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Educators help future nurses understand healthcare reform

Monday October 14, 2013
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Joan Valas, RN
As the nation’s healthcare conversation turns to implementing the cornerstones of reform, nursing schools are refining course content and creating assignments that will better prepare nurses for the profession’s new reality.

Together with the influence of the Institute of Medicine’s 2010 “The Future of Nursing,” report, the Affordable Care Act has opened numerous possibilities for nursing roles at all levels, and educators are making sure students are ready.

Minerva Guttman, RN, EdD, NP, nursing school director and associate professor at Fairleigh Dickinson University, Teaneck, N.J, said the ACA’s biggest impact has come in

FDU’s master of science program, where nurse practitioners are prepared. Those nurses will become part of a primary care expansion needed to serve the more than 30 million newly insured when the ACA is fully implemented. Reform has changed the content of the school’s health policy course for nurses, she said. One of the students’ assignments is to approach their congressmen, state legislators and senators to ask about a particular facet of health reform, such as how programs will be funded.

“We sit there as nurses, often as recipients,” Guttman said. “It’s the law and you implement it.”

In the FDU policy course, Guttman said students get a chance to question the law as it is being developed and advocate for more resources.

NP enrollment grows

Healthcare reform has directly impacted enrollment, she said, evidenced by the nearly 30% increase in those registering for the NP program in the past year. She attributes that to the increasing importance placed on the role through the ACA and the IOM report.

There also is a heightened need, according to Guttman, to understand insurance options.

“We nurses have to advise patients how to access insurance and how to differentiate [among the options],” she said.

Some states also head into reform with limitations on scope. In New York and New Jersey, NPs cannot practice independently and must work collaboratively with physicians. With healthcare reform’s emphasis on primary care and access for all, this presents issues for nurses. Guttman said FDU is working to prepare students for the realities of their future.


Winifred Connerton, RN
“Say you are in an underserved area [and] suppose there’s no doctor there you can collaborate with,” she said. “How are you going to practice and deliver the care?”

Thinking upstream

Healhcare reform has brought about a change in the way nurses study public health issues, said Noreen Nelson, RN, PhD, CNS, a clinical instructor at NYU College of Nursing.

Before the ACA, she said, the emphasis in community nursing was on assessment — determining what health problems were prevalent among a particular patient population. The missing piece, according to Nelson, was a focus on root causes and improving outcomes of the population in a sustainable way.
In NYU’s community health nursing course, students are asked to think “upstream” about community health problems, meaning to look at how the problems got to this point.

In the case of obesity in a school, nurses would examine what was causing the high number of cases and develop sustainable solutions. Were vending machines with unhealthy snacks contributing to the problem? Should more resources be put into health counseling?

The process mirrors what hospitals are being charged to do — finding ways to integrate community resources with patient populations to improve outcomes.
“This is a real-time process,” Nelson said. “They are really looking at a particular community and they all have different communities to look at.”

Understanding reforms, measures

Hands-on training at Columbia University School of Nursing in New York includes exposure to electronic health records and accessing data sets.

Columbia’s nursing dean, Bobbie A. Berkowitz, RN, PhD, CNAA, FAAN, said students in both the clinical and research areas are affected the ACA. Those in the DNP program will need to be clinical innovators in accordance with the ACA and savvy about payment reforms and what it means to be practicing in a system that pays for quality and measures, she said. Columbia’s DNP program focuses on a comprehensive care specialty, preparing students both for primary care and specialties such as gerontology.

PhD candidates are looking at systems. The ACA influences how these students study comparative effectiveness and results coming from the Patient-Centered Outcomes Research Institute, established by Congress. Berkowitz said Columbia students get exposure to other cornerstones of the ACA, such as interdisciplinary team care. Nursing students, medical students and dental students work as volunteers in an on-campus student practice treating low-income and uninsured patients.

ACA sparks reflections, questions

At Adelphi University’s College of Nursing and Public Health, Garden City, N.Y., educators ask students to examine their own feelings about tenets of the ACA and their responsibilities under healthcare reform and in light of the IOM report.
Joan Valas, RN, PhD, ACNP-BC, associate professor, said nurses should articulate how their roles are changing.

For example, some Adelphi students were assigned to write a personal reflection about how they feel about the uninsured becoming newly insured. Students were asked to detail how this changes responsibilities for the nurse. In Valas’ health policy course, one module includes researching and discussing an aspect of healthcare reform, such as the medical home. Students discuss who makes up a team and what’s at stake for each member.

Winifred Connerton, CNM, PhD, an assistant professor at Pace University’s Leinhard School of Nursing, Manhattan, teaches NPs in her graduate-level classes, and though curriculum hasn’t changed specifically because of the ACA, the act often comes up in discussions.

As new NPs, Connerton’s students are challenged to think about what healthcare reform means now that their patients have a different level of access to care.
While students are excited change is coming, some wrestle with whether patients should bear more personal responsibility for maintaining their own health, Connerton said.

“It’s a very good conversation starter around policy, around access to care for patients and also around nursing and participating in policy,” she said.

Nurses helped to create the ACA and have the opportunity to shape it. The question Connerton often asks her students is, “if you don’t like something in it, how do you fix it?”

Marcia Frellick is a freelance writer.


To comment, email editorNY@nurse.com.
ACA primer

What nurses and nursing students need to know about the Affordable Care Act:

“It is a living, breathing document,” said Winnifred Connerton, RN, Pace University. It is a law, but policies will change as needs change and nurse input is important in shaping them,
she said.

All nurses should check out info on Healthcare.gov, where they will find a wealth of information on the ACA. Connerton said nurses need to know the information for their work, their own families and the communities they serve. Nurses often are the point persons for questions.

Understanding patients’ insurance options is becoming increasingly important as access to care opens for millions. States opened their exchanges Oct. 1.
New York’s marketplace is called NY State of Health (NYstateofhealth.ny.gov). New Jersey’s will be run by the federal government. Information is available at Healthcare.gov.

A priority of the ACA is increasing access to primary care providers, but nurse practitioners have restrictions on working independently in both New York and New Jersey.

You will be paid for what you do well. Nurses should understand quality metrics, which affect their pay and evaluations.

Source: Nurse interviews