Nurse Practitioner Case Study

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

There will be a few challenges ahead for our healthcare system and the nursing profession: 1. The Aging Population- (baby boomers will be hitting retirement age). 2. Poverty-“the increasing numbers of disenfranchised people and pressure to limit health care expenditures will collide to create an intense values conflict for nurses of the future”. (Chitty & Black p.382) 3. Unhealthy Lifestyles- (obesity, tobacco use, lack of exercise, stress, HIV/AIDS and drug abuse). 4. Faculty and Student shortages- making nursing shortage worse. Nurses as

Registered nurses are an integral part of the healthcare system, and make up the largest number of healthcare professionals. According to the Bureau of Labor Statistics (2015) “The employment rate for registered nurses is expected to grow by 16% between 2014 and 2024”. This is more than double the average rate of growth for a profession. The rapid growth rate can be attributed in part to better management of chronic diseases and the baby boomer generation. The growth in the nursing profession is paramount, however the demographics of the nursing population does not mirror the demographics of the population served.

According to Health Resources and Services Administration If the system for providing primary care in 2020 were to stay fundamentally the same as today, there will be an estimated shortage of 20,400 primary care physicians ("Projecting the Supply and Demand for Primary Care Practitioners Through 2020," n.d.). In addition this projection doesn’t include the decreasing number of people perusing the medical degree and the baby boomers retiring form this filed of science. In the hand we are experiencing a significant increase in NPs and PAs. Considering this projected shortage, which is actually a very frightening situation the increasing number of NPs and PAs, can effectively be integrated; we could reduce the number of physician shortage by over 69 percent in 2020.

Currently, there is still a large shortage of primary care practitioners in the United States. The margin between available providers and those in need continues to grow. Many people without proper access to care have to delay seeking help for what ails them ("Health Wanted," 2012). Glicken & Miller (2013) state that approximately 16,000 primary care providers would be necessary to meet the existing demand. Rural communities would represent the area of greatest need followed closely by low-income urban areas. The number of underserved individuals is estimated to have reached fifty-seven million. This demand will only increase, as 52,000 primary care providers are expected to be needed by the year 2025 (Glicken & Miller, 2013, p.1883-1889).

The physician shortage is of highest concern in the United States, especially since the Patient Protection and Affordable Care Act has been passed. The question is, do we really have a physician shortage? Is it by geographical region or by specialty? I will explore this question and have several different solutions to the physician shortage problem.

Today, the United States is facing a shortage of about 16,000 primary care physicians and this number will continue to grow by 2025 (Amirault, 2014). Primary care physicians (PCPs) are the doctors who focus on overall health and offer the treatments and preventive screenings that save lives. A physician shortage is a situation in which there are not enough providers to treat all patients in need of medical care. The Association of American Medical Colleges (AAMC) has long pointed out that the shortage of primary care physicians will be a major setback for the American healthcare system advancing (Amirault, 2014). The shortage of primary care providers presents

The projected physician shortage is well documented. Several estimates have been made as to the severity of the shortage with the Association of American Medical Colleges (AAMC) predicts required 46,000 physicians to meet demand and a study by Cowell et al putting the number at 44,000 by 2025 (1). The reasons for this increased demand are numerous. For starters, as John Prescott, AAMC chief academic officer, says, “There 's 10,000 more baby boomers every single day in the U.S. and those individuals tend to require additional care” (2). Those baby boomers requiring care will undoubtedly include retiring physicians; 2,504 family physicians are expected to retire in 2015 alone with that number only expected to grow in upcoming years (1). In addition to the increased care inherently required by elderly patients the Affordable Care Act (ACA) has expanded medical insurance to several that have never had access before; while this is great news to those with coverage for the first time it also increases the number searching for a physician. A report prepared for Congress stated that the ACA was poised to increase the shortage of physicians by 8,000 by 2025 (4). Even current clinics have been forced to turn down 250 potential patients a day due to a lack of physicians causing sick persons to drive hours to find care (3). Compounding the problem, new physicians tend to shy away from the 60-hour weeks worked by their predecessors instead looking for a better work/life balance (2, 3).

