REVIEW OF CURRENT HEALTHCARE ISSUES
If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
Table of Contents
These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare:
- Review the Resources and select one current national healthcare issue/stressor to focus on.
- Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
BY DAY 3 OF WEEK 1
Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
BY DAY 6 OF WEEK 1
Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.
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Module 1 Week 1 Initial Discussion Post
Health Care Issue
Since 1960, there have been times when there weren’t enough nurses across the country. Even though more people graduated from nursing programs between 2003 and 2013, a lot of them quit their jobs within the first year. This happened while many experienced nurses retired, and others went back to school for more advanced degrees. Along with these changes, there are more older people needing care, more people with health insurance, and fewer nurses available after the COVID-19 pandemic. This shortage of nurses is a big problem because it affects how well healthcare can be provided.
Having enough staff has been shown to help fewer people die in hospitals. It’s estimated that we’ll need about 300,000 more nurses between 2020 and 2030.
Impact on Work Setting:
In my job as a corporate wellness nurse, we only have about 12.5% of our nursing positions vacant. We do a lot of our work through telehealth, which makes it easier for the existing staff to handle more clients. We’ve also hired three temporary nurses, but it’s not ideal because our work requires trust and continuity. We’ve had to work longer hours, and appointment times with new patients have been shortened to fit more people in.
Health Care Organization Response:
Our company recognized how the staff was affected, so they gave us more time for paperwork that doesn’t involve patients. The leaders started having meetings every month to talk about how our work has made a difference in people’s lives, especially during times when we were short-staffed. They also organized activities for us to learn and connect with each other since most of our work is done remotely. We did surveys to see how satisfied we were with our jobs, and they shared the results with us. They even announced that they would support us in getting more education and certifications.
Conclusion:
The nursing shortage has affected our work in wellness, but our company has taken steps to help. They’ve been open with communication, supported our career growth, and found ways to bring in more staff when needed. They’ve reminded us of the importance of our work and offered incentives for learning, which has boosted morale. This approach has been successful in other places, like the Well-being project at Anne Arundel Medical Center.
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.
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Collapse SubdiscussionIris Cornell Response to Beth from the instructor
Thanks for sharing on the healthcare issue identified in your posting as the nursing shortages. What might be the top three barriers to address this issue in your organization?
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Collapse SubdiscussionBeth Howell First Response to Dr. Cornell -Beth Howell
Hello Dr. Cornell,
Thank you for your response.
The three barriers of my healthcare organization in addressing a nursing shortage are financial challenges, training constraints, and the energy or inertia needed to create a change.
The cost of recruiting and replacing a staff member equates to 20% of the position’s salary (Lyon et al., 2022). For example, if an average nurse’s salary is 80,000, it would cost 16,000 to recruit and replace them. If five nursing positions are vacant, that equals 80,000 to fill those five vacancies.
In addition to the cost of hiring, there is a decrease in productivity while the new staff members are trained. With the established staff absorbing the extra work from unfilled positions, lower productivity is a challenge and adds even more workload.
The energy and inertia required to affect a change is the third barrier. The nursing shortage concerns have been discussed, and my company has been very receptive to hearing the staff’s concerns and potential solutions. However, the solutions have been slow to implement. Despite the slow response, I have the utmost respect for how my company has managed, listened to, asked questions, and implemented creative staffing solutions demonstrating key skills called the 5Ds. The five Ds are “defining, discovery, dream, design, and delivery” (Broome & Marshall, 2021).
In summary, the three barriers to resolving short staffing at my company are cost, time, and inertia. With close to 80% of all primary care offices having short staffing, having skills to navigate the short staffing barriers will help (Lyons et al., 2022).
References
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.).
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.
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Collapse SubdiscussionOluwashola Adebola Adeniji Response #1Hello Beth,The American Nurses Association (ANA) predicted that by the year 2022, the number of available employment opportunities for registered nurses in the United States will exceed those available in any other profession.
According to projections made by the United States Bureau of Labor Statistics, the need for new registered nurses is expected to exceed 275,000 between the years 2020 and 2030.
A study that was conducted by the National Council of State Boards of Nursing found that the typical age of a registered nurse working in the United States in the year 2020 was 51 years old.
