Health Problem in the State of Florida

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05.05.2020
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Abstract

There are efforts to realign the healthcare sector in order to ensure that it meets the increasing needs of a growing population as well as the demands for specialized healthcare for the elderly. Due to this fact, nurses are viewed as a possible solution to this challenge. However, their contribution cannot be realized in an environment, where they are continued to be judged as less qualified specialists for treating people. It has been proved by the research that preventing nurses from fully practicing authority exposes the healthcare sector to sufficient unnecessary costs, including the costs of medical errors and huge turnover rates that lead to huge recruitment expenses. Consequently, if these barriers are abolished, nurses will have better opportunities to provide their services in the underdeveloped areas and will be highly motivated. It will lead to a reduction in turnover rates. Therefore, the research recommends that the US Senate passes the laws that will allow qualified nurses to prescribe medication, so that they would be able to practice the art of caregiving in a more autonomous manner, thus helping the healthcare sphere to reach its goals of improving its functioning and delivering quality services.

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The core aim of the healthcare sector is to ensure that it is well-prepared for handling the demands of the public in different spheres. It means that the sector should change together with healthcare needs. Currently, according to the Healthy People 2020 (HP2020) and Affordable Care Act (ACA), the strategies focus mainly on the matters of healthcare quality and accessibility. The intention of the HP2020 is to ensure that the health services are accessible to all the people around the USA regardless of their area of residence. It is a goal that is aimed at improving health services in underdeveloped areas. Similarly, the ACA encourages health caregivers to ensure that the healthcare serves are both of high quality and accessibility. When meeting these two aspects, there is a need to ensure that there are health workers in all areas of the caregiving. Moreover, there is a need for the governing authorities to provide an environment that enables the nurses and other health caregivers to practice freely, basing upon their area of specialization. Nurses, for example, are the major workforce in the health sector, and they can be very helpful in improving its accessibility. They can also be helpful in improving the quality of healthcare, particularly in the underdeveloped areas if they are provided with the appropriate working environment. However, it has not been the case for many nurses in Florida, as it is not the case in other states, where they were constantly deprived of full practice authority, as they were supervised by other physicians during performing their duties (Hain & Fleck, 2014). When the scope of nursing practice is highly limited by barriers, it affects their ability to help the patients and makes it difficult for them to play their role in improving both the accessibility and the quality of the healthcare sector.

Problem Statement

Barriers to the full practicing authority of nurses represent a factor that jeopardizes the health care objective of improving both the accessibility and the quality of caregiving.

Literature Review

One of the greatest challenges, faced by the healthcare sector, is the shortage of caregivers that has made some people experience huge difficulties in accessing health services. However, this is a problem that can be solved if the nurses are given full authority to prescribe medications. In Florida, nurses were fighting for full practice authority and even took this issue to the Florida Senate, where they experienced a great resistance of the Florida Medical Association (Hatter, 2016; Hain & Fleck, 2014).The main reason for the denial of full practice authority was based on the qualification background of the nurses and the assertion that they were not qualified enough for having full authority in the treatment process (Hain & Fleck, 2014). However, with more nurses getting their bachelor’s degrees and with an increased number of advanced practice registered nurses (APRNs), this excuse is no longer valid. For instance, in Florida, medical doctors begin to indicate support for the idea of giving nurses full practice authority. Rep. Cary Pigman, who is a doctor in Florida, supports this idea and claims that nurses represent the needed extra qualified medical force that can help Florida’s health care sector to meet the increasing demands of a growing population with insurance cover (Hatter, 2016). Moreover, 505physicians, n= 505, participated in the research, and 70% of them were in support of the improved autonomy of the nurses, based on their training knowledge (Hain & Fleck, 2014, para.10). Similarly, the Institute of Medicine (IOM) agrees that there is a need to ensure that in the near future APRNs will be in a position, in which their practice will be limited only by their qualifications.

Due to the lack of any academic arguments for the continued denial of the nurses’ autonomy in the treatment process, the barriers were associated with the ongoing inequality between the genders in the society. The same point of view was outlined by Lugo in his assertion that the continued barriers to full practice were imposed by gender inequality (Lugo, 2016). The findings of the research proved that states upheld the detrimental policies that affected women in different spheres of life, such as, for example, domestic violence (Lugo, 2016). Moreover, it was also discovered that all those states that opposed giving full practice authority to the nurse also had fewer females in the public office. It led to the formulation of a hypothesis that the continued denial of a right to practice one’s qualification to the fullest extent is a gender issue (Lugo, 2016). This is a perception that highly discourages nurses and leads to the fact that many of them feel a lack of a clear career paths. This phenomenon has eventually led to high turnover rates in these restrictive states.

