Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

As President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010, he stated that the core principle of healthcare reform is that “everybody should have some basic security when it comes to their healthcare.”1 The legislation, including the reconciliation bill, the Health Care and Education Reconciliation Act (signed March 30, 2010), is designed to reform healthcare insurance policies and practice, and expand coverage to the insured in the United States. The 2 bills together are known as the Affordable Care Act (ACA).Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

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The Future of Nursing: Leading Change, Advancing Health observes that the changing landscape of health care and the changing profile of the U.S. population will require fundamental shifts in the care delivery system (IOM, 2011). In particular, the report notes concerns about a shortage of primary care health professionals in the United States, particularly given the expansion of insurance coverage under the Patient Protection and Affordable Care Act (ACA). It suggests that advanced practice registered nurses (APRNs), if permitted to practice to the full extent of their education and training, could help build the workforce necessary to meet the country’s primary care needs and contribute their unique skills to the delivery of patient-centered, community-based health care. While the Institute of Medicine (IOM) report makes special mention of the role for APRNs in primary care (see Box 2-1), the report’s recommendations are not limited to those settings, but encompass the full continuum of health services in many health organization and community settings.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

There is a shortage of primary care physicians nationally and within the Medicaid program, yet studies repeatedly show that primary care reduces cost and increases quality for consumers.

Nurse practitioners can play an important role in expanding primary care capacity in the Medicaid program. Nurse practitioners (NPs), often called mid-level providers, are able to provide some aspects of primary care, complementing the work of primary care physicians. Nurse practitioners are nurses with advanced clinical training. They need fewer years of training than physicians making them a more immediate support to a stretched primary care workforce. Additionally, NPs reduce cost because their average earnings are half those of primary care physicians.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

NPs are important for areas of the country that face severe primary care physician shortages – this shortage is particularly acute for rural areas and southern states where the patient-to-primary care physician ratio is higher and where fewer physicians are choosing to practice. Studies show that NPs are more likely to practice in these underserved areas than primary care physicians, increasing access for Medicaid patients and the uninsured.

Although NPs are trained to provide primary care, states differ in scope-of-practice guidelines. Scope-of-practice guidelines dictate what authority NPs have with their patients. Some states allow NPs to provide primary care, diagnose, and prescribe without physician oversight, while others have more restrictive scope-of-practice guidelines that require physician oversight and may limit NP practice and prescription authority. For example, Alaska allows NPs to diagnose and prescribe all medications without physician oversight while Missouri requires written documentation of physician involvement for NPs to diagnose and prescribe.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Expanding NP scope-of-practice strengthens primary care capacity. Greater NP autonomy increases consumer access to primary care while freeing up physicians to manage more complex patient cases. States can support consumer access to health care by passing legislation that eases restrictions on NP scope-of-practice.

There is extensive research documenting nurse practitioner’s ability to provide high quality care, resulting in similar patient outcomes to physician-provided care. Similarly, patients that see NPs report high levels of satisfaction.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Harnessing NPs can also help address a common barrier to care for Medicaid beneficiaries: the shortfall of primary care providers. The 2014 expansion of the Medicaid program, mandated by the Affordable Care Act, will enroll approximately 16 million new participants, many needing a primary care provider for the first time. Empowering NPs to diagnose and prescribe without physician oversight is one important tool in helping to ensure that there is an adequate primary care workforce to serve this new population, especially since NPs are more likely than MDs to treat patients in settings where provider resources are scarce.

