More Jobs for Nurses From the Affordable Care Act

¶ … Growth and Changes in Nursing

Now that the Affordable Care Act (ACA) is the law of the land, nurses can expect to have even more responsibility and even more opportunities to use their skills. This paper reviews how the restructuring of the U.S. healthcare system impacts the nursing field. And this paper reflects on how continuum of care, accountable care organizations, medical homes and nurse-managed health clinics will be affected by the ACA.

Nursing Shortages

There already are critical nursing shortages in the United States, which is the reason that foreign nurses have become "…an integral part of the U.S. healthcare system" (Arnold, 2013). In fact, according to Arnold, healthcare organizations have been bringing nurses from abroad into the U.S. For "…over fifty years in response to cyclical nursing shortages" (1382). Now, with the Affordable Care Act in place there is expected to be an increased demand for foreign nurses; indeed, there were 267 international nurse recruitment firms in the United States in 2007, and it is easy to imagine that number growing as the shortage of trained nurses continues. The advantage for hospitals -- besides being able to fill their vacancies -- is realized in cost savings, Arnold continues: hiring a foreign-trained nurse could save a hospital up to $50,000 in a two-year period (1383).

Continuum of Care

The Affordable Care Act seeks to provide "a better continuum of care," one that is "person-centered" and that offers control while enhancing "quality" (Shugarman, et al., 2011). The ACA also sets out to improve the continuum of care in four domains: a) long-term care insurance; b) home and community-based services (HCBS); c) care coordination; and d) workforce reinforcement (Shugarman, 11).

The CLASS provision in the ACA (Community Living Assistance Services and Supports) provides, for the first time, people in the middle class with an "affordable opportunity to plan for and access supportive services," Shugarman explains (12). In fact CASS actually reinvents how healthcare professions view long-term care; in the past long-term care was identified as helping those in poverty, those very sick and lonely, Shugarman continues. But with the Affordable Care Act long-term care the idea is to provide services for the "near-poor and the middle class" (Shugarman, 12).

Accountable Care Organizations

On page 14 Shugarman notes that Accountable Care Organizations (ACO) offer incentives to providers to improve service arrangements for "vulnerable populations," which would include the elderly and others who are disabled or struggling with health issues. The point of an ACO is not to solve all a person's problems, but rather to be "accountable for improving the quality of healthcare…while lowering costs" (Shugarman, 14).

In the peer-reviewed publication, Dispute Resolution Journal, the author reveals that the Centers for Medicare and Medicaid Services (CMS) has established protocols that are designed to "improve coordination and communication among doctors and hospitals," and improve the quality of care in the meantime (Ronai, 2011).

Medical Homes

D. Scott Jones writes in the peer-reviewed Journal of Healthcare Compliance that the growth of home health is driven in large part by the rapidly aging population in the United States. Also, more Americans are living longer and "more productive lives" and they wish to grow old at home rather than being institutionalized in any way. However, as positive as this program is under the ACA, there have been terribly abusive billing policies.

However, there are provisions going into the ACA that will ensure accurate compliance and patient accuracy when it comes to billing for medical home services. That is important because home health is a "robust and rapidly expanding segment of the healthcare industry"; as mentioned earlier, the American population is aging rapidly and the need for adequate nursing services and home care has never been greater (Jones, 40). Home health, as Jones explains on page 40, has "great potential to improve quality of life and care for patients."

Nurse-managed Health Clinics

The great need that has arrived along with the ACA is the need to deliver healthcare to poor people who will be getting insurance for the first time -- and nurse practitioners in "nurse-managed health centers are poised" to meet this need (Pron, 2013). This truly shows remarkable progress in the delivery of healthcare services because nurse practitioners provide nearly the same level of service as doctors, and "more NPs may choose employment" in nurse-managed clinics because they desire "job satisfaction and autonomy" (Pron, 213).

Conversations with Three Nurse Colleagues

"Jean," an RN who has been in the field for 14 years, worries about the foreign nurses that will need to be brought into the U.S. To supplement hospitals and clinics that are short on U.S. nurses. She finds the idea of foreign nurses "unsettling" because the foreign nurses she has worked with have very different healthcare values, and their ability to convey good quality conversation in English is often lacking. But she likes the idea of nurse-managed clinics, where nurse practitioners and RNs run the show completely, without a top-heavy administration (that is typical in hospitals) and without doctors needing to be present.

Jean was raised in rural Oklahoma, and she understands the great need for healthcare services in rural areas where poverty is the norm, so she is encouraged that the Affordable Care Act can fill in the gaps for some of these very remote communities. "There are nurses that enjoy work away from the noise and crime of the big cities," she told me. "I for one would seriously consider working in a nurse-managed clinic, run by nurse practitioners, in a rural area. Those folks so appreciate good healthcare service because they have for the most part been left out of the mix."

"Susan" was "sickened" by the loud protests and "lies" told about the Affordable Care Act during the time it was still being debated in Congress and around the country. She remembers being "outraged" by the claim that the Act had "death panels," as some politicians asserted, that would decide whether an elderly person should live or die. "I am so glad all that B.S. is over with and we can begin to see the benefits of the Act," she said. Her attitude was the same as mine: a) that millions of people are now insured who previously had no insurance; b) people can't be disqualified because of pre-existing conditions; c) children can stay on their parents' policies until they are 24; d) home is where many older people would rather stay, and thankfully the ACA allows for that to happen for many older people -- rather than be institutionalized; e) long-term healthcare is available at a reasonable cost to consumers.