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Importance of advanced practice nurses
Importance of advanced practice nurses
Contemporary nursing practices
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The current practice of nursing is expected to evolve as the ways in which patient care is delivered continues to develop. The Patient Protection and Affordable Care Act (PPACA) has inspired new models of care that improve accessibility, continuity of care, cost efficiencies, and the accountability of health care systems. Concepts, such as Accountable Care Organizations (ACOs), Primary Care Medical Homes (PCMH), and Nurse-Managed Health Clinics (NHMC) are necessary to support the initiatives of health care reform, which includes developing methods of advancing approaches in the continuum of care to improve patient outcomes. Considering recent initiatives, it is crucial that the role of registered nurses evolves to meet the changing demands …show more content…
These organizations are aligned with a collective network of providers, hospitals, and various other specialties who are responsible, as a group, for management of patient care and outcomes (O’Hara, 2014). The IT infrastructure of an ACO allows for the exchange of patient information between providers, thereby improving transparency. Subsequently, this fosters the continuum of care across providers by promoting appropriate prevention and treatment measures, while decreasing redundancies in care. Therefore, this concept not only serves to promote continuity of care and patient outcomes, it also serves to promote cost savings. ACOs have a unique opportunity to share in the savings that are realized by their organization through Medicare’s Shared Savings Program. After a pre-determined term, Medicare assesses the actual cost savings and distributes a percentage back to the organization as a reward for delivering responsible, efficient, quality …show more content…
In this model, Advanced Practice Registered Nurses, specifically nurse practitioners, are a fundamental resource for providing primary care. Grants provide the funding that enables both PCMH and NMHC models to improve access to underserved populations, allowing each to focus their efforts on prevention, coordination, the management of chronic disease and information (ANA, 2010). NMHCs also serve as critical access points to reducing hospital admissions and preventable visits to the emergency room, which equate to millions of dollars in savings each year (American Association of Colleges of Nursing [AACN],
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
Making a clinical decision is a skill that needs to be acquired, and nurses are accountable for any decision that is made, so they need to understand how they make decisions (Nursing and Midwifery Council (NMC), 2015). A greater understanding of how nurses make decision is essential to follow research and development of decision making skills (Clark et al, 2009) . A first step to a decision making process may entail understanding a framework or model. Baumann and Deber (1986) define decision making as situations in which a choice is made among a number of possible alternatives often involving values given to different outcomes”.
Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid
The Affordable Care Act (ACA) was passed in 2010 with the goal of expanding healthcare coverage to all Americans by reforming insurance policies and practices (Tillett, 2011). The ACA upsurges the demand for an increase in primary care providers in order to supply quality care to the much larger population that will have coverage and therefore acquiring healthcare. The Institute of Medicine (IOM) through its report The Future of Nursing: Leading Change, Advancing Health has generated a solution to the shortage of primary care providers by promoting a transformation of the nursing profession to fill the gap.
There is a shortage of all health care professions throughout the United States. One shortage in particular that society should be very concerned about is the shortage of Registered Nurses. Registered Nurses make up the single largest healthcare profession in the United States. A registered nurse is a vital healthcare professional that has earned a two or four year degree and has the upper-most responsibility in providing direct patient care and staff management in a hospital or other treatment facilities (Registered Nurse (RN) Degree and Career Overview., 2009). This shortage issue is imperative because RN's affect everyone sometime in their lifetime. Nurses serve groups, families and individuals to foster health and prevent disease.
For patients, when ACOs are fully functional they represent an increase in patient experience in several ways. First ACOs allow open communication between physicians from different specialties coordinating together to determine solutions. Second, ACOs also establish a single point of contact for all questions concerning care. Finally, these organizations represent a centralized network of physicians for the patient, creating a team to deliver comprehensive care. In fact, there is mounting evidence that suggests the potential benefits of care coordination in ACOs for both patient experience and quality, including reduced hospital admissions, improved quality of chronic disease management, improved patient satisfaction, and better access to specialty care (Stille, 2005). For providers, ACOs provide an opportunity for better collaboration on the various modalities they use on their patients, as well as improved workflow and communication. There are several stakeholders in which the large scale implementation of ACOs would affect. Federal and state government health insurance programs like Medicaid and Medicare, one type of stakeholders. With the implementation of ACOs and the shared savings model, Medicaid and Medicare now have a financial incentive to partner with healthcare organizations to deliver better outcomes at lower costs. If done correctly, Medicaid and Medicare stand to save large
Advanced practice registered nurses play a significant part in extending access to health care by providing primary care and specialty care services to clients. Advanced practices registered are mentors, educators, researchers, and administrators. According to Health Resources and Services Administration, “Ninety-six percent of the NP workforce reported being in clinical practice, providing direct patient care” (Health Resources and Services Administration 2016). Furthermore, “Nearly three percentages were in faculty positions and approximately one percent was in administrative positions”(Health Resources and Services Administration 2016).
It is no secret that the current healthcare reformation is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify a way to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal…” (Bailey, Jones & Way, 2006, p. 381). The key to a successful healthcare reformation is interdisciplinary collaboration between Family Nurse Practitioners (FNPs) and physicians. The purpose of this paper is to review the established role of the FNP, appreciate the anticipated paradigm shift in healthcare between FNPs and primary care physicians, and recognize the potential associated benefits and complications that may ensue.
