Nursing and the Changing Healthcare Environment

The healthcare system has a dramatic impact on nursing practice, and nursing practice has a dramatic impact on the healthcare system. At the beginning of the 1900s nurses made home visits and tended to the needs of the sick. Hospitals soon became the hub of healthcare delivery, and nurses provided nursing care. Nursing education evolved, and the practice of nursing expanded. In the 1970s and 1980s nurses sought more autonomy, especially with regard to hospital administration and physicians—one of the reasons for the development and increase of nurse practitioners. At this same time, healthcare costs began to drastically rise, creating a congressional demand for cost containment related to Medicare—government health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with permanent kidney failure. This demand began with prospective payment through diagnosis-related groups (DRGs), and health insurance companies joined in the demand, forcing hospital administrators to cut costs to survive.

While hospitals remain a crucial component of the healthcare system, they are but part of the maze. Rising costs have moved more procedures, treatments, and surgeries into ambulatory (outpatient) settings. People seeking healthcare today face a variety of settings for services that revolve around health promotion, illness prevention, diagnostic testing, treatment, surgical procedures, rehabilitation, and supportive and palliative care. All these settings need nurses, opening new avenues for career paths since a nursing license allows nurses to work in numerous settings without the need of additional education.

Healthcare changes, coupled with a troubled economy, have left a growing number of people with no health insurance. According to the National Coalition on Health Care, almost 46 million Americans (18% of the population under 65) had no health insurance in 2007. Lack of insurance means decreased access to health care for many Americans, but nursing has stepped in to assist with this crisis. Nurses throughout the United States bridge the healthcare gaps to the indigent and uninsured through nurse-run clinics, university- and hospital-based programs, public health services, and community programs such as parish nursing. These nursing roles provide much needed care to an often forgotten population, and they provide nurses with opportunities for more autonomous practice.

Medical advances and technology affect nursing practice. Medical advances have resulted in an explosion of diagnostic and monitoring equipment, as well as new pharmacological preparations and surgical procedures. Some of these advances have made nurses' lives easier, while others have increased their responsibilities and educational needs. Digital thermometers save time, but the proliferation of new and potent drugs creates constant need to update knowledge on these drugs' expected actions, adverse effects, and compatibility with other drugs. Many of today's medical advances have resulted in new job venues, giving nurses the opportunity to work in diagnostic centers and ambulatory surgery centers.

Technology now gives us computerized record keeping and resources. Clipboards have been replaced by laptops, textbooks by PDAs (personal digital assistants). Telehealth uses technology to provide healthcare over distance by allowing physicians to diagnose and treat patients via the Internet. Telehealth technologies reduce cost, improve access to care, facilitate client provider communications, and remove the barriers of time and distance. It is especially beneficial in rural areas where healthcare access is limited by provider shortages, lack of insurance, and geographical distance to healthcare facilities. These and other technological advances have resulted in the specialty of nursing informatics and the inclusion of healthcare technology into basic nursing education.

Nursing informatics isn't the only specialty to come out of healthcare changes in the past few decades. Others include hospice nursing, forensic nursing, legal nurse consulting, transplant nursing, holistic nursing, HIV/AIDS nursing, international nursing, toxicology nursing, and the nursing entrepreneur.

Nursing and the Patient Care Partnership

Ethical client care requires that nurses respect client rights. The American Hospital Association (AHA) first adopted the Patient Bill of Rights in 1973. The purpose was to contribute to more effective patient care with rights that were supported by the hospital on behalf of the institution, its medical staff, employees, and patients. The bill was replaced in 2003 by the Patient Care Partnership that informs patients about what they should expect during their hospital stay with regard to both their rights and responsibilities.

The goal of the Patient Care Partnership is for clients and their families to have the same attention and care that healthcare providers would want for themselves and their families: high quality care; a clean and safe environment; involvement in their care; protection of their privacy; help when leaving the hospital; and help with their billing. These rights are available for clients to read in several languages.