Review of Health Care Issues

Review of Health Care Issues

Fluctuations in national nursing shortages have been observed since the 1960s (Buerhaus, 2021). Despite an increase in nursing graduates between 2003 and 2013, one out of every five nurses left their positions within the first year (Broome & Marshall, 2021). This dynamic is further complicated by the retirement of experienced nurses, who constitute one-third of the nursing workforce, and the trend of staff registered nurses pursuing advanced degrees (Buerhaus, 2021). In addition, the aging population, a rise in the number of insured patients, and the depletion of nurses following the COVID-19 pandemic have compounded the national nursing shortage, raising concerns about the long-term implications for delivering quality healthcare (Buerhaus, 2021). Research has demonstrated a correlation between improved staffing levels and reduced mortality rates (Dall’Ora, 2022). It is estimated that the demand for nearly 300,000 more nurses will arise between 2020 and 2030 (Hadad, 2022).

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Impact on Work Setting

As a corporate wellness nurse, our work setting experiences a relatively low vacancy rate of 12.5%. The adoption of telehealth services has allowed the existing staff to effectively accommodate the additional client load resulting from vacant nursing positions. Furthermore, the organization has hired three temporary nurses to fill the staffing gaps. However, the nature of the nursing role in this setting involves nuanced interventions that require trust and continuity for meaningful progress. Thus, relying on temporary nursing staff may not be the ideal solution. To manage the staffing shortage, the workday has been extended, and the duration of new patient admission appointments has been reduced from one hour to half an hour to accommodate more patients.

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Health Care Organization Response

The healthcare organization has recognized the impact of staffing shortages on the nursing staff and has taken several measures to mitigate the challenges. Non-patient charting time has been added to the nurses’ schedules, allowing them to manage their workload more efficiently. The leadership team has initiated monthly meetings where they share impact statements, highlighting the positive changes in patients’ lives during the challenging short-staffed period. This serves as a reminder of the nurses’ mission and the importance of their work (Jacobs et al., 2018). To combat the sense of isolation resulting from the shift to 75% remote service delivery, the organization has arranged “lunch and learn” activities. Additionally, the organization conducts yearly satisfaction surveys, sharing the results and outlining steps being taken to address significant concerns. Most recently, the organization has announced plans for professional development and funding for certifications.

Conclusion

The national nursing shortage has indeed impacted the corporate wellness setting, and the organization has taken proactive steps to address the challenges. These measures include promoting open communication, fostering responsiveness, encouraging career development, and implementing innovative staffing solutions. The organization has consistently emphasized its mission and the priority of helping patients live healthier lives, which has helped the staff weather the challenges of staffing shortages (Lyon et al., 2022). Highlighting the sense of purpose and offering incentives for education has significantly boosted morale, as evidenced by the Well-being project at Anne Arundel Medical Center (Jacobs et al., 2018).

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present Course. Nursing Economic$, 39(5), 247–250.

Dall’Ora, C., Saville, C., Rubbo, B ., Turner, L., Jones, J .& Griffiths, P.(2022)Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. https://doi.org/10.1016/j.ijnurstu.2022.104311Links to an external site.

Haddad LM, Annamaraju P, Toney-Butler TJ. (2022). Nursing Shortage. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018).Engaging employees in well-being.  Nursing Administration Quarterly, 42(3), 231–245.

Lyon, C., English, A., Cebuhar, K., & Emerick, J. (2022). Don’t Leave Me! Strategies for Medical Staff Retention. Family Practice Management, 29(3), 5–9.

 

BY DAY 3 OF WEEK 1

SAMPLE 3

• • • National Healthcare Issue

      In our roles as healthcare leaders, our primary concern is addressing the challenges that confront us in providing top-quality care to patients and their families. As future Advanced Practice RNs, we are committed to collaborating with physicians and administrators to develop innovative care coordination methods for our patients. This care model, incorporating mid-level RNs, has the potential to relieve some of the burdens on physicians, allowing them to focus on higher-level tasks and reducing the risk of physician burnout. This approach aligns with the Quadruple Aim by emphasizing the importance of community outreach and education, cost management, and enhanced patient care and satisfaction. Advanced Practice RNs can play a crucial role in delivering various services, such as preoperative assessments and the management of acute illnesses like upper respiratory infections and otitis media, at a lower cost than physician fees, in settings like clinics, urgent care facilities, and emergency departments (Bromme & Sorensen Marshall, 2021). Ongoing challenges in American healthcare include ensuring cost transparency, protecting patient privacy, and providing assurances regarding patient data security. Over the years, my facility has implemented additional security measures in our IT and Privacy departments, particularly in Medical Records, to ensure timely reporting of electronic security and privacy breaches.

