Nursing Care Plans

dr. wakefield:thank you very much, operator. i want to welcome allof you and thank you for joining the call today. i'm doctor mary wakefieldand i'm the administrator of the house resources andservices administration. that's a division of the u.s.division of health and human services and i'm also a nurse. and i am very, very excitedto be joined today by the first lady of the unitedstates, michelle obama.

and to be speaking with all ofyou about the very important role that nurses can and areplaying in the implementation of the affordable care act,which president obama signed into law just over six months ago. as the first lady knows, acrossamerica, nurses are on the front lines of our nation'shealth care system, each hour of each day. nurses know how much our nationneeded real health reform. and now that the affordable careact is the law of the land, we

know what a huge difference itsprovisions will make to millions of americans across the country. but this is still a very newlaw, and we know that your patients have questions aboutwhat this law means for them. and that's why we so appreciateyour interest and willingness to spend some time with us thisafternoon to hear about what we think will be vitally importantinformation for both you and for your patients. so on today's call, firstyou'll hear from our first lady,

michelle obama, who willhighlight what this law means for you and for your patients. and then you'll hear fromme again about a few other components of the affordablecare act relevant to nurses. and then i'm going to turn itover to jillian roth, another nurse, who will speak aboutthe importance of prevention. a strategy thatis just integral. it's an integral partof this new legislation. finally, we'll have just a fewminutes to take your questions

before wrapping up. so now i'm honored to turn overthe call to our nation's first lady, michelle obama. the first lady:thank you, thanks somuch, dr. wakefield. thank you for that introductionbut more importantly thank you for your hard work in fightingfor health care reform for so many years. she's truly been a wonderfuladvocate and a partner to this white house.

i also want to thank all thenurses who are joining me here today at the white house. and of course i want to thankall of you joining us on the call across the country today. we have a wonderfulrepresentation of the profession on this call. but we're on this call today totalk about what health insurance reform means for youand for your patients, specifically the new provisionsthat just went into effect.

but i do want to start bysaying that i was looking forward to this callfor a couple of reasons, not just because we're talkingabout important reforms, but because barack and i haveseen firsthand the crucial role that nurses play in ournation's health care system. and just to recall a story,i will never forget the time back in chicago, whensasha was then a baby, she was just aboutfour months old, and one day she justbegan to cry inconsolably.

and up until that time,sasha was a healthy, happy baby who rarelycried for no reason. so of course we knewsomething was wrong, and we immediatelytook her to the er. and as you all can imagine,when a child gets sick, you are scared, and we werecertainly scared when we got to the hospital. and we were even morefrightened when sasha was diagnosed with meningitis.

but what made that difficulttime so much easier to bear was really all of you. it was the nurses. and don't get me wrong, thedoctors did a phenomenal job. but the nurses were the onescommunicating with us every single step of the way, usingtheir expertise not just to comfort our little babygirl, but to comfort us. and thank god, everything turnedout okay, and sasha is healthy, as everyone knows.

but it's because of thatexperience we will always be grateful to the nurses whohelped us then and to all our nurses across the country whoprovide such outstanding health care each and every day. and i know that so manyamericans have their own stories to tell aboutthe skill, the care, the compassion thatnurses showed them during difficult days. we all have these storiesbecause in moments of need,

nurses are on the front linesof america's health care system. nurses are the oneswho make things work. and that's the reasonwe're talking today. you all play such a criticalrole in helping patients understand what's goingon with their health care, giving them the information theyneed not just to get better, but to stay healthy. and right now, there's some veryimportant new information that we really need tohelp pass along.

last week, we hit thesix-month anniversary of the affordable care act. that means that we're startingto see more of the reforms take effect, including newprotections and benefits in the patient's bill of rights. so for example, insurancecompanies can no longer discriminate againstkids because they have a preexisting condition. patients can no longer bedropped by their insurance

companies because they get sick. people suffering from a seriousillness like breast cancer can focus on their treatment becausethey no longer have to worry about hitting theirlifetime limit on coverage. and college kids and youngadults just starting out on their own can now get coveragethrough their parents' plan. now, all this means thatindividuals and families have more control overtheir health care. but here's the important point:these reforms aren't abstract

theories that just makefor good talking points. these are real changes thatwill benefit americans all across the country. and some of the biggest newchanges and benefits are the reforms that deal withpreventative care, because we all know,everyone on this call, that the best way to keepfamilies healthy and cut health care costs is to keeppeople from getting sick in the first place.

