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A Peer Response must be substantive by bringing information to the discussion or

A Peer Response must be substantive by bringing information to the discussion or further enhance the discussion. Each Peer Response must have a minimum of ONE reference with citations (the best is a peer-reviewed article). Word count is greater than 75 words or at least 5 sentences in length. Please respond to each question separately.
Discussion question/Participation #1
The nursing shortage has been a huge concern for various reasons. In fact, the state of California is in a severe nursing crisis. Covid has been responsible for the shortage for the past 2 years now. While we were all learning about the pandemic and its effect on the public and how to treat our patients while protecting ourselves, frontline workers were faced with the unknown as our treatment plans changed day to day as we grew more knowledgeable about what we were facing. According to Hwang, hospitals around the nation, especially California are losing nurses due to high job pressure, demanding staff assignments, and inundated ERs brought on by the Virus (Hwang, 2020). Not to mention the emotional burnout, extended hours, quarantine, and now the state mandate for the vaccine. There are literally not enough nurses to meet the patient care demands, not to mention specialty trained ICU nurses. Hwang also states that people are going out on stress leave from physical and emotional exhaustion (Hwang, 2020).
Besides the pandemic, the nursing shortage is on the rise because there are not enough schools to meet the demands of entry level students, and according to the Institute of Medicine, most hospitals now are challenged with a hire rate of 80% bachelor nurses which further delays the number of nurses joining the workforce (Rosseter, 2020). This is also in compliance with meeting the Magnet standard. Baby boomers are also retiring, some earlier than expected because of the physical demands and the unsafe work environments as nurse-to-patient ratios are being challenged (Rosseter, 2020). There is no denying that people are living longer, and that’s a great thing. It shows how far we have come in medicine over the centuries, but it also comes with the need for nurses to care for the elderly. Skilled nursing facilities are shutting down across the nation because there are simply no nurses to care for the aging population.
Discussion question/Participation #2
Even before Covid, there was a building shortage of nurses developing. Multiple causes work together to create this shortage. Some of these factors were laid out by the National Institute of Health. They include an aging population with accumulating comorbidities, aging nursing staff reaching retirement age (Haddod, Annamaraju, & Toney-Butler, 2020). These issues are made worse by nurse burnout (Haddod, Annamaraju, & Toney-Butler, 2020) which grows as nurses who remain in the workforce are met with more and more patients as the shortage grows. COVID 19 made this shortage grow at an even faster rate as many nurses retired early and many nurses are currently being burned out as they are working extra hard during these times.
Discussion question/Participation #3
Nursing shortages are an ongoing issue in the nursing profession. There are several factors that contribute to this issue including nurses being near retirement age, nursing school enrollment not enough to contribute to reducing nursing shortage, shortages in nursing school employees, aging population, profession stress and reduction in job satisfaction causing nurses to leave the profession (Whitney, 2018). Changes in education, work environment, legislation/regulation, and research and technology are areas of improvement that are needed to reverse the nursing shortage (AACN, n.d.). Improving education to better prepare student nurses to maintain long-term commitment to the nursing profession and improving the work environment to prevent burn-out and increase safety can contribute to reversing the nursing shortage. While the number of nursing programs has increased, the number of students enrolled and graduating is declined and insuffiencient to meet the needs of the growing demand for nurses (AACN, n.d.). Different demographic areas may have one or more of the factors that contribute to the nursing shortage, so the approach to reverse the nursing shortage may vary depending on the demographic location. With multiple contributing factors of the nursing shortage, it is important for these factors to be addressed on multiple levels and will need long-term action to reverse the nursing shortage across the health care system.
Discussion question/Participation #4
Health care reform has shifted from a disease -centered health care system to a system that focuses on wellness and prevention. Since the Affordable Care Act of 2010, the transformation is influenced by quality and safety. While a cure is important, the pressure is on the health system to reduce and prevent illnesses from occurring in the first place. Wellness and prevention are being promoted with a true interest of bringing back patient centered care through primary and secondary efforts to limit the amount of tertiary focused treatment alternatives. Disease prevention, weight control, hypertension, diabetes are all preventable illnesses, and are the costliest illnesses that lead to inpatient hospitalizations. The focus is on education and public awareness. Outpatient clinics are in high demand for diabetes management. It is better to prepare the newly diagnosed diabetic or to monitor at risk hypertensive patients and educate on the prevention and lifestyle changes with appropriate resources rather that treating a patient for a heart attack (if they survive it) or absorb the cost of dialysis that could have been prevented with the proper support. With more that 30 million new Medicare and Medicaid recipients (because of the ACA) the focus in healthcare needed to change (NAP, n.d.). The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) have joined forces to establish an Initiative for the Future of Nursing to revamp the policies and educational requirements that will turn out nurses in 2 years to meet the demands of the ACA (NAP, n.d.).
Discussion question/Participation #5
The health reform legislation, the Affordable Care Act of 2010, and the American Recovery and Reinvestment Act of 2009, which proceeded it, include a range of initiatives that seek to redesign the organization, financing, and delivery of health care. Many of these programs, for example, primary care medical homes and accountable Care Organizations (ACOs), rely on interventions that fall directly within the scope pf practice of RNs. With this, the focus of health care reform has shifted from a disease-oriented health care system toward one of the wellness and prevention by presenting guidelines of measures that creates a healthy lifestyle. This includes creating healthy living environments, safe communities, better access to community and preventive measures such as screenings and immunizations and elimination of health disparities. Other areas of priority include healthy eating and exercise, mental health, reproductive health and a drug and tobacco free lifestyle (Benjamin, 2011).
This trend will continue as hospital systems are transitioning and branching out to include community-based health care homes that provide primary community care with ancillary services such as radiological and laboratory services within on facility in the community. In today’s society, patients appreciate the ability to have care services closer to their homes and are more likely to participate in their care and preventive measures when they do not have to travel to separate locations for healthcare (Sochalski & Weiner, 2011).
Discussion question/Participation #6
Healthcare reform legislation with multiple provisions signed into law by U.S. President Barack Obama and became known as Obamacare and some of the provisions include lower costs, preventive care and prohibited insurance claim denial or higher premiums for preexisting conditions (Whitney, 2018). It has changed from focusing on being disease oriented to focusing on wellness and preventative care. Focus is now on creating healthy enviroments and lifestyles for communities we serve by providing easier access to preventative care through screenings, immunizations, and eliminating some health disparities. Nurses are athe heart of this focus by educating patients, their families, and the community. This education includes the importance of a healthy diet and active lifestyle.

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