The Role of Government in Influencing Health Care And Nursing Practice – Health System Example

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"The Role of Government in Influencing Health Care And Nursing Practice" is a delightful example of a paper on the health system. Despite opposition from numerous quarters, nurses were the first professionals in the health sector to support health reforms. This culminated in the signing of the Affordable Care Act and the Health Care Education and Reconciliation Act in March 2010. This paper seeks to explain how the government can influence health care and nursing practice. The following are avenues through which the government influence may be felt. Full use of Advanced Practice Registered Nurses The government has become aware of the role nurses play given the evidence that Advanced Practice Registered Nurses provide high-quality care.

It can continue to demonstrate its support and recognition through the implantation of health reforms in ways that bring clearly define nursing’ s roles. Inhibitors to nursing practice that limit absolute use of nurses exist in the private sector health policies and both laws in state and federal. Alienation by private insurers and health plans Many health plans and insurers limit access to Advanced Practice Registered Nurses by not recognizing them as primary care providers or paying them at lower rates.

With the choice to select Advance Practice Registered Nurses as their provider, consumers are left with less provider availability. Therefore, nurses forego the reimbursement by the private health plan, enter into a contract with physicians, and are paid under the physician’ s name. In some health plans, however, even this is not possible. This affects even recipients of Medicare-enrolled Medicare Advantage Plans and Medicaid recipients. The government should employ regulations that prohibit this discrimination backed by clear enforcement mechanisms and penalties for noncompliance. State Laws State laws governing the practice of nurses vary.

Some states have sought to fully utilize Advance Practice Registered Nurses by allowing them to practice without statutory association with a physician. However, in other states, this statutory association with a physician is required ranging in restrictiveness. The government through legislation and regulation, and in teaming with nursing organizations, commit to strategies to override restrictions on nursing practice in state scope of practice laws and regulations. Federal laws In order for services to be covered by Medicare, through federal law the government requires that APRNs work in collaboration with a physician even in states where this collaboration is not a requirement.

Furthermore, through Medicare, nurses are required to be paid 85% of what the physicians get. Through collaboration with the American Academy of Nursing, the government could remove these disincentives to health plan organizations n utilization of Nurses. Nursing and Healthcare workforce In the National Health Care Workforce Commission, the government should reserve a position solely for professional nurses and have the commission have nurse workforce planning as a major agenda to be addressed. The government has also initiated the Family Nursing Practitioner’ s training program slotted for support to 2015.

This should also be ensured to have adequate funding and continued support. Through working with nursing organizations the government should develop and implement aggressive education and outreach efforts to attract more nurses through efforts to use the scholarship and loan repayments available as incentives for more nurses to begin, complete, and more rapidly complete Advance Practice Registered Nurses education. Development of Care Models Centre for Medicare and Medicaid Innovation Centre for Medicare and Medicaid Innovation during its quest for innovative payment and service delivery methods, the government should regulate to make sure that among the experts being consulted by the Centre for Medicare and Medicaid Innovation are Nursing Practitioners.

Furthermore, the Centre for Medicare and Medicaid Innovation mandate ensures that nurse-led practices, including those by Advance Practice Registered Nurses, are eligible and included in these models. Medical homes and health homes For the full success of the medical home models, it is paramount that the government ensures all fundamental care practices are eligible to participate. Advance Practice Registered Nurse-managed practices provide primary care services to a wider range of patients, including numerous patients with chronic conditions, usually in underserved communities.

Advanced Practice Registered Nurses and other registered nurses, working alone or with other professionals, are capable of providing many of the needed services (Solheim, McElmurry, & Kim, 2007). The government should enforce federal guidelines or criteria for recognition as a medical home, or for eligibility for payment of care coordination or other services provided through medical homes, should include all types of primary care providers, including Advance Practice Registered Nurses, as eligible practices. Accountable Care Organizations The formation of accountable care organizations (ACOs) was to manage and coordinate care for fee-for-service Medicare beneficiaries.

Government regulation should ensure that advanced Practice Registered Nurses, in addition to qualifying as accountable care organization professionals, may create provider groups or networks to form and participate in accountable care organizations (Gauld, 2005). In addition, ensure that no physician direction of accountable care organizations or supervision of Advanced Practice Registered Nurse practice groups involved in accountable care organizations should be required.   Similarly, encourage the formation of accountable care organizations in which Advance Practice Registered Nurse serves as providers in partnership with hospitals or other institutions— Advanced Practice Registered Nurses are not to be limited to roles as employees of physician groups or hospitals. Finally, technical assistance available to small practice groups, particularly those formed by Advanced Practice Registered Nurses or other non-physician groups. Quality of care initiatives The government should ensure that funding, dissemination, and utilization of research on nursing’ s contributions to patient safety are among the priorities for this program and seek input from nursing experts regarding research on provider assessment health care processes and systems and on opportunities to minimize distress and injury to the health care workforce (Hoffman & Emanuel, 2013).

Another role the government may play may include improving non-hospital care for seniors by ensuring that Advance Practice Registered Nurse's practices are included among the practices of the independence at home demonstration programs. Through regulation, the government criteria must ensure that Advance Practice Registered Nurse-led models are well represented among entities participating in the Community-Based Care Transitions Program (Budetti, 2008). To ensure that the much-needed primary healthcare is vast spread, the government should ensure continued adequate annual funding of Nurses Managed Health Clinics.

In addition, the Nurse Managed health clinics should be included in the regulatory definition of essential healthcare providers and get enhanced benefits and resources available to Federally Qualified Health Clinics. With the enabling Advanced Practice Registered Nurse-based models by the government, not only will the nursing practice be effective, but also a complete transformation of the health care sector will take place. The nursing practice is at the core of health care from home-based provision to hospital-based care, not to mention that to get to every citizen, numbers in primary care are required.

These numbers will only be effective once enabled by government teaming with stakeholders to ensure the smooth advance of health care and nursing practice (Tilburt et al. , 2013).


Budetti, P. P. (2008). Market justice and US health care. JAMA : The Journal of the American Medical Association, 299, 92–94.

Gauld, R. (2005). Health Care Information and Communications Technology: Promises and Challenges for Government and Health Services. Journal of E-Government, 2, 99–111.

Hoffman, A., & Emanuel, E. J. (2013). Reengineering US Health Care. JAMA: Journal of the American Medical Association, 309, 661–662.

Solheim, K., McElmurry, B. J., & Kim, M. J. (2007). Multidisciplinary teamwork in US primary health care. Social Science and Medicine, 65, 622–634.

Tilburt, J. C., Wynia, M. K., Sheeler, R. D., Thorsteinsdottir, B., James, K. M., Egginton, J. S., … Goold, S. D. (2013). Views of US physicians about controlling health care costs. JAMA : The Journal of the American Medical Association, 310, 380– 8.

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