Patient Protection and Affordable Care Act

PPACA
Two provisions in the PPACA (Patient Protection and Affordable Care Act) that impact my current nursing practice are 1) the call for increased access to care and 2) the call for more preventive care. The Institute of Medicine (IOM) in its Future of Nursing report stated that nurse practitioners should be allowed to practice to the full scope of their education and training (IOM, 2010), which is something they are not permitted to do in every state. Many states require nurses to practice under the supervision of a physician, but as O’Brien (2003) pointed out, Advanced Practice Nurse Practitioners (APRNs) were trained to take the place of the physicians who were leaving the primary care field for specialized medicine. Nurses were trained and educated to be able to provide primary care—the same kind of care that physicians provide. And yet in many states they are not permitted to practice independently of physicians. As a result there is a serious limitation on access to care for people, because nurses cannot open their own facilities. Instead they must work in larger facilities that are limited in terms of how many patients they can see. If the PPACA is to be taken seriously, then my current practice of nursing should be such that the recommendations of the IOM are put in place so as to help increase access to care for patients in accordance with the Affordable Care Act.
An example of this issue is in Oklahoma where currently nurses are still required to practice under the supervision of a physician, though legislation has been introduced that would allow nurses to practice to the full scope of their education and training without needing to be supervised by a doctor. However, the ACA is not being implemented in the way that it was envisioned and that causes the entire health care system to be defective, as there are clearly steps that can be taken to remedy the situation, but legislators at the state level are slow to catch up to the reality.
The other provision is the need for more preventive care. In my current practice, I want to be able to provide preventive medicine and increase the health literacy of patients so that they can develop good health habits, avoid behaviors that would be bad for their health, maintain a healthy diet, exercise and so on. The fact that so much of health care is subsidized, however, creates an environment in which care providers are incentivized to treat patients instead of practicing preventive care. Patients end up being over-diagnoses and over-tested because they come in for minor issues and the care provider works for an organization that is interested in putting profits before people, so more treatments and unnecessary tests are ordered, drugs may be prescribed and the quality of life of the patient may end up declining as a result. This is not the type of care the ACA envisioned, but it is the type of care that goes on.
I want to practice health care in accordance with the provisions of the ACA, particularly in accordance with the two provisions identified here. I want to be able to provide greater access to care by practicing to the full extent of my education and training without the supervision of a physician, and I want to be able to practice preventive care by putting people before profits. The ACA was written and passed for a reason and yet it seems that it is often overlooked and the details that made it worthwhile to pass are passed over and no one seems to mind. In my practice, I will aim to promote nursing independence and work to get legislation changed that will allow the ACA to be implemented as it should be. I aim also to boost the health literacy of patients and actually practice preventive care.
References
IOM. (2010). The future of nursing. Retrieved from http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
O’Brien, J. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy, 60(22), 2301-2307.