Introduction
The complicated healthcare system has been the subject of discussion for a long time in the United States (Diana, et al., 2007, p. 413). Numerous attempts have been carried out to try and reform the sectors. After the World War II, major healthcare reform was attempted by President Harry Truman. There was the introduction of Medicaid and Medicare in the 1960 while the 80’s experienced spirited healthcare overhaul campaigns by Senator Edward Kennedy. In the 1990’s reforms on healthcare originated from states after national attempts failed. The incremental change did little to improve healthcare delivery in the US. In the presidential campaign of 2008, candidates spurred and differed sharply on the way to approach the issues but both agreed that reform was necessary (Lundy, et al., 2009, p16).
The healthcare sector in the US for along time stuck to capitalistic ideals which exploited the population and denied millions of people their right to access to decent healthcare (Lundy, et al, 2009, p 16). Opinion was unanimous on the need for healthcare reform in the US. Reforms according to Lundy et al., is episodic and responds to multiple forces of change. Major changes in the delivery of delivery of healthcare underlie all reforms as envisioned by various advocating groups.
Nurses form part of the advocate groups that have routed for a sweeping healthcare overhaul in the country. Their contribution to the implementation and success of any such an overhaul is critical. Nurses endorsed the Healthcare reform document of the 1990’s and also that fronted by President Barack Obama in 2010. This partly influenced by core nursing values like belief in health services for all, illness prevention and wellness (Lundy, et al, 2009, p. 16). According to Lundy et al., nurses have always supported the need for cost containment as well as the assurance that quality will not be compromised. They have also pushed for reduced barriers to advanced nursing practice and promotion of nursing care.
2008 Healthcare Reform
A bitter debate characterized the run up to the passage of the Healthcare Reform Law in the United States. The Obama administration projects that over 32 million people will be covered by the time the law takes full effect. People will be required by law to take healthcare coverage from their employer, a government program or on their own. Failure to purchase medical coverage will attract a fine.
Many nurse organizations have applauded the move by congress to pass the healthcare reforms bill with anticipated big gains by the nursing profession. Professional in nursing, student undertaking the nursing course and the public health centers were some of the beneficiaries of the bill that was passed by the house on March 21 2010 (Routson, 2010). Routson further says that a number of professional associations like the AAFP (American Academy of Family Physicians), ANA (American Nurses Association), and other health entities that are non-profit endorsed the reconciliation bill that the house passed.
According to American Nursing Association President Rebecca M. Patton, MSN, RN, CNOR, the passage reforms marked the final phase of the healthcare overhaul in the US. She was positive the move would enable most people access healthcare affordably in the US (Frellick, 2010 par. 2). According to the America College of Nurse Midwives (ACNM), the healthcare reform law s passage would greatly improve maternal and infant health.
A number of provisions in the law directly or indirectly touch on the nursing profession and they will form the subject of discussion in this paper.
The Health Care and Education Affordability Reconciliation Act of 2010 on Nursing
The law contains numerous provisions that touch on nursing. However, there are those that touch directly on nursing like nursing graduate education and management of nurse managed health clinics. They will for a long time influence the practicing of nurses in the US in their quest to participate in the provision of universal healthcare.
Many areas concerning nursing are addressed in the healthcare reforms law. Education of nurses has been given the highest priority in the financial assistance programs stipulated in the law. Various grants and loans programs have been included for nurses and nurse students to pursue geriatric and advanced nurse education.
There are programs for nurses too that target loan advancement and repayment. These programs make it easier for nurses and would be nurses to easily access loans for higher studies and a relatively favorable repayment regime (ANA, 2010).
There are service delivery programs that have that aim to take core services closer to the people. Programs like nurse managed health clinics, graduate nurse education demonstration, national prevention health promotion and public health, prevention and public health and clinical, community preventive services, school based health centers, maternal, infant and early childhood home visits, independence at home medical practice, access to certified nurse midwives and patient centered outcomes research are specifically meant to promote closer services to the people. The program’s success relies heavily on the participation of nurses. The law has increased funding for all the programs listed above effectively giving impetus to the important role of nurses and as a result rewarding their involvement (ANA, 2010).
Improved Access to Nursing Education
Reauthorization of Title VIII Nursing Workforce Development that falls under the Public Health Services act will have profound effects on nurses’ education both in the short and long runs. They have been put in place to ensure nurses access necessary education, training and funding from the federal government. The major objective of these programs is to ensure availability of enough nurses to take care of the population’s healthcare needs especially in the aftermath of the healthcare overhaul.
These programs have been recognized under the overhauled healthcare law, a boost for the current nurses and those studying to be nurses in future. The programs have enhanced profession advances of the nurses, staffing of fresh nurses and enhancement of service delivery to patients.
The programs include:
Advanced Education Nursing programs which provides grants for nurses to health educational institutions fro nurses to take masters and post masters studies.
Nurses who fall into different categories in the nursing field like midwives, administrators, anesthetists, specialists and educators are prepared under this program (Frellick, 2010 par. 4). The law goes further and scraps the 10% cap requirement for nurses who would like to pursue doctoral studies. Availability of funds for nurses in furthering their education has been a major impediment. Nurses who would like to pursue masters and doctoral courses too can now easily access nursing faculty loans.
After graduation, the graduates can chose to work at a school of nursing and in return will have 85% of their loans cancelled. With the law, nurses are almost assured of further education funded by government.
On a more basic level, the law provides for Workforce Diversity Grants which goes a long way in helping people from disadvantaged backgrounds and who want to pursue nursing. Besides the WDG, there are also, the Nurse Education Practice and Retention grants (Frellick, 2010). Accredited state and local government, academic health centers, schools of nursing, nursing centers, are eligible to receive grants from the federal government to help in the training of nurses.