and, as a result of theaffordable care act, that's going to be easierbecause many preventative services are now coveredat no out-of-pocket costs. things like mammograms, cervicalscreenings, colonoscopies, childhood immunizations,prenatal and new baby care, high blood pressure treatment,all of these are included in new insurance plans withno deductible, no co pay, no coinsurance, nothing. these steps are crucial becausethey can help combat preventable

conditions that can haveserious health consequences later in life. take childhoodobesity, for example, an issue that's of particularconcern to me as first lady and as a mother. it's an epidemic that's sweepingthe country and it's one that i've been trying tocombat through our "let's move" initiative. these new reforms are criticalin addressing this challenge

because we know thatpreventative care, at least certain steps iftaken early in a child's life, can help reduce obesity andimprove a child's prospect for a healthier future. we know, for example, thatbreastfeeding can have an impact on a child's health. that's why the affordable careact makes it easier for a mother to breastfeed onceshe's returned to work. we know that prenatal care andearly childhood screenings can

have a dramatic effect on achild's chances of becoming obese later in life. so the affordable care actcovers screenings for an array of conditions that affectpregnant women and their babies. we know that kids getting theirbmi checked is an easy step that can help parents makebetter decisions about their children's health. so the affordable care actcovers bmi screenings. and it's not justchildhood obesity.

preventative measures like thesecan have a major effect on so many chronic illnesses likediabetes and heart disease or high blood pressure. so those are just some of theexamples of what's in the law. but in order for this law tomake a real difference in people's lives, we have tomake sure that people know about these reforms and thatthey take advantage of them. and that's why we need yourhelp in spreading the word. so we're asking youall to get involved

in this outreach effort. talk to your patients about howthese reforms can help them. also, talk to your colleaguesabout the best ways to inform patients about what thisnew law means for them and for their families. but in closing, just let me saythis to all of you on this line. so many of you have playedsuch an important role throughout this process. from the very beginning, it'sbeen nurses who have sat at

the table sharing yourideas, sharing your concerns and your experiences. and as a result, all ofyou have helped to make this law even better. so i want to thank you for that. and we needed your help thenand we need your help again to spread the word. so, again, thank you everyonefor the work that you've done, thank you for the work thatyou're going to do and all the

things that you do every singleday to make this country a healthier, more secure place. and with that, i'm going to turnit back over to mary wakefield who will provide a few more detailson some of the other reforms. thanks, again. dr. wakefield:thanks, so much, mrs. obama. it is wonderful to hear yourthoughts about the affordable care act's impact on improvingthe health of the nation, and also to hear yoursupport for nurses and

the work that they do. and as a nurse, from myperspective, i greatly appreciate the obamaadministration's strong support for nurses. and i know my nurse colleaguesacross the nation do, as well. that support is clearlyevident throughout the affordable care act. earlier today, in fact, i joinedhhs secretary kathleen sebelius to announce $253 million inhealth resources and service

administration grants that werereleased under the affordable care act's public healthand prevention fund. bolstering our primary careworkforce and included in that announcement were twosets of nursing grants. and i think they each meritmention; one of them, a $31 million allocation underthe advanced nurse education expansion program that as oftoday will go to 26 schools of nursing to increase full-timeenrollment in primary care nurse practitioner and nursemidwife programs.

we expect these funds tosupport 1,300 primary care nurse stipends over five yearsand to fully train 600 nurse practitioners andnurse midwives by 2015. additionally, we announced thismorning $14.8 million to fund 10 nurse-managed health clinicsto provide primary care. these clinics, managed byadvanced practice nurses, provide primary care or wellnessservices to under-served, vulnerable populations. funding is for three years andit will provide access and

training -- access to primarycare and training for more than 900 advanced practice nurses. more broadly, the affordablecare act makes an historic investment in primary care byexpanding the health resources and services administration'ssupported network of health centers across the country. these centers provide a rangeof primary care services to patients, and they treat anyonewho comes through their doors. health centers are slated toreceive an additional $11

billion over the next fiveyears, to double by 2015 the current patient baseof 19 million people. and this influx of supportfollows on the heels of a $2 billion investment made throughthe recovery act stimulus funds just last year that expandedhealth centers and the services that they deliver. right now, we have about 15,000nurses that work in health centers, including hundredsof advanced practice nurses. so looking forward, you canimagine the opportunities for

nurses that will emerge overthe next few years as we work to expand the primary care system. the affordable care act alsoinvests $1.5 billion in the national health service corpsover the next five years. that's in addition to $300million invested in the national health service corps last yearunder the recovery act to boost the number of clinicians whowork in under-served areas. advanced practice nurses areeligible to join the national health service corps.