      Impact on Patient Privacy, Safety, and Healthcare Costs in Communities

      The United States has experienced a significant surge in the use of electronic platforms for personal, legal, and healthcare-related purposes. However, this convenience comes with the risk of compromising personal data privacy. In contrast to the European Union, which is protected by the General Data Protection Rights (GDPR), the United States does not offer comprehensive protection against biases, discrimination resulting from automated decision-making and profiling, or the lack of transparency in the use of personal data in profiling. The GDPR includes provisions related to the right to be forgotten, public participation in data processing programs, and tools used for implementation and enforcement transparency, none of which are fully integrated into U.S. regulations (Gilman, 2020). The United States and private insurance companies do not assume full responsibility for safeguarding private information, nor do they enforce stringent measures on public companies, for-profit entities, or private healthcare businesses to ensure transparency in the provision of goods and services. This lack of transparency in healthcare has led to issues such as personal information being sold to third parties and insurance companies, the absence of notifications and consent for automated data collection, and limited support for lower socioeconomic populations in accessing their personal healthcare information, including Electronic Health Records (EHR) and facility costs. While Congress is considering adopting the GDPR as a framework for creating better safeguards and transparency for patients’ healthcare and personal information, there is still a long way to go. Some states, such as California, have developed regulations to protect their residents, including rules regarding the notification and protection of personal information sold to third parties. In my search for costs associated with primary care visits, I encountered unreliable websites, and some sites that were no longer providing cost comparison information for patients, possibly due to the impact of the pandemic. One privately-held company, passionate about offering cost transparency to patients, announced its cessation of updates in May 2022 due to the owner’s retirement (Dahlen, 2022).

      Certainly, the United States has established privacy and security laws through the Department of Health and Human Services and Civil Rights, particularly the Health Insurance Portability and Accountability Act (HIPAA). HIPAA mandates that covered entities must safeguard patient information, including demographic data and information related to patients’ past, present, and future physical and mental health conditions. The secure encoding of personal patient information is especially vital as the Internet of Medical Things (IoMT) is used for in-home patient care, such as monitoring weight for patients with congestive heart failure, tracking diabetic plasma glucose (PG), and monitoring cardiac concerns through event or Holter monitors. Additionally, it allows for the interrogation of cardiac pacemakers or implanted CPAP devices through electronic means in healthcare settings. These examples involve the electronic transmission of data over the internet, which enhances provider efficiency and patient satisfaction (Bookert et al., 2022). However, such services may not be accessible to patients who lack internet access due to homelessness, cost barriers, transportation limitations to and from healthcare facilities, scarce resources in certain geographic areas, or medical conditions that restrict travel. Patients with various medical conditions may feel stigmatized by healthcare teams, preventing them from seeking second opinions due to resource limitations, lack of funds, or restrictions imposed by state or county governmental assistance programs.

      Conclusion

      Safeguarding electronic data and information from automatic data collection and unauthorized access by artificial intelligence (AI) is an ongoing challenge. Balancing the formulation of AI rules to protect privacy while providing useful data for healthcare providers is a delicate task (Park et al., 2018). Achieving cost transparency while monitoring patient satisfaction scores remains a struggle within the Quadruple Aim, particularly in the context of fee-for-service and value-based payment models. Both models have their advantages and challenges, impacting government reimbursement through Medicare and potentially increasing costs borne by patients. Such cost challenges are particularly daunting for low to middle-income populations and elderly patients with fixed incomes (Park et al., 2018). As we continue to grapple with these ongoing disparities, it is essential to advocate for our patients, ensuring their safety and well-being.

       

      References

       

      Bookert, N., Bondurant, W., & Anwar, M. (2022). Data practices of internet of medical things: A look from privacy policy perspectives. Smart Health, 26. https://doi.org/10.1016/j.smhl.2022.100342Links to an external site.

      Broome, M.E., Sorensen Marshall, E. (2021). Transformational Leadership in Nursing. From Expert Clinician to Influential Leader. Springer Publishing Co.

      Dahlen, V. (2022). Consumer Health Ratings: Your Guide to Quality and Costs. https://consumerhealthratings.com/Links to an external site.

