Nurse and CRNA Workforce Development: Health Policy Analysis - Term Paper Example

Nurse and CRNA Workforce Development: Health Policy Analysis Introduction It has been criticized that the healthcare policy in the United States simultaneously provides excess, inequity, and paradoxically deprivation. Any healthcare system must have up-to-date specialty medical care facilities with adequate primary and preventive care provisions. Those who have access to private or public insurance coverage can have reasonable access to these services since there is well trained workforce. Policy defects lead to gross inequity which allows excessive care than necessary, adding to the cost and potential harm. On the contrary, some people cannot access care since they are uninsured, inadequately insured, or are covered with Medicaid and thus refused by the healthcare workforce. Thus, these people cannot access care. These have been interpreted by the authorities to be indicators of failings of the health care system due to defective or less than optimal policies, and the major problems in the system are indicated by high costs of care and lack of access, in which cases many deserving patients even do not report a health problem due mainly to costs and prevalence of problems of access. The inability to receive health services at the time of need may be due to unavailability of healthcare personnel. In this context it is to be acknowledged that the most valuable resource in healthcare is the pool of workforce which comprises the human resources of the healthcare system. In this assignment, an yet to be enacted health system policy will be analyzed to its pros and cons so that suggestions and pathways of implementation and their benefits can be analyzed in order to get better insight into the policy to be implemented. A. Historical Analysis of the Policy The promise of delivery of high-quality health care becomes affected with the shortage of nursing workforce, which is a real problem in American Healthcare System. The nursing shortage in all categories of nursing is a critical component of the healthcare reform that is intended to be implemented through healthcare policies. The Institute of Medicine confers that the state of the American Healthcare System is badly in need of reforms due to the complexities of health systems and to the ineffectiveness of health policies in recent times. In order to be able to induce a reform in order to deliver quality healthcare to the consumers with gradually increasing demands, there had been several legislations listed in Title VIII of the Public Health Service Act where the priority had been to reauthorize the nursing workforce development programmes. Jones et al. (1996) covers the background of the need of such reforms. It was noticed that there was an evolving workforce shortage in allied health professionals including nursing. This attracted notice of government, researchers, and policy makers. Many of the positions remained vacant. Other surveys in this area indicated that there were growing shortages in the registered nursing work force, particularly in the operating theaters and certified registered nurse anesthetist positions. A recent survey in South Carolina also supported these findings across hospitals. Moreover, the problem appeared to be more crucial since the existing educational systems would not be able to meet the growing needs for workforce expansion. The US Bureau of Labor Statistics also confirms these occupational statistics. While there are difference in opinions regarding the reasons for such workforce shortages and their severities, the main reasons appear to be employee burnout, lower quality of healthcare delivery systems, lower job satisfaction, lack of professional advancement, lack of training, alternative career prospects, and low professional and public images. While research is ongoing, the health policy is the major contributor to these factors, which needs to be reformed (Jones et al. 1996). The shortage of nursing workforce as opposed to the increased demand has been recognised by the policymakers to be the most significant contributing factor for a weak infrastructure in healthcare delivery systems. This shortage of nursing workforce including CRNA had been unattended for last 10 years despite compromising the quality and safety of care in a significant manner. On the face of increasing consumer demands, further intensification of the shortage, retirement of experienced staff, and expansion of the healthcare needs, The Health Resources and Services Administration (HRSA) predicts a shortage of one million nurses by 2020. This mandates an immediate action, otherwise leading to accentuation of the shortage which may jeopardize the quality of care and access to it (Derksen and Whelan, 2009). The health policies regarding increasing the nursing workforce have failed. While a cost-effective form of quality health care has been proposed to be accessed by all irrespective of race, ethnicity, culture, insurance, the growing shortage of physicians makes it imperative that at least primary and preventive care be provided to all. This can only possible through utilization of nonphysician workforce, where nurses feature to be the largest in number. However, nurses who are habituated to the hospitals with superspeciality care, may not be able to provide a slot for such. This entails development of new workforce and training of the existing nurses to provide such care accessible to the population at a far less cost without any hint of compromise in quality. It had been known earlier that in underserved rural America will suffer most out of this growing shortage of health workforce, a large chunk of which is nurses. While the policy agenda had been to cover the uninsured population with simultaneous improvement of quality through cost-effective measures, the