and in fact, of the 4,700national health service corps clinicians currently in the field, 15% are advanced practice nurses. but we have standing vacanciesfor about 1,700 more health care professionals at 1,400 locationsnow across the country. so for advanced practice nurseslooking for an opportunity to serve those who are in most needof primary care, and have the government help to pay off theirstudent loans while they work, i'd urge them to go onlineon at hrsa -- that's hrsa.gov -- and visit the nationalhealth service corps site.

lots more opportunitiesas a result of the and there are other affordablecare act provisions that are also important to highlight. if nurses are to play anexpanded role in a reformed health care system, clearly thenaccess to nursing education programs is ofparamount importance. the affordable care actreauthorizes and it significantly increasesfunding for all seven of the health resources andservices administration's

nursing programs, programs thatrepresent the primary source of federal funding fornursing education. and faculty shortages are aleading factor in admissions backlogs at schools of nursing. at present only 13.2% of rns have a graduate degree, and only 12% of those are employed in educational settings. while the affordable care actaddresses this challenge by updating the advanced educationnursing traineeship and the nurse anesthetist traineeshipprogram, prior to the affordable

care act the health resourcesand services administration was prohibited from granting morethan 10% of those funds to doctoral students. but fortunately the affordablecare act eliminates this cap, and support for training andadvanced education practice is also highlighted in the nursingworkforce diversity program. similarly, the nurse facultyloan program provides funds to schools that enable them tooffer loans for masters- or doctoral-level nursingstudents that are interested

in becoming teachers. the combination of increasedfiscal year 2010 appropriations and additional funding from lastyear's recovery act means that this program, the nurse facultyloan program, is significantly larger now than ithas been in years. and the nursing student loanprogram gives students with limited financial resourcesaccess to long-term, low-interest loans. it also provides partial loancancellation for nurses who

work in shortage areas. the affordable care actincreases the amount that student nurses may borrow by almost 25% -- to a maximum of $17,000. and the affordable care act alsoexpands the nurse education loan repayment programto include faculty. the overall impact of thesechanges associated with the affordable care act will, ithink, be a continuation of the positive trends that werereflected in hrsa's most recent national sample survey ofregistered nurses, which found

that while demand still outpacessupply, the nursing profession is growing, we're bettereducated than ever before, and we're becoming more diverse,more reflective of the patient populations that we serve. even so, though, we have gaps tofill in each of the areas, which is why these investments thati've just mentioned are so important to going forward. to keep up with the pace ofreform and to learn more about how the affordable care acthelps you and your family,

and to direct your patients toa rich source of information, i would encourage everyone onthe line to go to the website, healthcare.gov -- "healthcare,"all one word, "dot-gov." this is a government websitethat allows users to compare the value of insurance plansavailable in their states, to compare the performance ofnearby hospitals, for example, and to learn aboutways to stay healthy. that site, that website, istotally geared to the needs of consumers, and it isremarkably easy to navigate.

in addition, it has beenstructured to evolve and expand as consumers use it. and comments to websiteadministrators are much welcome so we can figure out evennew ways to improve it. remember, it's healthcare.gov. so thank you very much for thisopportunity to share a bit more information on theaffordable care act. and i'd like to invitejillian roth, a nurse, to speak to all of us.

jillian? ms. roth:good afternoon. my name is jillian roth and i'mpleased to join mrs. obama and dr. wakefield for thisimportant conference call. let me add my greetings to thethousands of registered nurses and nursing students whoare on this call, as well. as nurses, patients look to usfor important information about how they can stay healthy andhow they can access important health care services.

