Blog
Aug 25, 2010
By Tina Johnson, CNM, MS
Director, Professional Practice & Health Policy
American College of Nurse-Midwives
The Patient Protection and Affordable Care Act will bring millions of newly insured citizens into the health care system. In order to meet the country’s needs, leaders are calling for high value, evidence-based solutions. Let’s start with the health condition that affects 100% of all Americans...childbirth! How can we provide high quality, high value maternity care for all women and families? The answers are in the evidence: midwifery care improves maternal and newborn outcomes and patient satisfaction, reduces health disparities, and saves money and resources.
The U.S. grossly outspends every other nation per capita on health care, yet our maternal and newborn outcomes lag far behind those of other developed nations. Childbirth is the number one reason for hospitalization, and its related hospital charges surpass those of any other health condition. Resource-intensive interventions like labor induction, epidural analgesia and cesarean section are overused, often without indication or consideration of alternatives, resulting in increased risk of maternal and newborn harm.
Cesarean section is the single most common operating room procedure in the U.S., and the rate is steadily climbing. Incredibly, in 2007, nearly one-third of American women delivered their babies by cesarean section. Maternal mortality has risen dramatically, and glaring racial disparities in maternal and neonatal outcomes persist.
How can we reverse these disturbing trends? Ensure that all women have access to maternity care providers and practices that support the normal processes of birth. Labor support, freedom of movement, intermittent monitoring, alternative birth settings, vaginal birth after cesarean...all have been identified as evidence-based practices that are underused.
Midwives truly are the experts in supporting healthy vaginal birth in all settings. Midwives caring for low-risk women improve infant mortality rates in both hospitals and birth centers when compared with physicians caring for equally low-risk women. Midwife-led models of group prenatal care reduce preterm and low birthweight rates and improve patient satisfaction. Birth centers provide improved outcomes for even the most at-risk women, reducing preterm birth, low birthweight and cesarean section rates, and reducing costs to our health care system. Skilled midwifery care is the gold standard among nations with the best maternal and neonatal outcomes, and has been identified as essential to reducing maternal mortality worldwide.
It’s time to bring that message back home. The time is now to promote and support midwifery in America--and to follow the evidence.
Visit the American College of Nurse- Midwives to learn more about their activities and join the conversation at Midwife Connection.
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Aug 16, 2010
By Rebecca Hendren
HealthLeaders Media
August 10, 2010
It's that time of year again. Graduating nursing students are preparing to take the NCLEX and are looking for their first jobs. This year, many are finding those first jobs in short supply.
Reports are rampant of new graduates being unable to find open positions in their specialty of choice, and even more shockingly, many are finding it tough to find any openings at all.
These new RNs entered school with the promise that nursing is a recession-proof career. They were told the nursing shortage would guarantee them employment whenever and wherever they wanted.
So what happened? Has the nursing shortage—that we've heard about incessantly for years—suddenly gone away?
The short term answer is clearly yes, although in the long term, unfortunately, the shortage will still be there.
The recession has brought a temporary reprieve to the shortage. Nurses who were close to retirement have seen their 401(k) portfolios plummet and their potential retirement income decline. They are postponing retirement a few more years until the economy—and their portfolios—pick up.
Many nurses have seen their spouses and partners lose their jobs and have increased their hours to make ends meet for their families. Some who left the profession to care for children or for other reasons have rejoined the workforce for similar reasons.
In addition, many hospitals are not hiring. The recession brought hiring freezes to healthcare facilities across the country, and many are still in effect. Help wanted ads for healthcare professionals dropped by 18,400 listings in July, even as the overall economy saw a modest increase of 139,200 in online job listings.
Organizations that are hiring may simply have positions for fewer new grads than in the past. This leads to fears that new grads will accept positions simply to have a job, and then jump ship when something better comes along. The chief nursing officer of a Kansas City hospital told me her organization is trying to protect against that by taking extra care when screening new graduates. Instead of just one interview, they now bring candidates back for a second interview to ensure they are really committed to the organization before they are hired.
