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As anyone in health care delivery knows, funding drives good care. Therefore, legislation affecting Medicare and Medicaid is always pertinent to nurses. President Bush’s tax cut, enacted earlier this year, was said to greatly diminish any budgetary reforms that would have boosted Medicare and managed care coverage.

That tenuous discussion about Medicare changed dramatically and permanently with the events of Sept. 11. Debate earlier in the year was inching toward some mild reforms for Medicare proposed by President Bush. One of the most visible reform issues was prescription benefits for seniors. Although some see a resurrection of the issue, most believe that it cannot survive the competition from bioterrorism appropriations bills.

The battered economic climate helped contribute to Medicare spending increases of 10 percent for fiscal year 2001-the largest increase since 1995. Even without the damage of terrorist attacks, the increases have been attributed to health care inflation and the growing number of beneficiaries. Medicare beneficiaries will likely bear a portion of increased costs with increases in premiums, deductibles and co-payments. (Medicare is expected to spend $41.7 billion on physician services in 2002, a $500 million increase.)

Another legislative casualty of Sept. 11 is broader coverage for the uninsured. Wakefield believes any progress in securing coverage for the uninsured will be stalled for a while, which will exacerbate the problem.

“Much of health care funding for the uninsured is supported by state government or state-federal partnerships. For a lot of states, we now have a markedly weakened financial situation with revenues rising, unemployment rising and the economy slowing. [But] by law, states are required to operate with a balanced budget. Thus, they will need to find cuts,” Wakefield said.

“There is a big outflow of money when people are out of work and not paying taxes. This, in turn, increases the state’s welfare rolls. States are feeling a tremendous pinch all over,” she said.

“Consequently, they will be belt-tightening, which will include health programs.”

Wakefield points to a rough economy as increasing the burden on state budgets as well as reducing the number of employers who offer health insurance. “Employers are getting double-digit increases to cover their employees. They will want to shift those costs to their employees,” Wakefield said.

Small businesses, especially, cannot afford 10 percent increases, she added, so employers will drop coverage. Increased costs and a weakened economy are likely through the end of 2002.

As 2001 winds down, Wakefield offers a summary of where the next legislative calendar is headed:

“It’s important for nurses to stay engaged in the discussion and debates,” she said. “When the cost of care goes up, access goes down and quality of care suffers. Nurses need to offer their perspective on what can be done and how to address those issues. Nurses, after all, are there to protect the public’s access to care. This is the time to provide accurate information to policy-makers and the public when these hard choices [about care and delivery] are made,” she said.

“It’s important for nurses to contribute to the national and state dialogue. How [else are] they going to make sure the voice of nurses is heard for the benefit of the public’s health?”

By Phil McPeck

Ah, the stories LaRae Huycke can tell. Huycke, MS, RN, is a clinical nurse specialist with a keen sense for the not-so-clinical aspect of nursing, the people side of science. For her work with Medicaid patients and people with disabilities, Huycke was a finalist in the clinical care category of NURSEWEEK’s 2001 Nursing Excellence Awards (South Central region).

She admits that some stories are meant to tug at the heartstrings of nursing students at the University of Oklahoma, where she teaches that patients are not charts, diagnoses and treatments. They are real people, who judge their hospital or nursing home experience largely by their connection with RNs.

“I think that as human beings we’re all connected,” Huycke said. “I’ve seen some nurses who could pretend, but that takes a lot of energy and most nurses are not very good at that.”

Huycke stresses connectivity in journal-writing assignments, telling students in her adult care classes, “Don’t tell me how you gave an enema or started an IV or cleaned up after someone vomited. I have done all those things and I know how to do them. I want to know how you felt about caring for that person that day, how you think that person must have felt being a patient today.”

As part of her master’s thesis, Huycke interviewed more than 700 people who were trying to sue medical providers. The hardest part of a hospital stay, aside from any medical challenge, is loss of control, she said. Patients have strangers telling them when to sleep, when to wake up and when to eat. For some, if the nurse doesn’t come, they can’t go to the bathroom. If a nurse doesn’t bring pain medication, they have to suffer.

“We need to be empathetic,” she said. “We always have to see the situation from the patients’ perspective.”

