Running head: PROFESSIONAL DEVELOPMENT ASSIGNMENT 1

Professional Development Assessment

Mallory White

Aspen University

May 2016
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Professional Development Assessment

A master’s degree in nursing is more than a piece of paper. To function as a competent

master’s prepared nurse, one must be able to develop the knowledge, skills, and attitudes of

healthcare as a whole and apply them to every day nursing practice. As a master’s prepared

nurse educator, it is equally important to be able to portray that knowledge, skills, and attitudes

to the future generation of nurses. Healthcare technologies are continually changing and

affecting facilities bottom line financially. Throughout this course, this nurse has gained a better

understanding of the correlation between the two, and how they affect nursing care.

Master’s Level Nursing Outcomes

Gaining knowledge about U.S. healthcare delivery and systems can greatly influence the

nursing profession. As a masters prepared nurse, it is important to develop, maintain, and

evaluate organizational and educational systems to facilitate delivery of care in a variety of care

settings. With adequate knowledge and influences, changes can be made to implement best

practices. For example, throughout this course, this nurse has gained knowledge about how

technology has changed healthcare. Sultz and Young (2011) state that technological advances in

healthcare are frequently accompanied by new vexing ethical and financial dilemmas (p. 45).

What was once a very personal industry has turned into a world filled with computers and other

machines.

As a nurse educator, this nurse has educated new nurses on the benefits and drawbacks

from technology. For example, bedside scanning and verification for medication administration

has drawn nurses to look at patients as a number instead of an actual person. It is easy for nurses

to be caught up with the business of working routine and simply scan patient’s wristbands
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without acknowledging the patient. While the process of bedside verification and scanning can

decrease medication administration errors, without proper care, it can decrease patient

satisfaction. When patients feel like they are being scanned or looked at as just a number, their

satisfaction with the facility can decrease. The decrease in patient satisfaction can also mean a

decrease in facility reimbursement from insurance companies, like the Centers for Medicare and

Medicaid Services (CMS).

Other technological advances have changed nursing practice and have forced many in the

profession to look at quality of life versus quantity. One example of this is a magnetic resonance

imaging machine (MRI). MRI machines can be expensive, and so can the costs of imaging for

patients. Sultz and Young (2011) estimate that one MRI machine can cost more than $2 million

and patient charges are about $900-$1200 per image (p. 401). With such a high cost, it is

important for nurses to advocate to their patients to examine the necessity of testing before

proceeding. Keeping up with current evidence-based standards is important for a master’s

prepared nurse educator in order to not only educate nurses, but also the patients on best

practices. Having knowledge of recommended imaging for a disease or illness can not only save

the facility money, but the patient too.

One key factor throughout the development, implementation, and evaluation of policies,

programs, and services for nursing is the focus on the facility’s bottom line. Through greater

understanding of U.S. healthcare delivery and systems, this nurse is better able to understand

why the focus on the bottom line is important. Many American’s are frustrated with the current

health care system, including healthcare administration and financial personnel. In order for

hospitals, and other healthcare facilities, to stay afloat, they rely on payment from insurance

companies and private payer patients.

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Nursing care is affected by the bottom line focus. Through preparation for a master’s

degree, this nurse has been able to implement policies and procedures to ease nurse’s burden of

focusing on the bottom line. For example, when preforming a dressing change, the nurse must

use the minimum amount of supplies and charge the patient for the materials used. He/she must

then document appropriately in order to ensure proper insurance reimbursement. As an educator,

this nurse has implemented an area of documenting where nurses can simply check boxes next to

commonly used dressing supplies. This helps to ensure adequate charging and documentation of

dressing change supplies, and can help increase reimbursement. Through this process, this nurse

has stressed the importance to bedside nurses the reason to think about the financial end of the

hospital.

The saying “money makes the world go around” definitely applies to healthcare. The

amount of money coming in and going out of a hospital, or other healthcare facility, affects many

people. Depending on revenue, the facility can afford to adopt new technological advances and

acquire pricy imaging machines. The amount of money facilities receive from insurance

reimbursement can affect the nurse-to-patient staffing ratio or the number of non-licensed

personnel that are hired to help nursing staff. The focus on a facility’s bottom line may start with

high-level administration and the financial department, but its effects trickle down to everyone

employed by that facility.

A better understanding of health care systems has allowed this nurse educator to develop,

maintain, and evaluate systems to facilitate changes in the nursing profession. This nurse has

gained a better understanding of the financial aspect of healthcare in the U.S. and has been able

to pass the knowledge along to the next generation of nurses. A great focus has been put on the

bottom line of healthcare facilities, and that is understandable- without money coming in, there is
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no money to pay staff. With that, a greater emphasis should be put on to patient care and patient

satisfaction. Patients in the U.S. are free to choose where they wish to receive their healthcare,

and nurses play a crucial role in satisfying the patients. When patients are satisfied, the facility

may receive more financial reimbursement, and the patient is more likely to return to that facility

for future healthcare needs. Without patients, nurses, and other health care professionals would

not have careers.

