The Effects of New Proposed Changes in Health Care on the Nursing Profession

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). The PPACA is the biggest change in health care since Medicare was introduced in 1965. The legislation impacts consumers, health care providers, employers, pharmaceutical companies and the insurance industry. The Congressional Budget Office (CBO) estimates that the PPACA will cost more than $900 billion over ten years and will bring the deficit down by $124 billion in the same time frame. The PPACA will lead to many changes in health care practices, and it will also open up opportunities for both patients and care providers, like nurses.

Workload

• The PPACA extends coverage to millions of uninsured Americans. By 2014, nearly every American will be required to have insurance through their employer, a government program like Medicaid or through their own purchase, or pay a penalty. According to the Kaiser Family Foundation, the uninsured are twice as likely to avoid the doctor's office for care. They instead turn to the emergency room (ER) as their condition becomes worse.

  While the PPACA may alleviate the pressure on ERs, it may put more pressure on nurses to keep up with the increased workload from patients entering doctors' offices and hospitals. The PPACA also eliminates a co-pay and deductible for preventive care. This again could mean more patients in the doctor's office who have avoided these services in the past due to cost.

Nurse Practitioners

• While more Americans may be making appointments to see a doctor, there likely will not be enough doctors to support the new patient load. An August 2009 article in "Time" reported that the United States faced a 30 percent shortage of primary care physicians. The PPACA recognizes this shortage and has allocated funding to establish nurse-managed clinics. These clinics will allow nurse practitioners (NP) to provide primary and preventive care to patients. A NP is a registered nurse who holds a master's degree and has undergone advanced clinical training to care for a wide range of patients. In some states, NPs already have the ability to treat and diagnose patients as well as prescribe medication.

Expanded Educational and Workplace Offerings

• To encourage nurse recruitment and retainment, the PPACA increases funding for nursing education, including grants for associate, bachelor's and advanced degrees and loan reimbursement. In addition to greater career opportunities, nurses will also find work opportunities in new areas of focus under the PPACA. These include nurse-to-family home visit partnerships, in which specially trained nurses make home visits to first-time, low income mothers. Opportunities will also be available in new school-based health clinics that will provide expanded care to students.