Catherine Hrycyk, MScN, RN Healthcare in USA / Advocacy for Better Care and Advancement of Profession Catherine Hrycyk, MScN, RN

USA Healthcare System Dominated by private insurance Lack of universal access: The only developed country without universal access Large fraction of population under- and uninsured High costs of care: Availability of of the most advanced technologies 17.6% of GDP (highest in the world) Outcomes lagging in spite of high costs Other healthcare systems have better outcomes with much less spending

Categories of Health Care Services Health promotion Illness prevention: Primary Secondary Tertiary Diagnosis and treatment Rehabilitation and long-term care

Health Promotion and Maintenance Goals: Remain healthy Prevent diseases and injuries Promote healthier lifestyles Assumption: Patients who adopt healthy behaviors are more likely to avoid certain illnesses These services require patients’ active participation.

Prevention Illness prevention services address health problems after risk factors are identified Three levels of prevention: Prevention of disease Early detection Prevention of complications and/or disability

Diagnosis and Treatment Modern technology helps refine methods of diagnosing and managing illnesses Examples: Imaging and detection of cancers Minimally invasive surgery High-technology services can lead to dehumanization of patients

Rehabilitation and Long-term Care Rehabilitation services help restore the patient to the fullest possible level of function and independence after injury or illness Rehabilitation with disease management services focus on helping patients understand and manage chronic conditions Long-term care provides services that the patient or family cannot provide but at levels that maintain individual independence as long as possible

Health Care Agencies Government or voluntary agencies Federal agencies State agencies Local agencies Voluntary (private) agencies and non-government organizations “Not-for-profit” or “for-profit” agencies

Level of Services Provided Primary care services – when the patient first enters the health care system Examples Goals Entry into the system Emergency care Health maintenance Management of long-term and chronic conditions Treatment of temporary health problems that do not require hospitalization

Level of Services Provided Secondary care services – management of a condition by a specialist after being referred by a primary care provider. Examples: Tertiary care services – provided to acutely ill, those requiring long-term care, those needing rehabilitation services, and the terminally ill Examples Quaternary care – research facility. Uncommon.

Level of Services Provided Subacute care services – goal-directed, comprehensive, inpatient designed for acute illness, injury, or exacerbation of disease process Goal: Provide lower cost health care and create a seamless transition of patients moving through the health care system

Maintaining Quality in Health Care Accreditation of health care agencies CMS approved two accrediting bodies The Joint Commission Healthcare Facilities Accreditation Program Goal of accreditation: Improve patient outcomes CMS – Centers for Medicare and Medicaid Services

Maintaining Quality in Health Care Agencies Continuous quality improvement and total quality management These systems focus on establishing procedures for ensuring high- quality patient care. Performance improvement

Health Care Disparities: A Continuing Challenge Health care disparities are differences in access to and the quality of health care provided to different populations. Causes of disparities Race, ethnicity, gender, age, income, education, disability, sexual orientation, and rurality Provider bias (Agency for Healthcare Research and Quality, 2013)

Nurse’s Role on the Health Care Team Provider of care Educator Manager Researcher Collaborator Patient advocate

Advocacy for Better Care and Advancement of Profession Power, Authority, and Influence Power – strength or force that is exerted or capable of being exerted Authority – legitimacy to exert power Influence – process of producing effects on action, behavior, and opinions of others Examples?

Policy Health policy – private or public rules, regulations, laws, or guidelines that relate to the pursuit of health and delivery of health services Policy decisions reflect the values and beliefs of those making the decisions Public officials act on the interest of their constituents to support passage of laws and development of policies. Professional organizations

Politics Politics is a process of influencing the allocation of resources Policies are decisions Politics influences those decisions. Stakeholders – individuals with vested interest Example: To increase funding for nursing scholarships, stakeholders lobby state legislators.

Linking Practice, Policy, and Politics Florence Nightingale worked with Sir Sidney Herbet, Secretary of War Lavinia Dock found ANA, pressured hospital administrators to improve working conditions, and galvanized support for nursing licensure (Lewenson, 2007). Karen Daley and needle stick injury – influence public officials to make nursing practice safer.

How Policy Influences Nursing Practice Laws define nursing practice Periodic need to influence lawmakers to modify the nurse practice act to reflect current clinical practice NPs reimbursement, autonomy, and prescription writing FDA sets rules for administering and documenting the administration of narcotics. Need to influence legislators regarding broader issues like pay equity, staffing ratios, etc. FDA – Food and Drug Administration

Professional Organizations Nurses join organizations to Network with colleagues Pursue continuing education and certification opportunities Stay informed on professional issues Develop leadership skills Influence health policy Work collectively for job security

Professional Organizations Reasons why nurses do not join organizations: high cost of dues, lack of time, and lack of interest Less than 10% nurses are members of ANA. Only 20% nurses belong to a specialty nursing organization. Types of organization Broad-purpose professional organizations Specialty practice organizations Special interest organizations

Professional Organizations The mission statement is generated by the membership and defines the organization’s purpose and goals and who is served by the organization. ANA Mission Statement: Nurses advancing our profession to improve health for all ANA Goals: “fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public”

Nurses and Unions Nurses may choose to join unions to Work collectively Have control over their practice and workplace Work to equalize power between management and staff National Labor Act and overseen by National Labor Relations Board Issues in contract negotiations: staffing, work assignments, and shared governance

Nurses and Unions Nurses wonder whether they should join unions. Closed shop – the management is required to bargain with the union and union membership is required as a condition of employment. Open shop – employees are not required to join but in which an individual’s contract will be dependent on what the union and management have negotiated. “Right to work” states – the value system of work culture is less supportive of union affiliation.

Benefits of Joining a Professional Organization Developing leadership skills NSNA Leadership University Nursing Alliance Leadership Academy Certification and continuing education ANCC offers a range of certifications

Benefits of Joining a Professional Organization Political activism Nurses depend on activism to protect their interests Direct reimbursements for NPs RN staffing Organizations with legislative agenda Coalition to support specific issues Health Care Without Harm

Benefits of Joining a Professional Organization Practice guidelines and position statements ANA on blood-borne and airborne diseases ANA Code of Ethics for Nurses (2015) Other benefits include: Access to journals, newsletters, and action alerts about particular topics that need immediate response, eligibility for group health and life insurance, networking with peers, continuing education opportunities, and discounts on products and services (car rentals, computers, or books) Deciding which organizations to join