I received an email the other day from Erika Stewart, an account executive for an onlinemarketing agency. As the propritor of a nursing blog, I get a lot of letters from people like Erika everyday. They want me to write up a blurb about their clients. I hit delete, delete, delete. Erika’s letter was different. Yes, she’s a publicist, but she wrote a compeling article that deserved a second look.

Erika sent me a short write-up discussing how the Federal Health Care reform will effect nurses and how we practice bedside care. She asked me to read her article and comment on its contents. She wanted my honest opinion about how this reform will affect nurses. This is what Erika wrote:

“The effect of health care reform on nurses set to go into effect in January 2012, the provision for Accountable Care Organizations seeks to improve the outcomes and cost effectiveness of health care in the United States. This is one of the major provisions of the hotly debated healthcare reform law. Nurses will play a critical role in implementing the changes.

All health care organizations in the country must become ACOs in order to receive Medicare reimbursements. The ACO will consist of a team of physicians, hospitals and ancillary care providers responsible for the care of a patient. A set amount will be paid per Medicare recipient, and the ACO must provide services to at least 5,000 Medicare patients over a three-year time period. Payment will be adjusted upward for the care of those with severe or chronic illnesses. Patients with private health insurance will also be served by ACOs.

The ACO system seeks to incorporate the more successful aspects of HMOs without restricting patient choice. The goal of the ACO is to increase quality of outcomes and patient satisfaction while reducing costs. Nurses will be vital members of the team. Dean of Health Sciences and Nursing at Sentinel University, Dr Catherine Garner, DrPH, MSN, MPA, RN, FAAN wrote a series of articles on this topic for Links: HealthCareers.com. She anticipates that the measure will enable nurses to move into managing care, rather than simply providing care. This empowerment will expand the role of the nurse in ensuring appropriate and effective delivery of services.

As the ACOs are established, there will be a high demand for nursing case managers who can help to coordinate services for patients under their care. The case manager will work directly with the patient to educate and provide comprehensive care. This approach should lead to more positive health outcomes and fewer unnecessary hospitalizations. According to the American Nursing Association, nurses will be instrumental in transforming the current “sick care system to a true healthcare system.”

Anticipating an increased demand for RNs, especially those with advanced skills, the healthcare reform law put into place several provisions for supporting the education of nurses. Chief among these is the reauthorization of Title VIII Nursing Workforce Development Programs, the major source of federal funding for nurse education. Money is provided to assist both entry-level nursing students pursuing an associate’s or bachelor’s degree and those seeking advanced training.

The healthcare reform law establishes a new $50 million grant program to prepare nurses to manage private health insurance clinics that can care for underserved populations. It also raises the funding for the National Health Service Corps from $75 million to $300 million. The healthcare reforms being put into place to give all Americans access to health insurance and care rely heavily on well-prepared, dedicated nurses to provide both leadership and management of patient care. These new opportunities carry with them a great deal of responsibility, a welcome change in the field of nursing. The potential of nurses to improve patient care has long been overlooked. Nurses are able to spend the time needed to work closely with patients in planning and executing their health initiatives.With the added incentives of higher paying and more responsible positions, nursing is becoming increasingly attractive to bright, energetic students who are ready to enter this dynamic field. The role of the nurse will be central in the development and maintenance of a successful ACO.”

Erika wrote a very nice article. Unfortunately, there is a huge downside for patients and bedside nurses in the brave new world of healthcare. Hospitals are going to be paid based on patient care outcomes and patient satisfaction. This means that nurses who are already overworked due to a lack of licensed nursing staff are going to be put under more pressure to produce. As a result, many healthcare organizations plan to bring in unlicensed healthcare workers to provide more of the bedside nursing care. Some nurses like Dr Catherine Garner’s, DrPH, MSN, MPA, RN, FAAN applaud this move. I take issue with Dr. Garner’s opinion. I was disturbed by Dr. Garner’s belief that these measures will enable nurses to move into managing care, rather than simply providing care. Bedside nurses are not empowered by this move. Nurses provide superior bedside care, and relegating this responsabilty to unlicensed staff is unsafe. I don’t want untrained caregivers working under my nursing license, nor do I want to be tied down to a desk filling out endless paperwork all day long. I am already an important memeber of the healthcare team and there is nothing wrong with simply providing bedside care.

Well, there you have it. That’s my opinion. Erika, I hope you aren’t too disappointed with my response to your article. Feel free to write to me again. I promise I won’t delete your email.