This steady aging of the population will cause the likelihood that more patients will require health care services. Health care professionals and policy makers are slowly realizing these trends must be addressed.
Nurses are well positioned to contribute to the solution for this potential wave of new patients. They comprise the largest segment of health care professionals. The foundation of nursing professionalism is that they regard the patient, his or her family and the community in a dynamic whole that can contribute to health instead of sick care. This core value is vital to any progress in health care reform. It is a given that many public health measures that have resulted in a decline of mortality were put into effect by nurses.
There are a few hurdles to clear on the road to preventative public health. One is that there are fewer doctors choosing primary care as a career. The number of graduates in primary care has been declining over the decades, only 2% of the graduates as recently as 2 years ago.
Secondly it is widely acknowledged that there is a national nursing shortage. For example, the National Nursing Workforce for Long Term Care in 2005 stated that there were 100,000 immediate vacancies in that specialty and that the nursing turnover rate was 50%.
The need for nurses will increase especially over the next decade. From now until 2016 100,000 new nurses will be needed each year. By the end of 2020 the need will be greatest ; 44 states will have a shortage of nurses. At that same time if the lack of graduates is not addressed nurses exiting the profession will exceed new graduates. Statistics show that presently 45-50% of nurses are over 50 years of age, and only 29% are under 40.
The shortage is contributing to decreased job satisfaction likely due to burnout, working conditions, and a feeling of lack of control. Emergency rooms are also crowded and the Health Affairs Journal stated in 2006 that if hospitals increased the number of nurses, 6700 patient deaths and 4 million inpatient days could be avoided yearly.
So hospitals must want to increase their nursing staff but could they if there are few nurses to hire?
The national and state levels are starting to implement policies to address the need and are also acknowledging the importance of nurses’ role in health reform.
The nursing shortage must first be addressed at the educational level. The Bureau of Health Professions, a Health Resource Service Administration Department is responsible for implementing Title VIII of the PHS Act. Title VIII will provide funding to support nurse education by attracting more applicants to consider nursing and by encouraging more nurses to pursue further education. Part of the reason for the lack of new graduates is that there are not enough teachers in nursing schools or even clinical placements. The PPAC act has created new grant, loan and loan forgiveness programs in place for the specialties of pediatric, public, geriatric, long term and chronic care. To date over 26.000 nurses have participated in the programs with the majority using the Nursing Student Loan Program or the advanced Practice Nursing Grant.
Graduate nurse education is also being financially supported. Hospitals which create a program for advanced practice nurses who train in demonstration Medicare models and who develop any of the following: primary, preventative, chronic or transitional care, will receive $50 million/ year for the next five years. They must partner with community based agencies, and an accredited school of nursing.
Acknowledging that reform must involve integrated and primary care the Act has also established state run Medical home/ Medicare programs. These programs will be community based, interdisciplinary teams for primary care. Nurse practitioners will be allowed to head those teams among others. They must be patient centred and practice evidence based medicine.
One significant advance in policy development is the decision of many states to expand/extend the role of nurse practitioners to fill the need left by a shortage of primary care doctors. This is important for 2 reasons. First, policymakers have finally realized that a system that emphasizes health as opposed to sickness will create wellness, cost savings and secondly, nurses are ideally positioned to provide that wellness. The PPAC will put $50 million into nurse managed primary clinics in the first year with sums to be determined over the next 4 years after that. These nurse managed clinics must provide care to underserved populations, such as a remote area. They will be affiliated with a academic nursing department or a qualified non profit or social services agency.
Some states give nurse practitioners the same responsibilities as doctors. Massachusetts in 2008 mandated that health plans must reimburse nurse practitioners as primary health care providers. Certified nurse midwives will now receive 100% of the rate that a doctor would receive for delivery care.
The AMA, which represents up to one third of doctors, is opposed to increasing responsibilities of nurse practitioners but hopefully this ambivalence will be overcome with continued proof that they provide care that meets or exceeds expectations.
In September of this year the Workforce Advisory Commission will begins its task of examining strategies for efficiency and collaboration among health care professionals or an interdisciplinary team. Nursing contribution to this effort is expected to be significant.
Still for nurses to reach their potential as essential contributors to real health care the reasons behind job dissatisfaction nurses face must be solved. There are nurses leaving the profession or working only part time to meet the challenges of burnout, stress, lack or respect, or feeling a lack of control over circumstances. Listening to their stories will set the real groundwork to meet the challenge of the current and future nurse shortage.
Sources:
http://www.kaisernetowrk.org/health_cast/uploaded_files/Nursing_Shortage_Presentation_nessler_2.pdf
http://nursingworld.org/MainMenuCategories/
http://www.usatoday.com/news/health/2010-04-16nurse-doctors
www.nln.org/newsreleases/annual_survery_2010.htm
http://bhpr.hrsa.gov/healthworkforce/rnsurvey
The Decision Tree T. Goetz 2009
Who Is the Foundation of Health Care? is a nursing article from the: MNU Blog. Home of Dickies scrubs, Urbane scrubs, Landau scrubs, and more nursing uniforms.
{ 0 comments… add one now }