i've been a registerednurse since 2007. i currently work in a hospitalin northern virginia in labor and delivery. i chose nursing because itchallenges my intellect and it allows me to make adifference in people's lives. i love my work and i feelprivileged to be with the women and their families at suchimportant times in their lives. i care for women fromall walks of life. and at times i see women whohave experienced complications

during delivery, and thesecomplications oftentimes could have been avoided with bettermanagement of their care, or if they have hadaccess to prenatal care. that's one reason i got activelyinvolved in the american nurses association's efforts to helppass health care reform. recently, i cared for two womenwho had no prenatal care because they lacked insurance. when both of these women arrivedat the hospital in labor, they had no idea how manyweeks along they were.

in the first case,the baby was preterm. had we known this, we wouldhave had a neonatologist available during her delivery. the second case was a youngwoman who thought she was 34 weeks along, yet it turned outshe was post-dates, so we ended up having to do a c-section anddelivering a very large baby. we are fortunate in both casesthat the deliveries went okay, but it's challenging when yourpatients arrive at the hospital and there is littleto no information.

it's hard to predict what kindof complications may occur, and those kinds ofsurprises can lead to devastating consequences. that is why access toprimary and preventive care is so important. one in eight infantsborn today is premature. premature babies often requirelong and costly stays in the nicu, and they experiencemany health issues and developmental delays.

high quality prenatal care cango far to reduce the number of premature births. i also have a husband who hasdiabetes, so on a personal level i understand the role ofdisease management and controlling his diabetes andpreventing complications. we know that diabetes and otherchronic diseases are on the rise and that we will be seeing anincrease in chronic diseases as our population agesunless we take action. as nurses, we really understandhow to prevent -- how preventive

and primary care services canhelp avoid complications. that's why i believe the healthcare law is important, and i'm excited about the new benefitsthat will help people access insurance and many of theseimportant health care services. thank you. dr. wakefield:thank you very much, jillian. i think we'll turn nowand take some questions. so the first question, i think,is coming from kay ball. kay -- and if you'd letfolks know where you're from,

and then we'd delightedto hear your question. ms. ball:kay ball, and i'm associateprofessor of otterbein university in westerville, ohio. and i want to say hello tothe first lady obama and dr. wakefield. and we're on the campus rightnow, and i'm joined on this call with many of mynursing faculty colleagues. so as you know, nursing is thenumber one trusted profession in the united states.

and because of this, we've beenable to form a very strong bond of confidence with ourpatients and their families. and we also know, as yousaid, that there are a lot of unhealthy lifestyles existingin america today and that many diseases and conditionstoday are preventable. with all this in mind, howcan nurses actively and collaboratively work withthe white house to promote prevention and healthylifestyles for all? and how can we as nursingfaculty help our nursing

students carry thismessage into the future so it can be sustained? the first lady:well, kay, thanks somuch for your question. thank you and yourcolleagues for your work. i think that it's awonderful question. let me just say that, firstof all, you all are doing -- already doing so much topartner and support this reform and the white house. and i guess at first blushit's just keep doing what

you're doing. i mean, as you said, americansrely on nurses for advice and for guidance, and i think thebest thing we can do is make sure that people understand theprevention services that are out there; continue to educatepeople about the importance of disease prevention early on. all of us have members inour family who are afraid of medical care. they don't go to the doctors,they don't go to nurses.

everybody here is noddingtheir heads in agreement. we all have experienced that,and i think that sometimes a conversation with a physicianfeels a bit more intimidating. but the folks in your professioncan have the conversations and to just remind people that wecan stop this train, many of these disease trains, fromheading down the track. and again, we've got to justlet people know about these new health insurance reforms; thatif people purchase plans now that they'll receive therecommended preventative care

with no out-of-pocket costs. that's really importantfor people to understand. that's one of the reasons whyreform has tried to make these provisions easier to access. and i would also just like toadd that it's important to remind patients that next yearmedicare beneficiaries will get free preventative careas well under the act. so that's another benefit that'sgoing to come along next year. so i think we're asking you tospread the word, to use your

-- not just your professionalchannels, the channels that you have working with patients in amedical setting, but also your personal channels as well. nurses are regular folks who goto church and go to the grocery store, they have kids atschool, they're on boards. use those avenues as a wayto continue to educate your communities about these reformsand to continue to push preventative care, because nolonger will insurance be a barrier to this kind of care.

