Running Head: ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 1

Role of Nursing Professionals in Healthcare Reform

Brittany Thompson
Auburn University School of Nursing
ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 2
Abstract
The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23,
2010, and initiated the most significant changes in United States healthcare delivery since
Medicare was established in 1965. A projected 32 million additional Americans will be provided
insurance coverage under this legislation, which calls for a radical transformation in all areas of
care delivery. Nurses make up the largest portion of the healthcare workforce and will act as
fundamental participants in the achieving the vision of healthcare reform outlined in the PPACA.
In order to meet the ever-increasing patient demand, the Institute of Medicine (IOM) released a
report that called for a complete renovation of the American care delivery system, with emphasis
on the advancement of nursing practice. Healthcare reform marks a turning point in the evolution
of the nursing profession, and at the forefront of this evolution is the American Nurses
Association (ANA). The ANA has been a long-time supporter of reform and the expansion of
care availability. In order for reform efforts to succeed, nurses must have a strong voice and take
advantage of their ability to positively impact the quality and safety of patient care. This paper
explores the role of nursing professionals in the reconstruction of the care delivery system in
order to improve the level of care and further elevate nursing practice.
Keywords: Healthcare Reform, Patient Protection and Affordable Care Act, Institute of
Medicine, American Nurses Association, nursing practice, nursing profession










ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 3
Role of Nursing Professionals in Healthcare Reform
Introduction
The healthcare policy reform effort has been a pressing concern in United States
legislation for decades. The Patient Protection and Affordable Care Act was signed into law on
March 23, 2010 following a century long debate on the governments role in providing
affordable care. The Patient Protection and Affordable Care Act is surrounded by controversy
and political disagreement. However, there is no question that the current United States
healthcare system is unsustainable due to the increasing costs, patient volume, and level of
acuity. In this evolving system, it is essential that nurses actively engage in the reform process
and take advantage of the opportunity to positively influence the quality and safety of patient
care.
The purpose of this paper is to examine the role of nursing professionals in healthcare
reform in order to provide quality patient care and elevate the nursing practice. The analysis of
this role is crucial in determining the future progression of the nursing profession. Professor
Peter Buerhaus of Vanderbilt University School Of Nursing recently stated, Over the next
decade, nurses will either accept greater accountability for clinical and economic performance, or
the profession will decline (ANAs Health System, 2010, p. 15).
The American Nurses Association and Health System Reform
The American Nurses Association, or ANA, is the only full-service professional
organization that represents the entire population of registered nurses in the United States. The
ANA is at the head of all healthcare policy initiatives pertaining to healthcare reform. American
Nurses Association defines healthcare as a basic human right that should be accessible to all
individuals. They believe that all people should have a standard package of essential healthcare
ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 4
services, and care provided should be affordable, available, and acceptable (ANAs Health
System, 2010).
In order to successfully restructure the United States health system, the ANA believes
that healthcare must move away from the liberal use of expensive, technology-driven services.
The system cannot rely on hospital-based services alone, but move to a more balanced approach
that is based on preventative services and community-based care. In 2008, ANAs Health System
Reform Agenda was published in order to reflect these beliefs on healthcare reform (ANAs
Health System, 2010).
The Patient Protection and Affordable Care Act of 2010, or PPACA, is in alignment with
many of the ANAs beliefs on healthcare reform. The American Nurses Association has been a
long-time supporter of health care reform and its efforts to expand access to care and protect
consumers. The ANA publically announced their support of the legislation following the
Supreme Court ruling that the PCAA was, in fact, constitutional law (ANA, 2012.)
The PPACA addresses the ANAs goals of making healthcare more affordable, available,
and acceptable, while also steering the health system towards community-based services and
preventative medicine. Initiatives to make care more affordable include providing assistance on
health insurance costs through subsides and credits, as well as the expansion of Medicaid for all
citizens under sixty-five with an income below 133% of federal poverty level. The PPACA
strives to increase the availability of care by prohibiting insurer discrimination and insurance
rating variability based on gender or health status. PPACA promotes cultural competence and the
development of a diverse work force in order to improve the acceptability of care. Finally,
funding for community health centers and programs to start nurse-managed and school-based
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health centers are all initiatives by the PPACA to move the system away from the overuse of
expensive, hospital-based services (ANAs Health System, 2010).
Although many of the initiatives implemented by the Patient Protection and Affordable
Care Act are in alignment with the goals of the American Nurses Association for health system
reform, the PPACA does raise some concern in the world of nursing professionals. Several
leaders in the nursing profession warn against the increasing stress and patient load and its effect
on safe, effective care. The nursing shortage and insufficient staffing have been proven to
negatively impact patient outcomes. While the ANA does support the expansion of healthcare
availability, there are noteworthy concerns around the logistics of providing quality care to the
increasing patient volume without a significant increase in nursing staff (ANAs Health
System, 2010).
Reform and the Future of Nursing
The Patient Protection and Affordable Care Act implements some of the largest
healthcare delivery changes to date and is projected to provide insurance coverage to
approximately 32 million additional citizens that were previously uninsured. These radical
changes will require a total transformation in all areas of care delivery, especially in the nursing
profession, which makes up the largest portion of the healthcare workforce. Nursing
professionals will shoulder increasingly prominent roles in all aspects of care delivery and act as
fundamental participants in achieving the vision of healthcare reform outlined in the PPACA
(Dykema-Sprayberry, 2014).
The Institute of Medicine, or IOM, released a report in 2010 that called for the complete
transformation of American healthcare delivery with a particular emphasis on the renovation of
nursing practice. The report gave tremendous recognition to the contribution of advanced
ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 6
practice nurses to meet the ever-growing patient demand, and also proposed immense changes to
nursing education, scope-of-practice, and role expectations. The IOM states four key elements in
elevating the nursing practice in order to transform the United States Healthcare System: Nurses
should practice to the full extent of their training and education, nurses should attain higher
levels of education through an improved education system that supports continuous academic
advancement, nurses should be complete partners with other health care professionals in
reshaping health care in the United States, and the improvement of data collection and
infrastructure in the nursing practice is required for effective policy making and workforce
planning (IOM, 2010).
Health System Reform marks a turning point in nursing practice and calls into question
the future direction of the profession. The increasing scrutiny and changing practice standards
pose a risk of increasing job dissatisfaction, burnout, and the perception that ritualistic rules and
regulations are more valuable to patient care than professional knowledge and clinical
proficiency (Nerf, Cimiotti, Heusinger, & Aiken, 2011). A pertinent question in the mist of these
vast changes will be how to equip both current and future nurses with the professional pride,
intelligence, and commitment to respond to the abundance of mandates and policies
implemented. The answer to this question lies in the quality of nursing leadership during this
time of radical change. The principles of transformational leadership must be implemented by
nursing executives in order to execute the changes mandated and empower nursing professionals
in the process (Dykema-Sprayberry, 2014).
In response to the immense changes of healthcare reform, members of the nursing
profession must consider both traditional and contemporary roles in advancing the practice to
meet the ever-changing needs in system. Traditional roles such as direct-care, or bedside nurse
ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 7
play an essential role in patient care delivery and cannot be diminished or abandoned. The
formidable force to expand and advance the nursing practice poses a danger of focusing entirely
on progressive roles with the unintended consequence of devaluing the traditional role of direct-
care nursing that is fundamental to the practice. It is crucial to maintain direct-care nursing with
dignity and empowerment to use clinical reason and nursing theory as the practice continues to
transform in the future (Dykema-Sprayberry, 2014).
Nursing Role in Healthcare Reform Influence on Quality Care
The PPACA strives to improve the quality of care in order to improve patient outcomes
and avoid unnecessary costs. Healthcare facilities will now be rewarded for quality care and
patient satisfaction. Quality Care Initiatives and National Patient Safety Goals play a vital role in
increasing the sustainability of the American Healthcare system and are outlined by the PPCA
and IOM. These changes greatly affect nursing professionals because nursing practice has a
direct influence on patient outcomes and quality of care (Dykema-Sprayberry, 2014).
These quality initiatives and safety goals provide nurses with great challenge and
opportunity to impact patient care. Some examples of nursing-sensitive quality indicators include
patient wait times, satisfaction rates, medication errors, healthcare-associated infections, pressure
ulcers, falls, failure to rescue, and increased length of stay. In order to achieve quality
improvement, nursing professionals must develop a vision of care that is grander than task-
completion and complacent adherence to concrete rules and regulations. It is vital that nurses
take pride in their profession and be accountable for providing excellent care. The flood of new
policy and mandates make it more important than ever to remember that each encounter with a
patient has therapeutic value that the nurse is uniquely equipped to provide. Nurses cannot allow
ROLE OF NURSING PROFESSIONALS IN HEALTHCARE REFORM 8
concrete regulations and benchmarks to interfere with critical thinking and clinical evaluation of
each patient to individualize care (Dykema-Sprayberry, 2014).
Shared decision-making and the transformation of intraprofesional relations is another
component of healthcare reform implemented to improve quality. This initiative to move away
from the traditional medical model and towards the idea of shared-decision making plays a vital
role in improving quality and patient outcomes. It takes full advantage of nursing knowledge and
requires that nurses play an active role in planning, implementing, and evaluating patient care.
Shared-decision making also requires nurses to remain informed of current political and
economic realities in healthcare in order to be apart of the evaluation of the organizations
strategic response (MacPhee, Wardrop, & Campbell, 2010).
Conclusion
Despite the controversy and political argument surrounding the Patient Protection and
Affordable Care Act, we as nursing professionals cannot ignore the inevitable evolution of the
American healthcare system. The PPACA initiates some of the most extensive changes in
healthcare to date and serves as a turning point in all areas in care delivery. Nurses will be on
the frontlines of implementing mandated initiatives from this healthcare legislation. It is more
crucial now than ever for nurses to remain abreast of current healthcare policy and economics in
order to have a strong voice in the reconstruction of the healthcare system. During this time of
vast change, nurses must assume a higher level of responsibility for both clinical and financial
performance in order to continue the advancement of nursing practice.



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References
American Nurses Association. (2012). Affordable Care Act is Still the Law. The American
Nurse, 44(4), 1.
ANA's Health System Reform Agenda Alignment with Patient Protection and Affordable Care
Act (PPACA) of 2010. (2010). Virginia Nurses Today, 18(3), 15.
Dykema-Sprayberry, L. (2014). Transformation of America's Health Care System: Implications
for Professional Direct-Care Nurses. MEDSURG Nursing, 23(1), 61-66.
Institute of Medicine (IOM). (2010). The Future of Nursing: Leading Change, Advancing
Health. Retrieved from http://www.iom.edu//reports/2010/the-future-of-nursing-leading-
change-advancing-health.aspx
Nerf, D., Cimiotti, J., Heusinger, A., & Aiken, L. (2011). Nurse Reports from the Frontlines:
Analysis of a Statewide Survey. Nursing Forum, 46(1), 4-10.