Discussion: ReviewS of Current Healthcare Issues
Discussion: ReviewS of Current Healthcare Issues
Discussion: Review of Current Healthcare Issues
If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.
To Prepare:
- Review the Resources and select one current national healthcare issue/stressor to focus on.
- Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
By Day 3 of Week 1
Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.
Discussion: Review of Current Healthcare
Issues
If you were to ask 10 people what they believe to be the most significant issue facing healthcare
today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
These and many other topics are worthy of discussion. Not surprisingly, much has been said in
the research, within the profession, and in the news about these topics. Whether they are issues
of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may
impact your work setting. You also analyze how your organization has responded to this issue.
To Prepare:
Review the Resources and select one current national healthcare issue/stressor to focus
on.
Reflect on the current national healthcare issue/stressor you selected and think about how
this issue/stressor may be addressed in your work setting.
By Day 3 of Week 1
Post a description of the national healthcare issue/stressor you selected for analysis, and explain
how the healthcare issue/stressor may impact your work setting. Then, describe how your health
system work setting has responded to the healthcare issue/stressor, including a description of
what changes may have been implemented. Be specific and provide examples.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days who chose a different national
healthcare issue/stressor than you selected. Explain how their chosen national healthcare
issue/stressor may also impact your work setting and what (if anything) is being done to address
the national healthcare issue/stressor.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 and Respond by Day 6 of Week 1
To participate in this Discussion:
Week 1 Discussion
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course
Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert
clinician to influential leader (2nd ed.). New York, NY: Springer.
Chapter 2, “Understanding Contexts for Transformational Leadership:
Complexity, Change, and Strategic Planning” (pp. 37–62)
Chapter 3, “Current Challenges in Complex Health Care Organizations: The
Triple Aim” (pp. 63–86)
Read any TWO of the following (plus TWO additional readings on your selected issue):
Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice
clinicians—Implications for the physician workforce. New England Journal of Medicine,
378(25), 2358–2360. doi:10.1056/NEJMp1801869
Note: You will access this article from the Walden Library databases.
Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared
workforce goal. American Journal of Nursing, 118(2), 43–45.
doi:10.1097/01.NAJ.0000530244.15217.aa
Note: You will access this article from the Walden Library databases.
Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-
being: Moving from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly,
42(3), 231–245. doi:10.1097/NAQ.0000000000000303
Note: You will access this article from the Walden Library databases.
Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician
comanagement: A theoretical model to alleviate primary care strain. Annals of Family Medicine,
16(3), 250–256. doi:10.1370/afm.2230
Note: You will access this article from the Walden Library databases.
Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses'
work settings, roles, and education preparation? Journal of Professional Nursing, 33(6),
400–404. doi:10.1016/j.profnurs.2016.11.005
Note: You will access this article from the Walden Library databases.
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment
models influence primary care and its impact on the Quadruple Aim. Journal of the American
Board of Family Medicine, 31(4), 588–604. doi:10.3122/jabfm.2018.04.170388
Note: You will access this article from the Walden Library databases.
Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery
system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-
0154-3. Retrieved from https://human-resources-
health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3
Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners'
scope of practice in New York state: Physicians' and nurse practitioners' perspectives. Journal of
the American Association of Nurse Practitioners, 30(6), 354–360.
doi:10.1097/JXX.0000000000000040
Note: You will access this article from the Walden Library databases.
Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education,
training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874–1880.
doi:10.1377/hlthaff.2013.0531
Note: You will access this article from the Walden Library databases.
Required Media
Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future
[Video file]. Baltimore, MD: Author.
Main Discussion Post- Week 1
Nurse staffing is a national healthcare stressor that impacts the health care system. Safe nurse staffing is essential to both the nursing profession and the overall health care system as it ensures nurses deliver safe, quality care in all practice settings (ANA, n.d.). Proper nurse staffing helps improve outcomes in several areas, including patient satisfaction, procedural and medication errors, patient mortality, hospital readmissions, and length of stay (ENA, 2018). Facilities need to develop a multi-faceted nurse staffing plan that should decrease cost without compromising patient safety, patient satisfaction, or staff satisfaction (ENA, 2018). Finding the correct balance between patients’ needs and the number of nurses to have on shift at a specific time is essential for facilities to be profitable and ensure both patient and employee satisfaction (Bazazan et al., 2019; Wynendaele et al., 2019).
COVID-19 caused drastic changes in bed capacity and nursing workforce requirements worldwide, with the hospital I am currently employed being no exception (Fan et al., 2021). I am presently employed at an Alaskan for-profit hospital in the Emergency Department (ED), as one of the charge nurses. In the ED before COVID-19, the RN to patient ratio in my facility was 3:1 with stable patients and 1:1 with any critical patient, including patients with an Emergency Severity Index (ESI) of 1 or sometimes 2 depending on specific situations. Currently, the RN to patient ratio is 5:1 with the remaining 1:1 with ESI 1’s.
Patient census in the ED has been down in the past two to three months at my organization. Nurses are forced to flex home if nurse to patient ratios drop below 3:1. Nurses who are flexed home are required to use his or her personal PTO to cover missed hours to maintain full-time or part-time status. For example, imagine it is two in the afternoon and the nurse to patient ratio in the ED is currently 2:1. A day shift nurse (7 am-7 pm) is forced to flex home and use five hours of personal PTO to pay their wages to maintain full-time status.
In addition to increasing the nurse to patient ratio, we are now required to take two 12 hour on-call shifts each month in addition to our full-time or part-time hour requirements to help cover department staffing needs. When a nurse is on-call, he or she makes four dollars an hour. This wage is not even minimum wage, yet it ruins two entire days for the nurse if they are not called into work. The on-call nurse is utilized if a nurse is flexed home and then there is an influx of patients who check-in, helps cover holes in the schedule, and covers if a nurse calls off sick.
