Coming Up Short
Combating the Nursing Shortage to Achieve Better Care for All
The theme for this year’s National Nurses Week centered on delivering quality and innovation in patient care. This initiative coincides with the goals and needs of the Affordable Care Act (ACA), also referred to as ObamaCare, as well as with several pending federal and state bills. The new legislation places greater importance on the role of nursing professionals to impact the health of patients, while also intensifying attention to the immense need for more nurses in the health care system.
During National Nurses Week, Rep. Eddie Bernice Johnson, D-Texas, introduced H.Res. 201: “Supporting the Goals and Ideals of National Nurses Week” to the House Committee on Energy and Commerce. The aim of the bill is to express “support for the … ideals of National Nurses Week [and acknowledge] the contributions of nurses to the U.S. health care system.”
Nurses Are Drivers of Preventive Care
There is a bipartisan acknowledgment of the importance of nurses to the success of the health care industry. Rep. Rodney Davis, R-Ill., observed that nurses are often the “first and last contact patients and their families receive.” Nurses have the power to lead the health care industry in educating patients about preventive care practices and how to lead healthy lifestyles, two cornerstones of ObamaCare. The dearth of primary care physicians makes nurses the obvious choice to act as primary care providers in community health centers, where the number of patients is expected to soar as more individuals and families, who formerly could not afford to participate in private health plans, begin to take advantage of the health care benefits.
ObamaCare became law March 23, 2010, and since then it has had notable impact:
- 47 million women have already gained access to preventive health services and experienced greater equality in terms of health rates;
- Out-of-pocket costs for mammograms and colonoscopies have been eliminated;
- In 2011, ObamaCare helped approximately 86 million Americans take advantage of free, preventive services previously subject to copays or deductibles.
These preventive health care measures are intended to help the general public and to cater to underserved individuals and communities, thus reducing the cost of health care for everyone over time.
Nurses are key to the success of implementing preventive health care measures and are integral to the Community-based Care Transitions Program (CCTP), helping avert unnecessary readmissions of high-risk Medicare beneficiaries, which cost more than $26 billion per year. These legislative measures depend on nurses to change the focus of health care from treatment to prevention. According to the Department of Health and Human Services, “Nurses making home visits can sharply reduce infant mortality and improve outcomes for mothers and children alike.”
Without a greater influx of nurses into the field, a huge deficiency will result. Karen Daley, president of the American Nurses Association (ANA), has estimated that “the total number of job openings for nurses due to growth and replacements” could exceed more than 1 million. The need for nurses with advanced degrees, such as registered nurses and nurse practitioners, is even more critical to the success of ObamaCare. The American Association of Colleges of Nursing has found a direct correlation between nurses with higher education and lower mortality rates among patients.
Current Legislation to Expand the Role of Nurses
House legislation that will depend on the growth in the number of registered nurses and nurse practitioners has been recently introduced. All bills are intended to reconcile common problems affecting nurses and create an environment that will allow them to be leaders in providing patient care.
- H.R. 1821: “Registered Nurse Safe Staffing Act of 2013” would require hospitals to establish a nurse staffing committee in charge of appropriating a sufficient number of registered nurses to provide direct patient care in each unit and on each shift.
- S. 739: “National Nursing Shortage Reform and Patient Advocacy Act” aims to establish a ratio of registered nurses to patients.
- H.R. 1907: “Nurse Staffing Standards for Patient Safety and Quality Care Act of 2013” would mandate a minimum number of registered nurses in various health care settings and in units designated for specific methods of treatment.
There are significant variations from state to state with regard to what a nurse practitioner is allowed to do. Often nurse practitioners are restricted from prescribing medication and treating patients without the written consent of a physician, which can limit their ability to practice, leaving their patients without a provider. This is deleterious to residents of lower-income neighborhoods who depend on nurse practitioners and community health centers to administer their primary care needs.
- In New York, bill number A4846-2013 would establish the Nurse Practitioners Modernization Act.
- Bill number S2309-2013 would allow “certified NPs to practice without collaboration of a licensed physician.”
- The New Jersey legislature has proposed bill number A3512, identical to Senate bill number S2354, which would eliminate the need for advanced practicing nurses to obtain a second signature for prescriptions once they have acquired 2,400 hours of licensed practice.
Nursing Schools Turning Students Away
With such a dire need for advanced nursing professionals, one would expect that nursing schools would be clamoring for students and incentivizing them to pursue advanced nursing degrees. Yet nursing schools are turning away viable applicants. Some people have taken this as a sign that the nursing shortage is being exaggerated, even going so far as to state that there are too many nursing applicants in an age where technology can be used as a replacement for nurses.
This assumption, however, is not only inaccurate -—it ignores the reality that the considerable number of applications rejected for admission to nursing programs is accompanied by a shortage of nursing educators. This underscores the complexity and depth of the nursing shortage, and illustrates the need for and importance of better recruitment methods.
In response to this reality, the Robert Wood Johnson Foundation announced last month the creation of a multimillion dollar national nursing program in one of the largest efforts to help mitigate the shortage of nursing educators.
California is a testament to how legislation and funding for educational programs can impact the number of people who enter the nursing profession. From 2004 to 2008, the number of nurse practitioners in California doubled; and following state legislation establishing ratios of registered nurses to patients based on the type of care required by the patient (intensive care, pediatrics, etc.), the number of registered nurses dramatically increased.
Nursing impacts everyone. Alleviating the nursing shortage, providing quality care for all patients and ensuring that today’s nurses are not overworked and underappreciated are key to the success of ObamaCare.
- Contact your congressional representative to urge his or her support of H.R. 1821: “Registered Nurse Safe Staffing Act of 2013,” its companion bill S. 739 and H.R. 1907: “Nurse Staffing Standards for Patient Safety and Quality Care Act of 2013.”
- Visit your state representative to ask about the expanding roles for nurse practitioners in your state, using the New York and New Jersey state models as guides.
If you are a health care professional or want to be part of a connected community serving in the nursing profession, contact the United Methodist Women’s Office of Deaconess and Home Missioner. To learn more about discernment events and the wide range of nursing opportunities where you can make a difference, send a message to firstname.lastname@example.org or call 212-870-3850.
Resolution 3201, “Health Care for All in the United States” (pages 318-328), in The Book of Resolutions of The United Methodist Church (2012.