Impact Of Health Care Reform On Nursing Practice
Health reform is an issue that has posed concern to both previous and current administrations. This is essentially in a bid to address gaps that have been observed in the healthcare sector. Delivery of health services, for a long time, has mostly been in the hands of doctors. The number of qualified doctors is not sufficient enough to serve the entire population. As a result of this there has been decreased efficiency and effectiveness in health service delivery. This has necessitated the need for legislations that empower other health service providers such as nurses, in particular, to alleviate these gaps. Some of these legislations have already been approved while others are still in the primary stages of implementation. A good example of such legislations is the Affordable Care Act. The nursing profession is at the very helm of these reforms.
Nursing students are set to benefit from increase in loan disbursements. The federal government will increase funding to students enrolling for the nursing course. This is helpful because there has been an increase in tuition fees for medical studies, in general, in most medical universities. This has drastically reduced enrollment in these institutions. Coupled with the high costs of living, many students have also opted out of school since they cannot afford the high expenses. In the long run, there is only a small number of graduates released into the workforce. This leads to a severe shortage of nurses in health institutions countywide. Coupling this to the constant shortage of doctors in these institutions, service delivery is greatly compromised. Increasing loans will predictably increase enrollments, enable students to learn fulltime and in the end, there will be a considerable number of learners graduating and joining the workforce to address the shortage. An adequate number of practitioners is crucial to reduce the doctor-patient ratio which also translates to quality care. The proposed health reforms will also increase funding to health facilities that are run by nurses. Many institutions all over the country heavily rely on nurses. This is because doctors are few and they are concentrated in top health centers which serve special therapy requirements such as referral cases and complicated diseases. As such, the low-cadre health facilities which are mostly run by nurses serve a large part of the population. Such centers also include geriatric homes, family care centers and centers for managing chronically ill patients. Increasing funding to these facilities will provide them with adequate drugs, equipment and proper staffing. This will greatly boost and ensure quality health service delivery. The health reforms also shift focus to clinical initiatives at the community level. Nurses are usually involved in visitation of communities in low-income areas in which they educate locals on proper health measures. This entails informing pregnant women on the importance of healthy diet, avoidance of strenuous exercise, supplementary products such as folic acids, importance of antenatal clinics and advising them to seek hospital delivery instead of local midwives. Others include alleviation of parasitic worms in children, proper hygiene practices, food handling and preparation, vaccination programs and waste disposal. The government at facilitating these projects through proper funding and capacity building. This will boost the continuity of care. In this, patient care is more intensive and covers all aspects. For instance, a patient will be given prescriptions, advised on the appropriate diet and lifestyle in general and how they can avoid consequent infections or complications. Prevention is the most effective way of reducing incidence of disease in any community. As such, addressing lifestyle changes and enhancing social health greatly averts non-communicable diseases such as hypertension, diabetes and cancer which carry the greatest burden to the population. This will therefore ensure a healthy state for the population at large.
The reforms will also ensure increased pay for nurses who offer midwifery services. In a majority of cases, deliveries especially those requiring caesarean sections have to be conducted by a medical doctor. Shortage of doctors and the emergency need of these services have led to the need for nurses to be trained on how to carry out these procedures. Upon certification, nurses can carry out these basic procedures even in the absence of a doctor. Removing the doctoral requirement and increase of remuneration serves as a proper motivation for these nurses in a bid to ensure good maternal and child health.
Another important point of focus is allowing nurses to occupy leadership positions. At the current state, only doctors are allowed the capacity to lead health centers. This is because they are presumed to have undergone more rigorous training which places them at a better position to make informed decisions more in relation to patient health. But over time and continued practice, nurses gain the knowledge and experience required and may be better placed to make informed decisions as compared to newly-graduated doctors. Allowing nurses to lead is thus a huge milestone for the profession. This also makes it easier for the creation of accountable care organizations. These are composed of all medical practitioners who voluntarily offer services to community members especially those under the Medicare program. Medicare program provides health insurance for persons over the age of 65, those who qualify for social security and those with end-stage renal disease. Most of the individuals under this program cannot afford the care that they need. Such strategies greatly benefit these individuals and society.