They also offer a nursing residency program that helps bridge the gap between school and practice and provides the mentoring and support needed to thrive at the organization.
In rural areas, hospitals worry that recent graduates who can't find a job will move away. Some organizations take the view that it's better to get new grads into the system in some capacity, even if not a perfect fit, and then accept internal turnover as positions come along. This allows the organization to nurture the new nurses and build their engagement by focusing on their professional development and proving they are committed to the growth of the nurse within the organization.
Once the economy improves, many of these issues will go away and new grads will once again have their pick of opportunities. And in the not-too-distant-future, the aging population will prove that the nursing shortage never really went away.
Reprinted with permission. © 2010 HealthLeaders Media, www.healthleadersmedia.com.
Aug 12, 2010
By Andrea Brassard, DNSc, MPH, FNP, Strategic Policy Advisor, Center to Champion Nursing in America at AARP
In my role as Strategic Policy Advisor for the Center to Champion Nursing in America, I think daily about the need to expand consumer access to advanced practice registered nurses (APRNs). But it is when I put on my clinician hat (or rather white coat) that I see the critical link that must be made between ensuring APRNs can provide the services for which they are trained and experienced and ensuring that Americans have access to health care coverage. This was never clearer than last week when I volunteered at the DC Cares Free Clinic, sponsored by the National Association of Free Clinics. More than 1,000 people came to this one-day free health clinic to get the basic health services they can't afford or are otherwise denied because they have no insurance. The District of Columbia has 57,200 residents without insurance—and there are millions of uninsured in nearby Maryland and Virginia.
As a nurse practitioner, I was there as a clinician to provide primary care assessment, diagnosis and to work with patients on developing treatment plans. At the DC Cares Free Clinic, nurse practitioners and physician assistants worked side by side with physicians, each clinician providing primary care to the more than 1,200 patients we saw that day. In the District, APRNs can practice independently; that is, we can diagnose, prescribe and otherwise treat patients without physician oversight.
As I began to see patients, the experience underscored what I’ve long known—what patients without access to health care will do to get by and the health risks these actions pose.
The question—"what meds are you taking?" became "what meds were you taking before you ran out?" One man borrowed diabetic medications from his brother and friends. One woman who I’ll call Louise (not her real name) ran out of her thyroid medication just that morning. Louise told me that she has seen a veterinarian (for her cats) more often than a physician since she lost her job. I was able to write $4 and $10 generic prescriptions for Louise. Louise was 54 and had not had a mammogram in 3 years. She put off her last mammogram and then lost her full time job two years ago. I was able to refer Louise for a free mammogram (and a Pap smear) at Howard University Cancer Center. The other screening test that Louise needed is a colonoscopy, which is likely out of reach for her until she can obtain private health insurance, or until her “Welcome to Medicare” exam.
At the end of my shift I introduced myself to Nicole Lamoureux, Executive Director of the National Association of Free Clinics. Nicole and I recently were appointed to a Department of Health and Human Services Committee to review and update the criteria used to define medically underserved areas and health professional shortage areas. The committee was formed as part of the implementation of the Patient Protection and Affordable Care Act.
You would not think that the District of Columbia was a medically underserved area. Yet, according to the DC Department of Health, approximately 45% of the population of the District resides in a medically underserved area.
APRNs, such as nurse practitioners, should be an important point of access for our underserved communities. In fact, DC has the largest percentage of nurse practitioners per population in the nation. Karen Scipio-Skinner, the Executive Director of the DC Board of Nursing thinks that the large number of NPs per population is due to the District’s APRN rules and regulations. APRNs can practice in the District without the barriers found in other jurisdictions. They can practice independently without physician supervision or collaboration agreements and prescribe medications without protocol requirements.
This is good news for consumers of health care. The District, like a number of states across the country who also allow independent practice for nurse practitioners, is well-positioned to take advantage of more funding for primary care and community-based health centers found in the recently passed Patient Protection and Affordable Care Act.