policy should look into adequate workforce development. With specializations, the number of primary care providers who can provide the frontline basic services has been decreasing (Nehring and Lashley, 2009). While healthcare policies attempt to increase the coverage and access, this demand of increasing workforce can only be met through development of nursing workforce. It has been predicted that if reform has to occur, the advantage can be taken of the development of already existing large workforce in the nursing sector. The policy makers, however, did not fail to see the pivotal roles played by the nurses in modifying the quality indicators, status of the preventive care, and outcomes of care. The existing structure of nursing education may also be accentuated to make them capable of practicing autonomously as advanced practice nurses may go a long way to subsidize these deficits. The AANA (American Association of Nurse Anesthetists) and ANA have expressed a total support to these policy changes. The policy makers have reauthorized the Title 8 of the Public Health Service Act. The government has provided a Public Health Investment Fund to these ventures, and seeing the fact that nursing education should also be reformed concurrently with this policy initiative, the Graduate Nursing Education initiative has been taken. This policy reform proposal has drawn support from House bill for PHIF and Health Workforce Advisory Committee. The Senate has passed a bill for Graduate Nursing Education, and a commission for National Healthcare Workforce has been set up further prospects of these bills (American Association of Nurse Anesthetists 2009). For Graduate Nursing Education a stand-alone legislation has been introduced. Anesthesia nursing workforce development is an example of these reforms since this matches with the current need for Nurse Anesthetists specially in the rural area surgical practices on the face of gradually declining number of anesthetist physicians who fail to cater the rural population. The Congress has announced its agenda for health reform in that the goal is to improve patients' access to affordable healthcare which is high in quality without any discrimination. Rural access to anesthesia care is a problem since even though the nurse anesthetists have been historically able to provide equal standard of expected care, their payment had been a problem. It is expected that with the policy of restoration of Medicare rural hospital payments for nurse anesthetists would encourage nurses to provide standard on-call services. The current policy of reversing 21.2% Medicare cuts would also help the population to access sufficient resources to support access to care (American Association of Nurse Anesthetists 2010). However, there are barriers to implementation. The causes of these barriers are manifold. As Cromwell (1999) has indicated the factors preventing smooth implementation of such policy reforms may be pressures to control cost of healthcare, competition among professionals including anesthesia advanced practice nurses. The nurse anesthetists can provide identical good care at a far less cost. Medicare attempted earlier to lower the financial returns to the physicians and anesthetists. This had created a hostile work environment, resulting in dismissal of nurse anesthetists from the hospital pay rolls. Domestic medical graduates are increasingly avoiding anesthesia as their choice of practice, and alternate payment methods and incentive for rural area practice may lead to nurses opting for anesthesia practice increasingly leading to the desired cost-effective mix of anesthesia professionals (Cromwell 1999). Expansion of healthcare to entire nation has been the most important agenda for the policy makers, and although these facts were known, the health care policy act was never implemented to its fullest extent leading to short-sightedness about the imminent future. These led to several long-standing and unattended problems, and these policy reform ventures could be an opportunity to execute these reforms, solve the problems, and changing the ways the healthcare workforce training programs are supported. The shortage obviously has two angles, one overall shortage of trained workforce and two, misdistribution of the already available workforce. These indicate a need for assessment of healthcare workforce needs and need for adjustment of many complicated and interacting variables determining the shortage. Moreover, there is no structured workforce planning in place in the United States. The factors that need due considerations are regional misdistribution of workforce, overspecialization, lack of knowledge about the expected demographics of the workforce, change in demographics of the population, and lack of training for workforce development (Derksen. and Whelan, 2009). The previously existing Federal solution to this problem in terms of policy implementation was justified in that the negative trend in workforce development and deployment could be solved with Nursing Workforce Development Programs. This was perceived to be a viable solution to the shortage; however, it needed proactive measures (American Association of Critical-Care Nurses and AACN Certification Corporation, 2003). Through expansion of school nursing programs and increase in the number of faculties, the nurses were expected to be trained efficiently in order for them to be able to practice in areas of critical shortage. Although these title VIII programs have failed to produce results, the government attempts to address shortage in healthcare workforce and reform the healthcare system through new policy implementation, these same programs with stronger deployment drives could result in better outcomes through education, practice, retention, and recruitment. These programs are designed to support the training of qualified