AJN, American Journal of Nursing:
In the News
AJN's Annual Year in Review: 2009 Editor's note: Each January AJN examines the major stories affecting nurses and health care during the previous year. The main issues of 2009 mirrored those of 2008: the failing economy, the financial impact of impending health care reform and its ripple effect on the nursing shortage, and concerns over pandemic flu and war. Public health officials were right in predicting the onset of a 2009 pandemic influenza, but it was H1N1 swine flu and not bird flu. The war focus was on Afghanistan and not Iraq, but the effects of limb loss, traumatic brain injuries, and posttraumatic stress disorder were just as devastating. And nurses' unions agreed that passing health care insurance reform was more important than organizational differences and agreed to join together to create a "super union" of nurses.
When President Obama took office a year ago, he inherited an economy in crisis, and predicted that it would get worse before it got better. By November the U.S. unemployment rate had inched above 10%, its highest level since 1983, and even the most optimistic forecasters expected little improvement before the middle of 2010. Although the Wall Street Journal recently called health care one of the few remaining "good bets" in the U.S. economy, citing Bureau of Labor Statistics data that the industry had added nearly 600,000 jobs since the start of the recession, the nursing profession has clearly felt the downturn's effects.
Slow changing of the guard. Men in relatively high-paid sectors like manufacturing and financial services have been most heavily hit by the layoffs. To support their families, more women in professions like nursing have delayed retirement, rejoined the workforce, or increased their hours. Whereas dire long-term projections of a nursing shortage remain unchanged, many recent nurse graduates are struggling to find hospital placements as experienced baby boomers stay put or return to work. A post on allnurses.com entitled "Only hiring new grads that are 'cream of the crop'?" received more than 140 comments from anxious graduates describing promised jobs that had disappeared and debating the relative merits of high grades and advanced degrees versus practical bedside skills. Potential changes in Medicare reimbursement to hospitals resulting from health care reform may be another factor inhibiting the hiring of new nurses.
The health insurance crisis. The Kaiser Commission on Medicaid and the Uninsured reported in August that EDs across the nation were being "overwhelmed" by an increase in visits from people who'd lost insurance coverage and had no source of primary care. In November, a bill introduced in the U.S. Senate proposed extending COBRA health insurance premium subsidies for laid-off workers another six months for a total of 15 months; the extension would also increase the subsidy from 65% to 75% of the premium and make it available to workers who'd lost coverage due to reductions in hours.
This stopgap measure took place against the backdrop of ongoing congressional attempts to agree on health care reform legislation to address the twin issues of access and cost, a process that may continue well into 2010. Reflecting the larger national debate on the topic, nurses' comments about health care reform on Web sites and on the AJN blog Off the Charts (ajnoffthecharts.wordpress.com) have run the gamut from angry to hopeful, from alarmist to thoughtful and inquisitive. Although any meaningful reform is sure to present daunting and unforeseeable challenges, most polls continue to show that a majority of Americans support greater regulation of insurance industry practices, measures to reduce costs, and a government-offered public insurance option that's intended to increase competition for the insurance companies.
New opportunities for nurses? As the reform process has focused media attention on long-neglected topics such as evidence-based medicine, such projects as the Center to Champion Nursing in America (http://championnursing.org), funded by the AARP and the Robert Wood Johnson Foundation, have sought to delineate and promote expanded practice roles for nurses by highlighting cost-effective, high quality models of care such as NP-led comprehensive care. In the long run, such efforts may lead to more, and more meaningful, work for the next generation of nurses as they make it clear that they know a great deal about how care is delivered, what works, and what doesn't.
Jacob Molyneux, senior editor
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