      Gilman, M.E. (2020). Five Privacy Principles from the GDPR, the United States, Should Adopt to Advance Economic Justice. Arizona State Law Journal, 52(2), 368–444. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=edb&AN=145229066&site=eds-live&scope=siteLinks to an external site.

      Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple Aim. Journal of the American Board of Family Medicine, 31(4), 588–604. https://www.jabfm.org/content/31/4/588Links to an external site.

      Rubin, R. (2021). Obstacles to Implementing AI Tools in Health Care. JAMA: Journal of the American Medical Association, 325(4), 333. https://doi.org/10.1001/jama.2020.26933Links to an external site.

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    • Collapse SubdiscussionDinorah Abigail De La Cerda 

      Dinorah Abigail De La Cerda

      Nov 30, 2022Nov 30, 2022 at 8:01pm

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      MODULE 1 MAIN POST- DINORAH DE LA CERDA

      Healthcare Issue

      At some point in our careers, we’ve probably all encountered the overcrowding issue in the Emergency Room. Whether you were the ER nurse that was juggling her two ICU patients and the other 2 ER patients you received at the same time, or you were that ICU or floor nurse getting the very brief non-detailed report from the admitted patient that has been held in the ER for 24 hours it is safe to say that admitted patients should not remain in the ER.

      During Covid, we saw how detrimental overcrowding could be, especially when patients needed a higher level of care and were rejected from hospitals. We also know that nursing burnout and shortages can also cause a backup of patients turning the ER into a parking lot where these patients remain until they can be transferred to the appropriate floor. In an article published in Health Affairs, it is said that boarding or the act of admitted patients being held can be “associated with several adverse outcomes” (Weiner & Venkatesh, 2022) some of which include death.

      If you have ever worked in an Emergency Room you know your squeaky wheel gets the grease. The ER that I worked in has been consistently boarding up to 18 patients with an ER length of stay of up to 100 hours for months. I have seen the first-hand effects of boarding myself. Recently, I was in charge, had my own section (4 patients), and was doing our “fast track” due to the fact we were holding 4 ICU patients, and my colleagues were maxed out. This led to decreased patient satisfaction and could have potentially caused me to make an error if I was not careful.

      Furthermore, another study on ER boarding showed that “prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients… requiring ICU admission.” (Choi et all, 2021). ER boarding is a major safety issue This makes the workplace for nurses rocky. One of the biggest issues I see with this in regard to the workplace is the fear of potentially losing my license, hurting a patient due to subpar conditions, or becoming so burnout coming to work would be detrimental to my own mental health.

      Solutions for overcrowding have been brought up such as; the expansion of hospitals both inpatient and ED, only providing care to emergencies, and helping uninsured patients receive primary care elsewhere. In the hospital I work for the providers do not really believe in using the Right Care Right Place which means oftentimes we are charting assessments and taking time to discharge the patients with a bloody nose that stopped bleeding 6 hours ago, or a rash that has been on that patients back for over a year.

      Ultimately the Emergency Room and the ER staff cannot sustain the boarding of patients. It cannot stop patients from walking in with emergencies and there is no cap that can be placed. To the detriment of ERs nationwide, nursing shortages increased the length of stay of admitted patients, guidelines for admission, and the misuse of emergency services all lead to increased boarding and thus affect patient health negatively.

      References:

      Choi, W., Woo, S. H., Kim, D. H., Lee, J. Y., Lee, W. J., Jeong, S., Cha, K., Youn, C. S., & Park, S. (2021). Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study. Emergency medicine international, 2021, 9952324. https://doi.org/10.1155/2021/9952324Links to an external site.

      Derlet, R. W., & Richards, J. R. (2008). Ten solutions for emergency department crowding. The western journal of emergency medicine, 9(1), 24–27.

      Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PloS one, 13(8), e0203316. https://doi.org/10.1371/journal.pone.0203316Links to an external site.

