Field Experience Log #4

Title of Event / Sponsors: 2017 Future of Nursing Annual Summit: Influential, Industrious and Inclusive…. Nurses Matter in Improving the Health of the Public / New York State Action Coalition

Preparation Steps Taken: Reviewed available information via the internet (https://www.foundationnynurses.org/) and summit brochure to gain insight of topics to be presented. Read the biographies for the speakers that were presenting. Gained insight of the history of the New York State Action Coalition.

Place / Date / Time / Length: The Sage Colleges, Albany, New York / June 8, 2017, 9:00 am /3 hours

Topic Under Discussion: Partners Improving the New York State of Health, Applying Nursing Workforce Data to Inform Practice and Policy Decisions, Nurses Leading Population Health and Primary Care

Names of Participants and Their Titles: Deborah Stamps (Co-chair NYSAC), Susan Apold (Co-chair NYSAC), Deborah Elliott (Co-chair NYSAC), Sally Dreslin (Deputy Commissioner of Health, New York Department of Health), Susan Senecal (Director, Statewide Hospital Quality Improvement Programs), Jean Moore (Director of New York Center for Health Workforce Studies), Laura Markwick (Assistant Professor of Nursing at St. John Fisher College), Susanne Curry (Manager Clinical Practice at St. Luke’s Cornwall Hospital), Wesley Willis ( Private Practicing Psychiatric Nurse Practitioner)

Brief Description of the Testimony / Meeting / Event: Multiple important health care issues and topics were presented throughout the summit. Discussion included the role of nurses in addressing current health care and health policy issues. The topics of policy initiatives in the state of New York to address the issues of reducing health care costs and improving population health were also presented. Presentations were given on ways in which nursing workforce data can be utilized as part of the decision-making process for health policy and practice changes. From this data, the various roles that registered nurses can play in promoting healthy communities and addressing primary care needs were highlighted.

Description and Analysis of the Health Policy Issue and Its Implications for Health Care: Key focuses of the New York Department of Health are improving access, containing cost, and advancing the Prevention Agenda. Since 2007, Medicaid enrollment has increased dramatically, providing coverage for an additional 2 million people in the state of New York. (Dreslin, 2017). This is in large part due to the state of New York electing to expand Medicaid under the Affordable Care Act. Prior to the expansion of Medicaid, low-income adults were a large portion of the population that were uninsured, often stating the lack of affordability of health insurance and the lack of employer sponsored insurance as the main reason for lacking coverage (Garfield, Majerol, Damico, & Foutz, 2016).

This additional coverage of 2 million people under Medicaid has been important to improving the health of the people in New York. Without insurance coverage, individuals cannot receive the medical care that they need to remain healthy and prevent illness. It is well understood that having health insurance plays a key role whether patients seek medical care and where they go to receive care, ultimately impacting their level of health (Garfield et al., 2016). This increase in coverage is just a small portion of addressing the population health concerns in the state of New York.

Much of the discussion focused around New York State’s Prevention Agenda. This is their blueprint to improve the health of people living in the state of New York and to reduce health disparities across the state. The emphasis for accomplishing these goals is on prevention of disease. Their progress is being monitored across 96 measures of public health and prevention, with 34 indicators showing progress at this time (Dreslin, 2017). Of the other measures, 51 measures have remained unchanged and 11 measures have moved in the wrong direction (Dreslin, 2017). Health disparities remains one of the principal areas of concern.

The next focus of the agenda to move these other measures toward improvement is to adopt and implement a health across all policies approach. Studies have shown that broader approaches that address the social, economic, and environmental factors that impact health are needed to achieve health equity and improve population health (Heiman & Artiga, 2015). A health across all policies is such an approach. Governor Andrew Cuomo launched a Health Across all Policies initiative, in January 2017, to integrate health considerations into policymaking across all sectors (New York State Department of Health, 2017). The non-healthcare partners include such entities as housing, transportation, economic development, education, and local planning committees. Such a multidisciplinary approach allows communities to truly be able to understand and address the social determinants of health that play a significant role to the issue of health and health care disparities that exist.

Having a robust infrastructure for primary care is another key piece to health promotion and disease prevention. Primary care, is essential care, that is integral in achieving the goal of the health care delivery system to optimize population health (Shi & Singh, 2015). This requires addressing disparities in access to care that exist. New York, like much of the nation, is facing significant challenges in the area of primary care. There continues to be a shortage of safety net and rural providers. Such shortages in primary care further impact access to care and the health disparities that exists, despite increased coverage through such programs as Medicaid. These health care disparities contribute to segments of the population receiving lower quality health care than others, resulting in poorer health outcomes (Kaiser Family Foundation, 2012).

Nurses can play an integral role in addressing the primary care needs that exist within New York, and across the rest of the United States. Jean Moore (2017) presented how nursing workforce data can help to inform public policies, the health and education sectors, and the public. Current changes taking place in the health care delivery system include shifting the focus to primary care and prevention, improving population health by increasing access to high quality, cost-effective care, the integration of health services through care management, the use of multidisciplinary teams, and payment reform to pay for quality, not quantity (Moore, 2017). As the largest group of health care providers are nurses (Shi & Singh, 2015), they will be very important to a successful transition in the health care delivery system.

Current problems that face the transformation of the health care delivery system is insufficient primary care capacity, maldistribution of available workforce, and providers such as nurse practitioners not being able to practice to the full scope of their training related to regulatory restrictions (Harvard University School of Public Health, 2014; Moore, 2017). Research has shown that nurse practitioners provide equal, or higher quality of care, as physicians in a more cost-effective manner (Harvard University School of Public Health, 2014; Naylor & Kurtzman, 2010). Currently, only a handful of states, including Vermont, have instituted legal scopes of practices allowing nurse practitioners to practice independently. Supporting changes so that legal scope of practice match professional scope of practice to allow nurses and nurse practitioners to practice to the full extent of their training will be integral in resolving these challenges.