The modern healthcare faces multiple problems starting from the decreased effectiveness of the existing insurance problems and ending with the gradual deterioration of the health of the nation caused by the environmental factors and diseases that have a detrimental impact on individuals. For this reason, functioning under complicated conditions, the sector must be flexible enough to implement new practices and create new tools that will help to consider the most relevant issues. Today, a growing population introduces a new demand in the healthcare sector. According to the analysis conducted by the United Nations (2019), by 2025, the population will increase by one billion people. The life expectancy continues to rise as well (United Nations, 2019). Therefore, the existing health policies should be adapted to the needs of the aging population so that they could enjoy the high quality of their lives and have an improved health status, which is vital for the whole state. Individuals should be able to access services and acquire care in all areas, regardless of their geographic locations or economic status.
Background
Unfortunately, the rapid changes in the demographics of the state introduced a set of pressing issues related to the healthcare sector’s effectiveness. Megacities can ensure the proper delivery of care to all groups of individuals. Still, in rural areas, the situation is more complicated because people could hardly receive medical help of the same quality and quickness as the city dwellers (Anderson, Saman, Lipsky, & Lutfiyya, 2015). Besides, the growth of the population contributes to the scarcity of highly qualified specialists (Peterson, 2017). Moreover, the existence of vulnerable groups of patients, or clients with limited abilities, also makes the problem more significant as there is a need for specific models of care delivery. Under these conditions, the significant challenge for the sphere of health care is the necessity to adapt to the needs of the ever-growing population.
The scope of the problem is evidenced by the fact that there are multiple attempts to find an appropriate solution that will be able to satisfy the needs of diverse population groups. Authorities of different levels engage in disputes regarding the alteration of existing policies with the primary goal to cover all individuals. In these debates, advanced practice registered nurses (APRNs), providers who work directly with clients in different environments, are given the top priority as one of the possible ways to resolve the problem. However, currently, in many states, they have a limited opportunity to prescribe medicines or provide care in various cases. For this reason, there is an attempt to reconsider the scope of their practice and create a policy that will be beneficial for everyone (Peterson, 2017). House Bill 607: Direct Care Workers, authorizes autonomous practice for specified health care practitioners and provides them with an opportunity to act without the physician’s approval (CS/HB 607, n.d.). The introduction of these appropriate changes can help to improve the situation. This paper will focus on challenges and possible solutions to close some of the gaps in healthcare access.
Increase in Demand
The growing population is an essential factor that impacts policy-making at different levels and creates the basis for change in different spheres. Regarding the healthcare sector, some aspects should be discussed to ensure that an appropriate policy is introduced. One of the major concerns is the increased proportion of older adults. The focus on the preservation of the high quality of life, along with the advances in treating multiple diseases, contributed to the appearance of the cohort of people aged 70 and higher who has specific needs (Pressler, 2017). They are characterized by limited abilities and the presence of an extended medical history, which means that they need frequent visits of health specialists to support their health status (Pressler, 2017). Policy-makers should consider this aspect of growing populations as one of the factors justifying the acceptance of the proposed legislation.
There is a tendency towards the appearance and development of a set of chronic issues that impact the health of the nation. It is estimated that, in America, approximately half of the population has at least one chronic condition. These patients account for 75 percent of healthcare resources (Raghupathi, & Raghupathi, 2018). The growing population means an increased number of cases every year and the need for enhanced supervision and care provision. In other words, demand will continue to rise, aggravating physician shortages (Voetsch et al., 2016). This increase will lead to a lack of appropriate quality care delivery, and chronic conditions will continue to worsen, again causing a rise in demand.
In addition to the increase in population, it should also be noted that the increase in health care coverage brought upon by the Affordable Care Act in 2014 has also caused an impact on the rapid increase in demand for healthcare services. Approximately 20 million Americans gained coverage through 2016 (Avery et al., 2016). This exacerbated the shortage of physicians. Thus, there must be an increased capacity in response to the continued changes in health care policies related to insurance coverage. Research assumes that the presence of additional healthcare provides may help to improve the situation. For this reason, House Bill 607 can be taken as a reasonable measure.
