|
At the frontline of the current healthcare system are nurses who tackle challenges that national healthcare reform efforts are designed to address. Day in and day out, these professionals bear witness to the need for quality, affordable healthcare for all.
And, through national and state initiatives, nurses are currently taking their place in the healthcare reform discussion, said Clair Jordan, MSN, RN, executive director of the Texas Nurses Association (TNA). One such project is being co-led by the Robert Wood Johnson (RWJ) Foundation and the Institute of Medicine (IOM). The "Initiative on the Future of Nursing" study committee of experts is hosting public forums across the country to gather information, particularly from nurses, on sharing innovative models of nursing care.
The ultimate goal of the 2-year joint RWFJ/IOM effort is to create a "blueprint for action" - a transformational report on the future of nursing, said Jordan.
"For healthcare reform to succeed, and for patients to receive better care at a cost we can afford, we must change the way healthcare is delivered," said Jordan. "And nursing is at the heart of patient care."
'Unknowns' Impacting State Goals
But passing national healthcare reform legislation has become a heavy burden on both state and national legislators. While state nursing associations in Texas, Louisiana, Arkansas and Oklahoma, have goals in place, the implementation of each state's healthcare legislation and reformation will ultimately depend on the details of a national reform program.
"Because of the current status of the national healthcare reform, there is still too much unknown regarding the actions that the state (of Oklahoma) might take," said Jane Nelson, CAE, executive director, Oklahoma Nurses Association (ONA). "Healthcare reform is still a precarious issue."
Some of ONA's legislative priorities include upholding the scope of practice of all nurses-LPN, RN and APN, supporting legislative efforts to improve Oklahoma's health status, supporting nurse education and faculty, and accessing and maintaining funds for all health services, Nelson said."Where healthcare reform will be going in this country at this point is certainly open for interpretation," said Jordan. "However, the driving forces behind healthcare reform must be addressed by whatever political direction or solution is proposed."
While the Obama administration's goal is to reshape the country's healthcare system by expanding health coverage and reducing costs, those efforts will need substantial funding, considering $2.5 trillion was spent on healthcare last year and nearly 46 million Americans still lack coverage, according to the Centers for Medicare and Medicaid Services (CMS).
Jordan identified those "driving forces" as those that could stabilize or reduce the cost of healthcare and cover the nation's uninsured who often seek primary care in emergency departments.
'Filling the Gap' for Primary Care
Another issue involves filling healthcare professional vacancies to care for America's aging population. With the majority of the country continuing to cope with a shortage of nurses, as well as physicians, Jordan sees APNs playing a vital role in filling the gap.
"Texas has the highest rate of uninsured in the nation - estimated to be as high as 44 percent of the state's 25 million residents," said Jordan. "In Texas, this could create a startling need for approximately 5,000 additional APNs."
Jean Zehler, MSE, RN-BC, NE-BC, president, Arkansas Nurses Association (ARNA) agrees. "The sustainability of the nursing workforce must address workplace safety, and APNs as independent primary care providers with full/direct reimbursement," she added.
ARNA's position on healthcare reform includes the delivery of primary healthcare in community-based settings, and using the most cost-effective providers and therapeutic options in the most appropriate settings, Zehler said.
"The nursing shortage is compounded by a lack of faculty for nursing schools, and includes the number and distribution of schools nurses, as well as nurse staffing issues," she explained.
Partnering to Improve Chronic Care
In a state where 1 million are uninsured, elevating the quality of care, notably in chronic care management, is particularly important for Texas citizens, said Jordan.
"In the previous (House) version of healthcare reform legislation, there were references to a new partnership between hospitals and nursing schools that would produce a new nurse practitioner to manage patients with chronic illnesses," said Jordan. "Many studies now support the role such practitioners can play in reducing healthcare costs and improving outcomes."
The purpose of the House-approved bill, HR 3962, "Affordable Health Care for America Act," is to provide affordable, quality healthcare for all Americans, and reduce healthcare spending, while another proposal, HR 3590, "Patient Protection and Affordable Care Act, (which passed in the Senate)" is designed to expand healthcare coverage to 31 million uninsured Americans.
Similar to other state nursing associations, the Louisiana State Nurses Association (LSNA) is waiting for the national healthcare reform legislators to commit to a solid plan.
"It is very difficult to know the overall impact that national healthcare reform will have on nursing in the state of Louisiana until a plan has been finalized," said LSNA president Denise Danna, DNS, RN, associate dean, Louisiana State University Health Science Center, School of Nursing.
Increasing Community-Based Healthcare
Danna said both 3962 and 3590 address the projected shortage of nurses and provide options for nurse retention through educational funding, loan repayments, retention grants and career ladders.
"With an emphasis on increasing primary care, and creating a model of community-based prevention and wellness through school-based and nurse managed health centers, the demand for APNs is evident," said Danna. "A system focusing on wellness, prevention and chronic disease management is needed."
However, Danna stressed that affordable quality healthcare and accessibility for all Americans must be the essential element of any reform package.
"In order to implement such a system, actions must address the shortage of our primary care workforce, specifically primary care physicians and APNs," said Danna. "Nurses are integral providers in the delivery of healthcare and must be an active part of any meaningful reform."
Amy McGuire is regional editor at ADVANCE.
|