Use of Advanced Nurses to Improve Healthcare Access

Healthcare Innovation

Healthcare is one of those industries and fields of work where the promotion of innovation and change management is key. It is also one of those fields where managing that change through tried-and-true practices such as evidence-based practice and so forth is a must. One change that is changing nursing a lot, especially when it comes to the advanced levels of nurses, is the flattening of the hierarchy that typically exists when it comes to what nurses are allowed to do, what they are expected to do and what they must do. Whether it be the aging of the population, the shortage of some types of doctors (or doctors in general) or general access to quality care for patients in general, there is often a distinct reason for the need and thus the prior mentioned need for innovation and proper change management in the nursing field is necessary and needed. While physicians and doctors in general should indeed remain above nurses when it comes to their level of responsibility and their list of duties, there is also the need to raise the profile and responsibility level of nurses and the shifts in the healthcare industry and society as a whole are just some of the major reasons why.

Analysis

Central Issue

As indicted in part by the introduction, there are a number of societal and industry factors that are emerging that are leading to pain points within the healthcare industry and for the patients involved. These factors and outcomes are leading to situations where the amount of doctors and specialists as compared to the people that need their services are entirely out of whack. One reason for this is the surging aged population in the United States, especially in comparison to the people in the United States that are not in the elderly demographics. This was brought on by a huge surge in the birth rate in the late 1940's, the 1950's and much of the 1960's when the Baby Boomers exited the period that was World War II and the build-up that accompanied it. That surge was followed by a huge fall in the late 1960's and beyond, as the rate fell by nearly half. What this has led to is that that glut of births is now representative of a population that is reaching retirement age and that group is much larger than the generations that are following behind them. This glut will eventually resolve itself, for better or worse, as the next few decades roll on. However, the glut of older people is causing all sorts of issues such as financial solvency with Social Security/Medicare as well as access to healthcare for all who need it. Of course, people that are of the older generations of Americans are also the people that need the most healthcare (Henry, 2009).

Another general factor that is leading to the need to innovate when it comes to the training and needs of nurses is the general shortage of doctors that is occurring in general. Whether it be related to the Baby Boomer glut or whether there is something else going on, there are many situations where the doctor/patient ratio for a given specialty or situation is entirely too skewed against patient access. After all, if someone needs an endocrinologist or an allergy consultation, they should not be waiting two or three months (or more) to get an appointment. However, this is often happening with Medicare/Medicaid patients and people with private insurance alike (Hoyler, Finlayson, McClain, Meara & Hagander, 2014).

Another contributor to the situation that is more prevalent than most is the plight of the Medicare and Medicaid patients just mentioned. Whether it be from the still fairly recent Patient Protection and Affordable Care Act, often referred to as ObamaCare, or other things before then or since, there has been a lot of tweaking and changes being made to the reimbursement schedules and other parts of that law. These changes and the general administration thereof has led to a lot of indignation and frustration for doctors that are operating based on a profit-based model. The ultimate outcome for many of those considerations and dilemmas is for doctors to give up, in a sense, and just say that they will no longer be accepting some patients. Indeed, there are some doctor offices that cater to those groups but there are many other doctors that are swearing off seeing such patients and dealing only with cash-only or private insurance as they say that dealing with the government insurance programs is too arduous and/or that it is a net loss for them. There are obviously some that decry this as soulless because healthcare is something that is perceived as a right but there are others say that the profit-based status of much of the healthcare industry is what it is and businesses that cannot a profit will not survive and it is not as if the government is bailing them out (Bassett, 2010).

If there is one general issue that fully summarizes and encapsulates the above, it is that there is a confluence of factors that is leading to lesser access to physicians, but general and specialty. In some situations, it is due to a growth in the population that has outstripped the number of doctors in the area. In other situations, there have been doctors leaving the market for any number of reasons, whether it be retirement, exiting of the government healthcare system or whatever. Regardless, too much of this at the same time and in the same area leads to problems with patients getting quality care and in a timely fashion (Fitzpatrick & Duley, 2012).

