Nurses and Health Care Reform

by
Dean, School of Nursing at the College of St. Scholastica

Changes within health care, highlighted by the passage of the federal health reform in the spring of 2010, afford tremendous opportunities and challenges for nurses. Despite differing opinions about health reform, the majority of Americans understand that the current health care delivery system is not meeting the standards of high-quality care set in other nations.

Concern over the high cost of health care services, paired with quality and safety issues, are critical facets in the national health care reform debate. In fact, the number of people killed by hospital-induced infections now rivals breast cancer. American health care is very expensive, largely because it’s focused on “illness care,” not preventive medicine. But it’s much easier—and cheaper—to treat people before they get sick! Yet, many patients with critical care needs cannot afford it, find it, or access it.

Both registered and advanced practice nurses are key variables in health care reform, affording remarkable nursing career opportunities. Nursing schools all over the country are doing their best to deliver programs geared toward future nursing roles and societal needs. Just one example: the aging baby boomer generation will live longer and therefore have more chronic conditions. The demand for nurses who can counsel and care for the elderly will rise dramatically in the coming years.

Nurses in hospitals and communities

Nurses care for patients and analyze highly complex situations. The patients on a typical hospital floor today would have been in critical care or ICU 10 years ago. This means nursing requires that much more education and training to become a beginning practitioner—but nurses are rewarded by a job that is interesting, satisfying, and flexible.

A Bachelor of Science in Nursing (B.S.N.) prepares students for the independent clinical judgment necessary for an increasingly challenging practice. Nurse executives now say they prefer the majority of their staff nurses to hold B.S.N.s as well.

In addition to working in fast-paced acute care hospitals, nurses often educate, counsel, and support their patients, helping them take better care of themselves. Many serious complications from afflictions like diabetes or obesity can be reversed or prevented by nursing services. For example, obesity is the #1 public health issue in America, and nurses are part of the effort to reduce it, especially in children. Preventive health care has been a part of nursing for years.

Families in many communities do their best to raise healthy children without adequate information or resources. Many nurses work with low-income mothers to support healthy pregnancy, infancy, and early childhood. There are studies showing how nursing services reduce criminal justice costs and improve mothers’ and babies’ health outcomes. The health reform legislation will provide health care access to many more people. However, the health care industry does not have sufficient capacity for that many new patients, so community health clinics will likely expand and provide more services, requiring even more nurses!

Returning war veterans need specialized health care services to regain health or readjust to their civilian lives. Nurses are critical to helping servicemen and women back into their communities, and rehabilitation skills afford nurses a tremendous opportunity to impact veterans’ quality of life. Currently, the Veterans Administration hospitals around the country employ about 70,000 nurses, but statistics suggest half of those nurses are eligible for retirement, meaning they will need help—fast.

But if you’re thinking that nurses spend all their time running from hospital bed to hospital bed, you’re mistaken. Today’s nurses can be found all over. They work in areas as diverse as emergency rooms, flight services, public health, schools, businesses, clinics, senior centers, retail clinics, and private offices. They travel and see the world working for companies that supply nurses to other hospitals. Some nurses specialize as midwives, nurse practitioners, nurse anesthetists, researchers, and educators. Nurses influence legislation, serve as expert legal witnesses, participate on corporate boards of directors, assist law enforcement, and work for pharmaceutical and device industries.

Getting technical

A revolutionary career area for nurses lies in health information technology. The last two American presidents have been very supportive of the use of electronic health records and have dedicated federal resources to this enterprise. Electronic health records (EHR) help eliminate simple things such as answering the same questions about insurance and allergies every time a patient sees a health care provider. From a safety point of view, EHRs seem to be more accurate and efficient than a paper record. In order to monitor and evaluate nursing care among patients, treatment, and facilities, nurses are needed to develop and test the quality improvement using EHR data. Nursing informatics is a field that develops standardized language and measurements regarding nursing care.

Another emerging technology is telehealth, or telemedicine, where services are provided to faraway patients via computer-assisted devices. Rather than have a patient travel to a health care provider or vice versa, telehealth allows people to stay in one place, saving time spent traveling.

Predicting the future

On the U.S. Bureau of Labor Statistics’ list of occupations with the largest projected job growth (from 2008–2016), registered nurses are #1, with 587,000 new jobs! Because fewer physicians are choosing family medicine these days, nurse practitioners will become the backbone of primary care.

With these expanding opportunities, students are seeking the B.S.N. in greater numbers. In 1980, almost 55% of registered nurses held a hospital diploma as their highest educational credential, 22% held a B.S.N., and 18% had an associate degree, according to figures from the federal Division of Nursing. By 2008, a diploma was the highest educational credential for only 13.9% of RNs, while the number with bachelor’s degrees had climbed to 36.8%, with 36.1% holding an associate degree. Finally, 13.2% of the nursing workforce holds master’s or doctoral degrees.

Government agencies and private foundations know the importance of a strong nursing workforce, and they support nurses with a variety of scholarships. Grants go toward expanding access to education for minority students, students willing to work in underserved areas, those interested in health information technology, and other areas. The National Health Service Corps, run by the Health Resources and Services Administration, funds larger tuition reimbursement and scholarship programs for nurses who agree to work in shortage areas for at least two years. The Robert Wood Johnson Foundation sponsors stipends for students entering nursing as a second career. Students should contact their intended school to get information on scholarship and loan opportunities. Many nursing schools now offer accelerated programs too.

Nurses must be strong scholars and compassionate healers. They must be able to employ technology and connect with families. This is a great time to be a nurse. New and amazing opportunities are on the horizon.

Marty Witrak, Ph.D., R.N., F.A.A.N., is a professor and the Dean of the School of Nursing at the College of St. Scholastica in Duluth, Minnesota. 

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