As I understand an organization needs to be profitable to survive and thrive in the healthcare system, my current organization has increased stress related to nursing staffing. Lowering the number of ED patients cared for by emergency nurses is the single best solution to improve patient flow and minimize ED overcrowding (ENA, 2018). Patient care, nurse satisfaction, and nurse intention to leave are all impacted by nurse staffing (ENA, 2018). Hospital management needs to pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines (Wynendaele et al., 2019, p. 896). Even though several charge nurses have brought evidence-based research to our leadership, my facility continues to implement these changes and is losing skilled nurses because of it.
References
American Nurses Association. (n.d.). Nurse staffing. Retrieved February 28, 2021, from
https://www.nursingworld.org/practice-policy/nurse-staffing/
Bazazan, A., Dianat, I., Bahrampour, S., Talebian, A., Zandi, H., Sharafkhaneh, A., & Maleki-Ghahfarokhi, A. (2019, May). Association of musculoskeletal disorders and workload with work schedule and job satisfaction among emergency nurses. International Emergency Nursing, 44, 8-13. http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.ienj.2019.02.004
Emergency Nurses Association. (2018). Position statement: Staffing and productivity in the Emergency Department. Retrieved February 28, 2021, from https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/staffingandproductivityemergencydepartment
Fan, E. M. P., Nguyen, N. H. L., Ang, S. Y., Aloweni, F., Goh, H. Q. I., Quek, L. T., Ayre, T. C., Pourghaderi, A. R., Lam, S. W., & Ong, E. H. M. (2021, January). Impact of COVID-19 on acute isolation bed capacity and nursing workforce requirements: A retrospective review. Journal of Nursing Management. Retrieved February 28, 2021, from https://onlinelibrary-wiley-com.ezp.waldenulibrary.org/doi/full/10.1111/jonm.13260
Wynendaele, H., Willems, R., Tryou, J. (2019, July). Systemic review: Association between the patient-nurse ratio and nurse outcomes in acute care hospitals. Journal of Nursing Management, (27)5, 896-917. http://dx.doi.org.ezp.waldenulibrary.org/10.1111/jonm.12764
Discussion: Review of Current Healthcare Issues
If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.
To Prepare:
- Review the Resources and select one current national healthcare issue/stressor to focus on.
- Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
By Day 3 of Week 1
Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.
Great post Alexis. As value-based payment spreads, a better understanding of existing models can guide which approaches deserve ongoing implementation and research efforts. This narrative review of the literature proposes a taxonomy of the primary health care payment models, highlights their distinguishing characteristics, and reviews their impacts across the Quadruple Aim (Park, Gold, Bazemore, & Liaw, 2018). They also discuss each payment model’s effects in supporting the 4 Cs of primary care; given the lack of widespread use and standardized metrics in measuring these primary care attributes, when relevant, each model’s hypothetical impacts did not use formal metrics. Based on these findings, they provided policy and research recommendations for payment reform to best advance primary care.
In response to rising costs from FFS, health maintenance organizations (HMOs) emerged in the 1980s to coordinate care and reduce use by capitating payments. In traditional capitation, providers are paid a prospective amount to cover all services within a specific period, most often as a per member per month (PMPM) fee (Park, Gold, Bazemore, & Liaw, 2018). Payments vary by age-group and sex and are determined based on initial average costs of care under FFS. A capitated fee can cover all primary care services, all outpatient services, or all health care services, including inpatient and outpatient. In contrast to FFS, capitation incentivizes cost control. Capitation may also exist as part of blended models with mixed PMPM payments and FFS or in a different risk-adjusted form mixed with pay-for-performance in comprehensive primary care payment; discussed models in a later section. In contrast to FFS, capitation shifts the provider’s financial risk, while the payer has a lower risk (Park, Gold, Bazemore, & Liaw, 2018).
Changes in the way health insurers pay healthcare providers may directly affect the insurer’s patients and affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform implemented in some areas of the country but not in others via random assignment (Einav, Finkelstein, Ji, & Mahoney, 2020). We estimate that the payment reform—which targeted traditional Medicare patients—had effects of similar magnitude on nontargeted, privately insured Medicare Advantage patients’ healthcare experience. Implications of these findings for estimates of healthcare payment reforms’ impact more generally, healthcare policy design (Einav, Finkelstein, Ji, & Mahoney, 2020).
References
Einav, L., Finkelstein, A., Ji, Y., & Mahoney, N. (2020). Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform. Proceedings of the National Academy of Sciences, 117(32), 18939–18947. https://doi.org/10.1073/pnas.2004759117
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How Evolving United States Payment Models Influence Primary Care and Its Impact on the Quadruple Aim. The Journal of the American Board of Family Medicine, 31(4), 588–604. https://doi.org/10.3122/jabfm.2018.04.170388
NURS_6053_Module01_Week01_Discussion_Rubric
| Excellent | Good | Fair | Poor | |
|---|---|---|---|---|
| Main Posting |
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. |
Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. |
| Main Post: Timeliness |
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
|
Points Range: 0 (0%) – 0 (0%)
|
Points Range: 0 (0%) – 0 (0%)
|
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
|
| First Response |
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. |
Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. |
Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. |
| Second Response |
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. |
Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. |
Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. |
| Participation |
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
|
Points Range: 0 (0%) – 0 (0%)
|
Points Range: 0 (0%) – 0 (0%)
|
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
|
| Total Points: 100 |
|---|
