Many see the signing of the Patient Protection and Affordable Care Act as a bright day for nursing, pointing to provisions in the legislation providing for more funding for nurse education; more research and programs for safety and quality; more investment in public health; and promotion of prevention and care management.
However, most of the new legislation will not take effect for months or years. Regulations still must be written. Funds must be appropriated. Pilot projects must be applied for and approved.
The work is not over at all, says Rebecca M. Patton, RN, MSN, CNOR, president of the American Nurses Association, which strongly supported the reform bill. The most important part is what happens after the bill gets passed.
Not all nurses and nursing groups are pleased with the law. Some believe it rewards insurance companies by requiring Americans to have health insurance without sufficiently reforming the industry to protect consumers. Others fear hospitals could face lower Medicare and Medicaid reimbursements even though they may see more patients. Nurse policy experts point out funds for the programs in the legislation are not guaranteed each year Congress must actually release the money.
Overall, however, nursing association leaders and policy analysts believe the legislation will open up new opportunities for nurses in all areas of education and practice. I really think this is nursings shining moment, says Jo Ann Webb, RN, MHA, senior director for federal relations and policy for the American Organization of Nurse Executives. The whole focus on prevention and being able to create a culture of safety and quality, thats what nurses are known for.
In the Community
The healthcare reform law provides a variety of funding and incentives for community-based care, including nurse-managed clinics and school-based health centers. The bill also allocates $1.5 billion over five years for programs such as the Nurse-Family Partnership, which pairs visiting RNs with young first-time mothers in low-income areas.
There are going to be 32 million more people insured, and of course practice will expand, says Jan Towers, CRNP, PhD, NP-C, FAANP, FAAN, director of health policy for the American Academy of Nurse Practitioners. Language in the legislation makes it clear nurse practitioners are considered primary care providers, she says.
By eliminating co-payments and deductibles for screenings, vaccines and some preventive care including annual check-ups for Medicare members the legislation helps ambulatory care nurses care for patients who couldnt afford these services in the past, says Traci Haynes, RN, MSN, CEN, regional director of clinical services for the National Healing Corporation and president of the American Academy of Ambulatory Care Nursing.
RNs also will be needed to manage care as part of medical homes and other programs, says Sheila A. Haas, RN, PhD, FAAN, a professor of the Niehoff School of Nursing at Loyola University in Chicago and a past president of the AAACN. The really big, growing role for RNs will be with the chronically ill population and coordinating care for that population, she says.
Possible challenges may arise as demand for primary care at first exceeds supply, some nursing association leaders reason, which could result in long waits for appointments at a clinic or in private practice.
In the Hospital
As more people are covered by insurance and start to seek primary care, presumably fewer will seek emergency care and crowding in EDs could eventually start to ease somewhat, says Suzanne K. Stone-Griffith, RN, MSN, CNAA, chair of the ED crowding committee for the Emergency Nurses Association.
The law also establishes a new trauma center program to strengthen ED and trauma center capacity and, starting in 2011, provides funds for emergency medicine research and to develop demonstration models for innovative emergency care systems.
The law provides grants to hospitals to provide transitional care services, or partner with community-based organizations to provide these services. It also establishes pilot and demonstration programs emphasizing patient safety, education and quality assurance. All these programs will need nurses who are traditionally skilled in these areas, as well as nurse researchers and clinical nurse educators to help with research and training, says Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. We need people in hospitals to be thinking about how to improve the quality of care and nurses in particular need to do everything they can to prepare themselves to deliver care as safely as possible, she says.
The legislation increases loan amounts for undergraduates, makes nursing schools and faculty eligible for fellowships and training programs for geriatrics, offers scholarships and loan forgiveness for graduate students who teach, expands workforce diversity grants, and increases funding for advance practitioners working in underserved areas.
It provides grants to schools and education centers that offer advanced degrees that emphasize team-based service, public health, epidemiology and emergency preparedness.
The Medicare demonstration program for advance practitioner training is slated to be awarded to only five hospitals and the competition will be tough, says Suzanne Begeny, RN, PhD, director of government affairs for the American Association of Colleges of Nursing. However, this provision eventually could be expanded to include not only more healthcare facilities, but also a variety of settings.
We have traditionally thought of the hospital as the first place to go after nursing school, says Susan Carlson, RN, MSN, ACNS-BC, GNP-BC, FNGNA, president of the National Gerontological Nursing Association. I think we have to look at the trends for where the jobs are.
Cathryn Domrose is a staff writer for Nurse.com.