This is the second in a series of scenarios designed to illustate what changes might look like with the implementation of the Affordable Care Act (ACA), known as Obamacare. Each health reform scenario presents a snapshot from a patient, healthcare, and business point of view. If you haven’t been to the hospital recently, read on.
Nicole is a veteran RN in the cardiac telemetry unit of the local hospital. She works the 12 hour night shift three days a week, and has four days off. Nicole’s staff is proud of the cutting edge technology that allows them to remotely track the patient’s heart rate from the nurses’ station rather than constantly taking vitals in the room. There is a portable EKG, beds with built in scales, and other state of the art devices that replace tests that used to require moving the patient. Even INR blood draws can be done without the lab by using a device similar to a glucose monitor.
Nicole is thankful that all records are electronic, sparing her back from carrying those heavy patient files. However, it takes time away from patients to update those records and enter the new information required for compliance with the new Affordable Care Act (ACA), especially if the server is down.
The new requirements have had positive results, though. It is much easier to remember to wash hands and enter data when working with a patient since hand sanitizers and computers are both inside and outside of patient rooms. The infection rate is dropping, an ACA compliance issue. There is a white board in each room for shared information between staff, patient, and families, and room service is available for the patient. A patient’s bill of rights is posted in each room, printed information about preventive care is given to all Medicaid patients, and satisfaction surveys are given at dismissal.
The hospital is required to track readmissions of patients in four main chronic illness groups, including heart/cardiac conditions. It also must increase patient satisfaction with hospital services. That means that staff must be careful to communicate closely during shift changes, attend training about patient education at dismissal, and deliver quality care at all times, not to mention entering billing codes for services provided. Especially important is accuracy in medications and understanding physician instructions.
It is a tall order and as her shift winds down, Nicole wonders if she was able to accoomplish all of that tonight. As a new nurse she worked with most unit patients by answering call buttons whenever she was free. Now each nurse works with only a few assigned patients and delivers care not done by nursing assistants. However, the most time consuming is data entry, no longer called paperwork. Nursing has changed and so has Nicole.