Former Secretary of Health and Human Services, Donna Shalala, has been quoted as describing today as the "Golden Age for Nursing." Why this statement may be easy to understand as it might relate to our aging, graying profession, it is sadly not as well understood how it relates to the changing healthcare landscape and the roles that nursing will play in the future. As the former Secretary of Health and Human Services under then President Bill Clinton, Shalala has the big picture view of the past, present, and future opportunities for our profession. She co-chaired the Robert Wood Johnson and Institute of Medicine's Future of Nursing's Initiative to develop a blueprint for using nurse-led models of innovation to improve the healthcare system. A must read for all nurses (http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-H), this report describes barriers that have prevented nurses from being fully used to the extent of their license and education and to respond effectively in an evolving healthcare system. Not only are there recommendations included but organizations and governmental agencies are identified and charged with the responsibilities to overcome and eliminate these barriers to ensure that nurses are well-positioned to lead change and advance health of our nation.
In my former role as president of the American Nurses Association, I shared Shalala's view and belief that this is the time of Nursing's Golden Age. But I will take it a step further and share that we are on the verge of witnessing our nation's time through the transformation of our healthcare system. Personally, as an individual who had a front-row seat, not just at the bill signing celebration, but throughout the 18-month debate and journey as we crafted the Affordable Care Act (ACA) of 2010, I am pleased at the outcome. Nurses will rightfully assume greater responsibility in our transformed healthcare system: responsibilities that we are prepared for and what our nation needs to improve the health of our citizens.
First, let us review what was achieved through the ACA. I specifically use the word achieved because it was through vision, collaboration, partnership, and strong leadership of nurse leaders that this legislation was created that transforms critical aspects of our healthcare system. I will admit that this is not perfect legislation, but most of it is incredible and good for you and the patients we serve.
The Affordable Care Act represents the broadest healthcare overhaul since the 1965 creation of the Medicare and Medicaid programs. The United States' healthcare priorities will now include prevention, early screening and diagnosis, and transitional care as a majority focus shift. In the past, it was challenging to focus and receive reimbursement on anything other than disease treatment. Imagine a world where effort goes into preventing illnesses from occurring in the first place. This represents a real paradigm shift that few nurses will take issue against once they understand it.
As a result of the 2010 ACA, nurses will be expanding their role broadly among practice settings in every state. Working on the front lines of patient care, as both staff nurses and advanced practice nurses, our input will achieve several of the objectives envisioned with the ACA. Cost-effectiveness, illness prevention, improved quality and safety, and patient-centered care outcomes will certainly be enhanced. The new law offers many opportunities to improve access to care while lowering out-of-pocket costs and securing comprehensive benefit packages that address health needs across the course of our lives particularly for women (http://www.kff.org/womenshealth).
Out of all of the ACA provisions, I am most excited to see the expansion of nurse-led clinics, with projections to double the number of patient visits. Competent, caring, cost-effective advanced practice nurses will become the only healthcare providers known to individuals, while providing primary care visits for the first time. APRN utilization will become the norm for primary care versus the exception in years to come. A very exciting example is the law establishing nurse-managed clinics in schools in underserved areas. Imagine completing scoliosis screening consistently in these school clinics and addressing this life-crippling condition before it becomes problematic. Imagine the impact these centers will have on not just the health of the students but also providing role models and potentially generating interest in future healthcare careers. At home, transitional care models with nurses providing and coordinating much of the care will be reimbursed, while reducing the frequency and financial impact of frequent readmission to hospitals. Imagine creating the cost-effective, safe, high-quality, and patient satisfaction "Orthopaedic Transitional Care Model" and then getting reimbursed for this model that supports your patients' needs at home versus inpatient stays. All of this is possible under the ACA.
No longer will anyone be denied coverage because of "preexisting conditions." Yet today, this has often been the case when individuals change jobs and switch insurance plans. All screening examinations, such as mammograms, will be considered prevention and will be covered at no cost to the individual, so it is hoped that all will use the screening opportunity to prevent and diagnose diseases early. One example that is pertinent for many nurses is the current status for diagnosing early osteoporosis. According to U.S. Preventive Services Task Force, women aged 65 years and older should be screened routinely for osteoporosis and will now be covered. Imagine how the outcome can be impacted if one can have osteoporosis diagnosed and treated early.
So it is understood, I will make this clear, it is time to stand up and be heard. It is so easy to get caught up in the "antimovement" of this legislation from the media without knowing the details. But as nurses, we owe it to our patients, our profession, and ourselves to become informed about the ACA rather than being distracted and accepting the negativity that exist about it. Take the time to search out nonpartisan sources such as the Kaiser Foundation and become better informed.
"To successfully transform the way healthcare is structured and delivered in our country, it is absolutely essential to actively engage nurses for their leadership, expertise and proven solutions," reported Shalala as she participated in several Future of Nursing conferences. Well understood by those outside of our profession, "Nurses and their concerns must be part of our national discussion about health reform, and viewed as a key to the solution."
This is indeed our Golden Age of Nursing. An age when our input and wisdom are valued. Join your colleagues as we implement many of the nurse-sensitive ACA provisions and realize Nursing's Future, A Platform for Improving Care.
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