How the Affordable Care Act affects nursing
The federal Affordable Care Act (ACA) won’t take full effect until 2014, but it already is having a big impact on the health care system in general and on the nursing field in particular, says Pat Kiley, an advanced practice nurse who teaches health care ethics in the University of Phoenix nursing program.
Here are five ways Kiley says the sweeping law is leading to new opportunities in nursing:
Advanced practice nurses are in demand.
A nationwide shortage of primary care providers inspired the Advanced Nursing Education Expansion Program, an ACA component that allocates $30 million to support academic training programs for nurse practitioners and certified nurse midwives. The funds help pay for instructors and for students’ housing and living expenses.
“Historically, money is the main driver of where nurses choose to work in the health care system,” notes Michael Grossman, a nursing management consultant who teaches in the nursing and health administration programs at the University.
While a shortage of qualified instructors and the potential loss of income during training once deterred many nurses from pursuing advanced practice certification, he says, “the ACA is now providing money to support the development of nurse practitioners, so naturally more nurses are considering that career path.”
More nurses will work outside hospitals.
The idea behind medical homes for the chronically ill is based on the law’s push to cut costs by moving more health care out of hospitals and into communities.
The ACA’s medical home pilot project provides funding to health care providers working together across disciplines and locations to treat chronically ill Medicaid patients. Private insurers are following suit. “[This policy] will make outpatient care more attractive for providers,” Grossman says, “which leads to a need for more ambulatory nurses.”
Nurses will be in short supply.
The law’s insurance mandate will bring more patients into the U.S. health care system than ever, and there won’t be enough nurses to handle the work. A shortage of 1.2 million nurses is projected by 2020, according to the U.S. Bureau of Labor Statistics. This will give nurses more choices in the type of work they do and where.
Providers are welcoming older patients.
Other key components of the ACA are new financial incentives for primary care providers treating Medicare patients, driving demand for geriatric nurses, Kiley notes.
“Ten years ago, most primary care doctors in my area would drop patients as soon as they turned 65 due to low Medicare reimbursement,” she says. “Now, you are seeing the exact opposite happen.” With an aging population and more money in the pool to care for them, she points out, doctors and hospitals want nurses who specialize in geriatric and hospice care.
New standards mean a new specialty.
Pay-for-performance programs under the ACA aim to improve the quality of care by compensating providers based on patient outcomes, not volume of services. The programs require adherence to complex clinical measures, which creates more work for nurses, notes Kiley, a legal nurse consultant. “All that paperwork takes nurses away from the bedside,” she says.
Meanwhile, increasing workloads will result in new opportunities for nurses, according to Grossman. “You’re going to see a new [nursing specialty] emerge from clinical performance measures.”