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Brenda Hubbard Teaching Project Nursing 217 The article that I have chosen to discuss is about the changing

roles of nursing, and in particular the direct-care nurse, with regards to the Affordable Care Act. The Affordable Care Act is the biggest health reform in United States history since the creation of Medicare and Medicaid in 1965, and its implementation has allowed, or will allow, 32 million additional people to gain insurance coverage who were previously uninsured or underinsured. Unfortunately, an act of this magnitude will lead to more rules and regulations, forms to fill out and policies to comply with, and this article discusses how to change the role of a direct care nurse, so that bedside nursing in a hospital doesn't become a place where new nurses become disillusioned with their role, "do their time" in that position (a year to three years that is required for most other expert nurse positions) and then move on to pursue their dream position elsewhere, or to continue their education on their way to advanced practice nursing. Hospital direct-care nurses are the largest group of frontline acute care workers. Their jobs are crucial to patient outcomes and satisfaction. However, with every new rule or regulation or reform, there usually comes an additional piece of paper or task for a direct-care nurse to do, (for example: hourly rounding, checklists, etc.) and this can actually have the opposite affect than what is desired. Basically, if nurses spend the majority of their time burdened by new forms and additional paperwork, they spend less time with the patient, and this decreases patient satisfaction as well as patient outcomes, ultimately decreasing the hospital's overall satisfaction scores and other ratings, leading to decreased funding which then leads to cutting direct care nursing positions because they are one of the biggest expenses in a hospital, causing fewer nurses to cover the same number of patients, again decreasing the amount of time spent with each patient. It is like a never ending cycle, where the new regulations meant to increase client satisfaction are actually causing the opposite. Three things were proposed by this article as a potential solution to this problem. First, hospital administration must support and empower their direct-care nursing staff. They should recognize that the frontline workers have a vast amount of knowledge and experience and when instituting new rules and regulations and policies, they should not be "inflexible protocols that dictate nursing practice and exclude professional judgment and individualized care" (Sprayberry, 64). Second, hospital administration should ensure that direct-care nurses have sufficient resources

to meet their growing responsibilities. Equipment that is in good working order, sufficient copies of the paperwork that needs to be completed, and a competent staff to work with are just a few things that make a nurse's day go so much better. Finally, the article suggests that the profession itself must reconsider the way it looks at direct-care nursing. Bedside nursing is a critical role, and it shouldn't just be thought of as a launch pad to better places. Even nurse educators should address the role in a different way and not say things like "well, after you get your year of med-surg in, you'll be able to move on." I think that this article presents some interesting ideas and it is important for all of us as nurses to be aware of how changing political atmospheres can affect our careers and the way that our roles can change. I also agree with the author, in regards to the way that we look at direct-care med-surg nursing and I think I have heard many times during this program other students or instructors make references to completing their year in the hospital first, or I don't want to but I will probably have to do a year of med-surg somewhere first. That is not a very good attitude for us to have! Direct care nurses are highly skilled and need to have finely tuned assessment skills so that they may properly address any emergencies or changes in status that a patient may have. We should remember that our patients deserve the very best of care and that we are there to do the best job that we can, no matter where we ultimately want to go.

Works Cited Sprayberry, L. D. (2014). Transformation of America's health care system: Implications for professional direct-care nurses. MedSurg Nursing, 23(1), 61-67.

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