Review of Current Health Care Issues

Since 1960, there have been ups and downs in the number of nurses available across the country. Even though more people have been graduating from nursing programs between 2003 and 2013, many new nurses quit their jobs within the first year. This happens while many experienced nurses are retiring, and others are leaving their roles to pursue further education. With the aging population growing, more people having health insurance, and the effects of the COVID-19 pandemic depleting the number of nurses available, there’s a big concern about not having enough nurses to provide good healthcare.

Having enough nurses has been shown to reduce the number of deaths in hospitals. It’s predicted that we’ll need nearly 300,000 more nurses between 2020 and 2030.

In the workplace where I’m a corporate wellness nurse, we only have a 12.5% vacancy rate, which is relatively low. Most of our work, about 75%, is done through telehealth, which helps us manage the extra work from the vacant nursing positions. However, we’ve also had to hire three temporary nurses. This job requires a lot of specific nursing care, and it’s important for patients to trust and know their nurse well. Having temporary nurses isn’t ideal for this reason. To cope with the extra workload, our workday got longer, and the time allocated for new patient appointments was reduced from one hour to half an hour.

The company understood how the staff were affected by the shortage, so they gave us more time for administrative tasks that didn’t involve patients. They also organized monthly meetings where we heard stories about how patients’ lives were changed for the better, even during tough times when we were short-staffed. This helped us remember why we do this job. Since most of our work is done remotely, they also arranged activities to keep us connected and less isolated. We regularly gave feedback through surveys, and the company shared the results with us and told us what they were doing to address any problems. Recently, they announced plans for professional development and funding for certifications.

The shortage of nurses has affected our work in wellness. The measures taken to deal with the shortage and keep nurses have been helpful. The leadership has made sure to communicate openly, be responsive to our needs, offer opportunities for career growth, and find new ways to bring in extra staff. They’ve emphasized our mission of helping patients live healthier lives, which has helped us through the tough times. Providing incentives for education has also boosted morale, as seen in 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.

 

BY DAY 3 OF WEEK 1

SAMPLE 3

• • • National Healthcare Issue

      As leaders in healthcare, we examine the difficulties we encounter when caring for patients and brainstorm ways to ensure everyone gets the best care possible. As aspiring Advanced Practice Registered Nurses (APRNs), we explore how to team up with doctors and management to find new approaches to patient care. By involving mid-level RNs, we can ease the workload on doctors, allowing them to concentrate on important matters and reducing burnout.

      This care approach aims to achieve the Quadruple Aim by promoting community health through outreach and education, managing costs effectively, and improving patient satisfaction. APRNs can handle tasks like preoperative assessments and treating conditions like respiratory infections and ear infections, which are less costly than seeing a physician. They can do this in various settings like clinics, urgent care centers, or emergency rooms. Challenges persist in American healthcare, including issues with cost transparency, privacy, and patient security.

      In recent years, my workplace has implemented additional security measures, particularly in IT and Privacy areas such as Medical Records, to ensure timely reporting of electronic security breaches and privacy violations.

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

      The United States increasingly relies on electronic systems for personal, legal, and healthcare purposes, but this convenience comes with risks to privacy. Unlike the European Union’s General Data Protection Rights (GDPR), the US lacks comprehensive laws protecting residents from biases, discrimination, and privacy violations related to automated decision-making and profiling. The responsibility for protecting private information often falls on individuals and private entities, with limited oversight or regulation.

      Transparency in healthcare is crucial for addressing privacy breaches, such as selling personal data to third parties and the lack of notification and consent regarding data collection. While there are efforts to adopt GDPR-like regulations at the federal and state levels, progress is slow. Some states, like California, have implemented their own privacy protections, but nationwide standards are lacking. Additionally, finding reliable cost information for healthcare services can be challenging, especially during the pandemic.

      The US does have laws in place, such as HIPAA, to safeguard patient information, especially as technology advances, like the Internet of Medical Things (IoMT), are increasingly used for patient care. However, disparities in internet access and resources can limit the benefits of these technologies for certain populations.

      Conclusion

      Ensuring patient privacy and data security remains a challenge, particularly with the increasing use of AI and data collection. Balancing privacy protection with the benefits of technology requires careful regulation. Additionally, achieving transparency in healthcare costs while maintaining patient satisfaction is an ongoing struggle. Fluctuations in government reimbursements can further complicate cost issues, particularly for low-income and elderly patients. Advocating for patients’ safety and well-being is essential as we navigate these challenges.

      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.

       ReplyReply to Comment

      Collapse SubdiscussionDinorah Abigail De La Cerda

      Dinorah Abigail De La Cerda

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

      Manage Discussion Entry

      MODULE 1 MAIN POST- DINORAH DE LA CERDA

      Healthcare Issue

      At some point in our careers, many of us have experienced the overcrowding problem in the Emergency Room (ER). Whether you were the ER nurse handling multiple patients or a nurse receiving a brief report from a patient who had been waiting in the ER for hours, it’s clear that admitted patients shouldn’t be kept in the ER.

