Academic journal article Online Journal of Issues in Nursing

The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse

Academic journal article Online Journal of Issues in Nursing

The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse

Article excerpt

The Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, is the most expansive healthcare reform legislation in the United States (US) since the creation of Medicare and Medicaid in 1965. The ACA establishes a new direction for the U.S. healthcare system that includes an emphasis on preventive services and primary care. It provides insurance coverage to millions who are currently uninsured and attempts to address areas of the current healthcare system that are in need of reform so that consumer needs for safe care and improved health outcomes are met.

The Institute of Medicine (IOM, 1999) has previously reported that 44,000 deaths occurred annually as a result of medical errors. The 2001 IOM report identified deficiencies in the quality of health care received by Americans; 50 million Americans remain without health insurance (Kaiser Family Foundation. 2012). and the cost for healthcare is increasing. The current healthcare system is failing even those with insurance. With $7,538 per capita annual spending, the cost for U.S. healthcare is at an all-time high and is nearly double that of any other Organization for Economic Cooperation and Development (OECD) nation (Kaiser Family Foundation. 2011). The ACA, upheld by the U.S. Supreme Court (National Federation of Independent Businesses v. Sebelius. 2011) will be fully implemented over the next two years.

The ACA will initiate reform throughout the healthcare system and Influence the provision of preventive and primary healthcare services. APRNs have historically been champions of preventive healthcare and primary care (Keeling, 2009). Implementation of the ACA presents an unprecedented opportunity for APRNs (nurse practitioners, certified nurse midwives, and clinical nurse specialists) to take a leadership role In offering primary care and strengthening preventive services. However, this opportunity for influence is dependent on having an appropriately educated nursing workforce which will include an increased number of nurses with doctoral education (Cleary & Wilmoth. 2011).

A relatively new member of the healthcare workforce, the APRN with a Doctor of Nursing Practice (DNP) degree (henceforth referred to as the DNP APRN or the DNP nurse) provide care and leadership In the areas of primary care and prevention (AACN, 2006T We will use the term DNP nurse In this article to refer to the APRNs and nurse administrators holding a DNP degree. Although the DNP nurse is prepared to work in direct patient care, academia, clinical research, or administration throughout the healthcare system, this discussion will focus specifically on the role of the DNP APRN in the provision of preventive services and primary care.

In this article, we will discuss how the ACA will serve as a prevention model, describe the role of DNP nurses as primary care providers, explain how preventive healthcare can be enhanced through the use of a primary care model, and address challenges related to increasing preventive care in our healthcare system. We will also consider the opportunities for DNP nurse leadership in developing community-based programs and advocating for policies to strengthen primary care delivery. We will conclude by noting professional and legal barriers that need to be removed before DNP nurses will be able to provide all the care they have been prepared to offer.

The Affordable Care Act: A Prevention Model

A comprehensive summary of the ACA Is beyond the scope of this paper, buta basic understanding of the provisions that Impact primary care is essential for understanding the role of the DNP nurse as the nation Implements the ACA. We have developed Table 1 to summarize the provisions within the ACA that have the potential to Impact primary care (Patient Protection and Affordable Care Act TACA!, 2010T These provisions, designed to expand insurance, Increase primary care access, and promote preventive health services, are important for Improving healthcare outcomes. …

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