Studies show that a higher concentration of primary care physicians results in higher quality, lower cost care. One recent study shows that a 10 percent increase in primary care physician to patient ratio results in a 7 percent spending drop ($369) per Medicare beneficiary, on average. This suggests that increasing primary care capacity is a bridge to cost savings and better care.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

After a detailed analysis of research showing how advanced practice registered nurses provide safe, quality care, the Institute of Medicine recommended rewriting federal and state laws to allow APRNs to practice to the full extent of their education and training — a position opposed by many physician groups.Today state practice acts, institutional rules, and federal statutes and regulations that require physician oversight or otherwise limit APRN practice continue to reduce access to care, create disruptions in care, increase the cost of care, and undermine efforts to improve the quality of care. This brief outlines the debates surrounding the regulation of APRN practice, the patchwork of laws and regulations that restrict patients’ access to APRN services, and the human and economic toll that accompanies these practice restrictions. The brief also debunks common myths about APRNs and highlights progress toward removing practice barriers.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

There are four distinct APRN roles: nurse practitioner (NP), certified nurse midwife (CNM), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA). Each role has a specific scope of practice that is based on their unique educational preparation and training and allows them to contribute to primary care in distinct and important ways (Federation of State Medical Boards, 2017, Safriet, 2002). APRNs bring a holistic as well as patient-centered and family-centered approaches to the prevention and management of complex health and behavioral issues addressed in various care settings across the life span. They work collaboratively with physicians and other members of the health workforce to optimize patient care and health. For example, NPs provide a range of comprehensive care services to address individuals’ physical and mental health needs across the life span, and CNMs provide primary sexual and reproductive health services across the life span as well as postpartum care, childbirth, and care of newborns (Phillippi and Barger, 2015, Pohl et al., 2010b). CNSs and CRNAs increase access to affordable care services for populations in rural areas (Seibert et al., 2004). APRNs provide needed services to some of the most vulnerable populations in our society, including individuals from racial and ethnic minorities, Medicaid and Medicare recipients, residents of rural and frontier areas, and the uninsured and underinsured (Agency for Healthcare Research and Quality, 2014, Buerhaus et al., 2015, Seibert et al., 2004).Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The ability of APRNs to practice to the full extent of their education and training is inextricably linked to state-level scope of practice¹ laws and regulations (National Coalition of State Boards of Nursing [NCSBN], 2008). At the state level, scope of practice for nurses is established either by legislative statute or by regulation, the Board of Nursing (BON), or other executive agencies (Buppert, 2014). Scope of practice in many states is limited by Board of Medicine (BOM) and/or Board of Pharmacy (BOP) oversight, removing the authority of nursing to govern APRN practice and licensure, and the ability for APRNs to practice to the full extent of their training as part of organized interprofessional health care teams (Hanson, 2014, Pohl et al., 2010a). Requirements such as mandated collaborative practice agreements (CPAs) and physician-supervised transition-to-practice periods²increase the cost of providing care, lead to gaps in care, and deter APRNs from working in these restrictive states, without any demonstrated improvement in safety or quality (Fauteux et al., 2017, Kleiner et al., 2014, Safriet, B.J. 2011).Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

State-level challenges to APRN FPA have been exacerbated by ambiguities at the federal level. For example, failure to define APRNs as primary care providers under the ACA left this matter up to individual states, which contributed to barriers to FPA such as inconsistent policies regarding reimbursement for services delivered by APRNs, including lower payment³ rates (Brooks Carthon et al., 2015, Kurtzman et al., 2017, Safriet, 2002, Safriet, B.J. 2011). Centers for Medicaid and Medicare prohibit APRNs from common tasks such as conducting admission evaluations and monthly assessments of patients admitted to skilled nursing facilities (American Association of Nurse Practitioners, 2012). In some cases, APRNs who have been authorized to perform within the full scope of their practice are later denied reimbursement for their services (Government Accountability Office, 2014), which limits patients’ access to care. FPA for all APRNs in every state is further impeded by lack of consumer awareness of the type and amount of training APRNs receive and the services that they can provide, opposition from professional medical associations, and legislators who are tired from previous legislative attempts to widen APRN scope of practice (Safriet, 2011).Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Nearly three years later, though physician opposition continues, a projected primary care provider shortage and the expected demands of healthcare reform are increasing the pressure on state and federal governments, insurance payers and healthcare administrators to do what growing numbers of people believe is simply good evidence-based practice.

