The Future of Nursing Question

The Affordable Care Act is still relatively new, and despite the scare tactics and fear mongering you have been hearing, there's really no way to tell what kind of lasting impact it will have on healthcare in this country.

This week, the Healthcare Advisory Board reported that inpatient volumes are continuing to shrink (~5% in 2013) and it looks like this will continue for the next couple of years. They think that a number of factors are causing this. As a result, inpatient jobs for RNs will continue to decrease. Reimbursement rates are decreasing also, so hospitals are having to decrease labor budgets - one of the most common ways is to utilize more unlicensed nurse extender staff and fewer RNs.

Although some folks are predicting more non-acute nursing jobs as ACA takes hold, there has been no evidence that this is happening. Logically, there should be more NP jobs if more people have access to primary care but this remains to be seen. The experts believe that non-acute staffing will likely follow the same patterns as hospitals... fewer RNs supervising more unlicensed staff.

Heck, at least they can't outsource nursing care to another country like they did with IT services.

There have been some discussion of this in the NP forum (which see) which may be enlightening to you.

I'm not sure what you mean by the idea that fewer CNAs will mean more RNs doing things "not under their scope." Anything in the CNA and LPN scope is also under RN scope of practice. Or am I misunderstanding you?

Props ( ::sarcasm mode:: ) for posing a homework question in an almost-unrecognizable form so people will give you the answers. ;( So, what have YOU found out yet?

Agree with username; it's too early to tell. Reimbursement was bound to decrease--that's just the nature of having for profit insurance and cutting government spending.

I personally would love to see fewer patients admitted with MIs and A1Cs of 15 because they had no primary care. Or shortness of breath related to anemia and stage 4 cancer.

lol no sorry GrnTea I am genuinely curious lol not a homework question but thanks your input

Agree with username; it's too early to tell. Reimbursement was bound to decrease--that's just the nature of having for profit insurance and cutting government spending.

I personally would love to see fewer patients admitted with MIs and A1Cs of 15 because they had no primary care. Or shortness of breath related to anemia and stage 4 cancer.

There you go, blatant support of the Death Panels. I guess the poor and the old would be next, right?

There you go blatant support of the Death Panels. I guess the poor and the old would be next, right?[/quote']

I am sorry, perhaps I wasn't clear. I am for more people having primary care to prevent and or treat serious illnesses before they become life-threatening. People without medical insurance cannot afford primary care and depend on Emergency Departments.

I believe one of the goals of the Affordable Care Act was to provide coverage for routine, preventative care.

Will that happen? I don't know. Could NPs help provide that care? My understanding is that medical doctors are resistant to giving over that role to nurses.

And I don't what you mean by death panels.

Totally unscientific theory here, but I think a lot of people are going to lose their jobs, caring for patients is just going to get more difficult because there will be less staff, and more people with go without health insurance and will therefore be more likely to be critically ill before going to the hospital.

Affordable Care Act is a misnomer. Maybe it's more affordable for some people, but there is a calculator online at Kaiser Family Foundation that calculates what your premium would be if you had to use the ACA to get health care. I was previously insured for around $283/month with a private insurance plan with a very low deductible (around $500) that paid 95% of my healthcare costs, and the calculator website said I'd owe about $346/month for insurance under the ACA silver plan, which only covers 70% of healthcare costs and has an average deductible of $2907 (source). The ACA is causing a lot of people to pay more money in healthcare costs - not less. I foresee most people foregoing insurance if they have to take a policy with higher deductibles, higher premiums, and higher costs than what they had before, and if people healthy enough to live without insurance forgo having any because of the insanely increased cost of having insurance under the ACA, I'm really wondering where the money is going to come from for people who are really sick. It just seems like a really bad situation.

Example of why insurance isn't necessary for healthy people under the ACA: I had to have an EGD done earlier this year and the cost of the EGD alone came out to $1200. If I had a $2900 deductible, and that's the only thing I needed to have done this year, I'd be paying for the entire procedure out of pocket anyway. So, I'd be paying for insurance that didn't pay a dime towards my medical procedures... I can't see how anyone would think there's much of a point to that.

If a lot of people think the way I do and the ACA doesn't have much money going in, I don't see how they'll be able to pay hospitals what they're owed. When hospitals don't get reimbursed, hospitals can't pay their staff. I know it's too soon to say for sure, but I just can't see this ending well.

Just a question:

Aren't a lot of people allowed to keep their insurance?

Also, since the ACA passed, I haven't paid a dime in Dr visits, birth control, or dental appts.

My above question is legit curiosity.

Yes, many people kept their plans, but following the trend we've seen in the last several years rates and deductibles were raised yet again. Per my employer, they went to a high-deductible plan because they would have incurred a surcharge for having a "Cadillac" plan.

I don't think people will be losing jobs because as baby boomers retire the workforce will be reduced through attrition.

I do think if Medicare is cut we may lose patients literally because seniors won't be able to afford care.

I am sorry, perhaps I wasn't clear. I am for more people having primary care to prevent and or treat serious illnesses before they become life-threatening. People without medical insurance cannot afford primary care and depend on Emergency Departments.

I believe one of the goals of the Affordable Care Act was to provide coverage for routine, preventative care.

Will that happen? I don't know. Could NPs help provide that care? My understanding is that medical doctors are resistant to giving over that role to nurses.

And I don't what you mean by death panels.

I apologize if misunderstood the intent of your post, I took it to mean that you supported those people being DENIED hospital admission.

BTW, the Death Panels are a little known addendum to the Obamacare bill. It allows the formation of panels of "experts" who would decide if certain patients should be denied healthcare (or even euthanized) because their care would not be "cost effective" or because they are not a productive member of society.

I went to a panel on this over the weekend, and the hospital recruiters seem to think the future of nursing is outside the hospital - home care, community care, primary care, and clinic based.