Evidently, these reforms recognize and appreciate the importance of nurses in the healthcare system as care providers. After sharing this information with my colleague nurses, they had both proposing and opposing views to the impact that these reforms will bring to nursing practice. A supporting view was that these reforms raise the standing of nurses in medical practice. For instance, they can now lead institutions and upon certification, can carry out procedures that were previously only carried out by doctors. This is a great motivation for nurses considering that for a long time, they have been considered as supportive care providers. Besides motivating nurses, it also improves their productivity since they now have an opportunity to manage patients more and it reduces the gap that was present before these reforms. The reforms increase the extent of cover of health service provision. This is because nurse-managed centers will now receive better funding and staffing. Bearing that these centers are the majority in the country and that they serve a large portion of the population, their impact on the general health is set to be enormous. This will in turn reduce congestion in referral centers and avert the need for transfers. Non-serious conditions will be easier and faster to manage and people can return to their places of work soon after recovery. In the long run, workforce productivity will be maintained at its peak and this is of great importance to the economy.
Another view was that these reforms will open doors for nurses to conduct research. This is facilitated by the fact that they can employ most of their skills in patient care since they will be recognized as primary care givers. On the other hand, the reforms recognize research conducted by nurses in the medical field. This is a great opportunity for them since they spend more time with patients as compared to other medical practitioners. Due to this, they are better placed to make observations on patient behavior, response and effectiveness of therapies that are currently in use. With this, they can propose adjustments or even come up with better strategies. This greatly improves the quality of services provided to patients.
An opposing view was that these measures will undermine the authority and place of doctors in patient management. Traditionally, doctors had the final say in anything pertaining to therapy or general patient care. The duty of the nurse was literally, to obey the doctor’s orders. These reforms scrap this practice completely. Nurses can carry out caesarean sections and even make the final call in some institutions. This may demotivate and discourage doctors. As a result, their dedication and productivity will decline resulting to a near-collapse of the system. Another concern was that elevation of the standing of nurses may lead to loss of jobs. Nurses normally operate under the umbrella of doctors. Enabling them to work at almost the level as doctors may bring out their weaknesses, inabilities and incompetence. As a result, many of them will be written off because they do not meet the expected standards. For such persons to keep their jobs, they desire to remain under the doctor’s guidance or else they will lose their livelihood. This notwithstanding, healthcare is a very sensitive aspect of human life and a wrong decision may lead to loss of life or cause unforeseen complications. Incompetent persons must either way be weeded out of the system to ensure sanity of healthcare delivery.
In general, the reforms that are being undertaken are for the sole purpose of benefiting the regular citizens. Healthcare being an important pillar for the survival and economic well-being of a nation, needs to be made affordable and available to all. Healthy individuals have a higher productivity than unhealthy ones and they can be retained in the workforce for a considerable period of time. As such, labor productivity is enhance earning the government sufficient revenue to run various development projects. One way to achieve good health for the population is by addressing gaps that are present in the current system. Recognizing the capabilities of nurses and empowering them goes a long way in boosting and widening healthcare delivery to the American population. Though the recognition of the role of nurses in healthcare is a huge milestone, more efforts need to be made in making healthcare affordable to the ordinary citizen.
References
- Sommers, B. D. , Musco, T. , Finegold, K. , Gunja, M. Z. , Burke, A. , & McDowell, A. M. (2014). Health reform and changes in health insurance coverage in 2014. New England Journal of Medicine, 371(9), 867-874.
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- McWilliams, J. M. , Hatfield, L. A. , Chernew, M. E. , Landon, B. E. , & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine, 374(24), 2357-2366.
- Niedert, K. C. , & Carlson, M. P. (Eds. ). (2016). Nutrition Care of the Older Adult: A Handbook of Nutrition Throughout the Continuum of Care. Academy of Nutrition and Dietetics.