      Weiner, S. G., & Venkatesh, A. K. (March 29, 2022). Despite CMS reporting policies, emergency department boarding is still… https://www.healthaffairs.org/do/10.1377/forefront.20220325.151088

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      • Collapse SubdiscussionSergio Aguirre 

        Sergio Aguirre

        Dec 3, 2022Dec 3, 2022 at 9:03am

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        Response Post 2:

        Hello Dinorah,
        “Emergency department (ED) overcrowding is widespread in hospitals in many countries, causing severe consequences to patient outcomes, staff work and the system, with an overall increase in costs” (Improta et al., 2022, para.1). Holding ICU patients in the emergency room is always an issue. It can compromise, patient health, particularly to the elderly and critically ill. I recall having DKA patients, and they would NEVER get an ICU bed. They would be considered, “light ICU’s” and the House Supervisor would chuckle at the notion of a DKA patient getting a bed.  On more than a few occasions, the patient would be downgraded to telemetry before they got a bed, meaning they would be in the ER for days, and had gotten completely off an insulin drip to qualify for downgrade.

        “Overloaded nurses are unable to effectively provide the care needed in a timely manner. Delays in processing ER patients also result in overcrowding, making it difficult to provide safe quality care“ (Kongcheep et al., 2022, para. 1). I understand, the concept of patients going to the ER for non-emergency situations e.g. medication refills, rashes, scrapes/lacerations. At times we would refer them to urgent cares, because we knew they were going to wait for hours. Many of these patients, don’t understand the workflow and I feel health literacy and education is needed to help them understand what their best possible options are. Overall a lot of work needs to be done and there is no simple solution to such a complex problem.

        References

        Improta, G., Majolo, M. Raiola, E., Russo, G., Longo, G. & Triassi, M. (2022). A case study to investigate the impact of overcrowding indices in emergency departments. BMC Emergency Medicine, 22 (143), https://doi.org/10.1186/s12873-022-00703-8

        Kongcheep, S, Arpanantikul, M., Pinyopasakul, W. & Sherwood, G. (2022). Thai Nurses’ Experiences of
        Providing Care in Overcrowded Emergency Rooms in Tertiary Hospitals. Pacific Rim International
        Journal of Nursing Research, 26(3) 533-548.
        https://web.s.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&sid=9449863c-7d20-43b8-a2ae-efba415f601d%40redis

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      • Collapse SubdiscussionKatie Saletel 

        Katie Saletel

        Dec 3, 2022Dec 3, 2022 at 9:27am

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        Thank you for your post.  Your response to this healthcare crisis resonated with me as I worked in the ED in a leadership role until mid-2021, where we boarded patients from cardiac, medical/surgical to ICU and mental health every day for days and weeks at a time with no solution but to endure and told to work more with less.  ED boarding longer than six hours did not begin to occur regularly until 2020, when COVID-19 impacted this crisis.  The American College of Emergency Physicians (ACEP) has defined a boarded patient as a patient who has been determined to be an admitted patient but cannot be transferred out of the ED to the appropriate unit (Kraft et al., 2021).

        When it comes to mental health patients in the ED, nationally, we are burdened with boarding these patients for long periods due to a lack of beds available at mental health healthcare facilities, or the facilities are unwilling to accept the patient based on acuity or physical violence history.  At my facility, for example, we had to determine the risk-benefit in admitting a patient to the medical floor until placement could be made versus keeping the patient in the ED.  We quickly found patients admitted to a medical unit until arrangements could be made and dropped the patient to the bottom of the list at mental health facilities because they were determined to be receiving care versus holding in the ED.  So, in order to keep the patient at the top of the list for accepting mental health facilities, we needed to hold the patients in the ED.  We worked very closely with our mental health unit, and the ED charge nurse worked to find a placement, but in the last three years, we have held patients for days or weeks trying to find placement.

        A group of clinicians hypothesized having emergency critical care nurses (ECC), who have knowledge and experience caring for both ED and ICU nurses who care for patients in the ED as boarded patients decrease the mortality of patients.  The study ultimately did not find a significant decrease in mortality (Nesbitt et al., 2021).  Lack of staff in the ED and inpatient presents challenges and risks for our patients, nurse burnout, and risk for errors or sentinel events.

