National Healthcare Issue or Stressor

NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

National Healthcare Issue/Stressor

A national healthcare issue/stressor affecting healthcare systems across America is disparities in healthcare. The inequalities in healthcare relate to specific ethnic, social, and economic groups. Many of those groups reside in rural and underserved populations where healthcare providers are scarce. Also, chronic diseases disproportionately affect these populations. However, social determinants such as race, socioeconomic status, educational level, and residency are sometimes unchangeable circumstances. Everyone deserves healthcare that is accessible, safe, effective, and affordable. The Triple Aim and Quadruple Aim are initiatives to assist with bridging healthcare gaps and Advance Practice Registered Nurses (APRNs).

The Triple Aim and Quadruple Aim relate to essential principles for delivering in the healthcare industry and specifically in individual healthcare organizations. The Triple Aim has three critical components the health of populations, containment cost of healthcare, and improved quality of patient care (Broome & Marshall, 2021). The Quadruple Aim adds another standard that focuses on bettering the work environment of healthcare workers. The addition of the fourth component is paramount in the achievement of the Triple Aim goals. The focal points of my work setting will be improving population health and work enthusiasm.

In correctional nursing, healthcare disparities among the inmate population are more remarkable than that of the general public. According to Nowotny et al. 2017, those incarcerated’ overall health is inadequate and worse than those not in prison, especially chronic conditions. Besides, healthcare worker vacancies are always an issue, and prison positions are hard to fill. Thus, it is difficult to recruit and retain quality healthcare professionals to treat detainees appropriately. The staff has to work additional mandatory hours beyond the 40-hour workweek, which is exhausting. So, the work environment is stressful, and staff burnout is a reality due to staffing shortages.

Response to Healthcare Issue/Stressor in the Work Setting and Changes Implemented

The prison’s answer to reducing health disparities and improving working conditions primary focus is on recruiting and retaining qualified healthcare workers. APRNs are a part of this innovation. Nurse Practitioners play an integral role in providing healthcare in prisons and primary care settings. Besides, there is an increase in APRNs graduating rates compared with physicians, which creates a change in the workforce without compromising patient care quality or a rise in healthcare cost (Auerbach et al., 2018). The Department of Justice offers retention, recruitment, and relocation pay incentives and student loan repayment to nurses and other healthcare professionals (U.S. Department of Justice, 2016). Likewise, at my correctional institution, there is an exercise center and other wellness programs such as health fairs. With all of these initiatives in place, the correctional facility is becoming more competitive, and hiring increases. Staff morale is improving, which decreases burnout and enhances healthcare quality, reducing disparities.

Conclusion

Health disparities are a significant problem in the private sector and institutionalized places, but with the effect of the Triple/Quadruple Aim and APRNs, the inequalities can decline.

References

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 Medicine378(25), 2358–2360. https://doi.org/10.1056/NEJMp1801869

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Nowotny, K. M., Rogers, R. G., & Boardman, J. D. (2017). Racial disparities in health conditions among prisoners compared with the general population. ScienceDirect3, 487–496. https://doi.org/10.1016/j.ssmph.2017.05.011

U.S. Department of Justice. (2016). Federal Bureau of Prisons: Program Statement. Retrieved November 30, 2020, from https://www.bop.gov/policy/progstat/3530.02.pdf

Module 1: Healthcare Environment (Weeks 1-2)

Laureate Education (Producer). (2018). The Healthcare Environment [Video file]. Baltimore, MD: Author.Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

Learning Objectives

Students will:

  • Analyze current national healthcare issues/stressors
  • Analyze the impact of national healthcare issues/stressors on healthcare organizations
  • Analyze strategies for addressing national healthcare issues/stressors
Due ByAssignment
Week 1, Days 1–2Read the Learning Resources.
Compose your initial Discussion post.
Week 1, Day 3Post your initial Discussion post.
Begin to compose your Assignment.
Week 1, Days 4-5Review peer Discussion posts.
Compose your peer Discussion responses.
Continue to compose your Assignment.
Week 1, Day 6Post two peer Discussion responses.
Week 2, Days 1–6Continue to compose your Assignment.
Week 2, Day 7Deadline to submit your Assignment.

Learning Resources

Required Readings

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

  • Chapter 2, “Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 34–62)
  • Chapter 3, “Current Challenges in Complex Health Care Organizations and the Quadruple Aim” (pp. 66–97)

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.

Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. American Journal of Nursing, 118(2), 43–45.

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.

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.

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.

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.

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.

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.

Required Media

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript


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.

Nursing burnout during the COVID-19 pandemic is a national healthcare issue that has had a profound effect on the vast majority of healthcare organizations, with my work setting being no exception.  This issue has significantly raised stress levels for direct care workers due to a number factors, with the primary topic being the risk for exposure.  However, several secondary effects have added to already high levels of concern, which include financial concerns, staffing shortages, and risk of exposing loved ones.

