Transforming Medicare Nursing Education
May 18, 2010
By Sheila P. Burke, RN, MPA, FAAN, Faculty, Harvard Kennedy School of Government; Sr. Policy Advisor, Baker Donelson
Since its creation in 1965, Medicare has provided support for nursing education. Back then, the majority of nurses were educated through hospital-based diploma programs.
Over the past 45 years, Americans’ health care needs have changed, and the nursing profession has responded to meet those needs. Americans are aging, experiencing more complex health conditions, and managing multiple chronic conditions. Simultaneously, their health care is increasingly delivered outside of hospitals, in an array of community settings—clinics, ambulatory care centers, and patients’ homes. Consequently, nursing education programs in our nation’s colleges and universities have gradually replaced hospital-based diploma programs, and the number of RNs graduating from diploma schools has declined. In 2007, only four percent of registered nurses were trained in hospital-based diploma programs.
Until recently, Medicare reimbursement for nursing education had not kept pace with our changing health care landscape, continuing to primarily invest nursing education dollars in diploma programs. But, with the passage of health care reform, also comes an important recognition that advanced practiced registered nursing (APRN) skills are needed for the Medicare population. APRNs, nurses with advanced graduate education and training, can provide primary care, chronic care management, transitional care and care coordination.
The Medicare Graduate Nurse Education Demonstration Program aims to increase the number of highly-skilled APRNs to care for Americans by providing $200 million to bolster the training of these key health care professionals.
It received little attention in mainstream health care media coverage, but what occurred was nothing short of transformative. The way Medicare pays for health care truly sets the bar for our entire health system. The Patient Protection and Affordability Care Act breaks the federal funding barrier for graduate nursing education and targets dollars toward educating nurses with the specific skills needed to meet the needs of Medicare recipients. In the end, patients and the nursing profession will be better for it.
Comments
I am a nursing educator in a "diploma" program - I am thinking the author is referring to ADN, BSN programs for entry level practice; use of the term "diploma" in the past has been for the 3 year programs that are connected to hospitals, not institutions of higher learning but I don't think that is what the author meant. In any event, as a product of ADN and then BSN with NP certificate and then MSN with FNP, where are these new nurses getting their clinical practicums? If we stop supporting entry level practice and start sending more and more dollars to advanced levels, we risk losing our clinical sites. Currently I am at least 10+ emails, 10+ phone calls and 10+ personal conversations trying to get the HMO where I have safely brought students for 4 years for their clinical experiences to respond to my request for dates and hours for Fall Semester. If these facilities are no longer getting money from Medicare to assist in the education of our ADN students, if this money is being shifted to advanced practice, the profession is truly going to suffer. ADN programs, without legislation, are not going away but we will "produce" a"product" with little clinical experience but license in hand for entry level into the profession. I hope nurse educators are advocating for appropriate hospital and clinical support whatever the end point degree because it is here that nursing education is really failing our students.
Great Article,
This is very useful information about Nursing Education
:)
Nursing Programs
Currently, Medicare funding for nursing education primarily goes to hospital-based diploma programs because this funding typically flows through hospitals. And when Medicare was first created, most registered nurses were educated in hospital-based programs. However, nursing education has drastically changed since then with all but 4% of RNs graduating from ADN and BSN programs, most of which receive no Medicare funding. As you point out, the country needs more highly skilled advanced practice registered nurses to provide primary care, chronic care management, pain management, and women's health care. That is why, in the Patient Protection and Affordable Care Act, Congress decided to test new funding for graduate nursing education the GNE demonstration project. This new stream for graduate-level nursing education does not affect the current funding for preparing RNs through hospital based-programs.
The issue you raise related to clinical placements is a serious one. The GNE demonstration project supports advanced practice placements, which should have little or no impact ADN or BSN placements. Nursing leaders in education and health care delivery need to continue and enhance collaborative efforts to address the clinical placement issue.
The Center to Champion Nursing in America is provided technical assistance in expanding nursing education to 31 states, including better utilization of clinical sites and simulated clinical experiences where appropriate. Clinical education is high on the priority list of challenges facing nursing education.
Nancy Ridenour
Dean and Professor
University of New Mexico College of Nursing
Good nurses are going to be highly demanded and only good well funded programs through funding can help train a new cohort of nurses who can keep up with the demand of a baby boom retiring generation who will no doubt place a big strain on our medical infrastructure. The funding for graduate level nursing should be considered independent for other funding including placing RNs through hospital based program. This new funding on the whole is net positive for nursing as it will advance the level and skills of nurses yet not jeopardize the existing funding in other programs.- MyFlorida.com
Nursing is one the best career option. Health care industry is one of the largest business. LPN programs has some best nursing courses in California.
Tomorrow's nursing education must be research based, and it is best taught by individuals who are prepared for the faculty role and who demonstrate competence in the multiple components of that role. Nursing education programs also must be designed to involve students as active participants in the educational enterprise, be flexible to meet constantly changing demands and individual student learning needs, be accessible and responsive to diverse student populations, and be accountable to the public. To these ends, new models of online nursing courses must emerge. We can no longer rely on tradition, past practices, and good intentions. Instead, recommendations for the adoption of proposed changes to nursing programs should emanate from evidence that substantiates the science of nursing education and provides the foundation for best educational practices.
I am happy to see Medicare funding finally wrestled away from hospitals to support Advanced Practice Registered Nurse education. Thank you to whoever was involved in the work to redirect funding to where it is better spent for the future instead of diploma programs.
Betty Gatten, RN, ADN, BSN, DNP/FNP student
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