The newly validated Patient Protection and Affordable Care Act is expected to expand health insurance to as many as 40 million individuals now without coverage. This leads to the question: Who will see them?
With coverage expanded so extensively in such a relatively short time, the American Nurses Association believes that one of the most effective means of meeting the healthcare needs of these newly insured patients will be through advanced practice registered nurses.
"What we know about those patients through things like the National Center for Health Statistics and health interview surveys is that they have been deferring primary care: wellness, screening, well child care, and some chronic care meds," says Peter McMenamin, senior policy fellow at ANA. "Given insurance, they will have more access to healthcare and these are the kinds of things that APRNs and RNs are particularly well suited to do."
The U.S. Bureau of Labor Statistics' occupational outlook handbook estimates that by 2020 there will be a demand for 712,000 additional RN jobs. From 2010 through 2020 the demand for RNs is projected to grow by 26%, well above the 14% average growth rate for all occupations.
The good news is that the nation's nursing schools have doubled the size of their graduating classes over the past decade. The bad news is that there remain huge waiting lists for qualified nursing school applicants, mainly because of faculty shortages and limited access to clinical sites.
"It is not that the shortage is gone, but [that] there has been an increase in the younger cohort of nurses entering the workforce," McMenamin says. "In 2000 U.S. nursing graduates came to about 70,000. In 2011 U.S. graduates came to more than 140,000. It is changing the age distribution of the workforce but at the same time we have 3.1 million nurses, so even 100,000 a year don't change the distribution very quickly."
The ANA says the U.S. nurse workforce median age is 46 now and about half is nearing retirement.
"We have a lot of Baby Boomer-aged nurses and they have not retired because of the economy," says Janet Haebler, RN, associate director for state government affairs with the ANA.
"As that changes, or as they continue to age, we are going to see them leave. And it is a dramatic number of people. With the nursing schools, the enrollments are up, but we also have wait lists and part of that has to do with the shortage of faculty, and those individuals are also aging out. We can predict that if we don't make some dramatic changes that we are going to see another or continued shortage that is going to exacerbate in the next five to 10 years."
The ANA is focusing its efforts on maintaining Title VIII educational funding for nursing workforce development. In addition, it is hoping to address the huge turnover in RNs, many of whom leave the workforce within two years of graduating from nursing school.
Haebler says that can best be addressed by improving the nursing work environment. "We are always advocating for safe staffing levels, mandatory OT prohibitions, safe patient handling policies, workplace violence prevention programs. All of those factor into the work environment and retaining qualified nurses," she says.
Haebler says ANA is also working to loosen the constraints on scope of practice for APRNs, which was recommended by the Institute of Medicine's The Future of Nursing report.
"Specifically we're talking about things like the supervisory requirements and collaborative practice agreements where the physician who may never see the patient only reviews the records and the APRN is charged to have that agreement with that physician," she says. "We're talking about the limited prescriptive authority where APRNs may only be allowed to prescribe a Schedule II substance for a certain number of days and then the patient has to come back. That is not good for the patient. It is not necessary."
Haebler says lower-skilled healthcare workers might seem logical candidates to train and advance in the nursing ranks, but it's not that easy. "It has nothing to do with the fact that there is not access or availability. A lot of it has to do with basic education," she says.
"Nursing requires a strong background in sciences and many of these individuals did not choose the professional nursing route to begin with because they did not have that strong background. You have to have a foundation in chemistry and biology before you can take anatomy and physiology and nutrition and microbiology. Many people are thwarted because they have to go back and deal with the basics that they missed in high school. So many of the people had to struggle, they got discouraged."
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John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.