Much has been said about what the historic health reform law passed last month means for consumers, businesses, insurance companies and doctors, but what does it mean for nurses—the largest group of health care professionals in the country?
In short, it will create a wealth of new opportunities—and demands—for them.
“This new law identifies nurses as critical players in meeting the changing health care needs of Americans,” said Brenda Cleary, Ph.D., R.N., F.A.A.N., and Susan Reinhard, Ph.D., R.N., F.A.A.N., in a joint statement after the law was passed last month. Cleary directs the Center to Champion Nursing in America, an initiative of the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation. Reinhard is a chief strategist at the center and senior vice president of the AARP Public Policy Institute.
That is in many ways good news for nurses, nursing and consumers, advocates say.
Nurses will continue to be in high demand, will be able to practice to a fuller extent of their abilities, will be able to take advantage of new sources of funding to advance their education, and will benefit from new funding for health care research.
But perhaps most important is the fact that nurses will be able to provide care for patients without regard for their ability to pay, according to Rebecca M. Patton, M.S.N., R.N., C.N.O.R., president of the American Nurses Association. “There’s nothing more dissatisfying as a nurse than to come to work and not be able to take care of patients because they don’t have insurance,” she says.
But it also makes it all the more critical to ensure that the nation has the diverse, well-prepared nursing workforce it needs to meet projected demands for nursing services as the population ages and as millions of new patients enter the health care system.
“We are definitely going to need more nurses,” says Suzanne Begeny, Ph.D, R.N., director of government affairs at the American Association of Colleges of Nursing. “A lot of the focus going forward is really on making sure we have enough providers for this newly expanded system.”
The new law includes key measures to address that challenge.
To start, it includes incentives to encourage more nurses to pursue higher education, which will enable them to carry out more specialized tasks and fill academic vacancies.
The demonstration provision for Graduate Nurse Education, for example, is a pilot program that will make certain advanced practice registered nurse training programs eligible for reimbursement through Medicare. “This program lays the foundation to transform the way Medicare pays for nursing education,” Cleary and Reinhard said.
The law reauthorizes funding for the Nursing Workforce Development programs under Title VIII of the Public Health Service Act, the primary source of federal funding for nurse education programs. New funding for Title VIII programs will allow nursing schools to grow and enable more nursing students to afford the increasing cost of tuition.
The law also removes a cap that limited spending on doctoral nursing programs to 10 percent of the total grant funding awarded to nurse education programs, which will help build the ranks of the nation’s nursing professors. It allows nursing faculty in associate and baccalaureate levels to participate in loan repayment programs.
In addition to providing incentives to lure more nurses into academia, the law also targets potential new recruits to the field of nursing.
Aspiring nurses who are racial and ethnic minorities or who come from economically disadvantaged backgrounds are eligible for new workforce diversity grants authorized by the law. Nursing and consumer advocates say this will help draw a wider array of people into the nursing workforce, which is predominantly white, and help ensure that Americans of all backgrounds get the care they need.
New Law Expands Nurses’ Scope of Practice, Creates New Job Opportunities
While the law takes steps to curb the looming nurse shortage, it also offers a range of new opportunities for nurses.
The law enables nurses to provide a fuller range of primary care services as leaders of nurse-managed health care centers; boosts reimbursement rates for nurse-midwives; and has special incentive programs for nurses and other professionals who specialize in areas such as pediatrics, geriatrics and long-term, chronic care.
Nurses will also be able to take advantage of new federal funding to send more nurses to the homes of first-time, low-income mothers and to public schools. Among other things, the law also creates a pilot program to help chronically ill Medicare beneficiaries stay in their homes and provides grants to establish community-based teams of nurses and other health professionals that provide coordinated health services.
Although they are pleased with the nursing-related provisions in the law, nursing and consumer advocates say there is more work to do to ensure that the nation has enough nurses.
While the law authorizes funding for many new programs, it does not actually determine the amount of money these programs receive. Nursing and consumer advocates now need to work to ensure that congressional appropriators fully fund the newly authorized programs.
Advocates will also have to work to make sure that pilot programs created by the law are successful and become permanent and that nurses win additional freedoms to practice to the full extent of their abilities, said Winifred Quinn, M.A., Ph.D., senior legislative representative at the Center to Champion Nursing in America.
“Although there is work to be done,” Quinn says, “the new law goes a long way toward building a 21st century nursing workforce to help consumers access a higher quality of care.”
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