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After the expression of this assertion, more states have realized the potential impact of nurses on improving the health care services and, thus, have removed the state-based barriers. Some of the states that have followed this path include Nebraska, Maryland, and District of Columbia (Robert Wood Johnson Foundation, 2015). According to the International Council of Nurses, the only way any health care system can improve both the cost of operation and the quality of health care is by appreciating the critical role that the nurses can play in this sphere (Benton, 2012). Moreover, according to Benton (2012), these are the nurses who have daily contacts with patients, so they should be provided with better positions in the treatment process if there is a goal of achieving the patient-centered healthcare. Besides, there is an assertion that nurses are not only qualified enough to be guaranteed autonomy in the treatment process, but they also should be involved in the policy making. This idea is a reflection of the fact that good policymaking process takes into consideration the demands of the target population. According to Benton (2012), nurses, who are in constant contact with the patients, are able to gain crucial information that can help to create policies that will improve both the accessibility and the quality of the offered services.

Barriers to the full practice authority of the nurses highly jeopardize the quality of the given care. It happens due to the fact that nurses have to divide their time of caregiving between caring for the patient and meeting the scope of practice demands (Martsolf, Auerbach, & Arifkhanova, 2015). Therefore, states that have removed practice barriers enjoy an improved access to the health services, since the nurses are involved in the patient care rather than in concentration on meeting the unnecessary systemic demands. Another crucial impact of the barriers to full practice authority is resulted in extensive turnovers. These barriers highly undermine the autonomy of nurses and demotivate them, so that a majority of them decide to move to the states where they will have more freedom in their practice (Martsolf, Auerbach, & Arifkhanova, 2015). It is a problem that has led to a continued increase of costs in the healthcare sector, because some states are constantly hiring new nurses, which requires high expenses.

Another common finding of any research in the healthcare sector is the fact that the number of primary level caregivers is becoming small, comparing to the growing demands of the increasing population. Moreover, there is a potential problem of the aging population, which is also on the rise (Hain & Fleck, 2014). Therefore, these two parameters demand changes in healthcare policies. There is a need for the adoption of a model that would appreciate the role of each caregiver and which would make the spirit of cooperation normal for the health sector (Hain & Fleck, 2014). Nowadays nurses even experience discrimination under the state payments policies, due to the fact that for getting a reimbursement from nurse-managed centers they have to obtain a backing of a physician. This is a phenomenon that has made nurses to remain as employees in hospitals or entities run by physicians (Hain & Fleck, 2014). This is a problem that is linked to the fact that in many states nurses have not been perceived as revenue generators. It happened so due to the fact that nursing fees were not differentiated from the institutional fees or any other form of charge, included in the billing statement (Hain & Fleck, 2014). As a result, they continued to be perceived as less important players both in the management and in the treatment dimensions of the healthcare sector. However, the continued growth of demands in the healthcare sectors requires more caregivers, so that nurses form an essential part of the health care sector that has a huge potential of ensuring that both the accessibility and the quality of the health care sector are improved without investing unnecessary extra costs.

The same case applies to the State of Florida, where policymakers need to appreciate the insights provided by some physicians and doctors, who realize that the continued demand for putting nurses under the supervision of physicians needs to be abolished. With a right to prescribe treatment, nurses will support more primary level caregivers, thus bridging the deficit between the number of specialists required to meet the growing demands of Florida population and the actual amount of workers in the healthcare sector.

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Proposal for Change

Nurses need to be given full practice authority in order to practice their art of caregiving to the best of their knowledge. Consumer watching groups such as AARP are in full support of the independent nursing practices, whereby all qualified nurses have freedom that is necessary for decision making at the primary level care (Hain & Fleck, 2014). Therefore, in order to improve access to the primary level care in Florida and the other states, there is a need to treat nurses as equal partners in the healthcare sector. Therefore, the appropriate legislations need to be formulated and passed by the United States Senate.

Ordering of Medication and Registered Nurses’ Autonomy

The US Senate will be required to pass legislation that would allow nursing practitioners to have the authority to prescribe medications to the patients. It will be very helpful in encouraging the nurses to practice independently. Moreover, it will also require the banning of supervisory demands of physicians in the areas where nurses have a qualification. This law will be helpful in improving the accessibility of health care through the use of nursing services in underdeveloped areas. Last, the law will empower the registered nurses to give medications to patients in their area of specialization.

Nurse Licensure Compact

The US Senate will also need to enact a law on Nurse Licensure Compact. It will ensure that there is a uniform procedure across the states on how nurses can obtain and maintain different practicing licenses. The law will also be fundamental for formulating and maintaining a license coordination platform, which will include the information about registered nurses, so that they can be easily traced by authorities, interest groups, and nursing associations in areas of their practice. Moreover, having a clear guideline in the process of license granting will ensure that the full practice authority is given only to those registered nurses, who meet the established requirements. It will also provide the basis for the creation of a reporting system, whereby member states can share crucial information on the licensed nurses that is an important undertaking, which will safeguard the health of the patients.