“As a physician, it’s a little embarrassing to see these medical guys who make a big deal of evidence-based medicine, and they’re against this,” said John W. Rowe, MD, a professor in the Department of Health Policy and Management at the Columbia University Mailman School of Public Health in New York City, former CEO of Aetna, Inc. and a member of the Institute of Medicine committee that published “The Future of Nursing: Leading Change, Advancing Health” in 2010. “The evidence is all in favor of having advanced practice nurses provide for basic primary care services.”Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Since the report came out, Rowe and others, including nursing organizations, consumer groups, businesses, state governors and public health organizations, have been working to reframe the scope-of-practice issue, taking it beyond turf battles between physicians and nurses. In addition to the IOM report, they point to evidence-based studies, reports and existing practice models showing how eliminating barriers to practice best serves patients at a time when primary care is desperately needed. (See sidebar for a list of some of these studies.)Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

“This is not a competition or about nurses having more power,” said Susan C. Reinhard, RN, PhD, FAAN, senior vice president for public policy at AARP, which has come out strongly in favor of expanding scope of practice for APRNs. “This is about nurses and other professionals being able to do what they are trained and educated to do. We need more primary care providers across the board. This is not a nursing campaign, it is an American campaign.”Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

As healthcare delivery changes and demand increases, all groups — including nurses — will have to let go of their territorial impulses, Reinhard said. Projections from the Association of American Medical Colleges predict the country will face a shortage of 45,000 primary care physicians by 2020. A nursing shortage also is predicted, as demand for care by aging baby boomers increases and more nurses retire. Nurses must be willing to allow other providers, including certified nursing assistants, health educators, home health aides, and, in some cases, family members to give whatever care they can safely provide, according to evidence and standards of practice, she said.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Seventeen states and Washington, D.C., do not require any physician supervision for advanced practice nurses. The rest require some sort of physician involvement in diagnosis, treatment or prescribing, and many states are considering legislation to change those laws, said Jan Towers, PhD, NP-C, CRNP, FAANP, FAAN, senior policy advisor for the American Association of Nurse Practitioners.

Besides legislative restrictions, other barriers to APRN practice include difficulty getting reimbursement from insurance companies; federal regulations preventing non-physicians from ordering home care services, hospice or medical equipment; and institutional barriers, such as not having admitting privileges at a hospital or not being allowed to perform certain procedures. Even in states where they are allowed to practice without physician supervision, APRNs still may struggle with restrictive hospital or compensation policies, Towers said. But she and others believe such restrictions are more likely to loosen in states that allow APRNs full scope of practice.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The barriers to scope-of-practice hurt patients in a number of ways, nurse practitioners said. Many times the laws make practice more cumbersome, forcing nurse practitioners and families to work around them, said Susan Apold, PhD, RN, ANP-BC, FAAN, dean of the division of health and human services at Concordia College-New York.

For instance, in New York nurse practitioners must sign a collaborative agreement with a physician, but if the physician dies, retires or is arrested, the nurse practitioner can no longer see patients, Apold said. To resume practice the NP must find another physician collaborator. In Florida, nurse practitioners cannot prescribe certain drugs for patients, even with physician oversight, Towers said. They must get a physician to officially prescribe the drugs. Federal regulations prohibit nurse practitioners from ordering home care or medical equipment for Medicare patients. The nurse or family must find — and pay — a physician to do this, Apold said.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

In Colorado, hospitals and nursing groups last year successfully battled a lawsuit brought by anesthesiologists and medical societies that would have required physician supervision of nurse anesthetists, something small rural hospitals said they could not always provide. In North Carolina, which is considering a law to require physician oversight of nurse anesthetists, Sharon Pearce, CRNA, MSN, fears a similar situation, especially if the state requires the physician to have anesthesiology training. The practice where she works, run by two nurse anesthetists, could not afford to pay an anesthesiologist’s salary, said Pearce, president-elect of the American Association of Nurse Anesthetists. Nursing groups in North Carolina are fighting the law, Pearce said, but they face formidable opposition from physician groups who are outspending them.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Physician groups, led by the American Medical Association and the American Academy of Family Physicians, actively oppose state legislation to remove physician supervision of APRNs, citing concerns for patient safety. An AAFP white paper stated physicians have an average of 11 years of education and training compared with 5 to 7 years for a nurse practitioner.