The mental health of healthcare teams with heavy social and work responsibilities is particularly affected in pandemics that affect society both socioeconomically and psychologically (Sayilan, Kulakac, Uzun, 2020).  Frontline healthcare workers that endure the greatest risks via prolonged close contact are expected to be the most at-risk for burnout.  As stress increases and burnout emerges, the risk for sleep deprivation and insomnia begin to form.  Stressful life situations have significant adverse effects on the mental health and psychological functioning of a person and lead to psychological problems such as anxiety, mental confusion, social deprivation, and depression (Yildirim, Solmaz, 2020).

My place of work is an acute behavioral health hospital, where for the past four years, I have held the night shift supervisor role.  My organization has been greatly affected by COVID-19, with the most significant area of affect being in staff shortages.  To help combat this issue, the for the time is several years, my hospital has begun to implement registry and traveling nurses.  While this may seem like a fix for our problem, it also opens the door for other potential issues that may affect patient safety due to the lack of familiarity with hospital policy and procedures.  In pandemics, the organization should maintain clear, fluid, and regular communication with the nursing staff, which would help increase staff members’ confidence and sense of control (Garcia, Calvo, 2020).  During these difficult times it is critical that staff feel safe and supported, which significantly boosts overall morale.  Making sure everyone has the tools for success and is up to date on current policies and practice changes, will help to ensure that goal is met.

References.

García, G., Calvo, J. (2020). The threat of COVID‐19 and its influence on nursing staff burnout. Journal of Advanced Nursing, 1–13. doi:https://doi.org/10.1111/jan.14642

Sayilan, A., Kulakaç, N., Uzun, S. (2020). Burnout levels and sleep quality of COVID-19 heroes. Perspectives in Psychiatric Care. doi:10.1111/ppc.12678.

Yıldırım, M. & Solmaz, F. (2020) COVID-19 burnout, COVID-19 stress and resilience: Initial psychometric properties of COVID-19 Burnout Scale. Death Studies. doi:10.1080/07481187.2020.1818885

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.

 I really enjoyed reading your discussion post. I completely agree that nursing burnout is a prominent national healthcare issue, that has been severely exacerbated by the global pandemic COVID-19. Burnout was first defined by Herbert Freudenberger in 1974 as excessive demands on strength, energy, or resources, resulting in exhaustion in the workplace (Reith, 2018). Symptoms of fatigue, inefficacy, malaise, cynicism, and frustration characterize burnout (Reith, 2018). Healthcare provider burnout is detrimental to patient care (Reith, 2018).

As you mentioned, increased patient acuity, workloads and staffing ratios are some of the mitigating factors behind nursing burnout. One recommendation to decrease nursing burnout is improving nurses’ resilience through on-shift and pre-shift work activities, such as implementing aromatherapy and the use of smartphones (Jones, 2019). This can be viewed as an impractical recommendation for certain clinical settings, such as the one I work in, due to rapidly changing patient acuity and dynamic workloads (Jones, 2019). It is my opinion that better staffing would go a long way towards resolving nursing burnout as this would decrease the workloads and help with patient acuity.

However, as we are encountering a global pandemic, it is understandable that staffing is spread very thin. Do you have any personal recommendations on strategies to effectively cope with nursing burnout?

References:

Jones, B. (2019). Fifteen minutes may decrease nursing burnout: A discussion paper.

International Journal of Nursing Sciences, 7(1), 121-123.

https://doi.org/10.1016/j.ijnss.2019.11.004

Reith, T. P. (2018). Burnout in United States healthcare professionals: A narrative review.

Cureus, 10(12), e3681. https://doi.org/10.7759cureus.3681

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


Assignment: Analysis of a Pertinent Healthcare Issue

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

  • Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
  • Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
  • Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

  • Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
  • Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
  • Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

Looking Ahead

The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.

By Day 7 of Week 2

Submit your paper.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
  • Due to the nature of this assignment, your instructor may require more than 7 days to provide you with quality feedback.
Grading Criteria

To access your rubric:

Week 2 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment Draft for Authenticity:

Submit your Week 2  Assignment draft and review the originality report

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Week 2 Assignment

Next Module

To go to the next module:

Module 2

Module 1 Week 1 Main Discussion Post

One health care issue that has been in the news nationally all this year, besides Covid19 that is, is the rising issue of people having to ration their insulin related to increased cost and/or lack of insurance coverage to pay for insulin.  As we all already know, diabetes is one of the predominate health issues facing our society today and the problem is compounded when people cannot afford the increase cost of the life saving insulin or their insurance will not pay these increased costs.  I have firsthand experience with this, as my own father had stop taking his Victoza (not exactly insulin, but still related to diabetes) in October of this year because his insurance coverage would not pay out on it anymore this year.  He was not able buy it on his own because it is insultingly expensive, and instead will have to use less effective oral medications to control his blood sugars for the rest of this year.

