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Being Proactive in Shaping the Future of Rehabilitation Nursing
The Census Bureau just released its annual Income, Poverty and Health Insurance Coverage in the United States Report (based on 2006 data). In this report, information about America’s income trends and poverty levels look encouraging at face value. Yet, when you look deeper, the picture is far from positive. So, how may this data affect the future of rehabilitation care and rehabilitation nursing?
2006 was the second year in a row that median household income levels rose (over $48,000). Although the poverty level fell for the second year in a row (by only three tenths of a percent), the number of Americans still living below the poverty line is well over 36 million, a disturbing statistic. Moreover, the number of Americans covered by health insurance is now at about 250 million with approximately 202 million having private insurance. In addition, 27% of the remaining population, 80 million, has some form of government health insurance (e.g., Medicare, Medicaid, Military Healthcare, and state health plans). Unfortunately, the number of uninsured also grew from 44.8 million to a staggering 47 million (up 2.2 million). At this rate, we will hit 50 million uninsured within the next 18 months.
Multicultural groups fair more poorly than the rest of the population regarding health insurance. As an example, 34% of Hispanics and 20.5% of African Americans are not covered by insurance compared to 10.8% of non-Hispanic whites. Further information from this report can be obtained at www.census.gov/prod/2007pubs/p60-233.pdf
So, what specific ramifications does this national data have to rehabilitation nursing and your individual practice? There are three significant issues to consider: (1) Rehabilitation nursing provides many individuals (with physical and/or psychological limitations) an increased possibility of a greater functional ability and better quality of life. With the expanding number of uninsured, the actions of rehabilitation nurses will have an ever increasing importance in patient care. Because our goal as rehabilitation nurses is to promote the highest level of independence and function regardless of the specific disabling condition, rehabilitation nurses must be more proactive in the prevention of additional associated difficulties (i.e., contractures, decubitus ulcers, depression, injuries related to falls) that will add to healthcare system utilization and cost. (2) Rehabilitation professionals should be constantly vigilant to communicate effectively with other health team members as well as patients/families, build upon the efforts of others, reduce unnecessary duplicative efforts, and identify specific and achievable outcomes and timelines that consider our diverse patient population. (3) Current nursing students and practicing nurses must be educated regarding rehabilitation concepts and practices whenever possible. Sadly, many nurse educators are not well informed regarding what constitutes rehabilitation nursing care and its ramifications to cost and care outcomes. In all settings and shifts, rehabilitation nurses must constantly use “teachable moments” to expand the knowledge of nurse educators and others concerning what constitutes rehabilitation nursing care and how this specialty practice not only enhances the quality of life for patients and their families, but also frequently minimizes unnecessary complications.
The national income, poverty and insurance data also raise major questions about who will pay for rehabilitation services. With increasing healthcare costs, the rising number of uninsured, and limitations of healthcare coverage, will rehabilitation be considered a nice addition to care and not a necessity? Will patients be required to pay or have higher copays for these services in larger numbers, thereby causing them to demand greater efficacy in terms of outcomes and speed with which rehabilitation care is delivered? What can rehabilitation nurses individually and ARN specifically advocate for our services at a national and local level? Do we need more research as presented in the September-October issue of RNJ by Audrey Nelson and others to document measurable outcomes of our practice? What specific actions can ARN and individual rehabilitation nurses take to augment the awareness and value of our specific type of care by healthcare executives, other national nursing organizations, state licensing groups, the VA, and other groups?
Standing on the sidelines is not an option for rehabilitation nurses. By using the 2006 data, we can proactively take action and have a voice in clarifying the importance of rehabilitation nursing. We also need to develop long-term partnerships to facilitate the capacity building of our services, while keeping our practice viable and in the forefront of patients, families, healthcare providers, insurance companies, and policy makers.