To say that emergency departments (EDs) are "busting at the seams" with more than 115 million seen in EDs and nearly 42 million injury-related visits annually is an understatement (National Center for Health Statistics, 2007). In addition, over a decade ago, an estimated 38.5 million U.S. residents aged less than 65 years did not have health insurance (Morbidity and Mortality Weekly Report, 1995). Today that number has soared to nearly 44 million (43.6M) according to the National Health Interview Survey (NHIS, 2007).
The Centers for Disease Control and Prevention (CDC) defines the term uninsured as persons who do not have any private health insurance, Medicare, Medicaid, State Children's Health Insurance Program, state-sponsored or other government-sponsored health plan, or a military plan. These individuals are also considered uninsured if their only insurance is Indian Health Service coverage or if they had only a private plan that paid for only one type of service (e.g., accident or dental care insurance; CDC, 2007).
The visit rate in EDs for individuals with no insurance is double that of those with private insurance whereas the visit rate to doctors' offices is higher for those individuals with private health insurance than for those with no health insurance (CDC, 2007).
Data from the NHIS revealed increases in uninsured adults. Nearly 15% of Americans are currently without health insurance (CDC, 2007). That is about 20% of the adult population aged 18-64 years in the United States and represents an increase of almost 19% from the previous year (CDC, 2007). In addition, 9.3% of children under the age of 18 do not have any health insurance provider (CDC, 2007). Data also indicate race and ethnicity differences in the increased percentage of uninsured individuals in the United States, which include 32% of Hispanics, nearly 16% of non-Hispanic Black persons, and over 10% of non-Hispanic White persons (CDC, 2007).
That said, during this election year, what can you as a nurse and specifically as an advanced practice nurse (APN) do to influence the future of healthcare in the United States and the role of APNs in that future?
First and foremost, it is imperative to follow the presidential candidates. Examine each candidate's specific platform with regard to healthcare and APNs. Ask direct questions of these candidates about the utilization of APNs especially when they visit your state.
Second, get involved in or become move involved with advanced practice nursing organization(s). Whether it is the American Nurses Association (ANA) or a specialty professional organization such as the Emergency Nurses Association's APN Work Team or APN groups from the American Academy of Nurse Practitioners, the American College of Nurse Practitioners, or the National Association of Clinical Nurse Specialists, it is crucial for APNs to make their collective voices heard regarding these national agenda items. When ANA outlined the need for APN autonomous care delivery in Nursing's Agenda for Healthcare Reform, the ANA remarked that APNs were the "key" to U.S. Healthcare (ANA, 2008). The ANA has since promoted APNs as one of the most important healthcare groups that will continue to be a part of America's healthcare system of reform (ANA, 2008).
Third, take that involvement to the next level. Attend meetings-town meetings, state legislative hearings, and/or national candidate forums-and speak up about the removal of barriers and inclusion for APNs. Send the candidates e-mails or letters and voice your APN opinions. APNs practice in EDs, retail clinics, and other emergency care settings. APNs have something that is more powerful than many other constituent groups-the fact that they provide the healthcare to these patients. So, tell your stories!!
Finally, remember to vote. Casting a ballot on election day when 1 in 44 voters is a nurse is a powerful statement and, when collectively harnessed, could change the direction of the upcoming reforms and the future of healthcare in this country. Healthcare in the United States-can it be reformed? With advanced practice nurses, the answer is a definite yes!!
K. Sue Hoyt, RN, PhD, FNP-BC, CEN, FAEN
Emergency Nurse Practitioner St. Mary Medical Center, Long Beach, CA
Jean A. Proehl, RN, MN, CEN, CCRN, FAEN
Emergency Clinical Nurse Specialist Dartmouth-Hitchcock Medical Center, Lebanon, NH
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