Healthcare Reform Legislation Effects on Nursing: An Expert Interview With Rebecca M. Patton, MSN, RN, CNOR

Laurie Barclay, MD

April 27, 2010

April 27, 2010 — Editor's note: Nurses play a key role in implementing the initiatives of healthcare reform, according to a presentation at the Preventive Cardiovascular Nurses Association 16th Annual Symposium, held from April 15 to 17 in Chicago, Illinois.

To learn more about how nurses can facilitate the transition to new healthcare policy, Medscape Nurses interviewed presenter Rebecca M. Patton, MSN, RN, CNOR, president of the American Nurses Association (ANA), based in Silver Spring, Maryland. The interview provides an overview of what healthcare reform will mean for patients and nurses, and highlights the need to remove unnecessary practice restrictions on advanced practice registered nurses (APRNs) in light of the continuing nurse and primary care physician shortage.

Practical suggestions are offered for nurses on how to provide a new, stronger level of leadership and to effectively direct and manage care in collaboration with physicians and other healthcare professionals. The roles nurses should assume include advocating for needed changes in healthcare policy, implementing vaccination campaigns, and responding to pandemics and other disasters.

Medscape: How will the new healthcare reform legislation affect access to care?

Ms. Patton: Providing patients with increased access to affordable, high-quality healthcare was ANA's overarching objective relating to healthcare reform, and the legislation goes a long way toward meeting this objective.

For starters, the bill will improve overall access by eventually providing insurance coverage for what is estimated to be more than 30 million additional Americans, and assistance to an estimated 25 million underinsured Americans. So those who have had either no coverage or inadequate coverage (and consequently limited access for economic reasons) will be able to access care at a reasonable cost.

Medscape: Does the new healthcare reform legislation include provisions for nursing education?

Ms. Patton: The reform bill invests heavily in nursing education and retention, as well as many other forward-thinking programs geared toward building and maintaining the nursing workforce of the future. These include various federal grants specifically targeted at associate, baccalaureate, and advanced education nursing; workforce diversity; and the National Nurse Service Corps, which repays 60% of nursing student loans in exchange for at least 2 years of practice at a facility that has a critical shortage of nurses.

All of these provisions are critically important in the face of a continuing nursing and primary care physician shortage. Over time, this will improve patient access by strengthening and expanding the nursing "pipeline," so that all patients have unhindered access to the quality care they deserve and that is their right.

Medscape: How will the new healthcare reform legislation affect the practice of nursing?

Ms. Patton: Anyone who's been following the healthcare trades and blogs knows that there's a battle going on at both the national and state levels involving the removal of unnecessary practice restrictions on APRNs. This is vitally important when you consider that APRNs are more than well equipped to deliver the high-quality primary and preventive care that millions of additional Americans will now be able to receive under the provisions of the healthcare reform bill.

I cannot underscore the importance of this enough; APRNs being allowed to practice to the full extent of their education, training, and capabilities is a clear and obvious solution to the patient access and primary care challenges that have been staring us all square in the face for some time now. Recognizing the integral role that APRNs play in the delivery of patient-centered primary care helps bring the focus of our healthcare system back where it belongs — on the patient and the community. By granting APRNs their full scope of practice, legislators will have taken a huge step toward ensuring that all patients have unhindered access to quality care.

Medscape: To what extent does the new healthcare reform legislation address wellness and illness prevention, and what role should nurses play in achieving these goals?

Ms. Patton: The ANA has always been a champion of patient-centered preventive care. It's the most direct route to keeping patients healthy and reducing costs, and there are several outstanding components of healthcare reform that address this need head-on.

A $50 million grant program will support the cost of operations of more than 250 Nurse Managed Health Clinics — which offer comprehensive primary care and wellness services to low-income and uninsured patients, and are led by APRNs. The legislation also establishes a grant program for school-based health centers, which serve a large population of children eligible for medical assistance under a state Medicaid plan or under waiver authority for this plan. Finally, the legislation calls for free preventive care under Medicare, eliminating copayments for preventive services and exempting preventive services from deductibles under the Medicare program — effective January 1, 2011. (This same provision applies to all new private insurance plans as well, effective 6 months after enactment.)