Technology and the Bottom Line

Health care delivery and organization is continually changing and evolving. One

major evolution of medicine has been changing from using physical assessment and natural

disease history to the use of newly developed technology as means of prevention. Health care

has also grown into one of the top business of the US. Sultz and Young (2011) estimate that

medical care in the US has grown into a $2.5 trillion industry, stating that “Americans spend

more only on food and housing than they do on medical care” (p. xvii). With so much money

at stake, hospitals and other health care institutions are focused, now more than ever, on the

financial aspect of health care to stay afloat; this is sometimes referred to as the bottom line. A

huge factor in the financial stability of hospitals and other health care institutions is the insurance

industry. Insurance companies have always played a major role in financing the health care

industry, but now, with changes in reimbursement, the increase in the aging population, and

increase in the number of Americans with health insurance, the idea of a single-payer system is

coming to mind for many American’s.

High Technology Solutions

Technology has changed a lot throughout the course of medical history. Salisbury (2013)

explains that changing technologies in medicine are no longer coming from just medical
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professionals. She discusses that team members specializing in engineering, medicine, and

technology are working together to create great advances in medical care. Salisbury (2013)

discussed findings by doctors at a conference sponsored by Johns Hopkins University Medicine.

Findings showed that advances in every day technology, such as video games, was also effecting

changes in medical technology. One example is the advancement of video graphics cards,

commonly used in video games. Those same ideas for advanced imaging were used in processor

units used to detect cardiovascular diseases and cancerous tumors. These devices provide

precise image quality to differentiate normal tissue versus tumors. The same ideas have been

applied to vein mapping to spot blockages. Because these methods are less invasive, and

proposed to be more accurate, they increase patient outcomes, and can prevent possible

infections from invasive diagnostic procedures.

Salisbury (2013) also explained technological advances that can be used by patients, both

in and out of the medical setting. She described the production of smart phone applications

(apps) that allow people to “take their own electrocardiograms, measure their own blood sugar,

and take their own pulse” (para. 9). Having the ability to assess what is happening inside of your

body at any given time is great for patient involvement in their health care. A patient having the

ability to monitor their heart rate or rhythm through a smart phone can also minimize the need

for bulky devices, like Holter monitors, which are worn by patients for a day or two, and then the

data is turned in to their physician for evaluation. A smart phone can allow for real time

uploading of cardiac activity and may lead to a faster diagnosis of cardiac disease.

One technology advancement recently implemented at a 400-bed hospital in northern

Ohio was the first in the region to have the additional use of a telestroke program. The facility is

equipped with the proper equipment to monitor for and treat most strokes, but the addition of
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telestroke has given them access to a nationally ranked hospitals Stroke Network of physicians,

including immediate access to vascular and interventional neurologists. With the use of a

mobile computer, equipped with a camera, speakers, and a microphone, physicians are able to

perform virtual examinations on a potential stroke patient who may be in need of immediate

intervention, or transfer to a higher level of care.

Both the emergency room medical director and nursing unit director have high praises for

the telestroke program. Medical director, Scott Campbell, MD (Firelands Regional Medical

Center, 2013) explained that although the facility is a certified Primary Stroke Center through

Healthcare Facilities Accreditation Program (HFAP), the medical center neurologists are not

always on site 24/7. He continues to explain that the addition of telestroke has granted patients

access to advanced neurological specialists and can provide expertise beyond emergency

medicine. Dr. Campbell continued to explain that about 87% of all strokes are ischemic,

meaning there is a clot blocking blood flow to an area of the brain. He continues to stress the

importance of early recognition of symptoms, in addition to the use of improved technology to

be able to treat those patients with lifesaving medicine.

Technology is changing quickly, both in the real world, and in the medical world.

Advances in technology have provided greater and quicker access to medical records for

physicians and other members of the health care team. Technology advances have also lead to

greater patient safety and prevention of co-morbidities through easier monitoring and detection.

The Bottom Line

Hospitals and other medical facilities have a constant worry of being financially stable.

Hussain (2007) explains that the bottom line has become the driving force in the hospital
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industry, leaving no room for compassion in dealing with the patients. He continues to explain

that patients and facilities become frustrated with the health care system when insurance

companies do not quickly pay their part for services rendered. That income is important for the

hospital to continue paying for things like their staff member wages, operating costs for

machines and equipment, and general maintenance. When a hospital does not receive

compensation from the insurance, they may turn to the patient to pay that debt.

Smeltz (2015) describes how hospitals are actively seeking out profitable surgeons or

physicians to increase revenue. He explains that neurosurgeons were the highest paid medical

specialist in 2012, earning an average salary of $670,000 because of their highly specialized

field. With technological advances that allow surgeons to perform various surgeries and aid in

managing diseases like Parkinson’s, and compressed nerves, neurosurgeons are a highly sought

after by many patients. In order for facilities to earn the highest income possible, to help their

overall bottom line, they must attract the highest number of patients. Smeltz (2015) states that

“even nonprofit hospitals need to make profit on some services because they may lose money on

others. They need to generate a positive bottom line to reinvest” (para 11).