Target Population

While there are some parts of the population that are more affected than others, the target population involved is really the entirety and totality of the United States population as well as people visiting on visas and such that need healthcare. The groups that are going to be more affected than others are people that are poor (and thus rely more, if not entirely, on Medicaid), people without insurance and people that are elderly, with the people on Medicare (especially Medicare alone) being the most vulnerable. Some of the affected populations and groups will shift over time as the population, the laws and so forth ebb, flow and change. However, some of the factors described above are going to be issues even in the most optimal of societal and demographic shifts (Stephens & Ledlow, 2010).

Thesis Statement

As indicated in the introduction, the proposed innovation and solution is to further integrate and expand the responsibility and participation of nurses when it comes to improving access to healthcare with the general public. For example, one major reason that doctor shortages are so nasty to patients is that doctors are quite often the only people that can prescribe medication. However, there are many classifications of nurses that can aid in doing this for patients provided that they are certain levels of competence and training. Just two major examples of this are physicians' assistants (often called PA's) and advanced practice registered nurse, often referred to as APRN's for short. A real word example of one of these are APRN's providing medication management services for psychiatric patients. They act under the supervision and direction of a board-licensed psychiatrist. The point, though, is that a psychiatrist and two or three APRN's, for example, will be able to serve and assist many more patients than a single psychiatrist could competently do on his or her own.

Scope of Issue & Theoretical Framework

The scope of this issue is rather wide, but not present across all realms of healthcare. Indeed, primary care physicians that are just seeing people for everyday maladies such as bacterial or viral infections can often see people on little to no notice. Even if that is an issue in a given geographical area, there are urgent care centers that are designed specifically for such situations. Of course, the government healthcare access issues and so forth can still potentially be issues. The point is that primary care is not usually the problem, although in can be in rural areas, areas with doctor shortage or for people with no private healthcare insurance. However, access to specialists such as endocrinologists, allergy experts and psychiatrists can be much more uneven. Indeed, the diabetics out there that need to see endocrinologists or the people with mental illness that need psychiatrists are going to encounter issues if they are not able to see the professionals that they need to see. Aggravating the issue more is that there are many people with mental health and diabetes issues (among other things) that are not even seeking treatment right now. If those people were to suddenly realize that their health is in bad shape and that they need to see a doctor that is an expert in that field right away, things would get even worse in areas that are already strained and new pain points in terms of geography would certainly be created (Paterick & Paterick, 2013).

Prevalence of the Issue

Even though the areas with problems are spread out and they do not exist everywhere, they certainly exist and they are numerous enough that the presence of them in concert leads to worse health results for the patients that are not being served. As just mentioned, the existing inability to assist the other people out there that should be getting assistance but are not doing so just makes the scope and nastiness of the problem even worse than it already is. In short, the prevalence of the issue is not everywhere and omnipresent but it is still not hard to find people that are in rather dire straits if one knows what sort of patients to look into and the parts of the country that are probably (if not definitely) the worst when it comes to access and care quality issues (Paterick & Paterick, 2013; Viola, 2012).

Necessity of Required Action

While not ensconced in the Constitution in explicit terms or anything like that, there are those that demand and assert that access to good healthcare is a right and that ability to pay, at the end of the day, is not of any consequence. Even people that are not wrapped up in that mindset can label things as they truly are and point out that there are entirely too many patients that have constricted access to care and this is leading them to not getting the healthcare outcomes they could and should. To be sure, there are many situations where the healthcare maladies are being brought on, in whole or in part, by the actions or inactions of the patient. For example, a patient with type II diabetes could probably alleviate much (if not all) of their symptoms and problems if they got healthy and led a better lifestyle. However, for as long as they need pharmacological and other interventions, the idea remains that this person should have the access they need to a proper doctor so that they can get the prescriptions for Metformin, insulin or whatever is needed. Of course, the same thing and idea should be applied to other dimensions and healthcare situations including heart care, respiratory function and even regular family practice care. Even if most "bugs" are things like the flu just a cold, there is the need to have a trained physician or advanced nurse to be able to serve a patient and rule out more severe things such as bronchitis, pneumonia and even epidemic flare-ups like Ebola or the current Zika outbreak (Paterick & Paterick, 2013).

