Introduction
In the article Nursing Leaders Can Deliver a New Model of Care, Shalala (3) portends that the pressing issues on the need to expand access to care and contain the escalating cost of healthcare can be aptly solved by remodelling the current healthcare system to recognize and appreciate the role played by nursing professionals. For far too long, he tells us, nurses have not been given adequate room and recognition to exercise their rightful role within the healthcare system. Things could change however, if this was done. Is this argument valid, or is it not? This paper takes a critical look at two main issues that Shalala fronts to qualify his argument.
Removing practice barriers
Shalala (7) portends that, “preventing APRNs from providing the care they are trained to give is inexcusable—and a waste of money and lives”. But is removing practice barriers a solution or is it just pure activism? My opinion is that it is both. Firstly, this is a very valid point he makes here—we should not invest in training nurses and then have the law bar them from implementing on the knowledge they gained. It is simply an illogical and an unnecessary hurdle to place on the profession. The push to have APRNs granted by law autonomy to exercise to the full extent of their training not only expands access by removing limitations on the nurses but also by freeing physicians to concentrate on more complex issues (Shalala, 7).
On the other hand however, pushing for removal of practice barriers is pure activism. There are two sides to this push; the scope of practice and payer policies. It doesn’t evade one’s attention that the major bone of contention is on payer policies that has less implications on the sector as whole compared to the scope of practice which has been relegated in the push. Shalala (7) clearly confirms this concern when he chooses to highlight the need for fair reimbursement through more rational and uniform payer policies and fails to give the same emphasis on the scope of practice. This apparent bias in the veiled agenda for autonomy is perhaps the reason some physicians and genuinely so are opposed to the push. For the push to succeed, all these fears must be dispelled. The idea should not be seen as aimed to replace physicians with nurses but rather a situation where the two can complement each other. It is my recommendation that the scope of practice should take centre stage for the push to succeed.
Promoting education
Shalala (8) strongly believes advocating for high levels of education and training by the nursing profession is a major boost in remodelling and improving the American healthcare system. This assertion is further augmented by research that finds that nursing professionals with advanced academic qualifications offer better quality services. According to research, having less patients per nurse and having a larger percentage of nursing staff with bachelor’s degree significantly reduces mortality rate of inpatients (Shalala, 8). This findings however, could as well be interpreted against the course Shalala wants to advance in this article. To properly interpret these findings, two pertinent questions regarding the current predicament of the U.S. healthcare system must be answered. The first question is whether the inadequacies in training of nurses is to blame for ineffective healthcare delivery? The second question is if it is to blame, whether then it is the right thing and moment to push for autonomy and greater say for the profession in the healthcare system?
To answer the first question, there’s no doubt in pointing out that current care delivery gaps are partly as a result of the nurses training inadequacies. It is an admission that not only gives credence on practice restrictions but also adds more impetus why greater autonomy would not be the appropriate move now. It is a dilemma between status quo and greater autonomy. To answer the second question then, a middle ground going forward should be forged. Since research already indicates that advanced education brings in better quality care delivery, restrictions should be relaxed on this basis. Restrictions on practice should be pegged on level of education such that degree holders have less restrictions than their non-degree holder’s counterparts and advanced degree holders even fewer restrictions.
Conclusions and recommendations
The argument that nurses holds the key to solving the current woes in the healthcare system is valid—but only to some extent. Firstly, it is true that loosening practice restriction will unlock unused talent in nurses and increase the number of care givers hence better access as is already the case in some areas (Shalala, 3). However, this is not the only issue hindering access. Access is an industrywide issue that requires collaboration and working mutually together by all industry actors. Secondly, it is not entirely valid that escalating costs of healthcare can be solved by nurses only—cost is largely a market factor of supply versus demand (Shalala, 12). Healthcare demand has been driven up by the increase of people insured and rise in chronic illnesses without commensurate increase in care providers. Care providers span across the sector from researchers, technicians, nurses, public health officers and physicians. This means, industry woes will be solved by looking at all the industry actors and not just nurses.
All in all as is clearly captured by Shalala (14), a better healthcare system will only be realized through better trained care providers and more efficient and cost effective intervention measures. It is an industrywide problem that must be solved through close collaboration and coordination of all actors.
Work Cited
Shalala, Donna E. “Nursing Leaders Can Deliver a New Model of Care”. Frontiers of Health Services Management 31:2 (2014): 3-16. Print.