the stories that jillian hastold can be eliminated because of these reforms. and i know that all of you whoare working in labor rooms around the country know theimportance, for example, of seeing mothers who havegotten good prenatal care. now they can do that, it'seasier, and we just need to -- we need your helpin spreading the word. so thank you so much forall that you're doing, and just keep it up.

and we'll takethe next question. ms. ball:thank you. dr. wakefield:and i think the next questionis coming from marlene heier. marlene, i hope i'm pronouncingyour last name correctly. if you let us know where you'refrom, and ask your question. ms. heier:yes, thank you. first, i would like to say it'sa privilege and an honor to be a participant in the forum. i am an orthopedic nurse fromketterine medical center in

dayton, ohio; have been in theorthopedic field for nine out of my 22 years in nursing. actually our concern on theorthopedic unit -- i understand that it seems almost that theaffordable care act pertains a lot to the younger populaceand preventive medicine. i understand that there willbe more free preventative care provided to themedicare populace. but our concern is willpatients' reimbursement be decreased to a point wherepatients such as ours will be

either discouraged orunable to continue to have elective joint repairs? a lot of them have reached apoint of immobility and extreme pain because of the necessityfor the joint repairs, and we're not talking about fracturesand repairs due to trauma. the most -- i'd say 80% of our patients are medicare recipients, so our reimbursement comes mostly from the medicare populace. and so the decrease in thereimbursement, our hospital would impact our nursing staffas well, and that directly

impacts patient care. so i guess our concern is how isthis going to impact medicare and the amount of reimbursement? dr. wakefield:thanks so much for that question, marlene, and it was nice to hear yourreferencing your practice in orthopedic nursing. i have practiced for a periodof time in orthopedic nursing, as well, so i have someappreciation for what you and your colleagues face in terms ofdelivering care both to younger

patients but also to medicarebeneficiaries that find their way to hospitals fororthopedic intervention. and the question that you raiseis a really, really important one, and i'm happy toanswer to this question. it's important because there'sa lot of misinformation and confusion about what medicarebeneficiaries are entitled to and how the affordable care actimpacts the medicare program. so i think i'd like to makea few comments about it. first of all, for medicarebeneficiaries and the care that

they receive from you and inother parts of the health care delivery system, guaranteedmedicare benefits will not change, whether a senior citizengets those benefits through original medicare or througha medicare advantage plan. guaranteed benefitsare protected and they will be protected. in addition to that, in additionto ensuring that guaranteed medicare benefits do notchange under the law, there are also new benefits.

so senior citizens haveaccess to new services. some of you have perhaps heardabout some of them that we've talking about most recentlythat has to do with the medicare part d program. so, for example, if a seniorcitizen on medicare enters the part d doughnut hole this year,they will receive a one-time $250 rebate check. and as of this month, aroundseptember 20th or so, we have about $1.2 million medicareenrollees that have already

qualified for that rebateand that have already been sent that check. we know how importantprescription drugs are to the health ofmedicare beneficiaries. that's a veryimportant expansion of health care services. and on that front, i think it'sprobably also worth noting that looking forward, next year,seniors on medicare will get a 50% discount on brand-name drugs when they hit the

doughnut hole. so in other words, beneficiarieswho enter the doughnut hole in 2011 will save on averageover about $500 on their brand-name prescription drugs. and as you continue to track theimpact of the affordable care act going forward, we'll seeeven more efforts to close the doughnut hole until it'scompletely closed in 2020. and it's probably worth justreiterating the point that the first lady made just a minuteago, and that is that senior

citizens will be receivingfree preventive care and a free annual wellness visitbeginning next year. so the medicare program writlarge is strengthened and the benefits for individual medicarebeneficiaries are expanded. this new law includes veryimportant tools to help strengthen access tohealth care services for medicare beneficiaries. i really do want to thank youfor that question because i think, personally, that seniorcitizens have gotten a lot of

bad information about the newlaw and i hope that as nurses you'll take the opportunityto answer their questions and ensure that senior citizens haveinformation that they need and honestly that they deserve. so thanks a lot for lettingme set the record straight a little bit on that front. and i think that we havetime for one more question. i think pennie branden, you'renext in line, if you'd like to ask your question and please do tell us where you're from.