Proposed Solution
Nurse practitioners are advanced practice registered professional nurses who go through advanced graduate education as well as rigorous clinical training. They provide a multitude of health services, including diagnosis and management of complex medical conditions. According to the American Association of Nurse Practitioners, for the past 50 years, APRNs have been providing not only primary care but also acute and specialty care. They may assess patients, order and interpret diagnostic tests, initiate and manage treatment plans, as well as prescribe medications. Currently, there are more than 270,000 licensed nurse practitioners in the United States; however, in many states, APRNs have reduced or restricted practice (AANP, n.d.). This means that they cannot be fully independent and must practice under supervision.
Currently, in Florida, nurses cannot work independently of physicians or prescribe various treatments or medicines without their approval. It introduces a set of critical problems and decreases the effectiveness of the whole system. In areas characterized by the complicated access to health services and care, nurses remain the major providers as they are responsible for the state of specific communities and work directly with clients (Wedgeworth, LaRocca, Chaplin, & Scogin, 2017). Still, in many cases, they remain unable to provide all needed services because of the existing limitations (Morgan et al., 2019). From this stems the necessity for their ability to work independently.
The need for an effective solution becomes obvious as the problem becomes one of the topical issues of the modern healthcare sector. The deficit of workers that can provide care to various groups of clients should be eliminated to guarantee that hospitals will be able to provide care to all representatives of local communities. However, because of the inadequate supply of new specialists, the task becomes challenging. In addition, according to Florida Center for Nursing (2019), most Florida’s nurses will become retired in a few years. For these reasons, health care practitioners should work independently to their full scope of practice (Peterson, 2017). Today, there are multiple disputes regarding this very solution as the competence and expertise of this cohort of specialists is doubted. There are fears that the decision to provide them with this level of authority may lead to the increased number of medical errors and malpractice. However, there are some additional regulatory measures that are introduced to ensure positive outcomes.
CS/CS/HB 607 recently passed the House on March 6, 2020, as amended, it was then amended by the Senate on March 10, 2020 and returned to the house, which concurred with the Senate’s amendment. The bill was passed on March 11, 2020. This legislation proposes to solve a set of problems associated with the growing population and increased demand of health care services. Effective July 1, 2020 the bill:
- Authorizes an APRN to engage in “autonomous practice” in primary care, including family medicine, general pediatrics, and general internal medicine, as defined by the BON, or, if the APRN is also certified by the American College of Nurse Midwives and as a certified nurse midwife, he or she may engage in the “autonomous practice” of midwifery.
- Defines “autonomous practice” to mean advanced nursing practice by an APRN is not subject to supervision by a physician or a supervisory protocol, after documenting several requirements with the Board of Nursing, such as completion of six college semester hours within the last five years, with three in pharmacology and three in differential diagnosis.
- Creates a nine-member Council on Advanced Practice Registered Nurse Autonomous Practice with four physicians, four experienced APRNs, and the State Surgeon General or his or her designee as chair.
- Requires an APRN practicing autonomously to report to the DOH defined adverse incidents within 15 days by certified mail (CS/HB 607, n.d.).
The introduction of this legislation will promote a set of positive changes in the functioning of the healthcare sector and contribute to its increased effectiveness. Thus, the document offers to transform advanced practice nurses into specialists that can work fully independently of physicians and contribute to the improvement of the health of the nation (CS/HB 607, n.d.).
Justification
As stated earlier, the U.S. Department of Health and Human Services (2019) has designated 7,031 Primary Medical Health Professional Shortage Areas, requiring 14,553 additional primary care physicians to eliminate the shortage. The bill is offered mainly because of the deficit of qualified health workers mentioned above and is focused on the radical reconsideration of the role of advanced practice nurses and their cooperation with patients. (CS/HB 607, n.d.). The modern approach to education and training presupposes that all APRNs acquire the amount of knowledge and information enough for their role, becoming responsible and qualified specialists that can contribute to the improvement of the health of a nation. Moreover, additional courses and educational programs can also help to eliminate gaps in knowledge and minimize the risk of malpractice. Under these conditions, advanced practice nurses can perform functions of physicians in areas with problematic access to the healthcare facilities and respond to the emerging threats.
The given change in the current policy has several advantages that should be mentioned. First, the provision of additional authority to nurses will help to reduce the work stress of physicians associated with the high number of patients they have to examine every day. A study by Petterson et al. (2012) projects an increase in-office visits to primary care physicians from 462 million in 2008 to 565 million in 2025, increasing physician burnout. If APRNs can work independently and prescribe pills, the number of clients will decrease significantly, and the effectiveness of these specialists’ work will remain sufficient. Additionally, advanced practices nurses will be able to provide services in distant areas contributing to the improvement of care delivery and meeting the growing population’s needs. The implementation of the given proposed measure also contributes to the reduction of emergency room visits for nonemergency health care (Peterson, 2017). Now, many patients with different problems have no options but to consult with physicians because of the absence of needed regulations. The reconsideration of the paradigm will help to achieve the goal outlined above and attain lower hospitalization rates.
