1. The Health Care Delivery System

2.  Mechanism for providing services that meet the health-related needs of individuals. major focus on quality and patient safety  Nursing is a major component of the U.S. health care delivery system.

3.  Quality/safety ◦ Evidenced based practice (EBP)  QSEN Standards  NLN Standards  Core Measures ◦ Safety standards (JCAHO)  Leapfrog group ◦ Emergency preparedness  Triage is the key ◦ Scientific and technical advancements  Robots, machines to do nursing work ◦ Hospitalists programs  Work with the nursing staff, part of hospital—not independent

4. ◦ Information technology  Improves nursing quality  Reduces costs  Enhances work flow  Allows for use of best practices ◦ Demand for quality care  Public well informed….or misinformed  Individual appraises nursing actions  Unit outcomes.

6.  Federal Level ◦ U.S. Department of Health and Human Services (DHHS)  State Level ◦ Department of Health

7.  Local Level Health Units ◦ Communicable disease control ◦ Health records maintenance ◦ Individual health services ◦ Environmental health and safety ◦ Public health education

8.  Hospitals  Extended care facilities  Home health agencies  Hospices  Outpatient settings.

9.  Schools  Industrial clinics  Managed care organizations  Community nursing centers  Rural primary care hospitals.

10.  Private Insurance  Managed Care ◦ Primary care providers ◦ Health Maintenance Organizations (HMOs) ◦ Preferred Provider Organizations (PPOs)  Company Self pay policy ◦ Alegent system.

11.  Federal Government Insurance Plans ◦ Social Security Act 1965 ◦ Medicare Medicaid ◦ Regulated by Centers for Medicare & Medicaid Services (CMS)

12.  Medicare ◦ Individuals over age 65 ◦ Public funding ◦ Permanently disabled individuals ◦ Individuals with end-stage renal disease.

13.  Medicaid ◦ Medically indigent ◦ Determined by federal and state governments ◦ Inpatient and outpatient hospital services ◦ Physician services ◦ Laboratory services ◦ Rural health clinic services

14.  Cost  Access  Quality.

15.  Four major factors increase the cost of health care ◦ An over supply of specialized providers ◦ A surplus of hospital beds ◦ The passive role assumed by most consumers ◦ Inequitable financing of services

16.  Prohibitive costs for employer to provide  Inability to obtain individual insurance  Cultural barriers  Persons with preexisting conditions  Shortages of health care providers  Limited access to ancillary services.

17.  Estimated that 30% to 40% of diagnostic/medical procedures performed in U.S. are unnecessary  Inappropriate use of resources  U.S. per capita healthcare spending= $8,000 ◦ (2008 stats)  Institute of Medicine (IOM) report ◦ Change recommendations for nursing/healthcare access  BSN at bedside  Ability to share patient info across all points of entry  EPIC.

18.  Positive Perception of Nurses ◦ Nurses are persistently seen as having the highest standards of honesty and ethics. ◦ The public believes that if nurses were allowed to use their skills, they would significantly enhance quality and reduce costs.

19.  Nursing shortage  Loss of control over health care decisions  Decreased use of hospitals  Changing practice settings  Ethical issues  Vulnerable populations ◦ Children, elderly, chronic disease. homeless

20.  Nursing Shortage: By 2020 the workforce is forecast to be 20% below requirements. ◦ Fewer people entering the profession ◦ Aging of the nursing population ◦ Other career options offering greater remuneration

21.  Loss of Control ◦ Consumers express a loss of personal control within the health care system. ◦ Some feel terrorized by the system. ◦ Many American workers state that their greatest concern is the possible loss of health care coverage.

22.  Decreased use of hospitals ◦ Shorter lengths of stay ◦ Technologic advances ◦ Greater availability of outpatient facilities ◦ More services available in outpatient settings ◦ Expectations/demands of third-party payers.

23.  Changing Practice Settings ◦ Most nurses currently practice in hospitals and will continue to do so in the future. ◦ There is an ever-increasing need for expanded services and settings. ◦ Larger numbers of nurses will be needed for primary care, public health, extended care facilities, and the home setting..

24.  Ethical Issues ◦ At present, citizens’ needs are greater than available resources. ◦ The United States is struggling with major ethical conflicts over allocation of scarce resources versus compassionate quality care..

25.  Discharge planning ◦ Assess needs, coordinate referrals, length of stay, evaluate progress, arrange for equipment /supplies  Social services ◦ Assess needs, assist with application for aid, evaluate discharge environment and care giver support  Utilization review ◦ Track length of stay, review resources used, evaluate level of care and placement

26.  Facilitate high quality patient care  Encourage high patient satisfaction  Promote better outcomes.

27.  Assign workers  Supervise care givers  Know practice act for state, job descriptions  Are accountable  Evaluate if delegation was successful. 2- 27

28.  Nurses continue to advocate for ethical distribution of resources as health care reform progresses.

29.  Nursing’s Agenda for the Future is a plan that focuses on strategies to improve professional conditions for nurses and quality of health care by 2010.. 2- 29

30.  Major overhaul of healthcare system ◦ ‘donut hole’ protection for seniors- rebate to supplement drug coverage max ◦ Eliminating pre existing restrictions ◦ Increasing age to 26 to be covered on parent’s plan ◦ Eliminating insurance dropping ◦ Increased tax on tanning (tax goes to cancer research) ◦ healthcare.gov website transparency ◦ New food labeling Source: Nursing Now! 2010

31.  Tax credits for small business providing insurance to <50 employees  Reduced out of pocket expenses for employees  2 year temporary credit for research into new therapies..

32.  Eliminating pre existing for adults  Eliminating increased ins. Payment based on gender or health status  No lifetime caps  Increased payment for medicare to rural hospitals  Options of coverage thru state run exchanges.

33.  Preventative care with no copay

34.  Leadership and planning  Delivery systems  Legislation/ ◦ Regulation policy  Professional/nursing culture  Recruitment/ retention  Economic value  Work environment  Public relations/ communication  Education  Diversity.

35.  Standards of care  Advanced practice  Public versus private programs  Public health  Community health  School nursing  Long-term care