Eyes, ears and talk
“What patients really connect with is a nurse who listens, makes eye contact and really hears what the patient says,” Huycke said. “They say, ‘I’m in pain,’ and the nurse says, ‘What can I do to make you feel better?’ or ‘I’m sorry you’re not feeling well today.’ ”

The bachelor’s degree in psychology that Steve Kresl-hotz, RN, earned from the University of South Dakota is never further away than a smile and an introduction as charge nurse in same-day surgery at United Medical Center, the regional hospital in Cheyenne, Wyo.

Kresl-hotz said he immediately tries to “figure out” patients, their communication styles and fears, sometimes breaking the ice with a joke and always with an invitation: “Let me know what I can do for you.”

“Get them talking. Let them open up a little bit. Address the stuff that’s going on with them currently. Try to figure out where their fears are. Everybody has them,” he said.

“Check blood pressure and you can tell pretty soon who’s really uptight,” he said. “But it’s amazing. If you sit there and jaw with them a little bit, you watch that old pressure come on down. The big thing is to be up-front and honest with people.”

As a hobby, Christy Jones, RN, admissions nurse coordinator at Miami Valley Hospital, a 750-bed facility in Dayton, Ohio, collects first-person accounts of patient-nurse relationships and publishes them on a Web site, NursesAreAngels.com. Over and over, she said, patients say that it’s the little things that count, that establish a memorable relationship with a nurse.

“Just taking an extra minute to sit down and listen when they’ve got something they want to talk about, or to brush their hair or rub their back, doesn’t take a great deal of skill to do, but it means more to them than whatever technical abilities you have,” Jones said. “Those are the kinds of things that make it meaningful to be a nurse.”

Emotional risk and remedies
Kresl-hotz said that even after 18 years of nursing he’s still susceptible to emotions that go along with patient care, especially when it goes beyond the medical to involve the chaplaincy or social services for patients who don’t have a dime in their pocket. “You can emotionally get pulled in,” he said. “Definitely the friendlier you become with people-especially if you’ve seen them a few times-when a bad outcome is occurring, you take a lot of that home.”

“With our population predicted to grow and with an aging Baby Boomer generation, it is only logical to conclude that unless a statewide nursing workforce plan is developed – and soon – the demands for RNs will continue to outpace supply.”

Does South Carolina have enough registered nurses (RNs) to support the increase in staffing necessary to enhance patient outcomes? Recent studies from Harvard University reinforce a growing body of evidence linking hospital workforce with better patient outcomes – which is another way of saying “better quality care.”
Findings from various patient care models demonstrate that increasing the level of registered nurse staffing results in better patient outcomes.1 Because RNs represent the largest portion of hospital labor costs, the expense of additional staffing is not insignificant. Research indicates, however, that the monetary benefits of reducing adverse events (injury, disability, and death) offset the costs of hiring additional RNs.2

South Carolina’s supply of RNs expanded from 32,294 in 2003 to 33,845 in 2005.3 All areas in South Carolina experienced an upswing in the supply of RNs during this time, with the Low Country having the largest boost (6.22 percent).4

Even with almost 5 percent more RNs, however, hospitals and other health care providers are competing to recruit sufficient numbers of nurses to meet staffing demands.5 Comparing South Carolina’s ratio of RNs to population (783 per 100,000) to the national ratio (825 per 100,000) is a basic indicator of the already-limited supply of nurses in the state. With our population predicted to grow, and with an aging Baby Boomer generation, it is only logical to conclude that unless a statewide nursing workforce plan is developed – and soon – the demand for RNs will continue to outpace supply.

Emerging Trends

There are several emerging trends to be seen in South Carolina’s RN supply data. One positive trend is diversity. Nationally, there is concern about the aging of the nursing pool, and limited representation by males and minorities. In South Carolina, however, a greater percentage of nurses are under 40 years of age than in the nation as a whole (37.0 percent versus 26.3 percent, respectively). South Carolina’s RN workforce also has greater numbers of males and minorities than national data show (Table 2).6 These proportions of males and minorities, however, are not reflective of South Carolina’s general population. (continue reading…)