How can nurse practitioners help improve access to health care for the uninsured and underinsured?
American health care costs are skyrocketing every single year, and with no end in sight. While the Affordable Care Act of 2010 will do much to help improve access to health insurance for everyone, it will also take several years for all components of the legislation to take effect, and even then not everyone will be able to afford the health care coverage they need.
One of the many goals of the Affordable Care Act of 2010 is to shift more basic primary health care services from physicians onto nurse practitioners, in an effort to both reduce costs and increase accessibility. The growing shortage of primary-care physicians in the U.S. has made routine health care more difficult and expensive to obtain, while licensed nurse practitioners are increasing in numbers and also charge far less for their services than their physician counterparts.
Congressional Budget Office estimates project that once fully implemented, the Act will help reduce the numbers of the uninsured by 32 million people (from a current 45 million); however, care gaps will remain. Given all of these complicating factors, how can nurses and nurse practitioners leverage their current positions and influence to help address the health care crisis?
One way that nurse practitioners in particular can make a real difference in the short term is by volunteering their time and expertise to serve those in need. One University of Phoenix alum and faculty member — Thom Denhalter, RN, MSN, FNP-C — is doing just that.
Denhalter’s career in health care has humble roots. “I started out as an orderly on the night shift in a large regional hospital right after high school graduation,” he says. “The job was mundane, but I was allowed to hang out in places like the ICU and ER. I would spend every free minute reading charts and observing the nurses’ work and how they interacted.”
From that low-paying, mundane job right out of high school, Denhalter found his calling. After observing nurses at work while working as an overnight orderly, Denhalter completed his associate’s degree in nursing and went on to work as a staff nurse in ICUs, in urgent care, and even as a flight nurse for one of the biggest flight medicine operations in the United States. From there he obtained BSN and MSN degrees from University of Phoenix, as well as a Family Nurse Practitioner Certification, which has led him into some more cutting-edge practice areas. “As a nurse practitioner, my first job was working with a peripheral vascular surgeon,” he says. He has also worked in Cardiology, but his passion is working as a volunteer nurse practitioner at a free clinic that serves the uninsured.
“For the past four years I have volunteered as a nurse practitioner in a free clinic that has a mission of providing health care to some of the most clinically vulnerable populations in the U.S. — immigrant farm families,” says Denhalter. “When I first started volunteering, I was astonished by how ill many of our patients were — and yet, they were still working.”
To those who might think that nurse practitioners are not actually providing “real” medical care, Denhalter has this response: “One of our core philosophies [as nurse practitioners] is providing patient-centered care within a holistic framework that combines nursing care and traditional medical care,” he explains. “Nurse practitioners do physical exams, interpret diagnostic testing, prescribe medications and treatments, and are licensed and regulated by their respective states.”
Denhalter can share many anecdotes about the gravely ill, impoverished patients he treats. “I worked with a 62-year-old woman who came to the clinic with symptoms of a urinary tract infection (UTI),” he says. “Her blood pressure was 200/104 and her blood sugar was 400. She’d been diagnosed with diabetes mellitus years earlier but had stopped taking insulin because she couldn’t afford it. Treating her UTI was just the beginning, because chronic hyperglycemia feeds the infection, and her chronic hypertension also put her at risk for atherosclerosis, strokes, renal insufficiency and retinal problems. Unfortunately, she represents a big percentage of our patients.”
For Denhalter, providing free care to the poorest of the poor isn’t just about charity or giving back — it’s about the overall public health of the United States. “The growing number of uninsured Americans — totaling 45.7 million people as of 2007 — is taking a toll on the nation’s health,” he says. “One in five adults under age 65 and nearly one in 10 children are uninsured. Uninsured individuals experience much more risk to their health than insured individuals. This gap [in care access] results in needless illness, suffering and even death.”
Denhalter believes that the principle solution to our nation’s health care crisis lies with its nurses, and especially with its nurse practitioners. “Nursing has had a profound influence on my worldview,” he says. “Thirty years in nursing has taught me that there is little difference between me and my patients ... we all age and eventually become disabled or infirm in some way before we die.”
In addition, Denhalter believes that nurse practitioners are perhaps best-positioned among all health care providers to bring about changes in the system. “Working on the front lines of patient care, nurse practitioners can play a vital role in helping realize the objectives set forth in the Affordable Care Act of 2010,” he says. “This legislation represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs.”
Indeed, a joint study released in 2008 by the Robert Wood Johnson Foundation and the U.S. Institute of Medicine (IOM) led to a two-year initiative to help assess and reconceptualize the American nursing profession as a whole, specifically in terms of improving access to health care for all. One of the study’s principle recommendations was that nurse practitioners should be able to practice to the full extent of their education and training — something that is not always possible given a legislative and regulatory environment that currently favors physicians. “Turf wars, resistance of third-party payers to recognize nurse practitioners as independent providers and pay them accordingly, and restrictive state practice acts are constraining nurse practitioners from providing primary care services,” Denhalter says. “These barriers need to be overcome to ensure that nurse practitioners are well-positioned to lead change and advance health.”
More than any other, the biggest obstacles both nurse practitioners and patients face are rising costs and lack of access to care. “Medicaid and funding for community health expenditures are both being slashed,” Denhalter says. “We know from research and common sense that the longer patients delay their health care, the sicker they become and the more complex and expensive their health care becomes.” By volunteering his services in a free clinic, Denhalter hopes to use his advanced-practice nursing skills to make a small step in the right direction.
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