NC Nursing and the Future of Health Care
Published April 10, 2013
By Tina C. Gordon, MPA CAE
Channel surf the news networks or scan the headlines of any newspaper and you can quickly see plenty of evidence that the health care universe is going through some massive changes. Insurance issues, medical innovations, access shortages, treatment protocols – the list goes on and on. Some of these changes are improving health care, others are preventing progress. Almost all of them are politically charged. As the entire health care industry continues to evolve, though, registered nurses are consistently well-positioned to help provide safe, affordable quality care for millions of patients. And here in North Carolina, we have some of the best examples of how registered nurses are increasingly a good solution.
For a long time, many Americans have simply been skipping past primary care. If they got sick, they would go to the Emergency Room. One of the main goals of the Affordable Care Act is to keep people from taking that costly and inefficient route by putting preventative and primary care back on the table as viable options. Experts predict that by the end of the decade, patients will be scheduling 15-20 million more primary care visits per year – and in all likelihood, registered nurses will play an integral role in providing that care.
Luckily, nurses are ready for the task! In many cases, advanced practice registered nurses (APRNs) like nurse practitioners (NPs) are already taking on many of those responsibilities. More than 15 states now allow NPs to have “Full Practice Authority” – essentially trusting them to use the entire scope of their training and postgraduate education to treat primary care needs for patients.
The rest of the health care community is well aware of this increasing demand and many industry leaders support this shift towards ARPNs. In a recent column for Forbes Magazine, Amesh Adalja, MD, made the case for optimizing the role of RNs in particular, saying, “Expanded scopes of practice, in which a non-physician renders care independent of a physician, not only expand access to health care and have the potential to decrease the cost of healthcare, but also reflect a respect for the free market system.”
Increased access is all the more important when you consider the provider shortages that we’re already experiencing. Our rapidly aging population is far outpacing the number of medical professionals going into primary care. Rural areas are particularly susceptible. Just last month, the News & Observer pointed out that 91 of North Carolina’s 100 counties are already designated as medically underserved. Many patients in these rural communities are turning to NPs, Certified Registered Nurse Anesthetists (CRNAs) and Certified Nurse Midwives (CNMs) who have proven track records of being well prepared, well trained and safe providers.
North Carolina does not currently allow Full Practice Authority, but it could happen soon; industry experts say this is the natural progression for health care. Multiple studies from prestigious groups like the Institute of Medicine (IOM) and the National Governors Association have enthusiastically supported this shift and determined that any quality or safety concern is a non-issue. In fact, the IOM report endorses the idea that nurses “fulfill their potential as primary care providers to the full extent of their education and training.”
Ultimately, nurses want to help lead the charge in changing the entire focus of health care. For too long, we as a society have reacted to illness instead of fostering wellness, which simply isn’t sustainable.
“We don’t have a health care system. We have a very costly sick care system,” said Joy Reed, EdD, RN, FAAN, the Head of Public Health Nursing, a few weeks ago at our biennial Day at the Legislature. “Let’s flip that paradigm.”
Nurses interact with patients more than anyone else in healthcare. They see the gaps in the current health care system and can quickly figure out how those gaps relate specifically to each patient. Allowing nurses to take on some of these wellness decisions is low hanging fruit. Patients would realize immediate and long-term improved health, which has the added benefit of driving down costs for everyone.
The bottom line is this: whether you’re talking about health care access, primary care shortages or tackling illness vs. wellness, registered nurses are a great solution for North Carolina. They are already handling some of the biggest changes in health care with the highest degree of professionalism and they are ready and willing to see their roles continue to evolve. For the health of our country, both figuratively and literally, it just makes sense to embrace that evolution.
Tina C. Gordon is CEO, North Carolina Nurses Association
April 10, 2013 at 3:22 pm
Teresa Lee says:
I found this article to be very interesting. I am a clinical social worker and not a nurse. It had been my impression that there was a nursing shortage in NC. These proposals would be great if there are enough nurses to go around.