But such training doesn’t mean physicians are the only ones able to provide safe, quality basic primary care — or even the best ones to do so, Rowe contended. He noted that as an experienced physician, he has more training, medical knowledge and experience than a new graduate nurse practitioner. “But it doesn’t mean I know more about providing core primary care.”Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The AMA declined to provide someone to expand on its view for this article. Instead an AMA spokeswoman provided a quote from the organization’s president, Ardis D. Hoven, MD, saying the group supports the use of “physician-led teams, comprised of a variety of healthcare professionals.” The AAFP has published a similar statement on its website.

Nurse practitioners agree the best patient care is delivered by a team of providers with the patient at the center, Towers said. “We’re very team-oriented. But that doesn’t mean the physician has to be the leader of the team.” The team works best, she said, when all members are allowed to practice according to the standards of care for their professions.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Apold said she believes many physicians who work directly with nurse practitioners do not necessarily agree with their own associations’ positions. When the Robert Wood Johnson Foundation brought representatives from nursing and physician associations together to discuss the issue, they generally agreed that doing away with hierarchies best served patients and that non-physicians could lead provider teams. But when they returned to their professional organizations, “the process fell apart because the associations were not able to divorce themselves from a guild mentality,” said Susan B. Hassmiller, RN, PhD, FAAN, senior adviser for nursing at RWJF.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

APRNs are not the only providers dealing with scope of practice barriers. Physician assistants, optometrists and pharmacists are battling regulations they say keep them from practicing to the full extent of their education and training. RNs also encounter legal and institutional limits that can hinder patient care. Hassmiller gives the example of a home health nurse who was unable to order Styrofoam boots for a patient to prevent foot-drop. The patient’s husband was forced to wrap her in a blanket, carry her to a car, and drive her to the parking lot of the physician’s office so the physician could examine her and order boots.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

As the demand for healthcare increases, nurse leaders and policy experts said, nurses must continue to use the latest evidence to show physicians, payers and employers what the public already knows: that nurse practitioners, nurse midwives and nurse anesthetists provide safe, excellent care,

Nurses can work with their organizations and other groups to pass state laws allowing APRNs to prescribe and practice without physician supervision, fight proposed legislation that would be restrictive, and lobby for changes in federal regulations. They can educate hospital administrators about what nurses’ education and training allows them to do, and press insurers to officially include APRNs on their lists of providers. The American Nurses Association recently proposed that insurers participating in the new state and federal health exchanges have a certain number of APRNs as recognized primary care providers.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Though progress seems slow, it is happening.

More states than ever are considering laws to expand scope of practice for APRNs, Towers said. Hassmiller is optimistic that within the next five years, consumer and marketplace demand will fuel the push to lift scope-of-practice barriers. As people become more familiar with the nation’s 155,000 nurse practitioners in settings such as retail clinics, community centers and medical groups, they are more likely to want to see them again, Rowe said, citing a recent study from the American Association of Medical Colleges. An increasing number of insurance companies are willing to directly reimburse APRNs, Apold said.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Fighting over who gets to be in charge, and who gets paid extra to be in charge, is ridiculous, given the impending need, Pearce said. “There’s going to be enough work for everybody. We should be walking arm-in-arm and seeing how we can collaborate together to do what’s best for our patients.”

