Nursing challenges

Labor unions are fighting to make sure their interests and input are considered as hospital executives adjust to a new business landscape under the healthcare reform law, along with new and threatened Medicare cuts devised to trim the federal deficit. As Labor Day approached, Modern Healthcare reporter Andis Robeznieks spoke with RoseAnn DeMoro, executive director of National Nurses United, who says hospitals so far are siding with profits over patients. DeMoro has been named to Modern Healthcare's ranking of the 100 Most Influential People in Healthcare all 12 years it has been published, and her fast-growing organization has been anything but shy in making itself heard in local and national healthcare debates. Below is an edited excerpt.

Modern Healthcare: How are nurses using their influence to shape healthcare reform, and what challenges are you facing along the way?

RoseAnn DeMoro: We're facing an environment where technology is just considered to be the god in the healthcare sector. The consultants are just rolling over this industry, so they're selling hospitals the technology as the panacea for making more profits and cutting care, and it's not. The challenge at this point is for the nurses, in particular, to be able to actually care for our patients in an environment that's far more concerned with care containment in terms of making profits higher, and so they're using technology and the nurses are supposed to relate to the machines rather than the patients.

And the conflicts in the healthcare industry with the nurses and the hospitals have taken a new dimension. The greatest challenge for the nurses is actually caring for a patient in a world where you have the ACA in effect. It's probably the most confusing healthcare system that will be imposed in the industrial world. That doesn't mean that it's all bad, but it's the confusion and the opportunism of the hospitals in terms of implementation that have been a massive challenge.

MH: What do you see as being the big concerns of nurses in the months ahead as reform gets implemented?

DeMoro: The hospitals and the insurance industries will try to capitalize on the ACA and do a lot of the things that they were hoping to do in the name of the ACA. So they'll blame the ACA for cutting care, for increasing prices, for doing things on a more limited basis that gives them maximum profits. The effect on the nurses (is that they must) try to care for a patient in an environment where healthcare isn't being provided rationally.

The federal government has really institutionalized levels of care for different people. Medicare, you had a uniform policy. Here you have multiple levels, multiple tiers. The types of care that people get are different.

There's a dumbing down of healthcare in the current environment, so you have care being pushed down to other professions in a restructuring where they're trying to displace doctors, they're trying to displace nurses, they're trying to displace the highest levels of care.

Because it's confusing, the hospitals can say anything that they want and then blame it on the ACA, and that's what's happening. Just from our perspective it's rather ironic, given the fact that they actually have a larger base, but it's not the base that they necessarily want because they want the healthy and wealthiest as their patients or as their customers. And what the ACA does, it expands access for a lot of people who are not in that boat.

MH: Do you see the different levels of care being offered at the same institution, or do you see it at different levels depending on the institution that patients are admitted to?

DeMoro: You've got these tiered levels of care, and it's basically all the care that you can afford. So, you're going to pay such a high out-of-pocket to get a better, a higher level of care that you're not going to be able to have access to the same type of procedures, testing or levels of care that you would have in a different tier. They've sort of expanded Medicaid. That's a positive because there will be more consistency. And I'm not suggesting that Medicaid is good healthcare. In fact, care is actually underfunded—profits are overfunded in the healthcare industry, and this exacerbates the problem.

Nurses shouldn't have to make choices and see a different level of care that different patients are getting. There should be a focus on preventive care for everyone. And I really want to emphasize everyone because if you get diseases, for example, those become social issues.

You've got the vilification of (President Barack) Obama, and for the people who know what the appropriate system is, they're kind of staying quiet because they don't want the Democrats vilified. So our health becomes a political football.

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