1. Catherine Hrycyk, MScN, RN
Healthcare in USA / Advocacy for Better Care and Advancement of Profession
Catherine Hrycyk, MScN, RN

2. USA Healthcare System Dominated by private insurance
Lack of universal access:
The only developed country without universal access
Large fraction of population under- and uninsured
High costs of care:
Availability of of the most advanced technologies
17.6% of GDP (highest in the world)
Outcomes lagging in spite of high costs
Other healthcare systems have better outcomes with much less spending

3. Categories of Health Care Services
Health promotion
Illness prevention:
Primary
Secondary
Tertiary
Diagnosis and treatment
Rehabilitation and long-term care

4. Health Promotion and Maintenance
Goals:
Remain healthy
Prevent diseases and injuries
Promote healthier lifestyles
Assumption: Patients who adopt healthy behaviors are more likely to avoid certain illnesses
These services require patients’ active participation.

5. Prevention
Illness prevention services address health problems after risk factors are identified
Three levels of prevention:
Prevention of disease
Early detection
Prevention of complications and/or disability

6. Diagnosis and Treatment
Modern technology helps refine methods of diagnosing and managing illnesses
Examples:
Imaging and detection of cancers
Minimally invasive surgery
High-technology services can lead to dehumanization of patients

7. Rehabilitation and Long-term Care
Rehabilitation services help restore the patient to the fullest possible level of function and independence after injury or illness
Rehabilitation with disease management services focus on helping patients understand and manage chronic conditions
Long-term care provides services that the patient or family cannot provide but at levels that maintain individual independence as long as possible

8. Health Care Agencies Government or voluntary agencies Federal agencies
State agencies
Local agencies
Voluntary (private) agencies and non-government organizations
“Not-for-profit” or “for-profit” agencies

9. Level of Services Provided
Primary care services – when the patient first enters the health care system
Examples
Goals
Entry into the system
Emergency care
Health maintenance
Management of long-term and chronic conditions
Treatment of temporary health problems that do not require hospitalization

10. Level of Services Provided
Secondary care services – management of a condition by a specialist after being referred by a primary care provider.
Examples:
Tertiary care services – provided to acutely ill, those requiring long-term care, those needing rehabilitation services, and the terminally ill
Examples
Quaternary care – research facility. Uncommon.

11. Level of Services Provided
Subacute care services – goal-directed, comprehensive, inpatient designed for acute illness, injury, or exacerbation of disease process
Goal: Provide lower cost health care and create a seamless transition of patients moving through the health care system

13. Health Care Disparities: A Continuing Challenge
Health care disparities are differences in access to and the quality of health care provided to different populations.
Causes of disparities
Race, ethnicity, gender, age, income, education, disability, sexual orientation, and rurality
Provider bias
(Agency for Healthcare Research and Quality, 2013)

14. Nurse’s Role on the Health Care Team
Provider of care
Educator
Manager
Researcher
Collaborator
Patient advocate

15. Advocacy for Better Care and Advancement of Profession
Power, Authority, and Influence
Power – strength or force that is exerted or capable of being exerted
Authority – legitimacy to exert power
Influence – process of producing effects on action, behavior, and opinions of others
Examples?

16. Policy
Health policy – private or public rules, regulations, laws, or guidelines that relate to the pursuit of health and delivery of health services
Policy decisions reflect the values and beliefs of those making the decisions
Public officials act on the interest of their constituents to support passage of laws and development of policies.
Professional organizations

17. Politics
Politics is a process of influencing the allocation of resources
Policies are decisions
Politics influences those decisions.
Stakeholders – individuals with vested interest
Example:
To increase funding for nursing scholarships, stakeholders lobby state legislators.

18. Linking Practice, Policy, and Politics
Florence Nightingale worked with Sir Sidney Herbet, Secretary of War
Lavinia Dock found ANA, pressured hospital administrators to improve working conditions, and galvanized support for nursing licensure (Lewenson, 2007).
Karen Daley and needle stick injury – influence public officials to make nursing practice safer.

19. How Policy Influences Nursing Practice
Laws define nursing practice
Periodic need to influence lawmakers to modify the nurse practice act to reflect current clinical practice
NPs reimbursement, autonomy, and prescription writing
FDA sets rules for administering and documenting the administration of narcotics.
Need to influence legislators regarding broader issues like pay equity, staffing ratios, etc.
FDA – Food and Drug Administration

20. Professional Organizations
Nurses join organizations to
Network with colleagues
Pursue continuing education and certification opportunities
Stay informed on professional issues
Develop leadership skills
Influence health policy
Work collectively for job security

21. Professional Organizations
Reasons why nurses do not join organizations: high cost of dues, lack of time, and lack of interest
Less than 10% nurses are members of ANA.
Only 20% nurses belong to a specialty nursing organization.
Types of organization
Broad-purpose professional organizations
Specialty practice organizations
Special interest organizations

22. Professional Organizations
The mission statement is generated by the membership and defines the organization’s purpose and goals and who is served by the organization.
ANA Mission Statement: Nurses advancing our profession to improve health for all
ANA Goals:
“fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public”

23. Nurses and Unions Nurses may choose to join unions to
Work collectively
Have control over their practice and workplace
Work to equalize power between management and staff
National Labor Act and overseen by National Labor Relations Board
Issues in contract negotiations: staffing, work assignments, and shared governance

24. Nurses and Unions Nurses wonder whether they should join unions.
Closed shop – the management is required to bargain with the union and union membership is required as a condition of employment.
Open shop – employees are not required to join but in which an individual’s contract will be dependent on what the union and management have negotiated.
“Right to work” states – the value system of work culture is less supportive of union affiliation.