 

 

The legislation increases coverage to those previously uninsured by prohibiting insurance companies from refusing coverage to those people with preexisting medical conditions, removing upper limits of care costs, and allowing adult children up to the age of 26 years to remain on the insurance policies of their parents. The ACA also provides coverage for people who cannot afford insurance by increasing the income level qualifying for Medicaid to 133% of the poverty level and expanding Medicaid coverage to childless adults. The bill includes mandated coverage without co-pays or out of pocket payment for preventive care including annual physicals, immunization, and gynecological examinations Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

This column will summarize the key provisions of the ACA related to nursing, including work force development and expansion of care. In this column, the components of the ACA are assumed to be established and funded. This is by no means certain. This column will also discuss recent report published by the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health.3 This report contains recommendations and solutions for the challenges facing nursing during this period of healthcare reform and was sponsored and funded by the Robert Wood Johnson Foundation. The committee developing the report is chaired by Donna Shalala, former secretary of the Department of Health and Human Services, and currently president of the University of Miami, Florida. The report defines healthcare reform in terms of quality, access, and value.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

To provide more coverage for people with illness, the insurance pool must enlarge to include more people who are healthy. The legislation mandates coverage for all individuals and requires employers to offer coverage to employees. By mandating coverage for all individuals, the aim of the reform is to include more healthy people paying into the system so that more people with illness can be covered by insurance.

The Affordable Care Act reforms do not all take effect immediately, but are set to phase into policy during the next 4 years. The ACA does not provide for a public option for health insurance, also called government funded health insurance, for all individuals in the United States. Healthcare in the United States will remain primarily for profit at this time.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The 2010-midterm elections have brought much uncertainty to the healthcare reform process. The 2 bills passed authorized money and programs but the appropriations for the funds have not occurred.2 A bill can suggest the amount of money to be spent on a program, but the authorization for the dollars is usually in a separate bill that must pass the appropriations committee.2,4 The Republican Party now controls the House of Representatives, while the Democratic Party retains control of the Senate. It is unclear what steps the Republican Party will take and what parts of the new reform bills the Republican Party will attempt to defund or drop completely.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

As healthcare reform expands insurance coverage for more individuals in the United States, the assumption is that more individuals will obtain healthcare, including acute and preventive care. This expansion of care will need an expanded workforce.5 Webb and Marshall6 describe the increased need for nursing services as healthcare is reformed. All facets of the healthcare system, including acute inpatient and outpatient care, chronic and transitional care, preventive care, home care, and palliative care, among others, will need more nurses and more nursing care. To expand the nursing workforce, changes in nursing education are needed. The ACA includes educational loan provisions as well as career incentives for those studying nursing and planning a career in some areas of healthcare.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Mason7 describes the emphasis in the ACA on expanding the number of primary care providers in the US system. There has been financial support for graduate medical education for many years, recognizing the primary role physicians have been given in healthcare in the United States. There has not been equivalent support for undergraduate or graduate nursing education, until now. The ACA formally recognizes the primary roles nurses play in the healthcare system, especially regarding preventive care.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The ACA reauthorizes and expands Title VIII of the Public Health Service Act. Title VIII was originally legislated to increase educational loan repayment for nurses. The Act was not adequately funded and placed a cap on the funds that go on to provide repayment for nursing doctoral program loans.6 The ACA legislates several important changes to Title VIII. A 10% cap on educational grants for nursing doctoral programs was removed. Nurses who serve as faculty are now eligible to apply service as faculty for loan repayment. The ACA allows the secretary of the Department of Health and Human Services to increase the amount of loan repayment for nursing studies as the cost of attendance at schools or universities increases, without the need for new legislation.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Title VIII has been expanded by the ACA to include a geriatric nursing traineeship program. This traineeship program anticipates the increasing need for services to older adults as the population ages and expects that nursing care will be a necessary component of the comprehensive care for older adults. Those nurses who accept these grants must agree to teach or practice in geriatrics, long-term care, or chronic care management. Title VIII now also includes a Workforce Diversity Grant program encouraging minority students to bridge into accelerated nursing degree and advanced nursing practice degree educational programs, hopefully changing the face of the nursing workforce to more accurately mirror the diversity of the American society.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Maintaining and documenting the quality of healthcare

