1. HEALTH CARE REFORM AND NURSING By Chelsey Giovanni

2. INTRODUCTION  The Patient Protection and Affordable Care Act (ACA)  New health care law- March 2010  Goals of ACA:  Decrease percentage of uninsured  Cut costs  Improve the quality of health care  https://www.youtube.com/watch?v=DGPOku5K_K4 https://www.youtube.com/watch?v=DGPOku5K_K4

3. OBJECTIVES  To determine where insured Americans are receiving care  Be able to identify one flaw of Health Care Reform  State one way that what health care reform impacts nursing

4. NURSING THEORY  James O. Prochaska’s Transtheoretical Model:  Determines individuals readiness to partake in a new healthy behavior  Because primary preventive services are covered, does this mean an individual will lead a healthier lifestyle?

5. ECONOMIC THEORY  Supply and Demand  Derived from K. Marx  As more patients enter the healthcare system there is a higher demand being placed on physicians and nurses in all health care fields.  Need for Advanced Practice Nurses

6. SUPPLY AND DEMAND  BLUE- Primary Care Providers  GREEN - Individual that is in general good health, had a primary care provider before health care reform  YELLOW - Individual that has a chronic health issue, but has been regularly seeing a primary care provider  RED - Individual that has newly obtained health insurance, has not seen a primary care provider in recent years

7. HEALTH CARE ENVIRONMENT  Currently :  42% of annual visits for new health care issues are made to an individuals primary care provider  28% are seen in the Emergency Department  20% are seen at specialist  7% are seen at outpatient facilities

8. ROOT CAUSE ANALYSIS Lack of Education Previous Lack of Resources Chronic Medical Conditions Some American’s Remain Uninsured Inappropriate utilization of health care Large influx of newly insured Lack of Primary Care Physicians

9. INFERENCES & CONSEQUENCES  Stress on health care professionals  Increase in Stand Alone or Urgent Care Clinics  Nurse managed walk in clinics  Increase in Nurse Practitioners

10. RECOMMENDATIONS FOR QUALITY & SAFETY IMPROVEMENTS  QSEN  Patient Centered Care  Teamwork and Collaboration  Informatics

11. RECOMMENDATIONS FOR QUALITY AND SAFETY IMPROVEMENTS DNP ProgramCost Per Credit Hour Oakland University637$ Michigan State University646$ Grand Valley State University690$ University of Michigan720$

12. ANA STANDARDS  Standard 3. Outcomes Identification  Standard 4. Planning  Standard 5. Implementation

13. REFERENCES  American Nurses Association (2010). Nursing: Scope and Standards of Practice, 2 nd Edition. Silver Spring, MD: Nursebooks.org; (p.9-10)  Auerbach, D. I., Staiger, D. O., Muench, U., & Buerhaus, P. I. (2013). The nursing workforce in an era of Health Care Reform.The New England Journal of Medicine, 638, 1470-1472.  Bicki, A., Silva, A., Joseph, V., Handoko, R., Rico, S. V., Burns, J., & Simonelli, A. (2013, December). A nurse-run walk-in clinic: cost effective alternative to non-urgent emergency department use of uninsured. Journal of Community Health,38(6), 1042-1049.  Koh, H. K., & Sebeilus, K. G. (2010, September 30). Promoting primary prevention through the affordable care act. The new England Journal of Medicine, 363, 1296-1299.  Pitts, S. R., Carrier, E. R., Rich, E. C., & Kellermann, A. L. (2010, September). Where Americans get acute care: Increasingly, it's not at their doctor's office. Health Affairs, 29(9 1620-1629.  Pre-Licensure KSAS. (2014). In QSEN Institute. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/ http://qsen.org/competencies/pre-licensure-ksas/  The Affordable Care Act- About the Law. (2014) U.S. Department of Health and Human Services. Retrieved from http://www.hhs.gov/healthcare/rights/