Healthcare Costs Expected to Double

Within the next decade, the total amount Americans spend on healthcare will probably double to $2.1 trillion, says a recent report by the Health Care Financing Administration. Much of the increased spending will come from the private sector through doctor’s services and a growing number of prescription drugs, especially costly new drugs. While Medicare spending will also rise, the rate of growth in government spending on healthcare is anticipated to slow within the next five years. Currently healthcare expenses account for 13.6% of the total national economy; but by 2007, the amount will grow to 16.6% of an economy that is itself expanding every year. Healthcare costs are becoming a larger piece of the nation’s economic pie, and the size of the total pie is growing.

Because of changes in government reimbursement, little growth is expected for nursing homes or home health agencies. Hospitals, the largest employers of nurses, are expected to grow more slowly than will other service providers. In fact, the portion of the healthcare dollar that goes to hospitals will probably drop from 35% currently to 32% by 2001. This data indicates that more future opportunities for nurses may come from areas outside the usual institutional employers: hospitals, nursing homes, and home health agencies.

Fewer Undergraduate, but More Graduate Students

Enrollment nationwide in baccalaureate nursing programs fell 6.6% for the 1997-1998 school year, according to the American Association of Colleges of Nursing. But admission to graduate programs edged up 1.6% during the same year.

A growing number of graduate students want to become nurse practitioners. According to the National Organization of Nurse Practitioner Faculties, the number of universities preparing nurse practitioners almost doubled from 119 to 202, just between 1992 and 1995. During roughly the same period, the number of nurse practitioners jumped by 47% to 71,000 according to the 1996 National Sample Survey of Registered Nurses conducted by the Health Resources and Services Administration, Division of Nursing. In fact, nurse practitioners now slightly outnumber clinical nurse specialists.

The survey also found that an associate degree was the most common highest degree earned by registered nurses, accounting for 34.6% of those employed; 31.8% of nurses had a baccalaureate degree, and 23.8% had a diploma. Nurses with master’s degrees accounted for 9.1% of employed nurses, but less than 1% of nurses were doctorally prepared.

Census Shows Generation Gap in Family Structure

Recent Census Bureau data describes a startling shift in the patterns of American families. While families headed by baby boomers are stabilizing for the first time in a generation, families with young children are increasingly headed by single women.

Baby boomers left behind a generation of dramatic changes as they matured. Divorce rates doubled between 1960 and 1990, but have recently stayed at about the same level. Married couples with children dropped from 40% of all American households in 1970 to just 26% in 1990; since then, they’ve edged only slightly lower to 25% of households in 1997. Although the percentage of single-parent families climbed from 6% in 1970 to 12% of all US households in 1990, the number only slightly increased to 13% by 1997. According to Census data, 45% of American households with children were headed by a parent aged 35 to 49 years and only 34% were headed by 20 to 34-year-olds in 1997.

Despite the overall leveling off of the percentage of single-parent families headed by baby boomers, 1997 Census data shows that 85% of black women with children younger than six years have never been married. Similarly, approximately 66% of Hispanic women and 56% of white women with young children have never been married.

New Portrait of Nurses

The most accurate picture of nurses comes from the National Sample Survey of Registered Nurses conducted by the Health Resources and Services Administration, Division of Nursing. Data collected in March 1996 were recently released, showing that nurses are older and more diverse since the last survey in 1992.

• Since 1992 the number of employed nurses grew by almost 263,000. While 2,558,874 nurses were currently registered in 1996, only 82.7% worked as nurses, the same percentage as in the previous survey. But compared to the earlier survey, slightly more, 59%, worked full-time.
• The number of nurses from racial or ethnic minorities grew slightly to 10%. Approximately 4.2% were black, 3.4% were Asian or Pacific Islanders; 1.6% were Hispanics; and 0.5% were Native Americans.
• Men accounted for about 5.4% of employed nurses. Although the percentage of male nurses changed little, the actual number soared by almost 50% to 113,683.
• The average age of all nurses was 44.3 years, but employed nurses averaged 42.3 years. The number of nurses younger than 30 continues to drop as more and more baby-boomers pick nursing as a second career. From 1988 to 1992, the number of young nurses fell 20%.
• Hospitals remain the most common employer, accounting for 60% of nurses; 17% worked in community or public health agencies; 8.5% worked in ambulatory care or physicians’ offices; and 8.1% worked in nursing homes or extended-care facilities.