Worrying about the bottom line does not just fall on the financial department in a

hospital. It is all a trickledown effect, throughout all members of the health care team. From a

nursing standpoint, a hospital’s attention to the bottom line is very evident. One example of the

effect on the bottom line is nurse-to-patient staffing ratio’s. With consistent nurse-to-patient

staffing ratios, the number of nurses needed on a shift can vary depending on the number of

patients per day. Hospitals do not want to pay wages for more nurses than are needed based on

patient population, so nurses may be given an extra day off or work on a different unit depending

on their need.
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Nursing care is also affected by the bottom line. Nurses must be vigilant about supplies

that are used for procedures. For example, if a patient has a wound that has a daily dressing

change, he/she must use the minimum amount of supplies needed to change the dressing. That

nurse must charge the patient for the materials used using the facilities charging system, but

he/she must also thoroughly document the use of those supplies to ensure proper insurance

reimbursement. As an educator, I have had to remind nurses many times to not only think about

the hospital’s bottom line, but to think about the patient’s financial status too. We would not

want to charge a patient for unnecessary supplies, especially knowing that it may not be

reimbursed by insurance, so either the patient or the hospital has to pay for it.

Insurance in the US

It is no secret that the insurance comapnites play a huge role on the health care industry.

Some have suggested the United States convert to a single-payer or universal health care system,

similar to areas like Canada or the United Kingdom. Some issues American’s have with the

current insurance industry include, lack of coverage for pre-existing conditions, gaps in coverage

between jobs, and high co-pay’s or deductibles. The suggested universal health care system

would be just that, universal. Everyone would be covered from the time of birth until death, no

exceptions. Hostert (2016) describes universal health care as a public good funded by federal

taxes that everyone has access to, similar to roads, streetlights, and national defense.

The idea of changing to a universal health care system also has its options. In the U.K.,

they have a National Health Service (NHS) that is completely funded by the government. The

government owns hospitals, and hospital employees, like physicians and nurses, are government

employees. Hostert (2016) explains that the NHS system has become one of the most popular
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arms of the British government, and it provides health services and emergency medical services

to everyone on the country, even visitors.

Proponents for a single-payer insurance system argue that it would not only provide

insurance for everyone, but it would save money for those who currently insured, because it

would relieve them of the burden of paying private insurance premiums. Sword (2010) states

that you “cannot provide economical health coverage for all with for-profit insurance companies

providing insurance coverage” (para 10). Sword (2010) describes a single-payer system

different than the U.K. has. She describes a system in which the government collects the money,

from taxes, and puts in a trust fund. This trust fund is then used to pay medical bills. “It would

be easier to see what is working well and what is not, and also much easier to spot potential fraud

or misuse of the system. It is also easier to enforce best practices and patient safety protocols”

(Sword, 2010, para 14). With a universal health care system, health care providers and facilities

can focus more on providing quality evidence based care instead of jumping through insurance

hoops.

The American people are resistant to a single-payer health care system in fear of rising

taxes or the government being too involved in citizens lives. Many have also feel that a

universal health care system can lead to lower quality care and a decrease in a drive for care

providers to be the best. Those people feel that if citizens have the option to receive care

anywhere, their facilities would lose out on business, and potentially have to shut down. The

Affordable Care Act that was passed by President Obama in 2010 received much criticism

despite the benefits it provided to millions of American’s. Switching to a single-payer system

would also receive much criticism and resistance, but like in other countries, over time,

American’s will be able to see the benefits to their health care.

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Conclusion

Whether it is changes in technology, financial focus, or insurance, the health care in the

US is constantly changing in hopes to increase the quality of care provided to the patients we

serve. American’s are paying trillions of dollars into a health care industry and deserve to have

the highest quality care that is patient focused. When facilities or insurance companies are

driving care based on finances and the bottom line, quality and evidence based care can suffer.

The American health care system has come a long way in terms of technology and insurance

coverage, but there is still a long way of development to go.

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References

Firelands Regional Medical Center. (2013). Introducing the region's first telestroke

technology program. Sandusky, Ohio. Retrieved from

http://www.firelands.com/media/55781/FB_Summer2013.pdf

Hostert, P. (2016). Single payer: The single solution. University Wire. Retrieved from

http://search.proquest.com/docview/1763243703?accountid=34574

Hussain, S. A. (2007). Hospital industrys focus on bottom line feuls resentment. The

Blade, A(7). Retrieved from http://search.proquest.com/docview/380574608?accountid=34574

Salisbury, S. (2013). John Hopkins doctors in West Palm Beach explain how video game

technology is spurring advances in medicine. McClatchy- Tribune Business News. Retrieved

from http://search.proquest.com/docview/1272365926?accountid=34574

Smeltz, A. (2015). Hospitals bank on neurosurgery procedures to boost bottom line. TCA

Regional News. Retrieved from

http://search.proquest.com/docview/1652241848?accountid=34574

Sultz, A. H., & Young, K. M. (2011). Health care USA: Understanding its organization

and delivery. Sudbury, MA: Jones and Bartlett.

Sword, L. (2010). We can do better: Single-payer plan is the best option, one local doctor

says. McClatchy- Tribune Business News. Retrieved from

http://search.proquest.com/docview/458676800?accountid=34574