More than one-third of nurses responded in a study conducted by Incredible Health that they want to quit their present positions before the end of the year owing to feelings of job exhaustion and the presence of demanding working conditions.
According to a report that was published by the AACN for the academic year 2019-2020, nursing schools in the United States rejected 80,407 qualified applications from baccalaureate and graduate nursing programs in 2019. The reasons for this included a lack of faculty, clinical sites, classroom space, clinical preceptors, and financial limitations.ReferencesFralic, M.F. (2013). Upskilling for new-era healthcare: Lessons from high impact readings. Nurse Leader, 11(4). http://dx.doi.org/10.1016/j.mnl.2013.05.008Links to an external site.
Rimmer, A. (2018). Upskill doctors to make the most of new medical technologies, report says. BMJ, 361(k2861). Doi: 10.1136/bmj.k2861
Ross, J.R. (2019). Upskilling could be an ideal treatment for healthcare’s employment woes. Retrieved 4 March 2020 from https://www.cardiovascularbusiness.com/topics/healthcare-economics/upskilling-could-be-ideal-rx-healthcares-employment-woesLinks to an external site.
Collapse SubdiscussionMarrisa Montano-White Marrisa Montano-White
Module 1 Discussion
Main Post
National Healthcare Issue
The national healthcare issue I have chosen to address is the nursing shortage which happens when the medical community does not have enough staff to operate appropriately. This is a critical issue to discuss because it affects patient care, nurse morale, patient satisfaction, the healthcare budget, and much more. The nursing shortage has been an ongoing issue exacerbated by the COVID-19 pandemic. According to Buerhaus (2021), in the next ten years, it is estimated that the number of nurses leaving the workforce for retirement will result in losing over 2 million years of nursing knowledge and experience that cannot be entirely replaced. It has been a goal to focus on replacing these seasoned nurses with well-educated nurses with BSN degrees. According to Gerardi et al. (2018), a goal of the Campaign for Action is to better utilize the existing nursing workforce by removing barriers preventing nursing students from getting their BSN. It is vital to focus on ensuring the next generation of nurses is well prepared to enter the nursing workforce because they will often be expected to take on more responsibility because of the shortage of nurses.
Nursing Shortage Affect on my Workplace
The national nursing shortage has affected my local workplace. I work at a large fertility clinic that relies on over 50 nurses for operations at our Colorado clinic alone. IVF nurses tend to have a high turnover due to the high-stress load and the pandemic intensified the nursing turnover. The additional reasons for turnover were that many nurses had babies and opted to either stay home or find work-from-home jobs, others decided to retire, and some nurses were lured to high-paying jobs at the hospital as travel nurses. The training for IVF nurses is very long due to the degree of specialty; therefore, vacant positions are very time-consuming to replace. My workplace has responded by increasing the base pay to attract more qualified nurses, implementing more charge nurses to help divide responsibility, continually hiring and training new nurses to staff up teams in preparation for filling vacant positions, and hiring LPNs to help with chart prep, data entry and various other tasks helping the IVF RNs. According to Ricketts & Fraher (2013), the “team-based” approach for nursing is being utilized increasingly to spread the responsibility of patient care to more people and use lower-paid positions such as LPNs as substitutes for aspects of care of higher-paid positions like RNs. The national nursing shortage will not be resolved anytime soon; therefore, it is essential to continue to be innovative to find solutions for covering patient care.
References
Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present
Course. Nursing Economic$, 39(5), 247–250.
Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. Links to an external site.American Journal of
Nursing, 118(2), 43–45.
Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of careLinks to an external site.
are closely connected. Links to an external site.Health Affairs, 32(11), 1874–1880.
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Collapse SubdiscussionIris Cornell Response to Marrisa from the instructor
Thanks for sharing the identified issue of nursing shortages. As a transformational leader, how might you address the problem in your organization?
Edited by Iris Cornell on Nov 30, 2022 at 7:08am -
Collapse SubdiscussionFabio Anifrani Response # 1
Marissa,
Thanks for your discussion post. I agree that staffing shortages are a definite problem for the healthcare community. As a national health issue, I appreciate your comments on how it affects not only patient care but also nurse morale, patient satisfaction, the healthcare budget, and beyond.
