growing healthcare needs. Expanding the workforce, in a

    profession that is already experiencing a shortage, is particularly important to expanding healthcare coverage.


    Therefore, other provisions were included in the laws to authorize resources for expanding the

    workforce. Programs to increase the number of advanced practice nurses and other registered nurses are needed for primary care, health promotion, and disease prevention.


    What Is Being Done to Ease the Shortage?

    What is being done to ease the shortage? Agencies, such as state workforce centers, are focusing efforts

    to provide an adequate supply of qualified nurses to meet their state’s healthcare needs. They are analyzing and strategizing ways to meet these unmet needs.


    The American Academy of Nursing held a conference to examine technology and work redesign. They explored ways in which technology could be used to transform nursing care. From this conference, a commission comprised of nurses from practice and education was formed. They identified a key to the nursing shortage was the shortage of nursing faculty, which directly impacts the educational preparation of the workforce. As a result, the commission is focusing its efforts on redesigning nursing education at all levels. They are also trying to identify barriers that prevent individuals from seeking nursing education.


    The National Health Care Workforce Commission

    The National Health Care Workforce Commission was formed as part of the Patient Protection and Affordable Care Act. Its purpose is to develop and evaluate healthcare education and training, identify

    and address barriers, and encourage innovation.


    This commission. chaired by a nurse. is comprised of 15 appointed members that represent health professions. employers. third-party payers, experts in healthcare services and economics, consumers,

    workforce investment boards, and educational institutions.


    However, despite the formation of this commission in 2010. it has yet to meet because of a lack of

    governmental funding. This commission could affect change, but without proper funding it has been

    rendered ineffective.


    More Important Than Ever That Nurses Get Involved

    As you can see. providing quality care is a major issue that is being addressed in legislation. It is

    more important than ever that nurses become involved in legislation at the local, state, and national levels because nurses directly impact patient care in a variety of settings.


    Moreover, with the advent of nurse-driven care models, it is important for nurses to be involved in

    regulatory changes. An important regulatory change initiative is to broaden the practice of advanced practice nurses so they can independently practice without oversight by a physician.


    Nurses also need to work to gain recognition for their value in the reimbursement process. Some

    strides have been made for reimbursement for advanced practice nurses. For example. they are now recognized as medical providers by Medicare, Medicaid, the Veterans Administration, the Department of Health, the Indian Health Services, and some private insurance plans. But much more needs to be accomplished.


    As you recall. the Institute of Medicine report identifies reimbursement for nurses as problematic. The report points out that it is difficult to identify nursing contributions in a fragmented healthcare system. in part, because healthcare organizations do not have accounting systems that are able to identify the economic value of nursing care.


    What Can Nurses Do to Show Their Value?

    What can nurses do to show their value? In a pay- for-performance healthcare environment. it is important that nurses exhibit leadership in obtaining reimbursement for care. Nurses are involved in the majority of care that prevents complications, such as falls. pressure ulcers, catheter-associated urinary

    tract infections, and a variety of other hospital-acquired conditions.


    Nurses need to demonstrate that they have a major impact on the quality of care by assessing risks and developing evidence-based practices to prevent these complications. Then, they need to collect and analyze data, evaluate outcomes, and implement evidence-based measures to improve care. And finally, they need to show the economic impact of nursing care on preventing these complications.


    The Future of Nursing: Four Key Issues

    If you recall. the Institute of Medicine report on the future of nursing gave recommendations for the

    nursing workforce. Their report was developed to improve the health of the population by supporting nurses in their efforts to deliver care. They issued eight recommendations that focused on four key issues.

    Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through a system that provides seamless academic progression. Nurses should be full partners with physicians and other members of the health team in redesigning health care. Better data collection and information infrastructure should be made available for effective planning and policy making.


    The Future of Nursing Is You

    As you can see. there is a lot of work to be done to further the nursing profession and to ensure safe.  quality care for a growing population. It is your responsibility as a nurse to demonstrate leadership and actively participate in your profession.

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