Impact

By allowing nurses to practice independently without controlling their activities and giving them the power to prescribe the controlled substances, it is possible to provide appropriate primary level care at the community level, thus improving the accessibility of the health services in Florida and other states. Moreover, through the integrated licensing system, implemented by the US Senate, it will be possible to identify the qualified nurses across the States that will be very helpful in safeguarding the health of the public. Thus, with the help of the improved level of practice autonomy and prescription, it will be possible for nurses to reach the remote areas across the USA, and it will enable more people to access quality and cheap health services as well as bring a long-needed change to the American health sector. Moreover, if the US Senate passes a unifying law, all the states will be using the same platform for managing health care, supported by nurses. This is a phenomenon that will put all nurses in the same working environment that will lead to the reduced levels of turnovers in some of the states, where these levels were high due to poor or suppressed way of practice. As a result, the USA will be able to ensure that nurses are motivated to perform their duties well by improving their working conditions and having a health sector that upholds the spirit of teamwork, so that all caregivers are appreciated and recognized within the sector. Therefore, the act of the US Senate will abolish the barriers to full practice authority that presently exist within the states in order to improve both the accessibility and the quality of the health care.

Cost/ Benefit Analysis

Along with giving the registered nurses a full authority of practice, clear and precise regulations will need to be established across the states. It will require a supervisory body that will be used to ensure that the guidelines are being followed across the country. Moreover, there is an integrated system of licensing and reporting that will need to be enacted and that requires substantial technological investments. Moreover, in order to ensure that nurses have the required capacity to manage the treatment process autonomously, there should be conducted more training, particularly on management. Therefore, an increased autonomy of nursing practice will attract the following costs; supervision cost, relevant training costs, and relevant technology investments. On the other hand, the benefits of these undertakings will include the improved level of accessibility of the primary level care. It will be achieved due to the treatment, improved by the nurses at the community level. The quality of the primary level care will also be improved due to the increased time of patient-nurse contact. Moreover, with the accessibility of the primary level care, caregiving will be effectively provided at the right time and in the right place. Besides, with additional caregivers at the primary level care, medical errors will profoundly reduce. Due to the improved nursing working environment, in which nurses feel more appreciated, turnover rates are also expected to decline, thus protecting the health sector from unnecessary costs of recruitment.

Relevant Numbers

The problem of turnover rates is a common issue for US hospitals. The rates were on increase up to 2015, and in 2016 the rate across the nation reached the point of 17.4%. A turnover of a single bedside RN attracts a cost from $37,700 to $58,400 that leads to a hospital loss of $5.2M – $8.1M (NSI Nursing Solutions, 2016, p. 1). There was a finding that any percentage change in the nursing turnover has a ripple effect of either saving or wasting the money of a hospital $373,200 (NSI Nursing Solutions, 2016, p. 1). Besides, according to Health & Hospital Networks, it costs hospitals approximately $82,000 to replace a nurse (Kerfoot, 2015, para. 4). Moreover, when it comes to the cost of medical mistakes, approximately 200,000 Americans die every year due to medical errors. In 2008 medical errors attracted $19.5 billion to the American health sector, 87% = $17 billion of which were included in the additional treatment costs due to the effects of the medical errors (Andel et.al, 2012). These are the expenses that can be avoided if nurses are given full authority to practice, as it will lead to improved accessibility and quality of health care as well as to reduced turnover rates that will protect the healthcare sector in different ways.

Numerical Presentation of Cost/Benefit Analysis

Costs= (Supervision cost + relevant training costs + relevant technology investment) = costs

Benefits= reduced levels of costs, caused by medical errors and nurses turnovers

n= turnover rate

Loss to the hospital due to a single RN turnover = $5.2M – $8.1M

Cost of rehiring a nurse = $82,000

Medical error cost = $19.5 billion

Cost versus Benefits= (Supervision cost + relevant training costs + relevant technology investment) versus (reduction in = (n ($82, 000)) + n (($5.2M +$8.1M)/2)) + $19.5 billion) + <200,000 deaths per year due to medical errors.

From the mathematical equation, it is clear that the benefits of providing nurses with full authority to practice their art of caregiving will help the health care sector to reduce many expenses as well as to save many lives by avoiding medical errors.

Conclusion

It is clear that more caregivers are needed in order to handle the growing demand of the healthcare sector across all states. Moreover, many professionals of the healthcare sector agree that the existing gap in the healthcare sector can be bridged by nurses if they are given full authority in their practice. Many states have realized the great potential that the nurses can have in the health care sector and have passed some laws that enable them to practice independently. It has greatly improved the accessibility of the primary level of care. With nurses getting autonomy in their practice, the quality and accessibility of the health service play a crucial role in protecting the industry from medical error costs and huge human losses. It is apparent that for a long period of time nurses have been seen as passive players in the health care sphere. According to the researchers, a factor that has led to their isolation from both the financial and the policy-making processes is closely related to the gender issue, since females form the largest percentage of nurses.

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For nurses to be actively involved in solving the challenge of the primary caregiving, the US Senate needs to pass the laws that would give nurses the mandate to prescribe medication, including a controlled substance, as well as would diligently control the licensing procedure that will ensure the safety of the patients. The current intention of the healthcare sector is to ensure that the accessibility and the quality of service are improved. It also aims to abolish the existing barriers in nursing practice in order to enable the nurses to apply their expertise at the primary level of care. In conclusion, it is clear that the state-based barriers to full practice authority for nurses are primarily based on the arguments related to qualification. Therefore, as long as these barriers exist, nurses will continue to face hostage and will not be able to play their roles in improving both the accessibility and the quality of the health services.

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