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Health Reform and Nursing Practice

Abstract

This paper explains the anticipated changes in the nursing practice regarding health reforms in the USA. First, the paper will describe the expected growth and changes in nursing practice. Some issues to be discussed include the increase in the number of nurses, the growing demand of nursing care services in geriatrics, the continuum of care, and improved the collaboration in the healthcare system. Then, this paper will provide the impressions of three nurses regarding the changes. The first two nurses had been professional nurses for 15 years. They understood healthcare reforms properly, and they were prepared for the changes that would occur during the implementation of these reforms. The last nurse had worked for only one year, but she was equally prepared for any changes as well. However, the nurses did not understand some challenges that would come with the implementation of health reform. This paper will discuss nursing shortage as an aspect that nurses did not understand.

Keywords: Medicare, Medicaid, evidence-based practice, continuum of care, health reform

Evolving Practice of Nursing and Patient Care Delivery Models: Health Reform and Nursing Practice

Healthcare reforms have led to the various changes in the healthcare system, particularly to the nursing profession. Thus, the government has enacted various acts that aim to increase health coverage for the United States citizens (NY State of Health, 2012). These laws form a significant part of health reform that ensures that healthcare services are affordable to every citizen. After the laws had been enacted, the nursing fraternity experienced various changes in the delivery of nursing services. Additionally, the government continues to make necessary modifications in the healthcare system. Accordingly, nurses anticipate more changes, both in healthcare settings and other nursing institutions. This paper examines the expected variations in the nursing practice, impressions of three nurses regarding the changes, and an analysis of their ideas with the facts about health reform.

Expected Growth and Changes

The nursing profession expects an increase in the number of nurses who will deliver adequate health services. Consequently, the US government has made significant steps towards overcoming challenges related to affordability and accessibility to health services (Obama, 2016). Currently, the percentage of uninsured people has reduced, while the number of people seeking health services in the hospitals has increased. This increase requires sufficient nursing staff to implement necessary treatment and prevention measures. As seen by the numbers presented by the United States Department of Labor (2015), by 2024, the United States will experience a 16% increase in the employment of nurses. Thus, many nurses are expected to deliver health services in the future.

The reforms will also warrant a high demand for nurses in geriatrics. The reforms have increased the number of senior citizens who seek health services (The Centers for Medicare and Medicaid Services, 2016). Thus, the United States is expected to have an increased population of older persons with various health problems such as Alzheimer’s disease (World Health Organization, 2016). Medicare has made it easy for these seniors to access health services in different healthcare settings. Accordingly, the demand for nursing services is also expected to increase. Therefore, all nurses, including those who have not specialized in geriatrics, are projected to offer more nursing services to the seniors as compared to the current situation.

The reforms will guarantee an improved continuum of care. As Fletcher and Dahl (2013) claim, nurses have contributed immensely to the treatment, prevention, and follow-up of various diseases in the healthcare system. At the same time, the Affordable Care Act together with Medicaid and Medicare have ensured the integration of treatment and prevention efforts to reduce the number of sick patients in hospitals (Medicaid.gov, n.d). In this regard, nurses are expected to advance their disease prevention skills to ensure that the number of patients seeking care in the hospitals reduces. One of the ways nurses can do this is to guarantee that they provide care to patients and implement follow-up strategies, not only at the patients’ home but also in other healthcare delivery settings to monitor the progress of recovery among patients. Thus, the implementation of this initiative will see many nurses work in the communities as opposed to hospitals.

The reforms will also lead to the coordination of healthcare delivery institutions with other sectors, interested in improving the healthcare system. Nurses are expected to contribute immensely to the coordinated activities since they form the largest number of healthcare workers in the United States. Eventually, the prevalence of some diseases will reduce, thus providing a positive image of the nursing profession. For instance, the Tobacco Control Act was signed in 2009 (Obama, 2016). Healthcare providers together with Food and Drug Administration applied significant efforts in regulating the production and consumption of tobacco. In 2015, the smoking rates reduced from 19.5% to 10.8%, with a subsequent decline in the prevalence of health problems resulting from smoking tobacco (Obama, 2016). Therefore, nurses are expected to spearhead further collaborative efforts to improve the healthcare system. Most importantly, the increased leadership roles of nurses are expected in the Accountable Care Organizations to unite all healthcare providers with the aim of treating and preventing diseases.

Finally, health reforms will ensure that nurses can embrace the utilization of Evidence-Based Practice (EBP) in the workplace. Improved affordability and accessibility of healthcare services have resulted in an increased number of patients seeking care, which will expose bedside nurses to many diseases. Nurses will need to be informed about various guidelines that regulate the management of illnesses. Additionally, nurses are expected to improve their educational achievements to provide high-quality care demanded by health reforms. Currently, plans are underway to increase the number of nurses with baccalaureate degrees because they play a critical role in implementing EBP to provide high quality and affordable care (American Association of Colleges of Nursing, 2015). Therefore, nurses are expected to have higher educational achievements to provide high-quality care in both medical homes and nurse-managed health clinics to guarantee proper implementation of these reforms.

Impressions of Nurses Regarding the Anticipated Changes

After reading many publications on health reform and its effect on the nursing profession, I decided to inform and interview my colleagues. Their responses indicate that they are knowledgeable about these reforms. They are also eager to implement the anticipated changes because of the envisioned benefits attributed to such reforms.

