NURS 8100 Assignment 1: Issues in Health Care Reform (Interview)
A Sample Answer For the Assignment: NURS 8100 Assignment 1: Issues in Health Care Reform (Interview)
Advanced practice nurses play a critical role in the provision of care that meets the healthcare needs of the diverse populations they serve. Since the recognition of the roles they play, advanced practice nurses have increased access to care in the modern America where there has been a significant shift in population profile. Over the past few years, significant transformations have been witnessed in the US healthcare system. They include increased coverage of patients under the Patient Protection and Affordable Care Act and rise in the baby boomers’ population.
The impact of these changes is that the US is expected to experience an acute shortage of healthcare workers to meet the changing population dynamics. Advanced practice nurses could act as a solution to this problem. However, their scope of practice remains limited in most of the states in the US (Altman et al., 2016). Therefore, there is an increased need for the policy makers, states, and government agencies to consider eliminating barriers to full scope of practice for advanced practice nurses as a way of addressing the anticipated challenges affecting the healthcare system.
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The Selected Recommendation
The selected recommendation for the policy brief from the IOM report is removing scope of practice barriers for advanced practice nurses. According to the report, advanced practice nurses should have the autonomy to practice fully according to the level of their training and education (Feller, 2018). The barriers to full practice among them can be eliminated with the adoption of various interventions by the Congress, state legislature, Centers for Medicare and Medicaid Services, Office of Personnel Management, and the Federal Trade Commission.
Some of the recommended interventions in the report include the need for the amendment of the requirements for the participation of advanced practice nurses in the Medicare program and the need for insurance to cover the services provided by the advanced practice nurses. It also includes the need for a review of the existing as well as proposed state regulations guiding the professional practice of advanced practice nurses (Institute of Medicine, 2011). Through these interventions, the authors of the report are optimistic that the scope of practice for advanced practice nurses will be expanded in accordance with their training and education.
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Background
The role of advanced practice nurses in health dates back to the 1890s when Lilian Wald developed the Henry Street Settlement where visiting nurses provided care to the poverty-stricken immigrants in the state. In 1925, Mary Brechneridge, a certified nurse midwife, established decentralized clinics in Kentucky with the aim of preventing maternal and infant mortalities due to shortage of physicians in the region. However, it was until the 1960s when nurse practitioner’s role was recognized in the US healthcare.
Nurse practitioners were seen as the most effective professionals that could provide care meeting the needs of the underserved rural populations in America. In the modern century, the professional roles and scope of practice for advanced practice nurses has expanded significantly (Keeling, 2015). However, full practice is yet to be recognized in most states, thereby, preventing advanced practice nurse from delivering care that optimize the health outcomes of the diverse populations using the knowledge from their education and training.
Current Characteristics
According to Altman et al. (2016), the scope for advanced practice registered nurses in most states in America currently remains limited. This is despite them having been trained to provide different service to address the healthcare needs of the diverse populations in America. The limitations are attributed to factors such as state laws, outdated insurance reimbursement schemes, federal policies, and institutional culture and policies (Altman et al., 2016). The extent of the limitation in the scope for advanced practice nurses can be seen from the statistics that only 22 states alongside the District of Columbia in America have adopted full practice laws and authority licensure for nurse practitioners. Additionally, 17 states have been categorized as reduced practice state while 12 states have been categorized as restricted practice states (Peterson, 2017). Therefore, significant interventions need to be embraced for the scope of advanced practice nurses to be expanded in the state.
The Impact of Recommendation
The recommendation to remove barriers to the scope of advanced practice nurses will have significant impacts. Firstly, it will expand the nature of services provided by these nurses to the diverse populations in America. In specific, the underserved populations will benefit from increased access to and availability of the service they need. The removal of barriers will also expand the role and autonomy of advanced practice nurses in healthcare. It will challenge them to explore additional ways in which their role in healthcare can be improved.
It will also strengthen multidisciplinary collaboration since they will have a greater role to play in the delivery of healthcare than it is currently (Woo et al., 2017). However, other groups of healthcare providers are skeptical with the action since it will diminish the role they play in healthcare. Despite this, most of the healthcare stakeholders are optimistic that the move will result in significant improvement in the US healthcare system (Bosse et al., 2017).
Current Solutions
Several interventions can be embraced to eliminate barriers to scope of advanced practice nurses. One of them is reforming the Medicare regulations that prevent advanced practice nurses from providing full care according to their training and education. The state laws should also be revised to provide full scope of practice for the advanced practice nurses. Institutional culture and policies should be transformed to accommodate the full scope for advanced practice nurses. Lastly, advanced practice nurses should advocate for the recognition of the system wide benefits associated with their full scope in the provision of their services (Brassard & Smolenski, 2011).