        ED nurses are not trained to care for patients long-term, and longer than five or six hours in the ED is too long.  We are currently opening an ED boarding/Obs.  area for ED patients that cannot be admitted to the inpatient area due to staffing, bed availability, etc. Specifically, hired ED Obs RNs will care for the boarded patients.  This includes ICU, medical/surgical, neuro, cardiac, and mental health patients.  The current ED leadership has also deemed patients needing 23 hours or less observation for rule-out purposes will likely stay in the ED under this Obs unit.  An example, an ED patient worked up for chest pain is deemed necessary for 23-hour observation with serial troponins, etc., could be placed into ED Obs as, more often than not, we admit to the cardiac unit only to have the patient discharged home 14 to 18 hours later, frustrated they had to endure admission, etc.  So, we will keep the patient in our ED as a boarded/Obs patient for a few reasons. First, to decrease stress and anxiety for patients and families in having to admit to the inpatient unit only to be discharged hours later, and two, to keep a bed in the cardiac unit available for patients needing a more extended stay or to transfer patients from ICU or step down unit into the cardiac unit.  This example would open an ICU bed for an ED-boarded patient or STEMI patient with recent arrival needing ICU care post PCI.  It will be a work in progress, but hopefully, this will be an alternative treatment option until the patients can be transferred to our inpatient area or an appropriate care facility.

        References

        Kraft, C. M., Morea, P., Teresi, B., Platts-Mills, T. F., Blazer, N. L., Brice, J. H., & Strain, A. K. (2021). Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department. American Journal of Emergency Medicine, 46, 550–555. https://doi.org/10.1016/j.ajem.2020.11.021Links to an external site.

        Nesbitt, J., Mitarai, T., Chan, G. K., Wilson, J. G., Niknam, K., Nudelman, M. J. R., Cinkowski, C., & Kohn, M. A. (2021). Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients. American Journal of Emergency Medicine, 41, 120–124. https://doi.org/10.1016/j.ajem.2020.12.067

         

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    • Collapse SubdiscussionTammy Young 

      Tammy Young

      Nov 30, 2022Nov 30, 2022 at 10:30pm

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       Lack of Access to Healthcare

      Lack of healthcare access is the inability to obtain healthcare services such as prevention, diagnosis, treatment, and management of diseases, illnesses, and disorders. Many people, even in the United States, do not have adequate access to healthcare. Healthcare must be affordable and convenient in order to be accessible. The three most significant deterrents to obtaining good healthcare are poverty, barriers to receiving services, and the allocation of resources that provide the services the University of Missouri, n.d.). To improve access for all Americans, it is essential to understand the perceived barriers to healthcare (Ahmed, 2010).

      Impact of the Lack of Access to Healthcare

      Compared to the United States, Kentucky is more rural, home to fewer minorities, and has a somewhat older population (USA Facts, 2020). The National Rural Health Association has identified that rural areas include a high proportion of seniors, higher acuity levels, and lower life expectancies. In addition, rural households have a lower median household income ($52,386 compared with $54,296 in urban households. Approximately 24% of children living in rural areas live in poverty. People in rural areas are more likely to suffer from obesity, lung cancer, COPD, and heart disease (Abell & Blankenship, 2019).

      The lack of health care access issues impacts Kentucky because the state is more rural than other states in the US. Local healthcare workers are challenged with serving a population with an average lower income, less education, disproportionate medical facilities, and an increased median age in rural counties.

      Response to the Healthcare Issue

      The University of Kentucky’s healthcare system has partnered with local and surrounding communities to provide access to good healthcare services, including education, prevention, maintenance, and research. The Kentucky Office of Rural Health (KORH), established in 1991, is a federal-state partnership charged with improving the health of rural Kentuckians by promoting access to rural health services. KORH provides a  framework for finding solutions to rural healthcare issues by linking small rural communities with local, state, and federal resources ( University of Kentucky School of Medicine, n.d.).

      The local healthcare community has organized and implemented programs to assist with free physical exams, cervical cancer screening, mammograms, colonoscopies, pediatric services, immunizations, and education for many common health concerns.

      Conclusion

      To improve access to health care, medical facilities, organizations, and federal and local governments must join forces. It is essential to network with health and other community organizations to find various options to meet the needs of a state with a large rural population. Collaborating with health-related academic units in college or university settings allows access to more resources, improving access to health services.

      References

      Abell, C. & Blankenship, M. (2019). Introducing Health Ministry in a Rural American Church. Journal of Christian Nursing, 36 (4), 244-250. doi: 10.1097/CNJ.0000000000000641.

      Ahmed SM, Lemkau JP, Nealeigh N, & Mann B. (2010). Barriers to healthcare access in a non-elderly urban poor American population. Health & Social Care in the Community, 9(6), 445–453. https://doi.org/10.1046/j.1365-2524.2010.00318.xLinks to an external site.

      University of Missouri School of Medicine. ( n.d.). Health Care Access. https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/health-care-access#:~:text=Health%20care%20access%20is%20the,have%20access%20to%20adequate%20healthcareLinks to an external site..

