How does increased access to healthcare affect nursing?

classicdame, MSN, EdD · Oct 29, 2013

our facility is assuming more staff will be required, but until the numbers appear we are not changing hiring projections. We are also concerned that reimbursement will be LESS, so we expect fewer staff to do more things. Every facility has limitations. Just this w/end we could not find another nurse to circulate in OR without calling loads of people. There is a limited number of beds, so people will not be admitted who used to be or will go home sooner which means nurses have only very sick people to care for. We have already stopped hiring LVN's as RN's are more versatile in the hospital setting.

SleeepyRN · Oct 29, 2013

our facility is assuming more staff will be required but until the numbers appear we are not changing hiring projections. We are also concerned that reimbursement will be LESS, so we expect fewer staff to do more things. Every facility has limitations. Just this w/end we could not find another nurse to circulate in OR without calling loads of people. There is a limited number of beds, so people will not be admitted who used to be or will go home sooner which means nurses have only very sick people to care for. We have already stopped hiring LVN's as RN's are more versatile in the hospital setting.[/quote']
Interesting, yet scary, thought regarding the patients being sicker. Lets say med surg nurse Betty has on average 5-6 patients. Right NOW they aren't that sick, but sick enough to be in a hospital. But then comes the month when we see the "least sick" patients being discharged (lets say to SNFs for rehab causing that facility its own problems) earlier to make room for those that are more sick. Let's pretend Betty maintains her 5-6 ratio. But THESE patients are sicker. That means closer observation, more documentation, more phone calls to the doc with changes in condition (which takes time), possibly even more meds to pass.... point being, the nurse to patient ratios in many hospitals is already making it very difficult to get everything done on time, let alone how much more time it's going to take to care for sicker patients. And because we are only 1 person, individualized patient care could suffer. Nurse Betty gets overwhelmed, makes a mistake that requires more time she doesn't have to fix the mistake, document it... I could go on and on, but unless nursing homes, clinics, hospitals.... hire more nurses and CNAs, I don't even want to think about it right now its too depression.

malamud69, BSN, RN · Oct 29, 2013

Well-we could hope that most "corporations" i.e hospitals etc...would do the human thing and hire more staff to meet the demand...but we are not living in a world where actual compassion, caring or even your vote (union or not) actually makes a difference! The new law is merely a band-aide on a system so broken that real change will probably not commence...so all the talk about ratios, acuity, staffing levels, reimbursement etc...is all smoke and mirrors for the true reality...those in control of the money only want more money so they will continue to use every excuse necessary to not adequately staff/care for other human beings( even where I work a very large city hospital our staff has been cut-and had been long before the ACA came into play-so much that it is simply unsafe-falls and deaths are up...guess what most "citizens" do not have the means to fight such a large corporate entity, so these incidences go mostly unnoticed except by staff-we can do nothing-even that-death and terrible care does not make the sociopathic hospital company stop its greedy practice!)...it is quite simple...the latest scapegoat of course being the patient protection and affordable care act!

classicdame, MSN, EdD · Oct 29, 2013

I agree with above posts. This is what we all hope. The reality is, if funds are not available to pay extra people then hospitals with marginal or deficit cash-flow will be forced to close. That would increase the burden for other facilities. There is a focus on customer satisfaction, so appropriate staff is essential. But I personally anticipate a day when hoping for enough people willing to work the long hours without good compensation will be a dream, not a reality.

nurse42long, RN · Oct 29, 2013

You could also look at it as more patient access to care may be great for hospital nursing. For example, patients who waited until condition was so bad that it required emergency care and hospitalization may now see a PCP or NP and have the problem dealt with at an earlier time, requiring no hospitalization. I would think clinics and other preventative measures could decrease need for over usage of emergency care. People are not going to naturally get sicker just because they have access to care. Prevention and better maintenance of chronic problems may solve a lot of hospital overcrowding, especially in emergency rooms.

Katie71275 · Oct 30, 2013

Great points!

nurse42long-I was also thinking that as well, with all of the clinics, the pt may see someone sooner...of course we will still have the uneducated who will still not seek care until the very last minute.

malamud69, BSN, RN · Oct 31, 2013

Great points!
nurse42long-I was also thinking that as well, with all of the clinics, the pt may see someone sooner...of course we will still have the uneducated who will still not seek care until the very last minute.

