Table of Contents
Studies postulate that nursing shortage is expected to be on the rise mainly as a result of the aging of Baby Boomers and also due to the growth in need of health care. The projected nursing shortage impacts not only the nursing profession, but also the public. To this regard, most of the recent studies on the subject have focused on the impact the level of nurses has on safe patient care. The findings of most of the studies point towards a negative relationship between shortage of nurses and patient care. The shortage of Registered Nurses results to nurses working for not only long hours, but also under very stressful conditions. This is associated with not only fatigue, but also job dissatisfaction and injury. Cimiotti, Aiken, Sloane, & Wu (2012) concluded that the increase in a nurse’s patient load resulted to increased rates of infection. Other impacts shortage of nurses include increase in mortality risk and an increase in health care costs. Hence the reduction in nursing shortage could improve both the quality of patient care and the well-being of nurses.
Numerous solutions have been offered as regards the nursing shortage problem. These solutions include subsidized funding, hiring minority and foreign nurses and wage increase amongst others (Berwick, & Hackbarth, 2012). As regards the funding options, most nursing schools are forming strategic partnerships with health care providers while also seeking private support aimed at helping expand student capacity. This is aimed at not only expanding enrollment, but also expanding clinical placement sites and supporting interprofessional engagement.
There has been increasing advocacy and popularity for the shift from a disease-oriented health care system toward one of wellness and prevention. This has seen the National Prevention Strategy call for in the Patient Protection and Affordable Care Act (PPACA) which it is hoped will shift the health care system from a sickness and disease based to one that focuses on prevention and wellness. The enacting of the PPACA, popularly referred to as the reform law, not only affirms the recognition of the value of wellness, prevention, and chronic care management to health care quality, but also establishes unprecedented federal support for the reform strategies. Thanks to the reforms, population health management, new opportunities though initiatives like direct federal spending for wellness, prevention and care management programs will improve health care quality and value. Additionally, the reforms will bring into play new delivery and reimbursement models that rely on not only enhanced efficiencies, but also care coordination and health management which will mainly rely on collection, sharing and analysis of health related data made possible with the widespread adoption of heal information technologies (Huntington, Covington, Center, Covington, & Manchikanti, 2011).
As regards to how nursing fit into this shift, the core of the shift lies with having not only trained, but knowledgeable prevention workforce that is conversant with conditions facing the community. Additionally, the workforce must be well equipped to serve the needs of the aging population. To this regard, nursing will be relied upon to improve the health of patients. This will be achieved through evidence-based recommendations and enlightening people to embrace preventive services like screening, counseling and precautionary medication.
The enactment of The Patient Protection and Affordable Care Act (PPACA) into legislation in March 2010 not only provides nurses with new opportunities aimed at delivering care, but enables nurses to play an integral role in leading change. The two key nursing provisions we will seek to discuss for this section is Primary Care Workforce and Indian Health. On primary Care Workforce, PPACA heavily invests in the expansion of community health centers with an investment of $11 billion and the National Health Service Corps with an investment of $1.5 billion. This changes will not only double the number of patients served, but also significantly increase health center patients (Huntington, Covington, Center, Covington, & Manchikanti, 2011). This implies that the medically underserved populations will have access to primary health care. On the Indian Health, PPACA gives Indian health care focused attention which aims at improving the performance of health and healthcare programs. This is achieved through targeting public health and health investments to specific subpopulations in form of school-based health centers and oral health-care prevention activities amongst others.
As regards to how the two provisions have impacted or will impact the current practice of nursing, there will be increased funding for education for nurses planning to work in underserved areas consequently alienating or reducing the shortage of primary health-care professionals and increasing access to primary health care. On the Indian Health, improved performance of health and health-care programs will achieve better patient outcomes at more reasonable costs while also ensuring provision of end-of-life care emphasizing on compassion and comfort.
Following the enacting of The Patient Protection and Affordable Care Act of 2010 (PPACA), there was need to develop integrated care delivery models. Models that would effectively manage both the quality and running of the health care. One such model is the Accountable Care Organizations (ACOs). ACO originated from Medicare. PPACA provides for allocation of shared saving between ACO and the Medicare. The model basically provides a framework for collaboration among all involved parties to health care delivery like the primary care clinicians, specialists, the hospital and other stakeholders. The model provides for acceptance of joint responsibility as regards the quality of care and the costs involved (McClellan, McKethan, Lewis, Roski, & Fisher, 2010). A bonus is provided on meeting certain quality and savings targets. As required by the statutory requirements, the services and care provided by registered nurses will be essential to the success of ACOS. The early versions of ACOs are hospital or physician centered. As regards to leadership, an ACO encourages greater nursing leadership as well as open participation.
The model is advantageous to patient outcomes given that nurses and clinical specialists are provided with leadership responsibilities within the model which is extremely important when providing care in underserved areas. On coordinated care plans, the model enables collaboration of registered nurses with primary care nurse providers (Berwick, & Hackbarth, 2012). Additionally, the model provides a platform supporting a continuous feedback loop with the collection of more data on the quality and efficacy of nurse-led care.
- Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste in US health care. Jama, 307(14), 1513-1516.
- Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American journal of infection control, 40(6), 486-490.
- Huntington, W. V., Covington, L. A., Center, P. P., Covington, L. A., & Manchikanti, L. (2011). Patient Protection and Affordable Care Act of 2010: reforming the health care reform for the new decade. Pain Physician, 14(1), E35-E67.
- McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982-990.