Some of the financial challenges faced by hospitals include reducing operating costs, Medicaid reimbursement, moving away from fee-for-service and the transition from volume to value. The Affordable Care Act (ACA) has helped move the health care system from a fee-for-service model toward a value-based model that rewards better outcomes and lower spending. ACA provisions target quality problems that lead to inefficiencies and jeopardized patient health. The value-based purchasing program for hospitals promotes greater accountability for performance by providing bonuses and penalties tied to publicly reported quality measures. Another issue facing hospitals is improving patient satisfaction scores, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Hospitals with high patient satisfaction usually receive higher reimbursement payments from the Centers for Medicare & Medicaid Services. Measures of patient satisfaction examine nurse and physician communications with patients and how doctors and nurses managed continuous care and the discharge process. APRNs are highly effective at maintaining the patient satisfaction and quality care expected under ACA.Staff Shortages
Health care staffing can be challenging for hospitals. Staffing vacancies and long fill times make it more difficult for hospitals to safely and profitably deliver care. In a 2018 survey conducted by the staffing firm Leaders for Today, almost 31 percent of surveyed hospital executives, administrators, and human resources leaders reported they could not find enough qualified candidates to fill healthcare staffing gaps. While the need for professional registered nurses has continued to grow, nursing schools across the country are limiting student capacity due to faculty shortages. According to the American Association of Colleges of Nursing (AACN), U.S. nursing schools turned away 64,067 qualified applicants from baccalaureate and graduate programs in 2016. The AACN found that the annual national faculty vacancy rate in nursing programs is 7.9 percent. Nurses with an MSN/ED degree are prepared to train the next generation of nurses in the delivery of high quality and compassionate care, thus providing a qualified source of employees for hospitals.
Effective leadership ensures a high-quality health care system that consistently delivers safe and efficient care. Approximately 52 percent of hospital leaders surveyed by Leaders for Today reported their organization’s ability to find qualified candidates in a reasonable amount of time was “not very good.” Hospitals are finding that it takes months to fill open positions. Slightly more than 25 percent of leadership/managerial positions are filled within three months; 39 percent of hospitals wait 4-6 months to fill these positions, with 31 percent waiting 7-12 months. Nurses who have earned an MSN/MBA dual degree are qualified to assume these highly sought and hard-to-fill positions. These APRNs oversee clinical operations, expand services and establish policies and procedures that ensure the best patient care possible.Patient Safety and Quality
According to Deborah J. Bowen, FACHE, CAE, president/CEO of ACHE, "assuring patient safety and providing quality care is the No. 1 job of hospital leaders.” Care provided by APRNs is safe, high-quality, and effective. Nurses who possess an MSN/Nurse Practitioner degree are equipped with the primary care knowledge and clinical reasoning skills needed to prevent, assess, treat and manage acute and chronic disease. In 2010, Yox and Stanik-Hutt systematically evaluated research examining outcomes related to care safety (prevention of injury or loss), quality (level of excellence) and effectiveness (compliance with guidelines and/or production of the desired result) in U.S. patients cared for by an NP as compared to patients cared for by a physician. They found that blood glucose levels, blood pressure levels, satisfaction with care, perceived health status, functional status, numbers of unexpected ED or office visits, numbers of hospitalizations and mortality rates in patients cared for by NPs were similar to those of patients cared for by physicians. Additionally, patients cared for by NPs had lipid levels that were better than those of patients cared for by physicians. Patients of NPs had lengths of stay that were similar to those of patients cared for by physicians and transitional care provided by an NP reduced patient readmissions.Patient Satisfaction
Numerous studies have linked APRNs with high levels of patient satisfaction. A systematic review conducted by Donald and McCurdy (2002) found NP primary care improves patient satisfaction and quality of care compared with physician care for patients with similar health problems. There was no difference in health outcomes between patient groups. Researchers found NPs consulted with patients longer and did more investigations. A more recent systematic review conducted by Woo, Lee and Tam (2017) found improvements in the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings when NPs were involved in emergency and critical care settings. According to researchers at the American Academy of Nurse Practitioners (AANP) 26th Annual Meeting in Las Vegas, NPs outscored physicians in a patient satisfaction survey among low-income primary care patients in Michigan. The survey found 50 percent of physician patients reported that they felt that doctors "always" listened carefully, compared with more than 80 percent of NP patients. NPs topped physicians in the percentage of patients who found that "things were explained in a way that was easy to understand," received easy-to-understand instructions, felt the healthcare provider showed respect for what they had to say and thought the provider spent enough time with them.