Clearly, the Covid-19 pandemic has done more to expose how critical staffing shortages have been over time and the major impacts they have on every aspect of care.
For example, when we consider the provider shortages at the national level, given that the population of people aged 65 years or older is expected to grow by 45.1%, and the general population is expected to increase by 10.4% over the next 15 years (Association of American Medical Colleges, 2020).
Furthermore, you made an interesting point when you highlighted that an estimated 2 million nurses would leave the profession in the next ten years without replacements in the pipeline. This is a significant loss since all those years of nursing knowledge and experience cannot be entirely replaced (Buerhaus, 2021).
To address the staffing shortages, healthcare organization leaders must understand the changes occurring within the workforce, how policymakers and leaders in the healthcare industry choose to manage the changes, and their impact on the delivery of safe patient care (Pittman & Scully-Russ, 2016).
Another critical step in understanding staffing shortages is for leaders within organizations to understand how to interpret the traditional methods of projecting provider shortages to improve how they allocate resources to expand their business (Pittman & Scully-Russ, 2016).
References:
Association of American Medical Colleges. (2020). U.S. physician shortage growing. Retrieved
November 30, 2022, from https://www.aamc.org/news-insights/us-physician-shortage
Buerhaus, P. I. (2021). Current nursing shortages could have long-lasting consequences:
time to change our present course. Nursing Economic$, 39(5), 247–250.
Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery
system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3.
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Collapse SubdiscussionPaulphielle Mcqueen Response #2 to Marissa,
I also chose to write about the nursing shortage that is happening nationwide as a healthcare issue. I found it very interesting when I was reading your post that over 2 million years of nursing could be potentially lost in ten years, due to the high stress the pandemic placed on nursing staff and other healthcare providers. My workplace also has initiated in aiding the nurses by obtaining travel nurses and also offering boys pay for anyone that would like to pick up extra shifts. It was said in an article that I included below that facilities offering retention bonuses and seasonal pay for picking up extra hours had a higher retention rate in their nurses.
References
Covid-19’s impact on nursing shortages, the rise of travel nurses, and … (n.d.). Retrieved December 2, 2022, from https://www.healthaffairs.org/do/10.1377/forefront.20220125.695159
President, J. C. V., Cusick, J., President, V., Manager, S. N. S. M., Nadeau, S., Manager, S. M., Shepherd Director, M., Shepherd, M., Director, Director, E. L. A., Lofgren, E., Director, A., Zhavoronkova, M., Adhikari, J., Rosenthal, J., Jackson, C., Sozan, M., Murphy, N., & Jarsulic, M. (2022, June 7). How to ease the nursing shortage in America. Center for American Progress. Retrieved December 2, 2022, from https://www.americanprogress.org/article/how-to-ease-the-nursing-shortage-in-america/Links to an external site.
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Collapse SubdiscussionAbie Kamara Hello Marissa,I agree that the nursing shortage is a national healthcare issue affecting the entire medical community, and it occurs when there needs to be more staff to operate appropriately. During the COVID-19 pandemic, working conditions for healthcare professionals and nurses have worsened in various countries. The US Department of Health & Human Services reported critical staffing shortages in over 20% of hospitals in the country. During the Omicron wave, military medical personnel was also deployed to help hospitals in several states. In January 2022, healthcare workers were asked to return to work after testing positive for COVID–19.
Due to the shortage of nurses, many were forced to work 12-hour shifts, which increased their patient load and required them to take mandatory overtime.References
Books, & Llc. (2010). Healthcare infrastructure in the united states: Emergency medical services in the united states, hospitals in the united states.
Goldenberg, D. L. (2020). How the covid-19 pandemic is affecting your health and your healthcare (1st ed.). Armin Lear Press.