There is significant scholarly evidence that this really is a national problem and is effecting patient outcomes negatively.  Fralick discusses why this may be happening, postulating that there are no laws in the United States prohibiting pharmaceutical companies from over pricing and raising the price of their drugs in combination with a lack of competition in the market as most insulin in the US is made by 3 companies (2019).  Fralick also points out the irony of the fact that a drug discovered in the 1920s and universally identified as the ONLY way—at the time—to treat the nearly 100% fatal disease is now today being exploited by pharmaceutical companies for profit (2019).

How bad is the problem?  Hart identifies in her research that the cost of insulins has tripled from 2002 to 2013 and then doubled again from that already inflated cost from 2012 to 2016 (2020).  This drastically outpaces any positive change in income most people might experience and can be compounded by a lack of insurance coverage or coverage (such as in my father case) that will not pay for all of the needed and life saving medications.  Pharmaceutical companies are being allowed to place their profit over the lives of the patients their medications are intended to help save.  Heng Nhoung sites that the problem is additionally compounded in cases in which food insecurity, which is defined as lack of consistent access to necessary nutrients, causes the diabetic to engage in the dangerous practice of rationing insulins while also contending with not having enough money for food (2020).  As you can imagine, that is a recipe for disaster.

At my workplace, patients are committed and cannot leave of their own accord.  This means that compared to other patients, or even their own situations when not in the facility, are actually better off.  The State of Minnesota purchases the necessary insulins for our patients regardless of cost.  However, that does not mean adjustments have not been made.  We have now switched to Semglee instead of Lantus.  Semglee is chemical similar to Lantus and nearly identical in function, but significantly less expensive.  My parents have been told by their Medicare Part-D provider that regular insulins will changed with respect to their Medicare coverage and they will no longer have to pay as much for the insulins they need.  However, this change in coverage does not apply to my father’s Victoza.  It is unclear if this change in coverage is limited to just the Part-D supplemental coverage or if Medicare as a whole will have better coverage on insulin.  Somehow, I fear this is NOT the case and probably means that low income diabetic patients who cannot afford Part-D supplemental coverage will continue to be in life threatening trouble.

References

Fralick, M., & Kesselheim, A. S. (2019). The U.S. Insulin Crisis – Rationing a Lifesaving Medication Discovered in the 1920s. The New England Journal of Medicine19, 1793.

Hart, L. (2020). Insulin Rationing. The Journal for Nurse Practitioners16(3), 213–217. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2019.10.023

Heng Ky Nhoung, Goyal, M., Cacciapuoti, M., Day, H., Hashemzadeh, T., Magee, M., & Jarris, Y. S. (2020). Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health21(4), 959–963. https://doi-org.ezp.waldenulibrary.org/10.5811/westjem.2020.4.45918

response

Diabetes is a disease that affects millions of people worldwide. Global health leaders identify diabetes as a non-communicable disease (NCDs). According to NCD Alliance (2017), in 2014, there were 387 million people with diabetes and is expected to rise to 592 million by 2035 without effective prevention and treatment. The U.S. has 30 million Americans with diabetes, and almost 25% or 7.4 million Americans need insulin (Rajkumar, 2020).

The United States is one of the priciest countries for prescription medications. Insulin is an example. Insulin is a 20th-century wonder drug that modernized diabetes from a fatal disease into a controllable condition (Luo et al., 2019). Yet, the cost of insulin is ten times more in the U.S. than in any other developed nation (Rajkumar, 2020). A reason for the high price is because insulin is a biological product and considered a biosimilar drug. Biosimilar drugs’ production and marketing are monopolized by three pharmaceutical companies: Novo Nordisk, Sanofi-Aventis, and Eli Lilly (Rajkumar, 2020).

I believe that the U.S. federal government needs to step in to regulate or amend laws to restrict the inflation of insulin prices or any prescription medication. People should not have to make life-altering decisions to forgo their insulin over food and shelter.

I hope your father finds a solution to get the treatment he needs and deserves.

References

Luo, J., Gonsalves, G., & Greene, J. (2019). Insulin for all: treatment activism and the global diabetes crisis. Lancet (London, England)393(10186), 2116–2117. https://doi-org.ezp.waldenulibrary.org/10.1016/S0140-6736(19)31090-6

NCD Alliance. (2017). Diabetes. https://ncdalliance.org/diabetes

Rajkumar, S. V. (2020). The High Cost of Insulin in the United States: An Urgent Call to Action. Mayo Clinic Proceedings1, 22. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mayocp.2019.11.013

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