Expanding healthcare coverage and maintaining quality is a focus of the ACA. Transparency in planning, staffing, and outcomes is directed in the legislation. Some specific mandates direct the Nursing Home Compare Medicare Web site8 to publish data for each nursing home or long-term care facility including staffing, resident census, hours of care provided per resident per day, staffing turnover, and staffing tenure. The format for this report is designed to enable consumers to compare facilities and also to compare a facility to national and state averages. The report is also designed to help the consumer understand the relationship between staffing levels and quality of care. The ACA also authorizes the creation of a national standardized complaint form to be used in long-term facilities and provides whistle-blower protection for employees of these facilities who complain “in good faith” about the quality of care provided in these facilities.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Furthermore, the ACA requires nursing facilities that are paid with Medicare and Medicaid funds to disclose information regarding their ownership and organizational structures. The aim of these transparency measures is to create a culture change within long-term skilled nursing facilities.9

The new legislation recognizes the role and importance of nursing within any system of primary care. Nurse-managed health centers are supported with an appropriation of $50 million in the fiscal year 2010 with increases authorized through fiscal year 2014. Nurse-managed health centers provide care for low income and vulnerable populations and also, crucially for nursing education, provide clinical sites for training advanced-practice nurses. The expansion of school-based health clinics is encouraged with new grants providing for new construction and equipment for these clinics.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Advanced practice nurses

As fewer physicians complete primary care residencies, the US population’s healthcare needs will bring about the increasing use of nurse practitioners who can provide primary care.2 The ACA established a program that allows groups of providers and suppliers to form Accountable Care Organizations to coordinate care for Medicare patients. The Accountable Care Organizations may be eligible for incentive payments when certain quality standards are met. Providers eligible to participate include physician assistants, nurse practitioners, and clinical nurse specialists. The ACA provides for a 10% Medicare bonus payment for primary care providers, including nurse practitioners and clinical nurse specialists, who practice in health professional shortage areas.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The ACA increases the reimbursement rate for certified nurse-midwives for covered services from 65% of a physician’s rate to 100% of the physician’s rate. The American College of Nurse-Midwives has worked for this legislation for many years. The recognition of certified nurse-midwives care as equivalent and valuable care is an important landmark within the ACA.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The healthcare reform legislation adds to current medical home legislation. A medical home provides comprehensive health management, care coordination, and primary healthcare. A medical home site is responsible to the patient for managing referrals and appointments and is designed to serve as a clearing house for the patient for all referrals and appointments. The medical home would a one-call/stop point of reference for the patient. At this time, medical homes operate under the direction of physicians. Although the language of the ACA does not exclude advanced practice nurses (APN) from leadership of medical homes, physicians are expressly mentioned. This has been interpreted by some states to mean that only physicians are eligible to direct the operations of a medical home.7 There is current legislation proposed to include APNs in the Medical Home Demonstration Project, but this legislation has not been brought to a vote.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Although the ACA represents what has been called the broadest changes in the US healthcare system since the creation of the Medicare and Medicaid programs in 1965,3 it is not clear as this column is being written, what parts of the ACA will be implemented and what provisions will be substantially rewritten and changed by the newly elected majority in the House of Representatives. Even though the Senate remains under control of the Democratic Party, senators may feel that support for healthcare reform is politically risky.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