Status in Health Policy Arena
Policy interventions have been embraced to address the limitations in scope of advanced practice nurses. According to Altman et al. (2016), 44 state action coalitions have been adopted since the release of IOM report. This has led to eight more states being classified as full practice states and others improving their laws to expand the practice of these nurses. The ACA also passed laws that prohibit the discrimination of healthcare providers who act according to their scope of certification by the insurers.
The CMS has also broadened its concept of medical staff to allow nurse practitioners to practice in accordance with the provisions of their scope. The Federal Trade Commission has advocated for the removal of barrier for advanced practice nurses through their persuasion of states with restricted or reduced practice. Therefore, with these policy changes, it is anticipated that the barriers to scope of advanced practice nurses will be eliminated in the near future in all states in America (Altman et al., 2016).
Conclusion
The role and need for advanced practice nurses in the modern and future America cannot be underscored. It is therefore important that barriers to their full scope of practice be addressed in all the states. The elimination of these barriers should be a collective responsibility of all the stakeholders involved in healthcare. Through it, optimum outcomes of care will be realized by the states.
References
Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing Barriers to Practice and Care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US).
Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing outlook, 65(6), 761-765.
Brassard, A., & Smolenski, M. C. (2011). Removing barriers to advanced practice registered nurse care: Hospital privileges. Washington, DC: AARP Public Policy Institute.
Feller, F. (2018). Transforming nursing education: A call for a conceptual approach. Nursing education perspectives, 39(2), 105-106.
Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing. OJIN: The Online Journal of Issues in Nursing, 20(2).
Peterson, M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74.
Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 63.
Health reform involves revamping a country’s or state’s health care system. It entails addressing the ever-rising costs of health care for individuals, families, and the government. Health reforms center on improving the benefits citizens receive from the country’s healthcare system and increasing access to health insurance. Healthcare reforms aim to lower the number of uninsured individuals, making healthcare more affordable and enhancing the quality of care.
During this course, I met with a state legislator and discussed a healthcare reform issue that has caught my interest. The purpose of this paper is to give a summary and analysis of the interview and discuss the health care reform issues I presented.
Selected State Legislator
I planned to present my healthcare reform of interest to a legislator from my state Illinois. With the help of my colleagues, I was able to plan a meeting with Representative LaToya Greenwood through her personal assistant. Greenwood is a Democratic member of the Illinois House of Representatives. She has represented the 114th district since January 2017 and is the chairperson of the Health Care Availability and Access Committee (Illinois General Assembly, n.d.).
She is also a member of several other committees such as Prescription Drug Affordability; Agriculture & Conservation; Approp-Elementary & Secondary Education (Vice-Chairperson); Data Analytics & IT; Appropriations-Human Services; Cybersecurity, Public Utilities; Museums, Arts, & Cultural Enhancement.
Rep. LaToya Greenwood was the legislator of choice due to her admirable track record. She has chiefly sponsored numerous bills as a Representative. She recently passed House Bill 4645 to strengthen minority representation in health care and stop the uneven quality of care across underserved communities (Illinois General Assembly, n.d.).
The bill was founded on her belief that every citizen in Illinois deserves the highest quality of health care at an affordable cost. Furthermore, Rep. Greenwood is dedicated to fighting for affordable prescription drugs and increasing the workforce in public health.
Summary of the Interview
The PA scheduled a one-hour meeting on 15th April 2022 at the Representative’s office from 10 am to 12 pm. The Rep welcomed me to her office, and after establishing rapport, I explained my purpose for the meeting and the desired outcomes from the meeting. The health care reform of interest was the introduction of a bill on mandatory Nurse-to-Patient ratios in all healthcare settings across Illinois.
I explained to the Rep that hospitals in Illinois do not observe the WHO-recommended nurse-to-patient staffing ratios, which are purposed to promote safe patient care and prevent nurse burnout. I gave an example of the California nurse-to-patient staffing ratios act. The bill was passed to address the increasing concern that patients’ safety is often compromised by inadequate staffing attributed to the increasing severity of health conditions and complexity of care (Livanos, 2018).
I explained the benefits of enacting a bill on mandate nursing ratios, including the challenges the state currently faces due to the lack of that reform. There is a connection between nurse workload and patient morbidity and mortality rates. Hospitals with unsafe nurse-to-patient ratios overwork their nurses, resulting in burnout.
Features of hospitals with high nursing workloads include increased incidences of medical errors and missed nursing care. Various studies found a high prevalence of hospital-acquired infections, like urinary tract infections and pneumonia, and failure to perform CPR in facilities with a high nurses’ workload.