      During the Covid pandemic, we saw firsthand how harmful overcrowding could be, especially when patients needed higher levels of care and hospitals were unable to accommodate them. Nursing shortages and burnout can also contribute to patient backups in the ER, turning it into a waiting area until patients can be moved to appropriate units. Research published in Health Affairs indicates that boarding admitted patients in the ER can lead to adverse outcomes, including death.

      Those of us who have worked in the ER understand that the most urgent cases often receive immediate attention. In some ERs, patients may wait for extended periods, with some staying for days. Personally, I’ve witnessed the effects of overcrowding, such as decreased patient satisfaction and increased risk of errors due to overwhelming workloads.

      Another study found that prolonged stays in the ER are associated with higher mortality rates, particularly among elderly patients requiring intensive care. ER boarding poses a significant safety risk and creates a challenging work environment for nurses. Many of us worry about making mistakes or facing burnout, which can jeopardize patient care and our own well-being.

      Various solutions to address overcrowding have been proposed, such as expanding hospital capacity, prioritizing emergency cases, and directing uninsured patients to primary care services. However, in some hospitals, there’s a lack of emphasis on providing the right care in the right place, leading to inefficiencies in patient management.

      Ultimately, the ER and its staff cannot sustain continuous patient boarding. Despite efforts to manage overcrowding, factors like nursing shortages, admission criteria, and misuse of emergency services contribute to prolonged stays in the ER, negatively impacting patient health.

      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

        Manage Discussion Entry

        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

        Manage Discussion Entry

        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.

        Shoshanna Tillman Follow Up Sick Visit: Musculoskeletal Shadow Health Transcript

        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

         ReplyReply to Comment

        Collapse SubdiscussionTammy Young

        Tammy Young

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

        Manage Discussion Entry

        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/

           ReplyReply to Comment

          • Collapse SubdiscussionTammy Young 

            Tammy Young

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

            Manage Discussion Entry

            Thank you for your response.

             ReplyReply to Comment
        • 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.

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          Collapse SubdiscussionHannah Timmer

          Hannah Timmer

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

          Manage Discussion Entry

          The healthcare topic I selected to write about is the lack of nurses in hospitals and medical centers. One of the most important healthcare issues today is not having enough nurses. We have seen this problem all across the country, especially during and after the COVID-19 pandemic. The shortage affected many jobs, but it was most noticeable in nursing because the demand for healthcare increased while the number of nurses decreased. This problem had a big impact on my workplace because we didn’t have enough staff, we worked too much, and we felt completely exhausted. As COVID-19 cases increased, so did the number of patients needing care. Before the pandemic, we usually had 4-5 patients at once. Handling four patients was manageable because we had enough nurses, but sometimes we had five, which was still okay. However, during the pandemic, we started having at least five patients and sometimes up to seven, which is not safe for the nurses or the patients. Taking care of seven patients at the same time really affects the quality of care we can provide to each patient.

          Having the right number of nurses is really important for making sure patients get good care and have good outcomes. When there aren’t enough nurses, mistakes can happen with medicines, which can be dangerous. Also, having too many patients has led to more patients coming back to the hospital after they’ve been discharged. In my workplace, we noticed more patients coming back because the hospital was trying to make room for new patients by sending others home too quickly. As I mentioned, we also had more patients to care for, which led to more accidents like falls and pressure sores.

          As nurses, we were exhausted, irritable, and very stressed out. It felt like we needed a long break after just a couple of days of work. Call lights were always on, we were constantly putting on and taking off protective gear, and the sound of IV pump alarms was ringing in our ears even after we left work. We kept losing nurses because their families got sick or they found other jobs that paid more for the risks they were taking. Nobody cared if we got sick ourselves because we were needed to take care of patients. At one point, the hospital wanted us to come to work even if we had COVID-19, as long as we didn’t have a fever.

          It felt like forever until the hospital finally started doing something about the shortage of nurses. They realized they were losing money because they had to turn patients away when there weren’t enough nurses to care for them. So, they started hiring nurses from other places to help out. Because there weren’t enough nurses, the hospitals had to pay these traveling nurses whatever they asked for, sometimes using money from COVID-19 relief funds. This helped a lot with the staffing problem, even though we knew these nurses wouldn’t stay for long.

          Our hospital also began offering bonuses to nurses who stayed long-term and started a special unit just for COVID-19 patients, paying extra to those who worked there because it was riskier. This really helped because it meant we had fewer patients with COVID-19 mixed in with other patients, which meant less time spent changing in and out of protective gear. This made things less stressful and time-consuming for us. These changes really made a big difference.

          The 4.3 million registered nurses in the country are very important for taking care of people, improving healthcare systems, making sure everyone gets the care they need, and keeping the country healthy. Dealing with the shortage of nurses took time, but things have gotten better since the start of COVID-19. We still have challenges, but having fewer patients with COVID-19 has made a big difference. Nurses might not be the only ones working in healthcare, but they’re a really important part of it. Just like anyone else, we deserve to work in safe conditions, starting with having enough nurses to do the job properly. When there are enough nurses, patients get better care, and everyone is safer and healthier.

          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