The first nurse has worked as a bedside nurse for 15 years. In her experience, she had been employed in various medical homes, nurse-managed clinics, and critical care settings. We shared much information regarding the previous and current reforms in healthcare. After the discussion, I asked her to explain her perceptions regarding all reforms and anticipated changes in nursing practice. Additionally, I asked her to talk about the new roles in nursing care delivery. The nurse said that health reforms would bring benefit to the public and the nurses. Then, she stated that the Affordable Care Act was an important reform because it could help her deliver more health services to the public, particularly the senior citizens. When I asked her whether she had considered the current shortage of nurses when issuing that statement, she said, “Nurses are few, and everybody knows that. However, different research studies have shown that the number of nurses increases. Therefore, it means that we will have more nurses to help in the new roles such as disease prevention.” Then, I asked her to explain her views regarding the effect of the reforms on the nurses working in communities. The nurse indicated that such a move would be significant because it would help nurses to develop their skills in the prevention of diseases and continuum of care. This nurse explained the anticipated changes concerning the improvement of competencies among nurses. All her views were positive during the entire conversation.

I discussed the reforms with the second nurse who had the same years of experience with the one I had talked previously. Similarly, this nurse had immense knowledge regarding health reforms. During the interview, he explained various acts, including the Medicare Access and CHIP Reauthorization Act and Children Health Insurance Program. Additionally, he explained Medicaid and Medicare in details and offered different opinions on their effects on healthcare in general. Then, I inquired from him about the anticipated nursing role changes such as increased community-based care, disease prevention, EBP, and improved nursing education. The nurse said that the most aggressive nurses would cope with the demands because the reforms would require each nurse to acquaint themselves with every new change. When I asked him whether that would be overwhelming to nurses, he said, “No. I did not mention that. The reforms will improve the curiosity of nurses. These reforms will also make nurses learn to diversify their functions despite their specialization.” He continued, “For instance, a community health nurse will need to understand the prevention of both chronic and infectious diseases to help in achieving some goals of health reform such as disease prevention.” Most statements from this nurse indicated that the health reforms would make nurses participate more in delivering health services as opposed to the way they do currently.

The last nurse had just worked for one year since graduation. In our discussion about health reforms, she was only aware of Medicaid, Medicare, and the Affordable Care Act. However, she could not explain them in detail. I helped her to understand various laws and the anticipated changes in the nursing practice in the hospitals, community health, and medical homes. Then, I asked her about her views regarding the changes. The nurse said that she would prepare adequately for any changes because she wanted to participate in the growth of the nursing profession. When I asked her whether she was willing to work in the community to help in preventing diseases, she said, “That is one of my goals. I will be proud to participate in reducing the number of patients who seek care in health facilities.” Similar to other nurses, her views were positive about the reforms.

Consistency of the Impressions with my Research About Health Reform

Most responses from the nurses were consistent with the facts about health reform. However, the three nurses did not consider some problems such the shortage of nurses and the associated challenges that came with the implementation of health reforms. For instance, the first nurse indicated that health reforms would improve the competencies of nurses. The second nurse distanced himself from the claims that these reforms would be burdensome to nurses. The last nurse did not mention anything related to nurse-patient ratio. Many patients are expected in the healthcare settings and so are the nurses to care for them (Medicaid.gov, n.d). The American Association of Colleges of Nursing (2014) indicates that despite the current growth in the number of nurses, the United States is likely to experiences a shortage due to the growing number of the aging baby boomers. Further, Rahman and Shamsudin (2015) argue that nursing shortage affects patient outcomes negatively. Therefore, nurses need to be aware that despite the significant steps of health reforms, such challenges exist. Consequently, they should be prepared to handle them as they plan to adapt to the anticipated changes. Most importantly, they should advocate adequate staffing to help meet the goals of health reforms.

Conclusion

Nurses are expected to adapt to the changes that occur in the healthcare system because of healthcare reform. These reforms guarantee the affordability and quality of health services to all people regardless of their physical status or level of income. Moreover, they have improved the accessibility of health services. The initiative has resulted in many patients seeking care in hospitals. Further, it has led to a decreased percentage of nurses who work in healthcare settings. Most nurses are aware of the advantages and the disadvantages associated with health reform. Accordingly, they have laid strategies to adapt to any changes that might occur because of health reforms. Considerably, these reforms benefit not only the patients but also the nurses and all other sectors involved in the delivery of health services.

References

American Association of Colleges of Nursing. (2014). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

American Association of Colleges of Nursing. (2015). Creating a more highly qualified nursing workforce. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce

Centers for Medicare and Medicaid Services. (2016). CMS quality strategy. Retrieved from https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/downloads/cms-quality-strategy.pdf

Fletcher, M. J., & Dahl, B. H. (2013). Expanding nurse practice in COPD: Is it key to providing high quality, effective and safe patient care? Primary Care Respiratory Journal, 22, 230-233. http://dx.doi.org/10.4104/pcrj.2013.00044

Medicaid.gov. (n.d). Prevention of chronic disease. Retrieved from https://www.medicaid.gov/affordable-care-act/prevention/index.html

NY State of Health. (2012). What is healthcare reform. Retrieved from https://healthcarereform.health.ny.gov/summary/

Obama, B. (2016). United States health care reform: Progress to date and next steps. JAMA, 316(5), 525-532. doi:10.1001/jama.2016.9797

Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Asian Social Science, 11(9), 326-332. doi:10.5539/ass.v11n9p326

United States Department of Labor. (2015). Registered nurses. Retrieved from https://www.bls.gov/ooh/healthcare/registered-nurses.htm

World Health Organization. (2016). Global health and aging. Retrieved from http://www.who.int/ageing/publications/global_health.pdf