I informed Rep. Greenwood that the biggest benefits from a health reform on safe nurse-to-patient ratios would be improved patient outcomes, reduced morbidity and mortality rates, reduced nursing turnover, and increased patient and staff satisfaction (Griffiths et al., 2018). Safe staffing ratios are equivalent to greater job satisfaction and reduced nurse turnover, saving organizations from the costs spent in frequently hiring new nurses. nurse-to-patient ratios influence most patient outcomes, most noticeably in mortality rates.
Nurse staffing ratios are linked to a higher likelihood of patient survival. Lee et al. (2018) found that patients were 95% more likely to stay alive when health facilities observed a hospital-mandated nurse-to-patient ratio. Besides, managing critically ill patients in settings with high nursing workloads and unsafe staffing ratios was associated with a significant decrease in the odds of survival.
Potential Challenges with the Health Reform
We discussed the potential challenges of enacting mandatory nurse staffing ratios and approaches to address them with Rep. Greenwood. I explained that the main shortcoming of the health reform is that health organizations will be mandated to increase the number of nurses without getting increased reimbursement for patient care.
Besides, the costs of hiring additional nurses needed for the increased mandated ratios will not be compensated by additional payments to health organizations (de Cordova et al., 2019). This will lead to unfunded mandates. Fortunately, the challenge can be addressed by providing a market-based incentive to healthcare organizations to improve nurse staffing levels (de Cordova et al., 2019). This will separate nursing care from the current room and board charges and adjust healthcare payments for optimum nursing care.
Feedback from the Legislator
Rep. Greenwood was pleased with the presentation since she is devoted to increasing the workforce in Illinois public health. She agreed that the proposed reform would significantly improve nurses’ working environment and quality of patient care resulting in improved health outcomes. She requested that I leave her with the printed proposal so that she can through it and make amendments where necessary. She also stated that she would organize another meeting to discuss the amendments and the way forward.
Conclusion
Enacting mandatory staffing ratios is the healthcare reform of interest. I presented the reform to Rep. LaToya Greenwood of the Illinois House of Representatives representing the 114th district. I presented the reform to Rep. Greenwood and discussed the benefits of enacting the bill on patients’ health outcomes and nurses’ job satisfaction. We also discussed potential challenges and solutions.
References
de Cordova, P. B., Rogowski, J., Riman, K. A., & McHugh, M. D. (2019). Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis. Policy, politics & nursing practice, 20(2), 92–104. https://doi.org/10.1177/1527154419832112
Griffiths, P., Maruotti, A., Recio Saucedo, A., & Redfern, O. C. (2018). Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Qual Saf.. https://doi.org/10.1136/bmjqs-2018-008043
Illinois General Assembly. (n.d.). Representative Biography. https://www.ilga.gov/house/Rep.asp?MemberID=2902
Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D. (2018). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of intensive care, 7(1), 1-9. https://doi.org/10.1186/s13613-018-0269-2
Livanos, N. (2018). A broadening coalition: Patient safety enters the Nurse-to-Patient ratio debate. Journal of Nursing Regulation, 9(1), 68-70. https://doi.org/10.1016/S2155-8256(18)30056-5
NURS 8100 Assignment 1 Issues in Health Care Reform (Interview)
NURS 8100 Assignment 1: Issues in Health Care Reform (Interview)
Health reform involves revamping a country’s or state’s health care system. It entails addressing the ever-rising costs of health care for individuals, families, and the government. Health reforms center on improving the benefits citizens receive from the country’s healthcare system and increasing access to health insurance. Healthcare reforms aim to lower the number of uninsured individuals, making healthcare more affordable and enhancing the quality of care. During this course, I met with a state legislator and discussed a healthcare reform issue that has caught my interest. The purpose of this paper is to give a summary and analysis of the interview and discuss the health care reform issues I presented.
Selected State Legislator
I planned to present my healthcare reform of interest to a legislator from my state Illinois. With the help of my colleagues, I was able to plan a meeting with Representative LaToya Greenwood through her personal assistant. Greenwood is a Democratic member of the Illinois House of Representatives. She has represented the 114th district since January 2017 and is the chairperson of the Health Care Availability and Access Committee (Illinois General Assembly, n.d.). She is also a member of several other committees such as Prescription Drug Affordability; Agriculture & Conservation; Approp-Elementary & Secondary Education (Vice-Chairperson); Data Analytics & IT; Appropriations-Human Services; Cybersecurity, Public Utilities; Museums, Arts, & Cultural Enhancement.