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Collapse SubdiscussionOluwashola Adebola Adeniji Response #2
Hello Marrisa,
The nursing profession is the biggest in the health sector, and its members play a crucial role in patient care. About 29 million nurses and midwives work worldwide, with about 3.9 million residing in the United States alone, as reported by the World Health Statistics Report. Around a million more nurses are required by 2020, according to projections.The American Nurses Association (ANA) predicts that between 2012 and 2022, the number of open positions for registered nurses will increase faster than in any other occupation in the country. The US Bureau of Labor Statistics predicts demand for more than 275,000 extra nurses between 2020 and 2030, as reported in an article published in Nursing Times. Jobs for nurses due to factors such as low fertility rates, high rates of attrition, and unequal distribution of the labor force, the nursing profession continues to struggle with a severe teacher shortage. From 2016 to 2026, the demand for nurses is expected to increase at a greater pace (nine percent) than the growth of other professions combined.
NURS-6512N Week 1: An 85-year-old white woman living alone with declining health
ReferencesAiken LH, Cheung RB, Olds DM. Education policy initiatives to address the nurse shortage in the United States. Health Aff (Millwood). 2009 Jul-Aug;28
Slattery MJ, Logan BL, Mudge B, Secore K, von Reyn LJ, Maue RA. An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles. J Prof Nurs. 2016 Nov – Dec;32(6)
Halter M, Boiko O, Pelone F, Beighton C, Harris R, Gale J, Gourlay S, Drennan V. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Serv Res. 2017 Dec 15;17(1):824.
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Collapse SubdiscussionKatie Saletel Module 1 Week 1 Initial Discussion Post – Katie Saletel
National Healthcare Issue
As leaders in healthcare, we focus on the difficulties of patient care and plan actions to ensure everyone receives quality care. As future Advanced Practice Registered Nurses (APRNs), we aim to work closely with doctors and management to develop new ways of caring for patients. By involving mid-level nurses, we can ease the workload of doctors, allowing them to concentrate on important matters and reduce burnout.
This care approach aligns with the Quadruple Aim, addressing community health, cost management, and patient satisfaction. APRNs can handle various tasks like preoperative assessments and treating common ailments, often at a lower cost than physicians. They can provide these services in clinics, urgent care centers, or emergency departments, thereby improving overall patient satisfaction and outcomes.
However, challenges persist in American healthcare, such as ensuring cost transparency, privacy, and patient security. Over time, our facility has implemented stricter security measures to safeguard medical records and ensure timely reporting of breaches.
The increased use of electronic systems in the US brings convenience but also risks compromising personal data privacy. Unlike the European Union’s GDPR protections, the US lacks comprehensive laws to safeguard residents against biases or discrimination in automated decision-making and data usage. Additionally, there’s a lack of transparency in how personal data is handled, especially concerning healthcare.
Efforts to enhance privacy and transparency, like those in California, are steps in the right direction, but more needs to be done at the federal level. Despite laws like HIPAA, protecting patient information remains a significant concern, especially with the growing use of IoMT devices.
While IoMT offers efficiency and convenience, it also raises concerns about accessibility and equity in healthcare. Patients without internet access or facing financial constraints may be left behind. Furthermore, certain demographics may face stigma or limited access to healthcare resources, hindering their ability to seek second opinions or access specialized care.
Balancing AI advancements with privacy protection is crucial, as is ensuring transparency in healthcare costs and patient satisfaction. The transition from fee-for-service to value-based payment models presents challenges, particularly for vulnerable populations like the elderly and those with limited financial means.
Advocating for patients’ safety and well-being remains paramount as we navigate these ongoing disparities and work towards a more equitable healthcare system.
National Healthcare Issue
As leaders in caring for patients and families in the healthcare setting, we look at the challenges we face in caring for patients and what action plans we can create to provide equal and high-level care. As upcoming Advanced Practice RNs, we look at how we can collaborate with physicians and administration to find alternative methods and care coordination for our patients. This care model, including mid-level RNs, can offload some burden from the physicians so they can focus on high-level matters and decrease physician burnout.
This model of care works to fulfill the Quadruple Aim of caring for the population’s health in community outreach and education, management of costs as APRNs for various duties such as preop physicals, acute illnesses such as upper respiratory infection, otitis media, and more which cost less than physician fees and enhances patient care and satisfaction. These examples can be performed by a qualified APRN in clinic, urgent care, or emergency department (Bromme & Sorensen Marshall, 2021). Continued challenges in American healthcare are cost transparency, privacy, and patient security assurances. Currently, my facility, over the years, has implemented additional security measures in our IT and Privacy areas, such as Medical Records, with policies in place to ensure that reporting of electronic security and privacy breaches is timely.