ms. branden:hello, and thank you, dr.wakefield and mrs. obama, and hello to all of my nursingcolleagues across the country. i am a certified nurse midwifeand an assistant professor of nursing at southernconnecticut state university. and i just wanted to ask aboutthe fact that all nurses are aware of the nursing facultyshortage, as dr. wakefield mentioned earlier. and in regard to that,i have two questions. firstly, what is the future goalof the administration to reduce

the shortage of nursesand nurse educators? and secondly, is theadministration actively involving educators on theground to strategically address the faculty shortage? dr. wakefield:great questions, and i canprobably help to answer that. pennie, thank you for them. first of all, you've heard afair amount of conversation about strengthening theprimary care workforce. that's really critical, both tohave faculty that are prepared

to educate that next generationof primary care nurses, and you see those provisions in thehealth resources and services administration strengthenedspecifically, and i talked a bit about those earlier. for example, with theavailability of new funding, through the prevention andpublic health fund that the secretary -- secretary sebeliusand i just announced earlier today -- those resources thatwill help prepare the health system to meet what we know isgoing to be increased demand for

primary care services as manymore individuals have access to primary care, in a lot ofcases for the very first time. but combined with thoseinvestments that i talked about earlier, you see the affordablecare act markedly expanding part of the -- different parts of thedivision of nursing programs that support the productionof nursing faculty. we just released last weekdata from our every-four-year, quadrennial survey onthe nursing workforce. and we can see pendingshortages in nursing faculty.

so they're not necessarilygetting better. so it's just in time that theaffordable care act is expanding the major programs availablethrough the health resources and services administration thatsupport nursing faculty, that support nurses to choosea career in teaching the next generation of nurses. so there areexpansions in programs. we've also made recentinvestments that we've announced just about a month ago,and we'll be making more

investments as we go forward. so yes, we've got a clear eyeon the importance of ensuring access for students,access to nursing faculty. and we are expected and wecertainly are working closely with nursing facultyacross the country. we also, for those of you whoare on this call, we welcome your input about how we can doan even better job of deploying these new resources. so we do our work in partnershipwith folks across the nation.

that's the expectationof this administration. and we invite and we welcomeyour input as we now have new resources to strengthen ourprimary care workforce and to strengthen ourinvestments in faculty. and -- please. the first lady:just one other thing, and icould have mentioned this in my answer -- this is mrs.obama, michelle obama -- but, you know, i wouldjust encourage you all, particularly in these tougheconomic times, as we're talking

to young people and people, youknow, who are looking for career changes -- and this issomething that i say to young people all the time-- the health profession is the growing sector. this is where thejobs are going to be. and when i -- i met a young girlthrough make a wish foundation just last week, i think it was,who said she wanted to be a nurse, and i told her thatthat was an outstanding choice because she'd probablyalways work in this economy.

so i would urge you all tospread the word to young people and people who are looking for acareer change, people who may be out of work and need to thinkabout where the next sort of sector of jobs is goingto be: it is right here. and again, with preventiveservice expansion, more nurses, more rns, more certified nursingassistants are going to be needed to fill this void,which will be great. and again, there are resourcesto get educated, to get your degree, to become a teacher.

this is where -- this isthe future of medicine in so many ways. so we need you to help justspread that word to young people starting out, to people who aremaking the change, because we're going to need nurses bigtime in the years to come. so just wanted to add that,and i'll turn it back over to dr. wakefield. dr. wakefield:thanks so much for thoseobservations, mrs. obama. and i want to thank nursesfrom across the country

for joining us today. that's about all the timethat we have for questions. but i do want to underscorethat if there's anything from this call that you needsome clarification about, or you want some additionalinformation about the affordable care act, as i mentioned earlier, please do go to that website, healthcare.gov -- "healthcare," all one word -- healthcare.gov. and in addition to thanking thenurses who participated in the

call all the across the nation,i want to extend from -- and on behalf of nurses, very,very special thanks to you, mrs. obama, both for yourleadership in terms of the health of the nation and forjoining the thousands of nurses from across the country whoparticipated in this call today to discuss with us some of thevery important provisions of the so thanks to you forbeing here with us. the first lady:it's an honor. thank you, thank you, all.