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.
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...
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).
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).
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).
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