Nursing should focus on patient and family centered care, with nurses being the patient advocate for the care the patient receives. Patient and family centered care implies family participation. This type of care involves patients and their families in their health care treatments and decisions. I believe that it is important to incorporate this kind of care at Orange Regional Medical Center (ORMC) because it can ensure that we are meeting the patient’s physical, emotional, and spiritual needs through their hospitalization.
About 32 million people will represent the newly insured, affecting the health care system and nurses are the fundamental in health system. Health care reform is positive for nurses. The health care bill provides money for advance practice and general nurse education. The law also creates a grant program for innovative safety net programs, such as nurse-managed health clinics. Due to the shortage of family Physicians, nurse practitioner programs are going strong. The health care reform is a good opportunity for nurses; the law will permit different approaches to deliver primary care and with the decreasing number of physicians going in to primary care, Nurses represent the best way to provide primary care to the millions of new insured people. (Satowski, 2010)
The American Nurses Association (ANA) developed a foundation for which all nurses are expected to perform their basic duties in order to meet the needs of the society we serve. The ANA “has long been instrumental in the development of three foundational documents for professional nursing; its code of ethics, its scope and standards of practice, ands statement of social policy.” (ANA, 2010, p. 87) The ANA defined nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” and used to create the scope and standards of nursing practice. (ANA, 2010, p. 1) These “outline the steps that nurses must take to meet client healthcare needs.” () The nursing process, for example, is one of the things I use daily. Other examples include communicating and collaborating with my patient, their families, and my peers, and being a lifelong learner. I continually research new diagnoses, medications, and treatments for my patients. As a nurse of ...
The purpose of this paper is to describe how I visualize my future role as a mastered prepared nurse professional. The Association of American Medical Colleges estimates that by 2015 the nation will face a shortage of 62,100 physicians, 33,100 primary care practitioners and 29,000 other specialist. The nursing shortage evaporated during the recession, because many nurses returned to the workforce, but nurse practitioners remain a scarce resource in many areas (Expanding the Role of ANP Risk and reward). American Association of Retired Persons (AARP), a supporter of transforming health care to meet the challenges of an aging population and a shortage of primary care providers, agrees that advance practice registered nurses (APRNs), could provide seamless, accessible, affordable, and equitable quality care if they are utilized to the full extent of their education and training (AARP). In 2010, the Institute of Medicine published The Future of Nursing: Leading Change, Advancing Health, a report which offered an intensive examination of what the nursing profession is now and should become. It states that nursing is at the heart of patient care and is therefore crucial to changing the way health care is delivered so that patients receive care at a cost they can afford. Nurses are a linchpin for health reform and will be vital to implementing systemic changes in the delivery of care (AARP).
There are companies like Norton Healthcare and Humana who has teamed up to improve healthcare. Both Norton Healthcare and Humana wanted to build their ACO internally by their own standards instead of being pushed from outside forces. Norton Healthcare and Humana were able to address breaches in payer claims. Addressing breaches in payer claims is essential to help reduce cost while improving access to healthcare. Parrish Medical Center has also implemented an ACO in hopes to expand to other stakeholders within the community. The downfall is that many healthcare organization think that implementation of an ACO is done overnight. ACO implementation can take up to five years. Also, the payer delivery system is not concrete in the beginning. Any information on patients who were seen by physicians outside of the organization are not seen. Data such as emergency department charges and payments can be easily missed (Goedert,
There has been a drastic cut in both the Medicare and Medicaid reimbursement rates. According to Robert (2012), “cuts of more than $360 billion to Medicare and Medicaid will be made over the next 10 years. The focus of nursing needs to emphasize more on wellness care and prevention rather than acute care” (McNeal, G., 2012). Nursing practice will need to shift more towards community and population focused nursing. Baccalaureate prepared nurses are provided with a curriculum that includes both community health and leadership skills that are not included in the associate program. By encouraging associate’s degree nurses to obtain a bachelor’s degree in nursing, an increase in the awareness of the needs of the community and population may be seen. The IOM report has outlined the anticipated obstacles that healthcare will face if changes are not made. By allowing nurses to provide care within their full scope of practice, quality care may be provided at an affordable cost to the population. The use of advanced practice nurses in primary care may provide quality, access, and cost efficient healthcare to high-risk populations and possibly decrease hospital admission rates, thus lowering the overall cost of healthcare. If nurses partner with doctors and other healthcare providers, it may improve healthcare by providing seamless transitions (Institute of Medicine,
Out of all of the members of the health care interdisciplinary team, nurses are the ones who spend the most time giving care to the patient. In order to give the greatest quality of care to a patient, it is important for nurses to “assume accountability and responsibility in fulfilling the role of the associate degree nurse, through personal and professional growth, integration of current evidence-based practice and understanding of multiple dimensions of patient-centered care” (Ivy Tech Community College, 2016). One of the most important parts of this is the nurse’s ability to take responsibility in patient care. Battié and Steelman (2014) notes that patients expect the best care from nurses, so it is only fair that nurses also expect themselves responsible for delivering the best care. Battié and Steelman (2014) also says that accountability relies on two parts: clinical expertise and effective communication. Nursing expertise can only be gained through personal growth that comes from practice or learning over time, while effective communication has been built into nursing through