Another benefit of the proposed solution is the reduction in costs associated with care delivery. Today, the rising cost of health care is a concern for everyone, including individuals, families, businesses, and society in general. It is projected that costs will continue to rise due to the increase in demand and lack of supply. A study found that states that allow APRNs to practice without physician supervision experience 16-35 percent increase in health care utilization, with more frequent routine checkups, higher quality of care, and reductions in inappropriate use of the emergency room by patients with ambulatory care needs, thus decreasing costs (Traczynski & Udalova, 2018). Additionally, a three-year analysis of the impact of health care costs of providing on-site nurse practitioners confirmed a significantly favorable benefit-to-cost function with savings of more than 1 million a year (Chenoweth et al., 2008). Thus, the suggested solution allows reducing governmental and personal expenditures related to the issues of health care.
Considering the fact that a more effective distribution of funds and lower payments are the basic requirements of populations, the given solution will help significantly improve the work of the healthcare sector. Finally, the improved teamwork between N.P.s and other health workers, including physicians, can be achieved and contribute to the enhanced outcomes (Pressler, 2017). Under these conditions, there are many advantages that justify the implementation of the given change and its positive impact on the care delivery model.
There are opponents of the proposed change emphasizing the fact that the utilization of this model can precondition the increase in the number of mistakes and malpractice because of the lack of competence among nurses. In 2018, the Cochrane Collaboration updated a review of findings of 25 articles that compared outcomes of patients being treated by physicians and APRNs. The review concluded that, when compared to physicians, APRNs provide equal or even better quality care, achieve equal or better health outcomes for patients, achieve higher levels of patient satisfaction, had longer consultation lengths and higher return visits, and had comparable resource utilization outcomes (Biezen et al., 2018). Another study was conducted with patients with complex comorbidities in the V.A. healthcare system who were treated by APRNs. The study conducted by Morgan et al. (2019) found that these patients had lower total expenditures than patients of physicians. In addition, it revealed that the same patients required fewer visits to the emergency department when compared to patients of physicians. Therefore, there is evidence of the fact that implementation of the bill will not lead to an increasing number of mistakes in the long run.
Conclusion
Altogether, the growing population contributes to the appearance of new needs that should be considered by caregivers. The increased number of aged individuals, multiple cases of chronic diseases, insurance coverage expansion, and the lack of specialists pose a question related to the effectiveness of the healthcare sector and its ability to cope with new challenges. Under these conditions, Bill 607 can be considered a correct and demanded step to improve the situation by providing advanced nurses with an opportunity to work independently, assessing, diagnosing, treating, and managing patients. It will help to improve outcomes and guarantee that the health of communities will remain at the appropriate level. Moreover, the costs of services and their quality can also be improved by implementing this change into the current policy.
Summary
The drastic increase in healthcare service’s demand is one of the main features impacting the state. The introduction of significant changes in the existing policies is evident in order to respond to new challenges and mitigate risks effectively. For the healthcare sector, it means the increased share of older adults, a high number of chronic diseases, and the expansion of health care coverage demand for more health care practitioners to become available. Under these conditions, the existing paradigm fails to meet the requirements of a growing population because of significant barriers to care delivery and the lack of authority among nurses who remain important actors responsible for outcomes (Peterson, 2017).
In this regard, House Bill 607: Direct Care Workers can be considered a valid and sufficient measure that can guarantee the improvement of the situation. It presupposes the reconsideration of the distribution of authority with the primary goal of providing advanced nurses with more opportunities to function independently and deliver care to patients in need. In accordance with the given regulation, licensed and authorized health practitioners will be able to prescribe medicines and treatments resting on their diagnosing. Regardless of some fears associated with the implementation of this very regulation, the in-depth examination of health workers will help to guarantee that they possess the appropriate level of knowledge, competence, and skills to achieve outlined goals and help to meet the needs of a growing population. The existence of multiple benefits such as the reduced cost of care, better coverage, less stress for physicians, and monitoring of the state of communities can also justify the need for the given change.
References
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