Questions Answered: What is the problems with quality care today? Why is quality of care lacking in areas? Quality of care plays an important role in assuring the standards of nursing performance. By providing specific performance requirements, standards of nursing performance can improve and provide quality of nursing care in health care settings (Scope & Standards, pg 33). Quality care is one of the most significant nursing standards of modern time. This particular standard must be implemented by nurse’s everyday.
One of the main concerns in nursing practice today, is quality of care in the health care setting (iom.edu). Recent reports from the American Nurses Association (ANA) and the Institute of Medicine’s Quality Initiative (IMQI) brought immediate attention to the public on the collapse of quality of care. The reports focused on the need to recognize, develop, evaluate, and ensure the quality of health care in the United States (nursing world.org). Both the ANA and IMQI represent a systematic effort to advance health care quality and patient safety concerns. Many other institutions have felt the need for further disciplinary actions to improve quality of care in healthcare settings.
Organizations such as the American Heart Association and Agency for Healthcare Research and Quality have also recommended that the healthcare system launch a systemic proposal to increase the quality of care. The American Heart Association has made the Quality of Care and Outcomes Research Interdisciplinary Working Group (QCOR IWG) to provide quality care to heart patients (americanheart.org). The QCOR IWG is a multidisciplinary group committed to making a significant contribution to improving patient outcomes and healthcare quality. The Agency for Healthcare Research and Quality developed a National Healthcare Quality Report to facilitate the needs of patients around the United States. By doing so, they are raising awareness to healthcare institutions for the improvement of quality of care (ahrq.gov).
Private groups such as the National Quality Forum (NQF), Leapfrog group, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) made recommendations and efforts to ensure healthcare quality. All of the organizations are trying to make an attempt to lower client dissatisfaction, identify specific quality indicators, and increase the quality of care in every health care institution in the United States (ahrq.gov).
A 2004 study, done by the Agency for Healthcare Research and Quality, concluded that 45.1 percent of people were not receiving the care they needed (ahrg.gov). Healthcare systems are now aiming at quality improvement, education, and implementation of quality care (ahrq.gov).
The ANA gives reasons for the lack of quality care in institutions today. One of these reasons is the lack of professional care. The registered nurse (RN) has one of the lowest censuses of the healthcare professionals and highest in demand. RN’s are now faced with an enormous amount of patients, little time to care for their individual needs, and long strenuous work hours. Longer hours from the nursing shortage lead to RN burn-out. This burn-out creates decreased quality of care, medications errors, and an increase of patient safety risks (nursingworld.org).
A nurse, D. Thomas, from the local Nursing Home discussed her time of burn-out. She states,One day, I had thirty patients to care for all by myself. I had two nursing aides that did everything except medications. The whole day I passed out dozens of meds. They didn’t have anyone for the next shift and my manager asked if I could work some over time. I worked sixteen hours that day. I made three medication errors and two patients had new pressure ulcers, but there was no one else to care for these individuals. The bad thing was, I didn’t even care for them, I just handed them their meds. The aides did all of the work because I was so pressured for time. That’s the way it is now, more nursing aides and less nurses. No one wants a nurse’s job because it is not what it seems (D. Thomas, personal interview, October 31, 2007).
Some healthcare facilities have instituted more unlicensed personnel to take place of the professional nurse. This is thought to be a way of quickly saving money for the institution. Staff substitutions have become major issues for patients today. In 1996, the ANA conducted a survey examining the concern of the quality of care in health systems. Out of all the adult clients polled, three-fourths indicated a serious concern that good quality of care is harder and harder to find. Thy also concluded that substitutions can be a “quick fix” to save money, but in the long run, they will minimize the quality of care for the patient (nursingworld.org).
Another major issue that limits quality of care is insurers. Insurers are tearing down refund rates and decreasing the number of services covered (Scope & Standards, pg 18). I found this statement to be true when I interviewed a patient, C. Erlain, who is a Blue Cross Blue Shield health plan member. He states,My insurance does not cover all of my procedures and tests. I am mad because I pay a lot of money each month to have good coverage and I don’t get the care that I need. One time I was at the doctors and he said that he could only spend fifteen minutes with me because my insurance does not allow me to go over that amount of time. I was so frustrated. How would I get the care I needed? Even if I got another plan, they would also have restrictions, so I don’t get the care that I want or need. If I could say anything to those insurance people, it would be why am I paying for something that doesn’t care about my health? Those people only care about the money, not the people. It’s unfortunate (C. Erlain, personal interview, November 2, 2007).
From my own experience in home healthcare, I was only allowed a limited amount of time to spend with the patient depending on their insurance. It was either fifteen minutes, thirty minutes, or one hour. Sadly, this was no always the best scenario for the patient. Although the patient was getting care, it wasn’t the care that they would have liked. One patient said to me, “Do you have to go already?” I was so busy that I could not stay and I knew no one could cover for me, so I left. It saddened me to feel that I hadn’t done my job to its full capacity.
I had too many patients and too little time. An insurer made my patient visits more of a “hello” and “goodbye.”Americans are limited when it comes to healthcare benefits and insurers are escalating insurance premiums (Scope & Standards, pg 18). The estimation of uninsured individuals in the U.S. reached forty-five million in 2002 according to the American Hospital Association. Forty-five million Americans will not even have the opportunity to receive any healthcare, let alone have quality healthcare (aha.org).
To expand the seriousness of the recommendation for quality of care, quality initiatives are going to large and small institutions to implement these suggestions. The government had made the Agency for Healthcare Research and Quality to bring about issues in the quality of care in healthcare settings (ahrq.gov). Implementing this task force helps to improve the quality of healthcare. It also better insures the health client that they will be provided with adequate care for their healthcare needs.
Improving quality of care is a team effort. The government bureau, healthcare agencies, and many other organizations are working vigorously to take an active role to enhancing the quality of care in healthcare settings. By doing so, this team effort will reach its goal to help patients to receive the quality of care they deserve.
Agency for Healthcare Research and Quality. (2007). Guide to Healthcare Quality. Retrieved October 29, 2007, from http://www.ahrq.gov/American Heart Association. (2007). Quality of Care and Outcomes Research Interdisciplinary Working Group. Retrieved October 29, 2007, from http://www.americanheart.org/presenter.jhtml?identifier=3016540/American Hospital Association. (2002). Medical Liability: A Looming Crisis? Part I& II. Retrieved November 2, 2007 from http://www.aha.org/aha/research-and-trends/AHA-policy-research/2003-or-earlier.htmlAmerican Nurses Association. (2007). ANA’s Safety and Quality Initiative. Retrieved October 28, 2007, from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/NDNQI/Research/QIforAcuteCareSettings.aspxAmerican Nurses Association. (2004). Scope and Standards of Practice. Silver Spring, MD: ANA.
Institute of Medicine’s Quality Initiative. (2007). Health Care and Quality. Retrieved November 2, 2007 from http://www.iom.edu/CMS/3718.aspx
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