Great point-just like those who are bashing the new law without even seeing if/how it will work...How do we educate? This IS THE question...we must start prevention education young and for all...wow sounds like single payer...for all.

malenurse69, MSN, NP · Oct 31, 2013

Great point-just like those who are bashing the new law without even seeing if/how it will work...How do we educate? This IS THE question...we must start prevention education young and for all...wow sounds like single payer...for all.

You know what I see obamacare doing? Destroying full time jobs and crippling the middle class (Yes as a nurse you will be targeted eventually and hired on part time.)

Premiums are skyrocketing for anyone making middle class livable wages. Sure, might be good for people on welfare who COULD get free health care before anyway, but do a quick google search of actual reported numbers on premium increases for people across the country. IF you look at the law and educate yourself, its a giant joke.

malamud69, BSN, RN · Oct 31, 2013

You know what I see obamacare doing? Destroying full time jobs and crippling the middle class (Yes as a nurse you will be targeted eventually and hired on part time.)
Premiums are skyrocketing for anyone making middle class livable wages. Sure, might be good for people on welfare who COULD get free health care before anyway, but do a quick google search of actual reported numbers on premium increases for people across the country. IF you look at the law and educate yourself, its a giant joke.

Interesting...lets see...corporations have been cutting and destroying the common worker for as long as I have been working-30 years or so...(The real reality is that workers have had no rights since time began...look at organized labor and its subsequent destruction by the corporate/capitalist monster-you need to do your homework as a working person!) It is a simple equation no matter how you want to propagandize it-it is called greed! Greed! So what then is your point? Are you really-rationally going to tell me that the middle class has already not been destroyed long before the ACA came to be??? Living wage? What planet are you living on? That wage has not increased since the 70's and the nails were hammered in during the Reagan years! I know- I have lived it... I guess it is too easy not to actually think about the reality when you are spoon fed propaganda!

CrossCountryRN2008 · Oct 31, 2013

Interesting...lets see...corporations have been cutting and destroying the common worker for as long as I have been working-30 years or so...(The real reality is that workers have had no rights since time began...look at organized labor and its subsequent destruction by the corporate/capitalist monster-you need to do your homework as a working person!) It is a simple equation no matter how you want to propagandize it-it is called greed! Greed! So what then is your point? Are you really-rationally going to tell me that the middle class has already not been destroyed long before the ACA came to be??? Living wage? What planet are you living on? That wage has not increased since the 70's and the nails were hammered in during the Reagan years! I know- I have lived it... I guess it is too easy not to actually think about the reality when you are spoon fed propaganda!

ACA is a scape goat for the greedy corporations and upper class to make only two classes rich or poor/working poor. If instituted correctly ACA could get rid of high tax consumption Medicaid use. Some states had already started forcing co pays and premiums for Medicaid for adults. ACA works similar. Other employer based and private insurances are charging more because they can not because ACA says to. People need to be informed not sheep following a heard of complainers and propaganda

malenurse69, MSN, NP · Oct 31, 2013

Interesting...lets see...corporations have been cutting and destroying the common worker for as long as I have been working-30 years or so...(The real reality is that workers have had no rights since time began...look at organized labor and its subsequent destruction by the corporate/capitalist monster-you need to do your homework as a working person!) It is a simple equation no matter how you want to propagandize it-it is called greed! Greed! So what then is your point? Are you really-rationally going to tell me that the middle class has already not been destroyed long before the ACA came to be??? Living wage? What planet are you living on? That wage has not increased since the 70's and the nails were hammered in during the Reagan years! I know- I have lived it... I guess it is too easy not to actually think about the reality when you are spoon fed propaganda!

Perhapas you should watch out for that propaganda you accuse me of being a victim to, perhaps your the victim! Just saying. Oh, and when you have time, follow these links, id love to see you cite some sources of how amazing obamacare is for this country. Actually no, i challange you to. But you wont will you? You will just call names and accuse me of being a propoganda fed drone, wont you? Follow these links and refute them with your own sources:

http://www.realclearpolitics.com/2013/10/28/middle_class_gets_screwed_under_obamacare_318727.html

http://www.breitbart.com/Big-Journalism/2013/10/28/la-times-obamacare-will-spike-premiums-30-percent

http://www.forbes.com/sites/theapothecary/2013/09/23/its-official-obamacare-will-increase-health-spending-by-7450-for-a-typical-family-of-four/

I could keep going.