Universal healthcare, born out of the Affordable Healthcare Act, will lead to changes in the healthcare field. While many developed nations have some form of universal healthcare, the United States has been slower to enact a system that makes medical care available to the public. Politics, state challenges and Supreme Court rulings aside, the medical community should proactively take a look at how reform could change the healthcare system. Here are a few ways that healthcare reform may affect the nursing community:
Hospital Consumer Assessment of Health Plans Survey (HCAHPS)
Pres. Barack Obama speaking in the East Room at the White House at the 2nd Healthcare Summit
HCAHPS is a national, published and standardized survey of patients’ levels of satisfaction with hospitals and care facilities. Pronounced “H-caps”, it provides common metrics and national standards for collecting this data. HCAHPS results are published quarterly and eight measurements are considered including Communication with Nurses, Communication with Doctors, Staff Responsiveness, Pain Management, Communication about Medicines and Discharge Information. Another measurement includes a composite score that combines Hospital Cleanliness and Quietness as well as a global item which is the Overall Rating of the Hospital. The goal of HCAHPS is to provide meaningful comparisons of hospitals and to create accountability by publicly reporting the results in order to incentivize hospitals to improve their quality of care. In fact, a portion of the payment from the Centers for Medicare & Medicaid Services (CMS) is linked to a hospital’s performance so there is a financial incentive for hospitals to improve. 1
What does this mean for the nursing community and, specifically, nurse educators? It is critically important that nursing programs incorporate bedside manner and a level of affect into educational programs. Foundationally, students must understand that their performance may not just be measured based on standardized objectives, but, also subjective evaluations by the patients. The patient-centered perspective may affect hiring practices, hospital budgets, nursing salaries and nurse-to-patient ratio. Initially, it has affected many nurses on the floor as hospitals have increased staff and asked nurses to respond to any patient call even if it’s not their particular patient.
Patient satisfaction is important but the metric can place pressure on hospital staff and, in the short run, may be difficult to implement. In the long run, patient satisfaction can make great business sense. In his book Patient Satisfaction: Understanding and Managing the Experience of Care, Dr. Irwin Press, Ph.D., an internationally recognized anthropologist, says, “When you take patient satisfaction very seriously, you will achieve higher quality of care; your staff will be more content with their jobs and turnover will be lower; you will be more likely to stay financially healthy; your competitive position will be strengthened; and you will be less likely to be sued.” 2 Many hospitals and care facilities are proactively addressing this trend by implementing customer service training for nurses and staff. At minimum, every member of the organization should be aware of the initiative, results and what patient satisfaction means to the bottom line of the business.
Shortage of Healthcare Providers
By 2014, coverage will be extended to more than 300,000 people. 3 With access to care being extended to 31 million uninsured Americans in coming years, it will be a challenge to find providers to care for them – particularly doctors. The Association of American Medical Colleges estimates that in 2015 the country will be in need of 62,900 doctors. 3 Between the addition of new patients due to the expansion of coverage and the aging boomer generation, the healthcare community should brace for the patient surge.
More doctors are moving toward specialized care and fewer medical graduates are entering the profession as primary care physicians. Combine these factors with a large number of primary care physicians nearing retirement age and there is a real concern about a lack of highly qualified health care professionals. Nurse practitioners are expected to pick up much of the burden. Nurse practitioners can serve as primary and/or specialty care providers, providing a blend of nursing and primary care services to patients and families. Some states require physician supervision while others do not, allowing nurse practitioners to operate independently under their own Advanced Practice license. Nurse practitioners have a wider scope than RNs, including the ability to prescribe, which frees up the physician providing for more efficient patient care.
The number of Nurse practitioners is expected to grow from 128,000 in 2008 to 244,000 in 2025. 4 Because nurse practitioners only require a RN license, a few years of work experience and a master’s degree, it may be easier to get this type of candidate into the workforce more quickly than a physician. The trend in the long-run is to make a nurse practitioner degree a doctoral level degree, as opposed to master’s level. However, if and when this happens, those nurse practitioners in good standing in certain states will be grandfathered in. Further, nurses are expected to be in excess in many areas, and this is an excellent way for current RNs to distinguish themselves and increase mobility and earning potential. Currently, 49% of office-based physicians work with other allied health professionals including physician assistants and nurse practitioners, etc. 4
In turn, educational institutions must prepare for the increase of registered nurses enrolling in master or doctor of nursing programs. Programs for nurse practitioners can be found both on campus and online which makes it easier for working nurses to return to school to increase their skill set, expand scope of practice and enhance employment opportunities. Like clinical nurse specialists, nurse practitioners can choose from a number of specialties including Acute Care Nursing, Adult Nursing, Community /Public Health Nursing, Family Nursing, Geriatric Nursing, Home Health Nursing, Neonatal Nursing, Occupational Health Nursing, Oncology Nursing, Parish Nursing, Pediatric Nursing, Psychiatric Nursing and Women’s Health Nursing. 5 Due to need, many nurses pursuing advanced degrees will find increase financial aid opportunities especially if working in underserved rural and urban areas.
Clinics, School-Based Centers and Home Visits
Pictured above is Dimock Community Health Center Complex in Boston, MA.
Nurse-managed care facilities and clinics are rooted in the nursing philosophy and process. These facilities are managed by nurses with advanced degrees and provide primary care with a focus on health promotion, prevention and maintenance. Logging more than 2.45 million patient encounters annually, Nurse-Managed Health Centers (NMHC) are well placed and suited to handle more primary care services. 6 Focused on wellness promotion, many NHMCs treat patients with chronic conditions such as asthma, hypertension and diabetes.
Similarly, School-Based Health Centers (SBHC) provide basic preventive care for school-aged children. Often, and particularly in urban and rural areas, these are the only non-emergency healthcare services that these children have. 57% of SBHCs are in urban areas and 27% are rural. Several studies have indicated frequent use and a high level of satisfaction with school based programs. 6
The Maternal, Infant and Early Childhood Home Visiting (MIECHV) program pairs RNs with new mothers in low-income areas. Located in 47 states, 6 territories and numerous tribes, these programs provide support to mothers and children under the age of 5. 7 The federal program provides $1.5 billion over 5 years and will be measured by fewer emergency room visits, prevention of childhood injuries, fewer infant deaths, avoidance of language delays, reduction of instances of abuse and neglect, as well as interactions with law enforcement as the children age. 7
Generally, nurse-managed care facilities have established a reputation as high-quality and cost-effective with high patient satisfaction rates. Health education and disease prevention are also important initiatives for NHMCs as nurses often are able to spend more time educating patients.
Healthcare has already changed, as nurses today can move into a variety of disciplines. Educational institutions have responded by making great changes with new programs, degrees and online options. The nursing profession is poised for success and will play a significant role inside and outside of hospital settings as this new era of healthcare continues to develop.
References:
1http://www.hcahpsonline.org/files/HCAHPS%20Fact%20Sheet%20May%202012.pdf
2http://ce.nurse.com/RetailCourseView.aspx?CourseNum=ce559&page=2&IsA=1
3http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?_r=0
4http://www.ama-assn.org/amednews/2012/07/02/bisb0702.htm
5http://www.bls.gov/ooh/healthcare/registered-nurses.htm
6http://journals.lww.com/ajnonline/Fulltext/2010/09000/Nurse_Managed_Health_Centers.17.aspx