Identification of Key Concepts

When it comes to the key concepts that exist when it comes to this situation, it would be important to define the nurses that would be best able to assist in stomping out the areas that have access-to-care or access-to-quality-care issues.

APRN -- Short for Advanced Practice Registered Nurse. These are registered nurses that have a master degree or higher in the nursing field. In many (but not all) cases, they can prescribe medicine provided that they are under the care and control of a supervising physician.

Nurse Practitioner -- Often referred to as NP's, these are nurses that are able to treat certain medical conditions. The difference between NP's and APRN's is that NP's do not always (it depends on the state) have to be under the direct supervision of a doctor. They can also prescribe medication.

Physician Assistants -- These are people that are national and/or state certified. Like the other nurses mentioned above, they can prescribe medications and act on behalf of a physician. What they do or do not do really depends on the specialty that they or their supervising physician are involved in.

Theoretical Framework

The overall theoretical framework that exists when it comes to this situation is striking a balance between having qualified and adept healthcare professionals providing healthcare to those that are in need of counsel and treatment while at the same time not watering down the qualification pool of the people that are giving out treatment in a way that endangers patients. Indeed, physicians are given their higher rank and credentials for a reason. At the same time, this should not preclude certain levels of nurses from being able to provide expedient and fully comprehensive care for situations that they are qualified to deal with. Of course, if an advanced nurse runs into a situation that concerns or confuses them, they can quickly and completely consult with the doctor above them. Further, the doctor can personally intercede and make do a higher-level consult for situations that require it. Lastly, doctors can supervise their advanced nurses by looking at reports and charts or even via supervising them directly. If they see issues with the manner in which the patients are being treated (or not treated), they can intervene (either on the spot or after the fact) depending on the precise situation involved and the importance of getting things correct right then and there. The danger, though, that has to be avoided is that doctors should not rely too much on these interventions and they have to be sure that they are keeping a proper watchful eye on the people that the supervise. If care quality is falling in terms of aggregate outcomes and performance, then the physician needs to take the proper corrective actions. Too much reliance on the use of nurses without the proper supervision could actually create new and much nastier issues. However, most patients can absolutely be cared for by an advanced nurse and the outcomes gained by the patient can be just as optimal and expedient as they would have been with a physician (Robeznieks, 2013).

Innovative Interventions

When it comes to innovative interventions, the key would be to define what is the proper supervision "balance" as mentioned above. There is obviously a situation where a physician could be too aggressive in coaching and correcting the advanced nurses. There is also a situation where the doctor is not being attentive enough and/or not intervening when they should. Evidence-based practice needs to help define where that balance is and should be (Robeznieks, 2013).

How Intervention Will Help

This intervention will help as the number of people that can assist in many to most patient situations will be all the bigger and this will help greatly ease the shortages that are occurring in many fields and cities around the country. For example, the first time a new patient goes to their neurologist, they can get a full and complete review from the actual neurologist. However, follow-up visits can be done by a PA, an APRN or a NP. If the advance nurse involved find a problem with bloodwork or something else with the follow-up visit, the neurologist can be looped in. If all is normal and alright, then there is really no need for the neurologist to be involved and they can simply review the nurse's notes and the bloodwork results just to verify that nothing is amiss. Of course, this would take much less time than the neurologist doing the work himself or herself. The point is that more patients can be treated and in an efficacious fashion. The physicians are still the leaders of the practice and they are still keeping a watchful eye on their patients. However, they are delegating much of their lesser and normal tasks to qualified professionals and this allows for more patients to be served at an acceptable level of treatment (Robeznieks, 2013).