The National Nurse Service Corps is also a beneficiary of the federal programs that funds for the development of nurses (Frellick, 2010 par. 4). Repayment of loans by nursing graduates has been made easier if the professionals agree to work in facilities experiencing acute shortage of nurses. The Nurse Education Loan Repayment Programs has been given a mandate to clear 60% of the nurses’ loan if they agree to participate. The money for settling the loans is provided for by the federal government (JNA, 1999).
Graduate Medical Education funds can now be used in the development of Advanced Practiced Nursing Programs.
These programs aid the development of clinical education. The measure according to American Association of Colleges of Nursing will cater for the expansion of clinical education which previously has acted as a barrier to APRN enrollments.
Improvement of delivery of nurse-led medical programs
Nurse- Family partnerships
Some of the most underserved people in the US healthcare system are expectant and nursing mothers who cannot afford decent healthcare. Specially trained nurses visit mothers, infants and children in their early childhood years to offer advice on safe pregnancies as well as advice on how to cope with caring children. The program which has been ongoing for many years has lasting impact on the health and development of mothers and babies. The program has been allocated over $1.5 billion over a period of five years, a marked improvement from the previous allocations. The availability of funds means more nurses will be hired, trained and will provide better survives to the deserving mothers.
School Based Health Centres
The program has been allocated over $200 million over a period of four years. The staff manning these centers includes nurses. This program authorizes federal grant programs and emergence appropriation that will cost the above figure. Comprehensive primary and preventive healthcare programs are offered through school based healthy centers. Uninsured and underserved students are covered under this program. The increased funding will especially make nurses’ work easier in the provision and delivery of healthcare services in SBHC’s (Stokowski, 2010 par. 1).
Nurse-Managed Clinics
Nurse-Managed Clinics have proven to be critical in the provision of medical services in the US. Primary and primary healthcare by nurses will benefit from the $50 million grant program supporting any innovative ideas safety net providers come up with.
Some areas experiencing low supply of primary care physicians greatly benefit from these clinics. The importance of these nurse-managed clinics is highlighted in the support statement by the chairman of the National Nursing Centers Consortium who said that the law recognizes nurses as the future of primary health care givers in the US (Frellick, 2010).
In addition to the above, there is a provision for the regular evaluation of medical programs and workforce including nurses by an independent group of 15 members. This group will make its recommendation to congress and administration on the necessary improvements and adjustments.
Impact of the nursing provisions
Following the passage of healthcare reform, there is a likelihood that the sector will be teeming with people seeking services. The professionals especially nurse practitioners, primary care physicians and healthcare workforce will be overwhelmed by the extra load of attending more patients. Again, there is a likelihood of overcrowding in the field as both trained and untrained people seek to take advantage of the grants and financial assistance that is provided for by the law. While training many nursing professionals is recommended, excessive joining of the workforce is likely to affect the market of nurses effectively making the profession attractive (Routson, 2010 par. 6).
The law also does put emphasis on prevention of diseases rather than cure. Nurses are therefore going to gain more prominence and their role in the healthcare sector will be more pivotal than it has previously been. Still other nurses see more opportunities in the field whether there is a shortage or surplus in the supply of nurses. Some practitioners foresee a chance for the nurses who will take on private practice, a chance to increase their earnings.
Changes in management
Facing a possibility of an increase of trained and registered nurses, the nursing management should work on modalities for better management of the profession. The healthcare reform law is just in its raw form and rules and guidelines have to be written to micromanage the numerous provisions that target nurses.
More nurse organizations should be formed to better serve the new nurses who will be joining the profession and the possibility of increased specialization. Specialization is especially eminent considering the expanded field where they will be practicing and the number of people they will be attending to (Stokowski, 2010 par. 2).
Conclusion & Recommendation
Nurses had campaigned for decades to have sweeping healthcare reforms that would recognize the critical role that they play in provision of healthcare services. The provisions contained in the laws gives them exactly that and much more than they bargained for. As the ANA president was quoted as saying, the law has been passed but the real task lies in implementation. More investments have to be made to realize the gains that the law envisions.
Education facilities have to be expanded to accommodate the possible swelling numbers of nursing students, intense lobbying is absolutely necessary to ensure congress does not amend any provision that may reduce the funds allocated to various nursing fields. The nursing organizations may be forced to battle a perceived better treatment by the government from other professions in the medical field. At the same time they may be facing an overly expectant public may turn unfriendly if their expectations are not met. Compromised quality and standards is always a possibility that faces crowded professionals fields. The expected surge in the number of nurses should therefore be carefully and closely managed to ensure the safety, quality and high standards that have characterized are maintained.
Doctor Nurses are better p-laced to understand issues affecting nurses, generally. More nurses therefore should be encouraged to pursue more doctoral courses so as to lead the nursing field and effectively champion the needs of nurses in the healthcare field.
References
American Nurses Association (ANA). (2010). Health System Reform: Key Provisions Related to Nursing. Web.
Diana, J., Kline, J., & Chaffee, W.M. (2007). Policy & politics in nursing and health care. New York: Elsevier Health Services.
Frellick, M. (2010). Healthcare Reform Bill: What Nurses Need to Know. Web.
Journal of Nursing Administration (JNA). (1999). Healthcare Reform: Its Effects on Nurses. Journal of Nursing Administration: Volume 29 Number 3. Web.
Lundy, S.K., Lundy, S.L., & Janes, S.L., (2009). Community Health Nursing: Caring for the Public’s Health. New York: Jones & Bartlette Learning.
Routson, J. (2010). Healthcare Reform and Nursing: How the New Legislation Affects the Profession. Web.
Stokowski, L.A. (2010). Healthcare Reform and Nurses: Challenges and Opportunities. Web.