THE FUTURE OF NURSING

Nurses must continue to work for changes in the healthcare system that will benefit patient care in the United States for all sectors of the American society. The recent report by the IOM creates a vision for healthcare that values nursing contributions to the nation’s health and hopes to build on the capacity of nursing to initiate, implement, and facilitate improvements in the healthcare system. The report is bold in its recommendations and its conclusions. Four key messages are brought forth in the report.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The first is that nurses practice to the full extent of their education and training. The report describes the maze of state laws governing advanced practice, creating a system in which APNs practice not according to education and training but rather by statute. It is recommended that the federal government take leadership and promote reform and wider scope of practice for nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists. According to Donna Shalala, chair of the IOM group, the federal government cannot force a state to change the legislated scope of practice for APNs, but the federal government could lead by including APNs in the Centers for Medicare & Medicaid Services reimbursement panels.10 The report recommends that transition to practice residency programs be developed and evaluated in community settings, helping new graduate nurses develop skills needed.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The second recommendation of the IOM is that nurses achieve higher levels of education and training through an improved education system that promotes seamless academic progression. As patient care becomes more complex, including the addition of evidence-based care, information management systems, and increasing team strategies, the report calls for nurses to attain competencies in leadership, health policy, system improvements among other fields. The IOM recognizes that the majority of the 3 million nurses in the United States are educated at less than the bachelor’s degree level. To improve the quality of nursing education, a seamless transition into programs providing higher degrees needs to be developed. The report states that nurses should be educated with physicians and other healthcare professionals as students and during continuing education. This dual pathway can increase team building and respect among professionals of different disciplines.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The third recommendation calls for nurses to be full partners, with physicians and other healthcare professionals, in the redesign of healthcare in the United States. Building on the previous recommendation for education and team building, the IOM recognizes that nursing has not been fully represented in the reform process and that true reform is not possible without the input of nursing. Nurses must work to be included on advisory teams and boards, must be active in decision-making processes, and must be willing to take responsibility for identifying problems, inefficiencies, and needed improvements in the system.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The final recommendation of the IOM report recognizes that effective workforce planning and policy will require better data collection and an improved information structure. The ACA mandates workforce data collection and analysis. If this initiative is not a funded portion of the ACA, other opportunities to develop a national database will need to be explored.

The IOM Committee on the Robert Wood Johnson Foundation Initiative on the future of nursing explores the transformation of the nosing profession in the current healthcare climate in the United States. This is a time to build on opportunities and have a voice and contribution in the healthcare system of the future.

NURSING LEADERSHIP

Nursing leaders have attempted to position nurses and nursing in the debate for healthcare reform. Not all nursing leaders are optimistic about reform capabilities. Mary Mundinger, former dean of the Columbia University School of Nursing and a leader in the development of nurse run clinics, points out that true reform is difficult for many to accept. Dr Mundinger states that with the ACA, the only facet of healthcare that may be changed is the requirement for every individual to have insurance. True system reform would mean that every patient would have the right care at the right time.11 She echoes the IOM Report, stating that while nursing can respond to the increased need for primary care providers, the current system is fragmented and regulatory barriers inhibit the full participation and contribution that nurses could make to the nation’s health. The healthcare system at this time provides care too late and in the wrong place at high cost, according to Dr Mundinger.11Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

Healthcare providers, including nurses, are divided about the correct course the United States should take for reform of the healthcare system. Issues that strain the system include the cost of insurance, the inability of many people to obtain insurance, the shortage of primary care providers especially for vulnerable populations, the barriers to the utilization of nursing to the fullest, and the difficulty some systems have in recognizing the contributions nurses could make. Reform does not stop with the Obama ACA, regardless of any changes that may be made in its provisions.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

It is difficult for anyone to keep up with the changes in legislation. Good sources of information for nurses include the American Nurses Association and each state association. Specialty organizations such as the Association of Women’s Health, Obstetric and Neonatal Nurses have updates on legislation that may impact the specialty. Web sites that nurses can access to obtain information and analysis that is pertinent to their specialties or interests are included in Table 1.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper

The healthcare system in the United States is one of the best in the world, at least technologically. The infant mortality rates and the lifespan are not the best in the world. If the American system is to reach its enormous potential, issues of coverage, access, and value must be addressed and viable solutions developed.

Deeper philosophical questions drive the healthcare debate. Is healthcare a right of all US citizens? Should healthcare, insurance, or both be maintained as a for profit system? What is the government’s role in the healthcare system? As the US system, people, and lawmakers struggle with these issues, nurses can contribute to the solutions and make our voices and opinions heard.Bills Or Laws That Influence The Doctorally Prepared Nurse 4 DQ 1 Essay Paper