nursing workforce through federal funding, financial supports in order to educate nursing workforce for practice in rural and medically underserved communities. The nursing community has found these programs to be effective with minor lapses, which indicates that review of the related policy and adequate adjustments to the needs of this hour can make is a very feasible and viable policy (APHA 2009). From the findings of Cleary et al. (2009), the support of Senate in authorizing funds can be derived. These financial helps to the aspiring nurses and institutions would go a long way for motivating people to join nursing in larger numbers Cleary et al. (2009). This is not only applicable for beginners, also for the existing nurses to get advanced nurse educations. Grants to nursing schools would facilitate education and newer training programs, which would foster retention of existing workforce. The federally funded student loan program, creating provisions for nursing teachers, provision of more funds, provision for nursing diversity grants for facilitation of advanced degrees, education preparation, completion of associate degrees, all have implications in this particular section of the reform (Chumbler et al., 2000). Previous literature supports these reform activities. Cleary et al. (2009) analyzed this problem and reported a renewed interest in this matter of current government. Development of nursing workforce was indicated to be very important since it is expected that there would be an increased demand for primary, basic, and chronic care management which could be effectively delivered by nursing workforce. The possibility of redesigning care delivery through reforms would also place stress on prevention and early detection of diseases in a cost effective manner by the new genre of trained nurses (Cleary et al. 2009). Cooper et al. (1998) indicated that nurses, nurse practitioners, certified nurse-midwives, and certified registered nurse anesthetists can serve the role of a physician very efficiently provided they are trained. Although they may not be able to provide the entire range of care, they may be sufficient to provide basic and primary care in the underserved areas (Cooper et al. 1998). Although some (Owens et al., 1999) have criticized this effort to be empowering clinical practice through legislation, not through education, given the current scenario of staff shortage this appears to be the right course of action to solve the problems of nursing staff shortage (Zelenock and Zambricki, 2001). Proposal Given the information above, it is proposed that there is a need for further research in this area. The proposed research will include the area of registered nurse anesthesia workforce development in the rural areas where surgery is practiced. The previous sections have indicated that there is a shortage of trained workforce in this area; however, the real parameters of training and practice requirements are yet to be known. In order to be able to accomplish that, a study may be designed across rural areas about the spectrum of conditions for which surgical care is provided, where anesthesia is needed. This would delineate the profile of a nurse anesthetist work role in such areas. If the current curriculum is compared with the work roles, the deficits in training could be easily determined, so taking advantage of the current attempt to reform healthcare, educational needs can be prescribed. Following this, the current government policies of fostering nursing education and provision for remuneration of nurse anesthetists working for the rural areas can be utilised to attract more nurses in this area who with appropriate training and education designed from the need assessment can fit to the increasing requirements. References American Association of Critical-Care Nurses and AACN Certification Corporation, (2003). Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification. Am. J. Crit. Care.; 12: 154 - 164 American Association of Nurse Anesthetists (2009). Mid-Year Assembly 2009 Federal Advocacy Agenda. Office of Federal Government Affairs American Association of Nurse Anesthetists (2010). Nurse Anesthesia Issues for Mid-Year Assembly 2010. Office of Federal Government Affairs APHA (2009). Agenda for Health Reform and Comparison of Senate and House Bills as of December 1, 2009. Sections 5202-5509 Chumbler, NR., Geller, JM., and Weier, AW., (2000). The Effects of Clinical Decision Making on Nurse Practitioners’ Clinical Productivity. Eval Health Prof; 23: 284 - 304. Cleary, BL., McBride, AB., McClure, ML., and Reinhard, SC., (2009). Expanding The Capacity Of Nursing Education. Health Aff.; 28: w634 - w645. Cooper, RA., Laud, P., and Dietrich, CL., (1998). Current and Projected Workforce of Nonphysician Clinicians. JAMA; 280: 788 - 794. Cromwell, J., (1999). Barriers to Achieving a Cost-Effective Workforce Mix: Lessons from Anesthesiology. Journal of Health Politics Policy and Law; 24: 1331 - 1361. Derksen, DJ. and Whelan, E-M. (2009). Closing the Health Care Workforce Gap. Reforming Federal Health Care Workforce Policies to Meet the Needs of the 21st Century. Center for Americal Progress. Jones, WJ., Johnson, JA., Beasley, LW., and Johnson, JP., (1996). Allied health workforce shortages: the systemic barriers to response. J Allied Health; 25(3): 219-32. Nehring, WM. and Lashley, FR., (2009). Nursing Simulation: A Review of the Past 40 Years. Simulation Gaming; 40: 528 - 552. Owens, WD., Cawley, JF., Jones, PE., Boodley, CA., Pulcini, J., Harper, D., Pournadeali, K., Yarnall, SR., Monahan, JH., Cooper, RA., Dietrich, CL., Laud, P., and Henderson, T., (1999). Nonphysician Clinicians in the Health Care Workforce JAMA; 281: 509 - 511. Zelenock, GB. and Zambricki, CS., (2001). The Health Care Crisis: Impact on Surgery in the Community Hospital Setting Arch Surg; 136: 585 - 591. Read More