NR 447 Week 1 Discussion – The Changing Aspects of Healthcare

Following the implementation of the Affordable Care Act (ACA), we treat every patient with the goal of fixing or managing their problem and teach methods to continue their care outside the facility. We have initiated checklists for chronic diagnoses such as MI, Stroke, CHF, etc., where we initiate these treatments in our facility and then ensure that they will be provided to the patient following discharge. With the ACA, according to Finkelman, “There is greater emphasis on teams, quality, efficiency, care coordination, and evidence-based practice (EBP). Leadership is needed to lay the groundwork, support changes, provide guidance to staff, and engage staff in the improvement processes at all levels of the healthcare delivery system, working actively with other healthcare professionals” (pg.3). Nurses, as well as case managers, have to utilize Evidence-Based Practice to render appropriate care, tests, labs, and medications to optimize the time the patient stays in the hospital and keep the patient from returning for the same diagnosis. If patients return for the same reason, then hospitals will not get paid for the treatment provided. I feel as though the implementation of the ACA has increased the number of people that come to the emergency room (ER) for treatment that could be provided at a primary care setting such as a doctor’s office. According to the article Emergency Department Use Across 88 Small Areas after Affordable Care Act Implementation, they found “A recent statewide analysis of ACA effects on Illinois ED visits for the 18- to 64-year-old population found an approximate 5% increase in ED visits above and beyond pre-existing time series trends in the two years after full implementation of the ACA” (pg. 812). They also discussed that they are unsure that this increase will change due to the availability of acquiring primary care with the utilization of the ACA. Hopefully, with more access to primary care, the number of emergency visits will decrease; however, I feel this is unlikely because patients want quick results and quick answers. My coworkers have felt the strain of the workflow lately in regard to the number of people coming to our facility. We are a small hospital with 88 beds, and lately, all floors have been at their max, requiring nurses to take their full load of patients. We’ve had situations in which we discharge a patient, and even before that patient has left, the bed is already assigned. The rate of retainment for nursing staff is low in my facility due to the high acuity and influx of patient flow with minimal staffing.

References:

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.

Feinglass, J., Cooper, A. J., Rydland, K., Powell, E. S., McHugh, M., Kang, R., & Dresden, S. M. (2017). Emergency Department Use across 88 Small Areas after Affordable Care Act Implementation in Illinois. Western Journal Of Emergency Medicine: Integrating Emergency Care With Population Health, 18(5), 811820. doi:10.5811/westjem.2017.5.34007

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