Nurses Will Play a Vital Role in the Enactment of the Affordable Care Act

While in the care of a nurse, patients have a champion: a health care professional working to assure timely tests, procedures, and rehabilitative activities that foster better and faster recovery.  Prior to discharge from a health facility, it is often the nurse who assesses a patient’s self-care ability (or access to home caregivers) to provide the type of treatments and medications needed to prevent relapse or even costly return to a hospital.

Responsibility for optimal recovery is of course shared by all health team members, but the unique position of nurses at the patient’s bedside (literally and metaphorically) gives us many avenues to influence care and cure.

Though nurses already play a central role in cost containment, care quality, and patient safety, current trends in nursing education have us poised for even greater contributions. That’s because good baccalaureate and graduate programs in nursing increasingly incorporate quality improvement in care settings. Through attention to ‘microsystem’ processes, we work toward better outcomes not only for individuals but also for health systems as a whole. Nursing prepares leaders, administrators, and researchers who can improve care processes and related analytics around outcomes and cost.

The coming enactment of reforms included in the Affordable Care Act will increase the opportunities for nurses to make both individuals and care systems as healthy as they can possibly be. Patient communication, preventive care, and navigation across the vast medical landscape are well-established foci in the curriculum at major U.S. nursing schools. These areas of expertise could not be more essential now that new insurance options and Medicaid expansion are bringing millions of individuals into a national primary care system already taxed by provider shortages.

Nurse navigators and transitional care nurses are stepping up to central coordinating roles within Accountable Care Organizations—the model wherein participating health care providers are collectively responsible for their enrollees’ care, and also can share savings resulting from efficiency and improvements in that care.

Nursing as a profession actively engages in leading efforts to improve patient care and reduce costs; this is integral to our professional values, knowledge base, and skills. We have earned the trust of Americans (we’re voted most ethical and honest in Gallup polls), and will use that trust, along with our health promotion expertise, to communicate with patients about the best prevention, timely care, and most efficient ways to get needed help as they navigate together through America’s evolving system of care.

Kathleen Potempa, PhD, RN, FAAN, is the Dean of the University of Michigan School of Nursing and a national leader in health promotion, nursing education, and research. Dr. Potempa is the immediate past president of the American Associate of Colleges of Nursing and recently concluded a four-year term on the NIH’s National Institute of Nursing Research Council.

12 replies »

  1. i think RN’s deserve more credit these days, there are just a few that make it through college, because it is a tough career move to get into. There are few to less of them and there job is emotional and physically challenging.

  2. The registered nurse is integral to patient care quality, satisfaction, and the effective and efficient use of health care resources. Registered nurses are qualified and educated for the role of care coordination, especially with high risk and vulnerable populations.

  3. I’m impressed, I must say. Rarely do I encounter a blog that’s
    both equally educative and entertaining, and without a doubt, you have
    hit the nail on the head. The problem is an issue that too few people are speaking intelligently
    about. I am very happy I found this during
    my search for something relating to this.

  4. I stumbled across this blog and the comments, and felt compelled to comment. Have any of you who are criticizing the importance and expertise of a care coordinator/manager ever used one? As someone who took care of an aging parent with Alzheimer’s, I had to fill that role – and it was exhausting and hard.

    Did you know that there’s a certification for care managers? Here are the qualificiations required to even sit for the certification exam: http://www.naccm.net/n_3.htm

    Care managers are required to be able to assess a patient, develop a care plan, coordinate and implement it, incorporate QI strategies, regularly evaluate the patient, and perform other tasks. These are hardly the ‘make appointments’ and ‘fax prescriptions to the pharmacy’ sorts of tasks outined above. Any organization that is considering these to be appropriate care coordination tasks is clearly not understanding the critical contribution that effective care managers can make to patient care.

    And for the record, I’m neither a care manager nor a nurse. Just a hardworking medical writer and editor who keeps an eye on these issues. [let the free-for-all on my grammar and sentence construction begin! :)]

  5. Cynthia, I agree with you about the fact that it is cost ineffective to hire RN’s as care managers and care coordinators.

    Apart from that, you are a very ignorant person for making that comment about a person being moderately-intelligent just because they have a GED. There are thousands of practicing RN’s with bachelors degrees and masters degrees who have a GED including myself. You are an idiot for making such a comment.

  6. I think nurses should be paid a substantial amount of income because of the high demand & responsibilities of the nurse!

  7. Cynthia is right.

    :Paying an RN salary to be a “case manager” is an extreme waste of money. High school students could do the job just as well at a fraction of the cost.

  8. John:
    From her late-August vacation, Dean Potempa checked in with this response to your questions: “Much of the literature supporting the emphasis on prevention, care coordination, and complex care management has come either from nursing research or physicians in group practices in the earlier attempts at managed care [e.g. Kate Lorig and Edward Wagner]. Note that the model in the ACA grew out of work by Mary Naylor, a nurse researcher in transitional care. Perhaps nurses ‘see’ the possibilities with clarity because of our academic/research traditions. But visions of care coordination were unfunded or underfunded prior to ACA, in the model with focus on acute care and episodic care. What the ACA does is allow the opportunity to use the greater emphasis posed in the reimbursement changes to innovate and find better ways of managing long-term complex care through engagement with family, caregivers, and community–and to focus on prevention. This is the territory of practice that nurses have been prepared for and comfortable with, even in the days it was found only in former public health models or physician offices.

    “In terms of the legislation, I am unaware of any legislation–certainly not in this era of partisanship–that could be defined as perfect. I think it was the best that could be accomplished to steer this unwieldy ship into a better long-term direction. BUT the imperative is that there must be alignment with the philosophy and practices to make this happen.”

  9. Care management and care coordination are way overrated, IMO, as well as the opinion of those who have the most elementary understanding of cost accounting. As funding of healthcare continues to taper off, hospitals will have no other choice but defund many costly and unnecessary medical Keynesian projects, such as inpatient massage and music therapy. Hopefully, hospitals will also have the good sense to put an end to the very costly and very unnecessary practice of hiring RNs as “care managers” and “care coordinators” to do rather mundane and mindless tasks, such as scheduling patients for inpatient and outpatient procedures, arranging home health care or nursing placement for them, arranging them to have a hospital bed or a bedside commode sent to their home, and faxing their prescription meds to pharmacy.

    Needless to say, it’s very wasteful and very cost ineffective to hire RNs to do this kind of low-skilled, low-stress work when a moderately-intelligent person with a GED and a little bit of clerical training can do the job with the same level of proficiency at half the price! At most, care managers and care coordinators are nothing more than glorified social workers.

    It’s even worse than that. RNs who are employed as care managers and care coordinators are generally in a higher pay grade than RNs who are hired as acute and critical care nurses. I have yet to figure out why hospitals do this especially given that care managers/coordinators, unlike acute/critical care nurses, never have to deal with life and death issues, and never have to put their license on the line to do what they do. Nor can they bill Medicare or any other insurer for the work that they do.

  10. Kathleen

    This is interesting. Other groups are less satisfied with some of the fine print here. What more would nurses have like to seen out of the ACA? What else do you think could have/should have been done? Or is this perfect legislation?

  11. So-thank you for stating the obvious for THCB readers.

    Although the KFF April tracking poll was a sad reminder of how the ACA’s existence isn’t a well known fact: http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-april-2013/. 4 in 10. Yikes.

    With the exchanges set to roll out October 1st, a major provision of the ACA, it is important to give nurses–who will continue to be so valuable to the cost containment and patient navigation–their due respect.

    Not even getting into the discussion of scope of practice here, although worth visiting…