"This is a time where uncertainty and opportunity co-exist," says Eileen M. Sullivan-Marx, PhD, RN, FAAN, Dean and Erline Perkins McGriff Professor of the New York University Rory Meyers College of Nursing (NYU Meyers). "This period can be fraught with policy mistakes or adoption of new policies that have unintended consequences, such as Medicare Part D's 'doughnut hole' under the second Bush administration that left gaps in coverage of medications."
In "Public Policy: Using Ethical Frameworks in Times of Transition & Uncertainty," published in the Journal of Gerontological Nursing, Dean Sullivan-Marx petitions nurses to turn to the profession's founding ethical frameworks and principles in order to shape care and emerging policies. She acknowledges that individual nurses may vary politically in stance on the issues; however, as advocates for quality, safety, and access to care, nurses have an ethical obligation to address issues that adhere to standards of care and the values of the profession.
She argues for the use of the American Nurses Association (ANA) Code of Ethics as a framework to discuss policy issues relevant to the nursing profession's care for older adults as new healthcare policy changes manifest themselves in the federal administration and states. The Code of Ethics prescribes that a nurse practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.
"A very practical example nurses may encounter is how to coordinate care for individuals who see a loss in Medicaid coverage, particularly older adults who are dually eligible under both Medicare and Medicaid," says Dean Sullivan-Marx.
The number of dually eligible older adults expanded to over 10 million under the Affordable Care Act. These individuals have the most complex health issues and are typically below the poverty line. With reductions in Medicaid access being proposed both at the federal and state levels, individual nurses may find themselves caring for persons who lose coverage of services in long-term care settings or for in-home care.
"If a nurse determines her patient would not be safe without these services, what is her recourse?" asks Dean Sullivan-Marx. "There are a variety of options, some more palatable than others, that range from advocating for care regardless of the patient's ability to pay, all the way down to discharging the patient with advice on seeking new enrollment opportunities, and to call 911 if care is needed."
Dean Sullivan-Marx points out that the aspects of practice and professionalism that may be most at risk during administration transition and expected health policy changes include access to affordable services including preventive and screening services, rehabilitation, community, and long-term care services for older adults.
"Assuring that all persons have access to care regardless of ability to pay, citizen status, health condition, or disability, and support for autonomy of nursing practice including advanced practice nursing are policies that must be followed at local, state, and federal levels," emphasizes Dean Sullivan-Marx.
It's important for nurses to acquaint themselves with their ethical code in regard to older adults as the ethical framework will support individual nurses and the profession to advocate for human rights, quality and safety for patients, families, and communities along with professional colleagues and society.
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