One of the more perplexing things about the nursing shortages is what I hear in regards to the NC Board of nursing from colleagues at the hospital. I have heard nothing but horror stories on how nurses are treated by their own board and it makes me glad I didn't take that path in school. I know a lot of people are aware of the perception that within the nursing community they are well known for eating their own and I just saw one of those cases first hand.
There is a former nurse here who had been charged with rental insurance fraud. This was something called in to the insurance company by an abusive husband this nurse had finally left. Long story short the company called the dept of insurance who did not investigate nor even contact this nurse until after they brought charges and had her arrested. The Dept of Insurance then contacted the board of nursing. Originally the nurse accepted a deferred prosecution agreement b/c paying the insurance company back was cheaper than paying the attorney fees to go to court. The charges would be dismissed once the company was paid back. The Board of nursing also did no investigation but put the the nurse on probation. She could appeal if she paid $300/hr for the appeal time. In the meantime her attorney was able to show that indeed there was no fraud and the rental insurance policy was intact at the time of the theft thus making the company responsible. The department of insurance withdrew the charges and the record was expunged. Now mind you this doesn't remove the fact that this nurse was arrested, taken to jail, made bond had her mug shot put on TV and in the newspaper and yet she never actually did anything wrong. She simply filed a claim after her house was robbed and that claim was paid. This came up a year and half later. Of note, the only suspect the police had in the robbery was the ex husband who called this claim in as fraudulent. No one bothered to investigate to find this fact out either. No apology was made and of course no retraction from the media.
To make matters worse, the Board of Nursing has refused to withdraw the record from their website, to take her off of probation, to reinstate her multi state privileges even though the DA has withdrawn all charges and expunged the record, thus meaning it never happened.
With this on her record, the nurse can't get a job. She is going back to school to become a bio medical engineer something I am sure she will excel at.
This was a nurse in NC for 20 years. She herself is a cancer survivor and also survived an abusive marriage.
Clearly, regulatory bodies make their own rules and can do as they please but if you treat your own people with such flagrant disregard and make no effort at doing what is not only fair but what should be legal, what motivation is there for people to go into this profession?
What she was ultimately told is just b/c they can't find you guilty doesn't mean you didn't do anything. No charges would have been brought in the first place if you were not guilty of something. I was witness to these comments. Very sad.
I work with nurses everyday and can speak to how hard they work and to how hard this nurse worked. I can also tell you she was one of the strongest patient advocates I have witnessed in my career which is double that of hers. I can certainly see why good nurses leave the profession in this state every day, what is left are the nurses you don't want taking care of your loved ones.
April 12, 2013 at 3:22 pm
dj anderson says:
Nurses provide the closest care to those in the hospital, I know from experience.
At the doctor's office, I've had physician assistants who spend more time with me, and seem to provide more thorough examination than the doctor. PAs are not nurses, but have BA and further training to become licensed. I truly don't know if my doctor's practice has a nurse in the office.
As for emergency room use, there is a case for its use other than after accidents or bleeding/breathing problems. Try getting sick on Saturday night, or any other night or weekend and try to go to the doctor's office. You can call and get the service adn go from there, often hearing take an aspirin (now Tylenol) and come in Monday morning if you are not better. That's diagnosis over the phone.
There are urgent cares all over the place, and still no nurses, but most of them close by 8 or 9pm, and they send you to the emergency room if you need more than a bandage or a pill since they can't admit to the hospital.
Maybe, if health reform truly reforms, there will be affordable health care available 24/7 -- when people really need it. Appointments are fine for follow up after diagnosis, prognostication, and initial treatment are complete.
Lastly, what was leaving dental care out of Obamacare all about? People are not so different than animals, and a sore mouth will lead to poor nutrition, and so on and so forth, as they say.
Other than surgery, most of the power of the physician is in the prescription. Nurses could prescribe Rx's for nasal and ear infections and diagnose colds and sore throats, just as well as a physician, if allowed, and without a physician working over them. Nurses could refer too-big-to-handle to the ER just like urgent care does.