Impact on Patient Privacy, Safety, and Healthcare Costs on Communities
America has surged in electronic uses for personal, legal, and healthcare-related circumstances but with electronic convenience comes the risk of personal data privacy being compromised. Unlike European Unions, which are protected by the General Data Protection Rights (GDPR), the United States does not fully offer US residents the protection of laws or regulations against biases or discrimination from automated decision-making, automated profiling, and lack of transparency in how personal data is used in profiling, right to be forgotten, public participation in programs for data processing, and tools used for implementations and enforcement transparency, of which, are all included in the GDPR template (Gilman, 2020). The US and private insurance companies do not necessarily, take responsibility for keeping private information protected, nor does it push restrictive measures on public companies, for-profit or private practice healthcare businesses in the transparency of goods and services offered. Transparency in healthcare from various directions leads us to recognize the breach of privacy by personal information sold to third parties and insurance companies, lack of notification and consent of use in automated data collection, and lack of support to lower socioeconomic populations in access to their personal information regarding care with Electronic Health Records (EHR) or facility costs. Though congress is working to look at the GDPR as a tool for creating better safeguards and transparency for patients’ healthcare and personal information, they have a long way to go. States have developed safeguards for their residents, such as California, which has regulations in place in notification and protections in selling personal information to third parties. In doing a search for costs associated with primary care visit, I found unreliable sites and sites that have since stopped monitoring and providing cost comparison information for patients. Possibly much of this could be due to the pandemic. However, one site posted a notification it was a privately held company that was passionate about providing transparent costs to patients, but due to retirement, they would stop updating the information; this was as of May 2022 (Dahlen, 2022).
One thing is for sure; the US has laws in place for privacy and security through the Department of Health and Human Services and Civil Rights regarding the Health Insurance Portability and Accountability Act (HIPAA), which does not allow covered entities must protect patient information including demographic information, past, present and future information as it relates to their physical, mental health conditions. Encoding personal patient information is especially important as the Internet of Medical Things (IoMT) is used for in-home care of patients for weight management of patients with congestive heart failure, diabetic plasma glucose (PG) monitoring, or temporary tracking of patient’s cardiac concerns by wearing of an event or Holter monitors, or lastly, interrogation of cardiac pacemakers or implanted CPAP devices either from home or by electronic equipment means in the healthcare setting. These are examples of data pushed electronically through the internet that brings efficiencies to providers and satisfaction from most patients (Bookert et al., 2022). Again, these services may not be available for patients who lack internet capabilities due to homelessness or inhibitive costs, transportation limitations to and from healthcare facilities, demographic regions with sparse resources available for specializations, or illnesses preventing them from traveling. Patients with diseases of various diagnoses may feel stigmatized by healthcare teams and, therefore, not allowed to get a second option due to a lack of resources, lack of funds, or insurance coverage with state or county governmental assistance program limitations.
Conclusion
Protecting electronic data and information from automatic data collection and artificial intelligence (AI) pulling private patient data without consent or lack of ability to pull results into a format that is useful by providers is still a challenge. There is a delicate balance in writing AI rules to protect privacy (Park et al., 2018). Having cost transparency with patient satisfaction scores monitored will continue to be a struggle in the Quadruple Aim as we continue fee-for-service models versus value-based payment models. However, both have their benefits and challenges. Government through Medicare repayments continues to fluctuate, which can also impact costs, pushing the patient to pay more out of pocket. This is challenging for low to middle-income populations and geriatric patients on a fixed income (Park et al., 2018). As we look at these ongoing disparities, we must advocate for our patients, their safety, and their wellbeing.
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 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 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 -
Collapse SubdiscussionKatie Saletel 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 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 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 Thank you for your response.
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Collapse SubdiscussionMarrisa Montano-White 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 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
Collapse SubdiscussionNavtej P Singh 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 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.
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