Since assuming the role of editor-in-chief of The Nurse Practitioner in 2005, three of the six December Editor's Memos have had the word "change" in the headline. At this time of year, we begin to think about where we would like to see change in the future. Holiday celebrations began with Thanksgiving a few weeks ago and will continue through the New Year, making the end of the calendar year a time to reflect on the events of the past 12 months. We are constantly bombarded with information from the media, and particularly social media. Too often, the news is about political unrest, the destabilized world economy, corruption, greed, and violations of human rights. Stories of one natural disaster after another in 2011 fueled incredulity and compassion for many across all faces of the human experience. Yet in a turbulent world, there is one constant-change. Very little remains the same forever, including healthcare.
A lesson from our elders
I have many patients who are octogenarians and a few nonagenarians. When given the opportunity, these elders readily volunteer stories about changes they have seen in their lives, and they correctly assume that as a nurse, I am interested in learning about their experiences with healthcare over the decades. They tell me how the traditional general practitioner, local pharmacist, and community nurse were highly respected in their day. Home remedies were tried before spending money on expensive medical care. Even I remember that we never went to a medical office when I was a child; the pediatrician came to our house for routine wellness checkups, "shots," and the occasional sick calls. One of my first preceptors as a nurse practitioner (NP) student was an 88-year-old physician who had finally decided that he was no longer able to manage his practice from his home, so he joined the staff at a family clinic. Insurance forms had become too cumbersome, and patients bartering goods and services for payment did not pay the bills. He was a dying breed in urban America. My elderly patients also remind me that there was always a little extra time during the visit for listening and talking-communication.
Looking back, looking ahead
What are some changes these elders have seen? There are efficient systems now that can process a large number of patients in a short period of time. Computers and electronic health records have given providers permission not to look at the patient anymore. Specialties have created services for different areas of the body; few practitioners deal with the whole person anymore. Healthcare costs have forced patients to choose between basics such as housing and food and proper medical care. I know that your patients could tell you about many other changes they have seen.
In a press release dated October 24, 2011, the U.S. Department of Health and Human Services announced the initiation of the Advanced Primary Care Practice demonstration, created by the Affordable Care Act (http://www.hhs.gov/news/press/2011pres/10/20111024a.html). The goal is to transform community health centers into advanced primary care centers and evaluate the outcomes for Medicare patients over the next 3 years. Patients will receive healthcare through the coordinated efforts of primary care physicians, nurses, and specialists at a central location in the community. Reimbursements will be determined by the quality of care patients receive based on measures such as control of chronic medical conditions, reduced ED visits and hospital stays, and improved access to care by Medicare beneficiaries. This is only one of the many changes in healthcare delivery instituted by the government in the past year. There are many more to come. It is our job to make sure nursing is in the thick of the ongoing reform. Is it possible we may be returning to days past?
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
Editor-in-Chief
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