We hope the bill would be used as an opportunity to offer health care to individuals who historically have not received services. While there is a valid concern from physicians that their practice would be negatively affected due to advanced practice registered nurses (APRNs) offering the same services, and therefore taking from their patient pool, this bill would allow for a greater population of individuals who live in more rural, less accessible areas to receive care and improve the overall health of these communities. Health disparities within the U.S. continue to grow, and we feel this bill is an effective way to address this wide-spread concern. APRNs are trained to provide a high level of care to patients, including prescribing medications, and this bill is not allowing them to overstep their licensure to practice; it is simply expanding the availability of their services. We assume there will be situations within these communities when patients will need a greater level of care, and the nurse will refer patients to a physician or other resource when necessary. This dynamic exists in the present, and the bill will not remove the nurse’s ability to serve as a patient advocate and judge when the patient will need a greater level of care. If physicians feel disgruntled with the idea of giving nurses more autonomy in areas where care is not readily provided, they should address this important issue by expanding their own care into less accessible areas. If the true role of a health care provider is to provide effective health care, instead of expecting patients to travel three hours to the nearest hospital, and therefore severely lessening their chance of survival, this bill is a direct extension of that role. Patients will save time, money and effort if nurses are more readily available outside of primary physician offices and hospitals.
Patients receiving home health care services from APRNs would be covered under Medicare, and, therefore, have services they could not have had previously. While this is obviously beneficial to individual patients, there would also be a stronger culture of home health care that is proven to be effective in the care of patients. The majority of health care funding is channeled into acute care settings, despite the fact that studies show these settings often negatively affect the health of patients while home health provides a much safer environment for healing. With more services being covered under Medicare, more individuals who could not afford home health care previously could choose to be treated in their own homes by a nurse. Not only could the bill provide greater patient outcomes, it would increase patient autonomy and involvement in their care.
We also feel this bill would address the cultural norm within health care that nurses serve as the subordinate to the physician. While we recognize that nurses receive less training than doctors and are able to perform fewer services, we also recognize that APRNs are highly-trained, in both skills and critical thinking, and capable of making decisions in the best interest of the patient. Collaboration between team members within a health care setting is integral to effective care, and whether this is between nurses or between a physician and nurse, the bill does not take away the nurse’s choice to consult a physician if s/he chose to do so.
Political Action Plan
To begin, we’ll do class raps within the nursing classes (juniors and seniors) to raise awareness about this bill, show our support, and provide an opportunity for them to take political action. A class rap involves a short 3-5 minute presentation at the beginning of a class to present the facts of the bill and the implications of its passage. Then we’ll raise awareness within ISAT and on the Commons to reach a broader range of students and faculty. Our goal is to get as many supporters as possible to 1. Show that many people are invested in its passage and 2. Create a strong visual when presenting the petition to our representative. We could also right an editorial for the local papers, such as the Breeze and DNR, to raise further awareness. We will provide them with a draft of a letter they can send to Representative Goodlatte that outlines their support of the bill and allows them to add any personal comments they would like. There is a draft available on the ANA website that we could use as our petition (American Nurses Association, 2011). We will then deliver the letters (hopefully a sizeable stack to have a strong visual) to Goodlatte’s office to encourage dialogue between him and nursing students.
Stakeholders
Patients: the stakeholder group that both pays for our health care system and uses it. Although the patient often has a great deal of experience in the health care system, he or she is not often able to provide input on new policy decisions, including the availability of home health care compared with traditional care provided in an acute facility. Patients are encouraged to contact their legislators concerning their opinions related to the Home Health Care Planning and Improvement Act. Taxpayers would have influence on this bill because their tax money would go towards funding Medicare.
Government: the U.S. government will be responsible for costs to Medicare and Medicaid resulting from the utilization of home health care. The increasing age of the American population will lead to a surge of elderly patients in our health care system, which will severely strain the economy due to Medicare utilization. With the Medicaid budget falling short by millions of dollars, the Government will have a definite role in the Home Health Planning & Improvement Act of 2011.
Medical professionals: a number of medical professionals will be affected by the Home Health Improvement and Planning Act, as evidenced by the number of medical associations supporting and disagreeing with the legislation. The American Nurses Association supports this bill because of the autonomy for APRNs granted by the bill. It would also expand the availability of health care resources to individuals. Supporters include the American Academy of Physician Assistants, American College of Nurse Practitioners, American College of Nurse Midwives, American Academy of Nurse Practitioners, and Visiting Nurse Association of America (Mullin, 2011).
Legislators: The Home Health Planning & Improvement Act of 2011 is a bipartisan bill. It is currently in both the House and Senate. The original sponsor is Susan Collins (R-ME), who introduced the proposed legislation to the Senate. She currently serves on the Appropriations Committee, Armed Services Committee, and is a member of the Special Committee on Aging. Co-sponsors in the Senate include: Sen. Daniel Akaka (D-HI), Sen. Kent Conrad (D-ND), Sen. Daniel Inouye (D-HI), Sen. Tim Johnson (D-SD), Sen. Jeff Merkley (D-OR), Sen. John Reed (D-RI), Sen. Ron Wyden (D-OR), and Sen. Chris Coons (D-DE). Representatives Allyson Schwartz (D-PA) and Greg Walden (R-OR) introduced the Home Health Care Planning and Improvement Act of 2011 to the House of Representatives. There are approximately 60 representatives in support of the act (up from 30 one month ago).
References
American Nurses Association. (2011).The home health care planning improvement act. Retrieved from https://secure3.convio.net/ana/site/Advocacy?cmd=display&page=UserAction&id=357&ct=1