Rep. LaToya Greenwood was the legislator of choice due to her admirable track record. She has chiefly sponsored numerous bills as a Representative. She recently passed House Bill 4645 to strengthen minority representation in health care and stop the uneven quality of care across underserved communities (Illinois General Assembly, n.d.). The bill was founded on her belief that every citizen in Illinois deserves the highest quality of health care at an affordable cost. Furthermore, Rep. Greenwood is dedicated to fighting for affordable prescription drugs and increasing the workforce in public health.
Summary of the Interview
The PA scheduled a one-hour meeting on 15th April 2022 at the Representative’s office from 10 am to 12 pm. The Rep welcomed me to her office, and after establishing rapport, I explained my purpose for the meeting and the desired outcomes from the meeting. The health care reform of interest was the introduction of a bill on mandatory Nurse-to-Patient ratios in all healthcare settings across Illinois. I explained to the Rep that hospitals in Illinois do not observe the WHO-recommended nurse-to-patient staffing ratios, which are purposed to promote safe patient care and prevent nurse burnout. I gave an example of the California nurse-to-patient staffing ratios act. The bill was passed to address the increasing concern that patients’ safety is often compromised by inadequate staffing attributed to the increasing severity of health conditions and complexity of care (Livanos, 2018).
I explained the benefits of enacting a bill on mandate nursing ratios, including the challenges the state currently faces due to the lack of that reform. There is a connection between nurse workload and patient morbidity and mortality rates. Hospitals with unsafe nurse-to-patient ratios overwork their nurses, resulting in burnout. Features of hospitals with high nursing workloads include increased incidences of medical errors and missed nursing care. Various studies found a high prevalence of hospital-acquired infections, like urinary tract infections and pneumonia, and failure to perform CPR in facilities with a high nurses’ workload.
I informed Rep. Greenwood that the biggest benefits from a health reform on safe nurse-to-patient ratios would be improved patient outcomes, reduced morbidity and mortality rates, reduced nursing turnover, and increased patient and staff satisfaction (Griffiths et al., 2018). Safe staffing ratios are equivalent to greater job satisfaction and reduced nurse turnover, saving organizations from the costs spent in frequently hiring new nurses. nurse-to-patient ratios influence most patient outcomes, most noticeably in mortality rates. Nurse staffing ratios are linked to a higher likelihood of patient survival. Lee et al. (2018) found that patients were 95% more likely to stay alive when health facilities observed a hospital-mandated nurse-to-patient ratio. Besides, managing critically ill patients in settings with high nursing workloads and unsafe staffing ratios was associated with a significant decrease in the odds of survival.
Potential Challenges with the Health Reform
We discussed the potential challenges of enacting mandatory nurse staffing ratios and approaches to address them with Rep. Greenwood. I explained that the main shortcoming of the health reform is that health organizations will be mandated to increase the number of nurses without getting increased reimbursement for patient care. Besides, the costs of hiring additional nurses needed for the increased mandated ratios will not be compensated by additional payments to health organizations (de Cordova et al., 2019). This will lead to unfunded mandates. Fortunately, the challenge can be addressed by providing a market-based incentive to healthcare organizations to improve nurse staffing levels (de Cordova et al., 2019). This will separate nursing care from the current room and board charges and adjust healthcare payments for optimum nursing care.
Feedback from the Legislator
Rep. Greenwood was pleased with the presentation since she is devoted to increasing the workforce in Illinois public health. She agreed that the proposed reform would significantly improve nurses’ working environment and quality of patient care resulting in improved health outcomes. She requested that I leave her with the printed proposal so that she can through it and make amendments where necessary. She also stated that she would organize another meeting to discuss the amendments and the way forward.
Conclusion
Enacting mandatory staffing ratios is the healthcare reform of interest. I presented the reform to Rep. LaToya Greenwood of the Illinois House of Representatives representing the 114th district. I presented the reform to Rep. Greenwood and discussed the benefits of enacting the bill on patients’ health outcomes and nurses’ job satisfaction. We also discussed potential challenges and solutions.
References
de Cordova, P. B., Rogowski, J., Riman, K. A., & McHugh, M. D. (2019). Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis. Policy, politics & nursing practice, 20(2), 92–104. https://doi.org/10.1177/1527154419832112
Griffiths, P., Maruotti, A., Recio Saucedo, A., & Redfern, O. C. (2018). Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Qual Saf.. https://doi.org/10.1136/bmjqs-2018-008043
Illinois General Assembly. (n.d.). Representative Biography. https://www.ilga.gov/house/Rep.asp?MemberID=2902
Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D. (2018). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of intensive care, 7(1), 1-9. https://doi.org/10.1186/s13613-018-0269-2
Livanos, N. (2018). A broadening coalition: Patient safety enters the Nurse-to-Patient ratio debate. Journal of Nursing Regulation, 9(1), 68-70. https://doi.org/10.1016/S2155-8256(18)30056-5