How nurses and hospitals are adapting to tectonic shifts in health care
Article By: Martin Daks June 10, 20195:10 am
The shortage of Nursing Faculty needs to be addressed to ensure that the pipeline for new nurses is not reduced as the evolving need for nurses in healthcare continues to increase.
This issue is addressed in a recent NJBIZ article featuring an interview with Dr. Edna Cadmus, Executive Director of the New Jersey Collaborating Center for Nursing. https://njbiz.com/the-next-generation/
A Consensus Study from the National Academy of Medicine
An ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine will extend the vision for the nursing profession into 2030 and chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century. The committee will examine the lessons learned from the Future of Nursing Campaign for Action as well as the current state of science and technology to inform their assessment of the capacity of the profession to meet the anticipated health and social care demands from 2020 to 2030.
In examining current and future challenges, the committee will consider:
The role of nurses in improving the health of individuals, families, and communities by addressing social determinants of health and providing effective, efficient, equitable, and accessible care for all across the care continuum, as well as identifying the system facilitators and barriers to achieving this goal.
The current and future deployment of all levels of nurses across the care continuum, including in collaborative practice models, to address the challenges of building a culture of health.
System facilitators and barriers to achieving a workforce that is diverse, including gender, race, and ethnicity, across all levels of nursing education.
The role of the nursing profession in assuring that the voice of individuals, families and communities are incorporated into design and operations of clinical and community health systems.
The training and competency-development needed to prepare nurses, including advance practice nurses, to work outside of acute care settings and to lead efforts to build a culture of health and health equity, and the extent to which current curriculum meets these needs.
The ability of nurses to serve as change agents in creating systems that bridge the delivery of health care and social needs care in the community.
The research needed to identify or develop effective nursing practices for eliminating gaps and disparities in health care.
The importance of nurse well-being and resilience in ensuring the delivery of high quality care and improving community health.
In developing its recommendations for the future decade of nursing in the United States, the committee will draw from domestic and global examples of evidence-based models of care that address social determinants of health and help build and sustain a culture of health.
Dr. Edna Cadmus provided testimony on behalf of the NJAC and NJCCN to the committee.
Reforming America’s Healthcare System Through Choice and Competition
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
U.S. DEPARTMENT OF THE TREASURY
U.S. DEPARTMENT OF LABOR
Section 3 Healthcare Workforce and labor Markets
Recommendations: Broaden Scope of Practice
States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.
The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.
States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., physician assistants, hygienists) that are not justified by legitimate health and safety concerns.
States should evaluate emerging healthcare occupations, such as dental therapy, and consider ways in which their licensure and scope of practice can increase access and drive down consumer costs while still ensuring safe, effective care. P.31
“For example, advanced practice registered nurses (APRNs),96 physician assistants (PAs),97 pharmacists,98 optometrists, 99 and other highly trained professionals can safely and effectively provide some of the same healthcare services as physicians, in addition to providing complementary services. Similarly, dental therapists and dental hygienists can safely and effectively provide some services offered by dentists, as well as complementary services. P.100
SOP statutes and rules often unnecessarily limit the services these “allied health professionals”101 can offer. A 2011 Institute of Medicine (IOM) report surveyed “[e]vidence suggest[ing] that access to quality care can be greatly expanded by increasing the use of . . . APRNs in primary, chronic, and transitional care,”102 and expressed concern that SOP restrictions “have undermined the nursing profession’s ability to provide and improve both general and advanced care.”103 In fact, research suggests that allowing allied health professionals to practice to the full extent of their abilities is not a zero sum game for other medical professionals, and may actually improve overall health system capacity.104 The previously mentioned IOM report found that APRNs’ scope of practice varies widely “for reasons that are related not to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work.” P.105
State decisions about scope of practice and reimbursement can also affect the development and utilization of allied health professionals, particularly in public programs. Private insurance has the flexibility to incentivize patients to find lower-cost, higher-quality provider alternatives when feasible. Public programs, more restricted by state regulations, can be less responsive to such changes in the healthcare workforce, even after scope of practice regulations accommodate them. Currently, for example, states vary widely in the degree to which they permit their Medicaid programs to reimburse allied health professionals directly for services. Services provided under the direct supervision of a physician are reimbursed as if the physician provided those services. State Medicaid programs can also pay for PA, nurse practitioner, and certified nurse midwife (CNM) services provided outside of a physician’s office, but only if state scope-of-practice laws do not require onsite supervision by physicians. Some states allow allied health professionals to bill Medicaid directly, while other states require them to bill under the physician’s number. For patients to realize the benefits of changes to state SOP restrictions, state Medicaid programs would need to reimburse allied health professionals independently for their services.”
Nurses on the NJCCN Board discuss New Jersey’s residency programs.
Nurses, Be Counted!
You may know that the Nurses on Boards Coalition is in the midst of its annual campaign to register nurses’ board service. If you serve on a board, and haven’t already registered, please visit the Nurses on Boards Coalition website, and be counted.
The mission of the Nurses on Boards Coalition is to improve the health of communities and the nation through the service of at least 10,000 nurses on boards by 2020.
Please also share with other nurses in your network, and on social media. Suggested tweets are below:
“Geneva, Switzerland; 6 August 2018 – The International Council of Nurses (ICN) has released a new position statement on Evidence-based safe nurse staffing(click link to view pdf), which calls for increased investment in safe, effective and needs-based nurse staffing levels in order to improve patient outcomes and create positive practice environments.
“The position statement, which was developed with the input of international experts and in consultation with ICN’s members associations, sets out both principles and key elements of approaches to ensuring safe staffing which is intended to help and support all those involved in determining staffing levels and ensure there is clear nursing leadership on this vital issue.”