Recalling the Why of Health Care Reform

By Jacob Molyneux, AJN senior editor ACA ruling imageIn a brief analysis of the gradual rollout and effects so far of the Affordable Care Act (ACA) at the start of this year (“The ACA Continues to Run the Gauntlet”), I reviewed a few of the issues the law was intended to address when it was passed in 2010:

* the highest per capita expenditures of any health care system in the world

* consistently worse outcomes on measures such as infant mortality rate than most other developed nations

* increasing numbers of uninsured Americans each year, to over 50 million in 2009, the year before passage of the ACA

* unsustainable annual increases in health insurance premiums and drugs costs, leading to astonishing rates of medical bankruptcy

* a Medicare reimbursement process that rewarded the volume of care provided rather than the effectiveness of that care

These worsening issues had become impossible to ignore. No one believes the ACA is a perfect law; there were too many cooks in the kitchen for that. But it’s at least a good faith attempt to address real problems, to get a framework on the table that can potentially be improved upon. […]

March 4th, 2015|health care policy, Nursing, Patients|0 Comments

AJN in January: Long-Term Complications of CHD Repair, Obesity Interventions, Nurses Planning for Retirement, More

AJN0115.Cover.OnlineAJN’s January issue is now available on our Web site. Here’s a selection of what not to miss.

Complications after cardiac repair. Nurses often encounter patients with complications that occurred years after congenital heart defect (CHD) repair. Yet many patients whose CHD was repaired in childhood have not had regular follow-up. Our CE feature, “Long-Term Outcomes After Repair of Congenital Heart Defects: Part 1,” the first in a two-part series, reviews six congenital heart defects, their repairs, and common long-term outcomes, as well as implications for nurses in both cardiac and noncardiac settings. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

To further explore the topic, listen to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes). A video of an atrial septal defect device placement is also available in the iPad edition of this article.

Obesity interventions. Patients with obesity often face stigma and bias, even from the nurses who care for them. “

December 29th, 2014|Nursing, nursing perspective|0 Comments

Tightly Scripted: One NP’s Experience with Retail Clinics

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Retail health clinics (walk-in clinics that are in a retail setting such as a drugstore or discount department store)KarenRoush have become an effective mode of providing increased access to care for many people and a growing source of employment for nurse practitioners (NPs). Their place in the health care arena may take on even more significance as the Affordable Care Act (ACA) increases access to care for previously uninsured people.

I worked as an NP in a retail clinic for about six months while working on my PhD. I left because of concerns I had about the model of practice. It didn’t have to do with the fact that I had to mop the floor at closing time or collect the fees and cash out the “drawer” every night. Nor because I spent eight hours alone in a small windowless room tucked away in the back of a drugstore. Those aspects were not great, but they weren’t deal breakers.

What was a deal breaker was the rigid programming of my practice. The computer was in control. From the moment the patient checked in at the kiosk outside my door, every action was determined by the computer.

The organization I worked for prided itself on following evidence-based practice, but someone forgot to tell them that the patient’s history, presentation, […]

November 1st, 2013|career, nursing perspective|1 Comment

They’re Not Taking Away Our Puppies (And God Help Them If They Do)

By Jacob Molyneux, AJN senior editor/blog editor

I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.

The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like. […]

September 30th, 2013|health care policy, Patients|9 Comments

One Is the Loneliest Number

By Shawn Kennedy, AJN editor-in-chief

The great Bartholdi statue, liberty enlightening the world: the gift of France to the American people.  Speculative depiction published the year before the statue was erected. In this depiction the statue faces south; it actually faces east/Wikimedia Commons The Bartholdi statue, liberty enlightening the world: the gift of France to the American people. Speculative depiction published the year before the statue was erected. In this depiction the statue faces south; it actually faces east/Wikimedia Commons

I’ve been struck recently by how the United States sometimes seems to stand apart from other nations. This is sometimes called “American exceptionalism.”

The most obvious example of this is the recent push—temporarily put on hold due to the emergence of negotiations about the possible handover of Syrian chemical weapons to Russia—to garner support among other nations for a military strike against the Syrian government in response to its use of chemical weapons against its own people.

By now, most of us have seen the graphic videos on media outlets and they are indeed disturbing. There are signs of neurotoxicity in some of the victims: rigid posturing, seizures, and foaming at the mouth. According to news reports, U.S. Secretary of State John Kerry says the evidence is “undeniable” and it deserves a harsh response. While several other countries and alliances have issued statements condemning the use of chemical weapons, thus far, other than France, […]

September 13th, 2013|health care policy, nursing perspective|2 Comments