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Nurses Missing from Healthcare Reform Talks

News  |  By Jennifer Thew RN  
   February 01, 2017

Nurse leaders could provide President Trump with insights to improve the nation's health and healthcare system, but they have not yet been included in the president's talks regarding healthcare reform.

Nurses are integral to the working of the healthcare system, yet not one has yet been called to advise the Trump administration on healthcare reform.

At more than 3.1 million strong, registered nurses are the largest group of healthcare professionals in the United States. They are also (for the 15th year in a row) the most trusted of any profession.

Yet, despite their number and esteem, President Donald Trump's administration has not actively sought input from nurse leaders regarding the future of the Patient Protection and Affordable Care Act, it's promised replacement, or healthcare reform in general.

Nursing groups such as the Tri-Council for Nursing and the Nursing Community coalition, reached out to Vice President Mike Pence, head of the Trump presidential transition team, after the election with offers to engage with the new administration regarding its healthcare agenda.

No nursing leaders were on the roster at Trump's Dec. 28 meeting with healthcare executives, however.

"I like to see that he's surrounding himself with people like Toby Cosgrove and the CEO of the Mayo Clinic [John Noseworthy] and those types of folks," says Claire Zangerle, MSN, MBA, RN, Chief Nurse Executive for Allegheny Health Network in Pittsburgh.

"But I'd really feel good if I saw him surround himself with some very knowledgeable and insightful nurse leaders."

Beth Houlahan, RN, DNP, CNEP, Chief Nurse Executive and Senior Vice President, UW Health in Madison, WI, agrees that nurses would be invaluable in shaping the new president's healthcare agenda.

"Why isn't [Trump] meeting with the head of the ANA or the president of AONE to get the nursing perspective as well? To me that would be one of the things that could be very advantageous to his leadership," she says.

"If he's well-versed in nursing's impact on healthcare in the country and he asks the right questions, he may be able to make some positive changes."

Both Zangerle and Houlahan hope nurse leaders will be brought into the picture to share their insights, but until such a meeting occurs, here's what the two nurse executives say the Trump administration should consider as it moves forward in setting healthcare policy.

The Ups and Downs of the ACA
The ACA has been under scrutiny since it was signed into law in 2010, and vows of repeal were made long before Donald Trump began his promises to overturn the legislation during his 2016 election campaign.

It's too simplistic to label the ACA all good or all bad, however.

In a recent HealthLeaders Media survey, "Healthcare in the Trump Era," two-thirds of respondents say the best option for the ACA is to make some changes, but otherwise retain it.

Zangerle and Houlahan agree that there are pros and cons to the current legislation.

"I don't want to say that the ACA is terrific or the ACA is terrible," Zangerle says.

The law "has done a good job of increasing the awareness of the importance of access to care, and access to care for everybody is really what the foundation is for the ACA. It also focused on managing one's own health," she says. "It started a larger conversation about of the cost of healthcare and the sustainability of an inclusive system."

But it has also created some stresses and strains on the healthcare system. "Our patient volumes were really going up even before the ACA," Zangerle says. "But once the ACA was enacted, that volume increased dramatically. "

"I can tell you it stressed the system and nursing specifically because there was an immediate rise in the number of new patients that were seeking healthcare."

"From a hospital perspective," says Houlahan, "the exchange is covering their ED visits and their primary care visits, so from a bottom line perspective it's really good."

"From a nursing perspective, these people have a multitude of chronic illnesses, some that they've never seen a doctor for so on an inpatient side people are much, much sicker."

Nurses Needed
The ACA's push towards ambulatory care has also affected staffing by creating new roles for nurses.

These roles include navigators, care managers, and transition care nurses. Yet, as important as these are, they also pull nurses away from the bedside.

"The ACA gambled, I think, on this assumption that we had the staff to take care of this influx of new patients, which wasn't really the case," Zangerle says.

"We didn't really get time to ramp up [the labor force] so you may see nurses leaving acute care to go into ambulatory care, which is fine, but there's little attention to the dilemma of backfilling those acute care positions especially, since many of those new patients present as acute care cases."

There is a silver lining to this obvious need for nurses, says Zangerle.

"The increased volume of patients really provides a stable growth trajectory of the nursing profession over the next 20 to 30 years," she says. "We just have to do a better job of recruiting and retaining the nursing talent so we can meet the demands."

How the Trump Administration Could Help
In order to have an adequate supply of RNs to care for patients in every setting, something needs to be done to fix the bottleneck at the beginning of the nursing pipeline.

"We've got the nursing programs, but we can't get students through the nursing programs fast enough because we don't have the faculty," Zangerle says. "I would like to see some type of enhancement to nursing faculty growth. Either through compensation, incentives for direct faculty, or programs that may promote formal practice appointments and practicing nurses who also serve as faculty."

If the Trump administration boosted support for nurse faculty development, either through Nursing Workforce Development Programs contained in Title VIII of the Public Health Service Act or via newly created programs, it would be a major win for nursing.

Learn from the Past, Plan for the Future
Before he moves forward on any healthcare reform, however, Trump would be wise to take situations like this under consideration while making a thoughtful assessment of what parts of the ACA have worked, what parts haven't, and what parts are somewhere in between.

"It's really [a matter of] dissecting it, learning from issues that came up in Obama's rollout, and not making it partisan," Houlahan says. "I think he needs to share the playbook with us along the way so people can be prepared and really understand what the changes, or the things that he repeals— what the impact of that is going to be,"

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Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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