With an expanding and aging population, the demand for physicians has never been higher. Rural regions across the country are already experiencing physician shortages, specifically in primary care. According to the Association of America Medical Colleges, the United States will have a shortage of more than 130,600 physicians by 2025, equally split between general practitioners and other medical specialties. Although its true that the number of medical students being trained in the United States is increasing due to the opening of new medical schools and expansion of class size, the number of practicing physicians will not increase unless the number of residency slots is increased. The number of residency training slots is the bottleneck to increasing the number of practicing physicians. New doctors need to complete a residency-training program in order to practice medicine, and these training slots are becoming progressively more competitive. The programs are limited in size, and the increasing number of medical school graduates leaves medical doctors without a enough training slots. The looming doctor shortage will only get worse if medical school graduates continue to be left out of residency training programs, and are forced to wait till the following year to re-apply.

- There is a large physician aftercare population for referrals. Healthcare needs are high and there are four hospitals within a 15 mile radius leaving the need for more

Texas faces a growing demand for Primary Care services, particularly in rural and underserved regions. The Texas Department of State Health Services reports that 16,830 primary care physicians were in active practice in Texas in 2009, or approximately 68 for every 100,000 people. The national average is 81 per 100,000 people. This shortage is compounded by a prevalent misdistribution of physicians across the state. Of Texas’ 254 counties, 118 were considered whole county health professional shortage areas, or HPA’s, and 71 contained either special populations or geographic areas that qualified for the designation of partial-county HPSA. Twenty-six counties had no primary care physicians in 2009.

Primary care practice will be greatly impacted by health care reform. To provide better health care, the country will see a trend away from specialty to primary care and the avoidance of acute issues by delivering this care in the community setting. As a result, primary care physicians will be overwhelmed with the patient load as the number of the insured increases exponentially. The committee recognizes the scope of nursing practice that remains untapped and therefore the profession

The health care issue that I have chosen to research is how we should address the shortage of nurses. I have chosen this topic because I work in a hospital and it is very difficult to recruit new nurses especially in specialized areas. Nurses in the workplace are the largest population of health care employees at 2.7 million nurses employed in the United States according to the Bureau of Labor Statistics. This is almost double the nursing assistants employed at 1.4 million which is the second leading health care occupation in the United States. The nursing profession has the largest job growth from 2008 to 2018 with a total of projection of more than 581,500 new registered nurse positions to be created. It is also projected by 2025 to have a nursing shortage that will grow to more than 260,000 registered nurses (N.d.), Overview of BLS Statistics by Occupation, http://www.bls.gov/bls/occupation.htm

Inclusion of the 674 patients who completed a HCCA into these data, gives a slightly different perspective into the variables. Appendix~\ref{AppendixB} further shows the R output of the Cox-PH model in the data set for patients with a CA and HCCA. After using the stepAIC function (as discussed in Chapter~\ref{Chapter3}) and manually removing variables with coefficients between -1 and 1, only 10 variables are chosen, namely; Meds to be initiated, Expected living arrangement, self-rated health, Urgency for comprehensive, face-to-face assessment, Urgency - Nursing, Urgency - Physiotherapy, Urgency - Occupational therapy, Service urgency and Client Group\footnote{These variables are coded iA32ba, iA33, iA34, iJ7, iNN4, iNN5a, iNN5c, iNN5d',

This paper will discuss a contemporary health issue and its potential impact on the nursing profession. As the nursing profession continues to grow, society has begun to see a decrease in the number of nurses in the profession. According to NursingWorld (2005) "The nation's hospitals have 126,000 vacancies for nursing professions. In addition, 75 percent of all hospitals vacancies are for nurses." Currently Registered Nurses are at the top of the list of occupations with projected job growth. So why are so many nurses leaving the profession resulting in a shortage? Is America truly experiencing a nursing shortage or are nurses just better educated, resulting in additional responsibilities?