       

      USA Facts. (2020). USA Facts, Our Changing Population: Kentucky. https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/kentuckyLinks to an external site.

       

      University of Kentucky College of Medicine. (n.d.). Kentucky office of Rural Health. https://medicine.uky.edu/centers/ruralhealth/kentucky-office-rural-healthLinks to an external site.

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      • Collapse SubdiscussionElin Danelian 

        Elin Danelian

        Dec 1, 2022Dec 1, 2022 at 2:47am

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        Response 1

        Hello Tammy,

        Thank you for your post. Healthcare is always expanding and changing to fulfill the requirements of the population and I agree with you that lack of healthcare access is a problem in today’s society. The lack of healthcare access impacts my work setting because there are patients who do not visit the doctor to avoid high out of pocket costs. A lot of these patients come into the hospital with more serious complications such as heart attacks because they have not had their check-ups with cardiologists due to the costs of healthcare. Having adequate access to healthcare enables people to proactively manage their health issues, which promotes positive long-term health results. Because so many Americans lack the material or financial means to access the healthcare treatments they require, healthcare access in the US is a public health concern (Coombs et al., 2021). I have had experience with patients who have not followed up with their physicians which has led to fatal complications. This makes it difficult for us healthcare workers who strive to help our patients and promote their well-being. Healthcare professionals encounter difficulties in providing treatment to people mostly in rural areas (Riley, 2012). My work setting has a financial department that can be called to help patients gain access to health care while in the hospital and for when they are discharged.

        References

        Coombs, N., Meriwether, W., Caringi, J. & Newcomer, S. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214217/

        Riley, W. (2012). Health Disparities: Gaps in Access, Quality and Affordability of Medical Care. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540621/

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        • Collapse SubdiscussionTammy Young 

          Tammy Young

          Dec 1, 2022Dec 1, 2022 at 8:29pm

          Manage Discussion Entry

          Thank you for your response.

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          Collapse SubdiscussionMarrisa Montano-White

          Marrisa Montano-White

          Dec 1, 2022Dec 1, 2022 at 11:55pm

          Manage Discussion Entry

          Marrisa Montano-White

          December 1, 2022

          Module 1 Discussion

          Colleague Response 1

          Hello Tammy,

          You have chosen a great topic to discuss. You bring up valid points on the lack of healthcare in The United States despite being one of the most advanced countries in the world. As you stated, one of the main reasons for the lack of healthcare is poverty, often found in rural areas. According to Potera (2017), the United States healthcare system was ranked last out of 11 first-world countries despite the United States spending 16.6% of the gross domestic product on healthcare compared to The United Kingdom, which ranked first and spent only 9.9% on their healthcare. The United States was also the only high-income country that did not have universal health insurance, and those with coverage still had high out-of-pocket costs compared to the other countries. It is past due time that the United States addresses the lack of healthcare and high costs.

          Response to the Issue of Lack of Healthcare 

          Many factors affect increasing access to healthcare; however, one of the first and most important areas to address is ensuring enough primary care providers are available to care for patients. According to Park et al. (2018), the members of The World Health Organization believe that the foundation of healthcare access for all is dependent on primary care because they have been proven to provide better quality care, improved outcomes, increased access, and decreased costs. Hopefully, the United States will continue to address the need for more primary care providers by attracting qualified applicants to programs for this. As more people graduate from these healthcare programs, it would be expected that more providers would be spread across the nation, enabling increased access to healthcare.

          References

          Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary careLinks to an external site.

                  and its impact on the Quadruple AimLinks to an external site.. Journal of the American Board of Family Medicine, 31(4), 588–604.

          Potera, C. (2017). United States Flunks an International Health Care Analysis: Findings reveal worst overall U.S. ranking,

          including for access, equity, and outcomes. AJN American Journal of Nursing, 117(10), 16.

          https://doi.org/10.1097/01.NAJ.0000525860.98310.15

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          Collapse SubdiscussionMleh Porter

          Mleh Porter

          Dec 2, 2022Dec 2, 2022 at 10:59pm

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          Hello Tammy,

          I enjoyed reading your post. Thank you so much for sharing this critical healthcare issue. In a survey of 11 developed countries, which include France, Australia, Canada, Germany, United Kingdom, and more, adults from the United States were more likely not to get the necessary healthcare services because of cost, leading to poor health and emotional struggles (The Commonwealth Fund, 2016). In 2016, about 33% of adults in the United States were unable to see a doctor when they were sick, forfeited the recommended care, and did not fill their prescription because of the cost of healthcare, in comparison to 7% in the United Kingdom and Germany (The Commonwealth Fund, 2016). These numbers show healthcare access challenges due to cost and other disparities in the United States. Access to healthcare is a serious issue as many people cannot access the healthcare services they need due to physical and financial resources. Access to healthcare for every individual is necessary to help manage health difficulties, which leads to better health outcomes (Coombs et al., 2021). I agree that healthcare needs to be available and affordable to be considered accessible.