Nurses will be on the front lines of all of these efforts.

Medscape: What can nurses do to facilitate a smooth transition for patients, nurses, and other healthcare providers in a climate of changing policy?

Ms. Patton: Naturally, healthcare reform brings with it questions and uncertainties for many Americans. Because of their widely recognized role as staunch patient advocates, nurses are in a unique position to counsel and educate patients on how the reform provisions will affect them directly.

It is vitally important for nurses to build a solid understanding of key healthcare reform provisions. By doing so, they will enable patients to take full advantage of every provision that enhances care for themselves and their families, and help them prepare in advance for any changes that may affect their insurance coverage by showing them precisely when these provisions kick in.

Likewise, close collaboration and communication on changing policies — with nursing colleagues, physicians, pharmacists, administrators, and other healthcare providers — will help facilitate consistent communication with patients and a smooth transition for the healthcare facility.

Medscape: How can nurses best advocate for meaningful solutions for health system reform, quality improvement, workplace standards, and environmental issues?

Ms. Patton: In short, by speaking up and getting involved! First, use the well-respected designation we annually earn as the most trusted profession. Identify yourself as one of the 3.1 million nurses that has a front-row seat every day to healthcare in every setting.

Nurses are closely in touch — and their roles vitally intertwined — with all of these issues in their day-to-day work. This puts them in an ideal position to observe best (and not-so-best) practices, identify potential problems or policy/procedural gaps, and catalyze positive changes. So, whether it's more efficient and effective on-rounds communication or safe patient handling practices, nurses are extremely well equipped to help identify and implement organizational benchmarks, the results of which can have a tremendous impact on larger national discussions and debates on these topics.

While the term "advocacy" is typically associated with the big-picture efforts of organizations like the ANA, it ultimately starts with passionate, committed individuals who care deeply about their patients and are willing to be leaders, problem solvers, and standard bearers in their own right. Nurses are patient advocates, and this is where every meaningful solution relating to patient care grows wings.

Medscape: What role should nurses play in H1N1 and other vaccination campaigns and responses to pandemics or other disasters?

Ms. Patton: Here are some key actions nurses can take:

  • Be an educated voice of reassurance to the community. Nurses should be well versed on the data and information being released by the Centers for Disease Control and Prevention and other reputable public health organizations, and use this knowledge to educate, counsel, and calm patients and the public.


  • Know your role in your employer's disaster plan. All healthcare organizations should have a disaster/emergency response plan. The ANA encourages nurses to be oriented to the plan, and become aware of what their roles will be in a disaster situation. We also encourage nurses to advocate for pandemic planning if it's not already part of the disaster plan.


  • If you think you will want to be a volunteer responder, register now. The best thing prospective disaster response volunteers can do is to register with an organized emergency response team. Be sure to discuss the decision to commit to a registry with your employer and your family/dependants.


  • Be personally prepared. Have a personal preparedness and emergency communication plan, and communicate it with everyone who depends on you. Keep essential supplies (e.g., food, medications, drinking water) at home for you, your family/dependents, and pets.


  • Be vaccinated; be immune! Nurses have a responsibility to be vaccinated to protect themselves, their families, their colleagues, and the people they care for. Not only will being vaccinated keep individual nurses from being sick, but it will help prevent them from spreading illness to their family, those they work with, and their patients.

Medscape: Thank you for your time and insights. Is there anything you would like to add?

Ms. Patton: Throughout the healthcare reform debate, the ANA's position has been that healthcare is a basic human right, and our goal is to achieve guaranteed, high-quality, affordable healthcare for all. Recently signed into law, the healthcare reform bill is not perfect; however, it is a critical first step toward achieving this goal.

Now we must redirect our efforts toward ensuring that nurses are utilized to the full extent of their capabilities, so that patients can realize the full promise of what this legislation has to offer them immediately and in the future. This includes making certain that APRNs — who are among the best-educated, most highly trained individuals in the profession — are able to bring their considerable skills to bear in delivering primary and preventive care services to millions of newly insured Americans, and that all nurses are recognized and appreciated for their leadership and expertise.


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