HMO Quality Report Findings

A new report examining the quality of managed-care plans found wide variations of quality across the country. The information was analyzed by the National Committee for Quality Assurance (NCQA) based on data collected from 447 managed-care plans covering more than 60 million Americans, about 80% of all patients enrolled in managed-care programs.

The report relied on data from the Health Plan Employer Data and Information Set, or HEDIS. The eight clinical HEDIS measures of quality are advising smokers to quit, beta-blocker treatment, screening for breast cancer, screening for cervical cancer, rates of cesarean section, childhood immunizations, eye exams for diabetics, and prenatal care during the first trimester of pregnancy.

Overall, plans that reported their quality measures to their members had higher marks on quality and more satisfied members than did plans that restricted the information.

The report found wide variation in practice between plans in the same region, as well as differences between regions. For example, patients in the South Central region who had heart attacks were treated with beta blockers less than 20% of the time, while patients in the best performing plans received beta blockers more than 90% of the time. Plans in New England scored highest in six out of nine quality measures, and plans in the South Central region scored lowest in seven out of nine measures of quality.

After new accreditation standards take effect in July 1999, all health plans will be required to submit HEDIS data. The information will be summarized as report cards on individual health plans – including their physicians and programs to promote health and treat chronic illness. Under the new standards, members will be able to obtain the reports through their employers or through the NCQA website at www.ncqa.org.

Medicaid Legal Advice Law Unconstitutional

A federal judge ruled unconstitutional a 1997 law that made it illegal to advise patients how to change their financial assets in order to qualify for Medicaid. Quickly dubbed by the Bar Association as the “Granny’s Advisor Goes to Jail” law, the statute was widely criticized even within the federal government. Both Attorney General Janet Reno and Vice President Al Gore refused to defend or enforce the law. It was intended to prevent middle-class patients from giving away or hiding assets to appear poorer and thus qualifying for Medicaid. Opponents charged that the law interfered with the patient’s attorney-client privilege and right of free speech.

Fewer Americans Have Health Insurance

The Census Bureau reported that the number of Americans without health insurance increased by 1.7 million during 1997, and an estimated 16.1% of the population, or 43.4 million people, lack health-insurance coverage. The groups most likely to lack coverage include Hispanics, part-time workers, the foreign born, people ages 18 to 24, and those with the least education.

Despite the general rise in uninsured Americans, the percentage of children without coverage remained unchanged at 10.7%. Although nearly one-third of people living in poverty lack insurance, the percentage of uninsured poor people with full-time jobs dropped from 52.2% in 1996 to 49.2% in 1997.

Give Recruiters Reasons to Hire You

What do recruiters look for when evaluating nurse candidates? One important item in today’s job market is evidence of your accomplishments as a nurse. You can illustrate your accomplishments through examples.

Regardless of your clinical specialty, review your experience and prepare examples demonstrating the professional characteristics that nurse recruiters seek most. Make sure that your examples stem from recent practice and highlight clinical skills related to the kind of unit where you hope to work.

• Caring or Compassion: Give instances when you developed a therapeutic and caring relationship with the patient and family based on an empathetic understanding of the patient’s experience of health, illness, and treatment. Show how you modified your care to respect the patient’s personal beliefs and values.
• Customer Service: Describe ways in which you “went the extra mile” or “put the customer first.” Before going to an interview, clearly determine how you define customer service in your day-to-day practice.Clinical Expertise: Include information that demonstrates your understanding of underlying physiologic and emotional concepts, rather than just relying on following physician orders, standing protocols, or tradition. Show how you individualized your nursing care based on the patient’s needs
• Critical Thinking: Think out loud as you work through clinical scenarios or case studies. Different nurses may come to the same conclusions, but for entirely different reasons. Give enough information to help the recruiter identify how you exercise critical thinking to make sound clinical judgements.
• Collaboration: Highlight ways you participated in teams, especially instances when you facilitated teamwork, provided support for colleagues, or contributed to the stability and emotional health of your work group.
• Commitment: Show how you have grown professionally by furthering your education, attending continuing education programs, joining professional organizations, and by facilitating the practice of nursing through committee work. Make sure your resume includes this information.

Jeffrey Zurlinden, RN, MS, ACRN, is a frequent contributor to Nursing Spectrum.