English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)
One of the provisions of the Affordable Care Act (ACA) that took effect in September 2010 allowed children/young adults to stay on their parent’s health insurance policies until their 26th birthday. The reason for this provision was that young adults ages 19-25 had the highest rates of being uninsured of any age group in the U.S.
For the past two springs in my health policy course I’ve asked students to raise their hands if they were now receiving health insurance under the ACA provision. This past spring about half of the students in this age range raised their hands. My own son who is in graduate school has been able to continue on my health insurance because of the ACA. Highly unscientific evidence for this part of the ACA working, but evidence nonetheless.
Now there is more objective evidence that the ACA is working for young adults. A NYT article today by Sabrina Tavernise “More Young Adults Have Health Insurance After Health Care Law, Study Says,” reports on data from a recent CDC/National Health Interview Survey. Lack of health insurance among young adults 19-25 fell from 33.9 percent in 2010 to 27.9 percent in 2011, translating into about 1.6 million fewer uninsured young adults. There was a corresponding increase in young adults having private insurance over the same time period, from 49.3 percent in the third quarter 2010 to 58.8 percent in the fourth quarter 2011. These positive changes for young adults were seen across different racial groups. Additional evidence that the ACA is working for young adults is that lack of insurance grew for adults ages 26-34.
As most everyone knows by now, young adults have been the hardest hit by the Great Recession. It is good to hear that something is going in their favor.
First District Nurses in Melbourne (Photo credit: Wikipedia)
That is, of course, if you are at all interested in this type of nursing work. Please do not believe anyone (and especially not your nursing professors who have probably not worked as a nurse anywhere since the 1970s) if they tell you to first work as a nurse in a hospital to “get experience.” That simply is not true. People can and do hire new grads for community/public health nursing. Hiring decisions for these sorts of jobs have more to do with the individual applicant—with his or her personality traits (flexibility, patience, humor among others), understanding of (or interest in learning about) community resources, passion for patient/community education and empowerment, and a personal value placed on prevention vs. costly curative/acute care. In your resume and interview remember to include any relevant work (including volunteer or service-learning before or during nursing school) experience in health and social service provision in the community. Do your homework before an interview—including making sure you understand important terms used in the job description. For instance, “harm reduction” does not mean sitting close to a door to escape from a potentially volatile patient…
Non-hospital places to consider when job-hunting: public health departments, community health clinics, nurse-managed community clinics, Health Care for the Homeless clinics, migrant health clinics, Indian Health Service clinics, home care/hospice agencies, nursing homes/long-term care facilities, school-based clinics (and school nursing in general), and occupational health clinics (including perhaps jail/corrections health care?). Similar to hospital residency programs for new nursing grads, some health departments and community clinics are piloting paid internships for new grads/new hires. Health departments in Wisconsin and North Carolina have examples of these.
And despite setbacks/job losses brought on by the recent Recession, health departments and community health programs are hiring nurses. And if the Affordable Care Act survives the caprices of the US Supreme Court, health care reform promises to bring a substantial increase in public health/community nursing jobs—or as the Future of Nursing IOM report states, it promises “to return the profession (of nursing) to its roots in the public health movement of the early 20th Century.” (pg 24).
If you are wondering whether going directly into public/community health nursing after graduation precludes you from ever getting a hospital job in the future—that is not the case either. Especially now with hospital systems’ focus on health care transitions, patient education, and patient care management/coordination, having had previous experience in public/community health nursing is an advantage. Hospital units always do additional training for any/all new hires anyway, so you can get back up to speed on the relevant patient care equipment, meds, etc.
Meanwhile, how to find jobs in public health/community health nursing? Like with any job search, working your personal contacts is important. Ask your community/public health nursing professor or clinical instructor (a fair number of students asked me–hence this blog post response). In the Pacific Northwest, here are places I recommend looking for jobs:
American Public Health Association online careers search (this one requires you to create an account but you don’t have to be/become an APHA member to do so. You can then upload/post your resume if you want–is easy to use and a relatively sophisticated job search system.)
Happy job hunting!
~p.s. For those of you who would love to go right into public/community health nursing but find yourselves in a hospital or other setting instead–don’t despair of ever being able to transition back into the community. Just try to find opportunities to volunteer in a community setting, doing health/social services sort of work. That will help you build your resume and skills for making the transition back out of acute care.
As part of the Affordable Care Act (ACA) health care reform, drug companies will soon be required to report payments and free lunches/dinners/cruises/vacations/gifts to physicians or payments to teaching hospitals. It includes any free ‘educational’ service for physicians or teaching hospitals. This is section 6002 of the ACA and is known as the Physician Payment Sunshine Act (sunshine, as in shedding light on or transparency). As part of the mandatory reporting, individual physicians and hospitals will be named, along with what items of monetary value they received and by which companies. This information will be publically available and easily searchable. Companies will be assessed hefty fines of up to $1 million for failing to report the information. This Sunshine Act was supposed to have already been implemented, but has been delayed while government officials at the Centers for Medicaid and Medicare sift through public comment and iron out final details.
I read through the proposed Physician Payment Sunshine Act (vol 76,no. 243/12-19-11 Federal Register), and found that they define “physician” as a doctor of medicine or osteopathy, dentists, podiatrists, optometrists and licensed chiropractors. Teaching hospitals are defined as hospitals having graduate medical education. And here is their rationale for the Sunshine Act:
“2. Transparency Overview
Collaboration among physicians, teaching hospitals, and industry manufacturers may contribute to the design and delivery of life-saving drugs and devices. However, while some collaboration is beneficial to the continued innovation and improvement of our health care system, payments from manufacturers to physicians and teaching hospitals can also introduce conflicts of interests that may influence research, education, and clinical decision-making in ways that compromise clinical integrity and patient care, and may lead to increased health care costs.” (p. 7)
Several states including Vermont have already implemented similar reporting requirements. Some physicians are complaining that drug companies are now wooing more nurse practitioners as a way around the reporting requirements. I saw that in action at this past fall’s regional nurse practitioner conference. It was overrun by aggressive pharmaceutical reps waiving tons of swag (including the ubiquitous drug pens), as well as signing NPs up for free lunches/dinners/talks, etc.
In the community health clinics where I’ve worked, most all of the family physicians were rabidly anti-drug company marketing and influence. One physician in particular would go on a tirade if she discovered one of her medical residents writing with a drug company pen. They—and everyone else in the building—would get a lecture in the evils of drug company influence on physician prescribing practices and health care costs. So I thought I had long ago purged myself of all drug company free stuff. While preparing to write this blog post I engaged in some late winter housecleaning searching for hidden drug company subliminal influences. I found six drug company pens, four of which were for drugs that have been pulled from the market as unsafe. I threw them all away. On a popular blog lamenting the Sunshine Act, one physician complained that he has to buy pens for the first time since he graduated from medical school in 1986.
The only drug company swag I found that I am keeping is a funky glass sun catcher given to me by a retired pharmacist who lives on my street. It has elemental alchemy symbols for strange things like lead and vinegar and talc—but is really an advertisement for a nasal decongestant hidden in small type at the bottom. See if you can find it on the attached photo—but don’t buy the stuff!