          The lack of access to healthcare affects my work setting. Some patients with chronic health issues have not been managed and have many complications. Unfortunately, many nurses and other healthcare providers see patients who end up in the hospital with chronic healthcare conditions, with poor prognoses due to a lack of access to healthcare.

          To improve access to healthcare, my health organization is offering telehealth visits. There is assistance with Medicaid/Medicare insurance applications, and those that do not qualify can also make payments on a sliding fee scale.

          Hopefully, more policies will be implemented to improve the issue of healthcare access in the United States.

          References

          Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among US adults with mental health challenges: A population-based study. SSM – population health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847

          The Commonwealth Fund (2016, November 16). In new survey of 11 countries, U.S. adults still struggle with access to and affordability of Health Care. Retrieved December 2, 2022, from https://www.commonwealthfund.org/publications/journal-article/2016/nov/new-survey-11-countries-us-adults-still-struggle-access-and

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          Collapse SubdiscussionNavtej P Singh

          Navtej P Singh (He/Him)

          Dec 3, 2022Dec 3, 2022 at 8:14pm

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          Hi Tammy,

          Very informative and needed post to decrease health disparities among different groups. A particular health difference is closely linked with social, economic, and environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced more significant obstacles to health based on their racial or ethnic group or other characteristics historically linked to discrimination or demographic exclusion, like rural areas, to experience poor healthcare quality (Churchwell, K., & Others, (2020).

          The epidemiological study evaluated US population data and individual-level claims data linked to mortality from 2005 to 2015 against changes in primary care and specialist physician supply from 2005 to 2015. Data from 3142 US counties, 7144 primary care service areas, and 306 hospital referral regions were used to investigate the association of primary care physician supply with changes in life expectancy and cause-specific mortality after adjustment for health care, demographic, socioeconomic, and behavioral covariates. Analysis was performed from March to July 2018 (Basu, S., & Others, (2019). We need to work for more rural areas primary care physicians, or the states need to change their regulations to allow APRNs to practice without limitations in rural areas to bridge that gap.

          References:

          Churchwell, K., Elkind, M. S., Benjamin, R. M., Carson, A. P., Chang, E. K., Lawrence, W., … &

          American Heart Association. (2020). Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association. Circulation, 142(24), e454-e468.

          Basu, S., Berkowitz, S. A., Phillips, R. L., Bitton, A., Landon, B. E., & Phillips, R. S. (2019). Association of

          primary care physician supply with population mortality in the United States, 2005-2015. JAMA internal medicine, 179(4), 506-514.

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      • Collapse SubdiscussionFatimah Johnson

        Fatimah Johnson

        Dec 3, 2022Dec 3, 2022 at 8:46pm

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        Response #2 to Tammy from Fatimah: 

        Hi Tammy,

        Accessible and affordable healthcare is essential, especially for the mental health community. Issues with access to mental healthcare are due to stigmas, limited services, and physical or financial resources (Coombs et al., 2021). Some strategies for improving access to healthcare include assisting in finding a means for transportation, medication, and insurance; sending appointment reminders; and identifying cost-effective resources (Toscos et al., 2018). Access to healthcare in the United States continues to be a national healthcare issue despite it being crucial for optimal health and wellness.

        References

        Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among u.s. adults with mental health challenges: A population-based study. SSM – Population Health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847Links to an external site.

        Toscos, T., Carpenter, M., Flanagan, M., Kunjan, K., & Doebbeling, B. N. (2018). Identifying successful practices to overcome access to care challenges in community health centers: A “positive deviance” approach. Health Services Research and Managerial Epidemiology, 5, 233339281774340. https://doi.org/10.1177/2333392817743406Links to an external site.

