The Future of Nursing in Alabama

Four years have passed since the Institute of Medicine released its report and recommendations on how nursing and America’s health care system must be transformed to meet urgent future needs.

What progress is Alabama making toward those goals?

“Based on the anticipated needs in health care by 2020, the Institute of Medicine identified several specific changes we must achieve to have adequate resources in place to care for our people,” Carol Ratcliffe DNP, RN, FACHE said. “Alabama has made progress on several points, but we have a great deal of work ahead of us.”

In addition to being an associate professor and coordinator of the Health Systems Management and Leadership program at Samford’s Ida V. Moffett School of Nursing, Ratcliffe is one of four co-leader of the Alabama Health Action Coalition (AL-HAC). Along with Ratcliffe, Kathleen A. Ladner, PhD, RN, FACHE, Jane Yarbrough, BSN, RN of Blue Cross Blue Shield of Alabama, and Lacy Gibson of the Alabama Hospital Association, are working to focus the efforts AL-HAC will be making on the state level as part of the Future of Nursing National Campaign for Action.

To recap the key points of the Institute of Medicine’s 2010 report, America’s growing elderly population means more people will need care, which is likely to overwhelm the nation’s healthcare resources unless steps are taken to prepare for this growth in demand.

Boosting the effects of preventive medicine through primary care is a logical first step toward stemming the tide, but a shortage of primary care physicians is already creating access issues in some areas. The nation’s three million nurses are the largest proportion of healthcare providers, and are the health system resource placed in the most agile pivot point for gearing up to meet these needs.

“To make this transformation possible, the IOM report identified four changes that must happen so we will have the capabilities we need in place to meet the needs we will soon be facing within the next five years,” Ratcliffe said.

Specifically, the report suggested that:

1) Barriers must be removed to allow nurses to practice up to the full extent of their education and training. 2) Nurses should be encouraged to achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3) Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States. 4) Effective workforce planning and policy-making require better data collection and an improved information infrastructure.

So, how is Alabama progressing in achieving these goals, compared to other states?

“We are making progress,” Ratcliffe said. “We’ve streamlined programs for nurses to upgrade their education and acquire the training they need to provide higher levels of care. We are graduating more nurse practitioners, and we are beginning to slow the flood of advance practice nurses we were losing to other states due to Alabama’s restrictive laws limiting their work.

“The recent law allowing nurse practitioners to prescribe a wider range of medications has made a difference. In the past, efforts to make care accessible in underserved areas were thwarted because nurse practitioners couldn’t prescribe the drugs needed to care for the patient. If a patient had a serious cough, you could give him a steroid, but not a cough medicine containing codeine. If a patient was injured, you could bandage his wound, but you couldn’t give him much to help with the pain. Now patients who don’t have transportation or money to buy gas to travel a hundred miles don’t have to suffer needlessly.”

However, Alabama’s practice laws still have a long way to go to remove barriers. These laws are considered among the most restrictive in the nation. For example, recently a group of nurse practitioners wanted to open a free clinic in an impoverished area, but there were unable to because they didn’t have money to pay a doctor to supervise them as required by state law. Thus, Alabama has a shortage of clinics in poorer areas.

None of the advanced practice specialties are designated in Alabama as primary care providers (PCP), which hinders them from directly receiving reimbursements from insurers and Medicare or Medicaid.

AL-HAC has prioritized key areas of focus where they will be working in the months ahead to move Alabama forward in the steps necessary to be ready to take care of its people by 2020.

“Our first objective is to establish and identify stakeholders in all regions that can be active participants in the plan to improve health care in the state of Alabama by increasing the proportion of nurses with a BSN degree to 80 percent by 2020,” Ratcliffe said. “This includes creating marketing strategies for community colleges to provide a seamless transition to a baccalaureate degree and higher. We want to identify and communicate financial resources for students, including employer-funded, federally-funded and other sources.

“Secondly, we understand the need to establish a comprehensive health work force data repository for all health care providers that will support health planning and policy development. To know where we stand now and where we need to address shortages, we support the creation and maintenance of a comprehensive health workforce data repository to include collaboration from licensing boards, the statewide Area Health Education Center (AHEC), Alabama Department of Public Health, and Alabama Department of Economic and Community Affairs (ADECA),

“Our third objective is to identify and prioritize challenges faced by each region that directly affect the health care of Alabamians. This includes secure health care for the underserved, the marketing of health care careers to students in rural areas, and securing funding for education. We also want to look at Regional Care Organizational Districts to help us stay up to date in our understanding of the specific needs of each region,” Ratcliffe said.

“The Alabama Health Action Coalition hopes to be a driving force for transforming health care through nursing in our state, with a goal of long-term, sustainable change, to improve the health of our population.”