         ReplyReply to Comment
• Collapse SubdiscussionHannah Timmer

  Hannah Timmer

  Nov 28, 2022Nov 28, 2022 at 11:50am

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  The healthcare issue I chose to write about is nursing shortages in the medical field. One of the most significant healthcare concerns today is the increasing shortage of nurses. We have seen this nationwide shortage, especially during and after COVID-19. The deficit hit many workforces, but we saw it affect nursing most as healthcare needs grew and nursing staff began to diminish. This issue greatly affected my workplace as we were understaffed, overworked, and completely burnt out. As Covid got worse, so did the patient load and patient needs. Before covid, we had 4-5 patients at one time. We often had four because we had plenty of nurses, but sometimes we got 5, and it wasn’t that difficult of a day. During covid, we began getting five patients at the least and getting up to 7, which is unsafe for a nurse and the patient. Managing seven patients at once significantly impacts patient care quality as well.

  Nurse staffing levels are crucial to maximizing patient quality and improving care outcomes. Adequate staffing helps keep patients safe and allows nurses to give patients the quality time and care they deserve. Without proper staffing, mistakes are prone to happen with medication errors, which can be very dangerous. Beyond that, higher patient loads have led to higher hospital readmission rates (Blouin & Podjasek, 2019). In my workplace specifically, we did see a lot more readmissions because the hospital was pushing people out to get new people in. As I mentioned, we saw larger and less safe patient loads and more safety issues such as falls and pressure injuries.

  As nurses, we were exhausted, crabby, and so stressed. It felt as though we needed a week off after working two days. Call lights never turned off, PPE was thrown on and off constantly, and the never-ending IV pump alarms were stuck in our heads as we went home. We kept losing nurses as their families fell sick or they went off to another facility that gave them hazard pay. No one cared if we got sick because we needed to be there to care for patients. At one point, the hospital wanted the nurses to come in even if we had covid if there was no fever.

  It felt like a century until the hospital started to respond to the nursing shortage. The response came from the hospital losing money due to diversion. Patients kept coming in, but there weren’t enough nurses to care for each person, so the hospital had to send people away. Due to this, the hospital quickly hired traveling nurses to take on these extra patients we were getting. As a result of the acute shortage of nurses, hospitals were forced to pay whatever rates the agencies requested, frequently utilizing COVID-19 relief monies or money from the Federal Emergency Management Agency (AJN, American Journal of Nursing, 2022). This began to help the staffing crisis dramatically, even though we knew they were temporary.

  Our hospital also started giving sign-on bonuses, so we started seeing more long-term hires. To help the crisis, the hospital also started a COVID unit. You were paid more if you chose to work on this unit as it was a higher risk. This helped immensely as the medical floor I worked on had Covid and non-covid patients. This was difficult as we constantly put on PPE and removed it. That took so much time away from patients. Every time a patient needed water or to use the bathroom, we threw on layers of PPE to do a simple task: take it off and go to a non-isolation room. It was this back-and-forth game all day that was so stressful and time-consuming. The separation of patients allowed for PPE to remain on and helped reduce the number of sick nurses we had. These were the main implementations I noticed that helped the most.

  The 4.3 million registered nurses in the country are essential to providing care, advancing local and national healthcare systems, eliminating health inequities, and enhancing the general health of the country (American Nurse Association, 2021). Addressing the inadequate nursing staff took time but has improved since the beginning of Covid. We still struggle with the issue, but the number of isolated patients has decreased dramatically, which has helped us immensely. Although nurses are not the main contributors to healthcare, they are a massive piece of it. Like any other working individual, we deserve safe and proper working conditions starting with adequate nurse staffing. With adequate staffing comes better patient and health outcome, along with a safer environment for staff and patients.

  AJN, American Journal of Nursing. (2022). Ovid: Welcome to Ovid. Staffing Crisis Fueled by COVID-19 Creates Boom for Travel Nurse Industry. https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgiLinks to an external site.?

  American Nurse Association. (2021). Nurses in the Workforce. Nursing World. https://www.nursingworld.org/ErrorHandling/ErrorFallback.html?aspxerrorpath=/practice-policy/workforce/

  Blouin , A., & Podjasek, K. (2019). The continuing saga of Nurse Staffing: Historical and… : Jona: The Journal of Nursing Administration. LWW. Retrieved November 28, 2022, from https://journals.lww.com/jonajournal/Abstract/2019/04000/The_Continuing_Saga_of_Nurse_Staffing__Historical.10.aspx

  

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