252 unit 3 | Professional Issues
(NIH). Originally a center at NIH, it became a
full-fledged insititute in 1993. NINR supports and
conducts basic and clinical research and provides
research training in health promotion, disease and
disability prevention, quality of life, health dispari-
ties, management of symptoms, and end-of-life
care encompassing the entire life span (http://www.
ninr.nih.gov).
Specialty Organizations
In addition to the national nursing organizations,
nurses may join specialty practice organizations
focused on practice areas (e.g., critical care, neuro-
science, obstetrics) or special interest groups (e.g.,
male nurses, Hispanic, Philippine, Aboriginal
nurses). These organizations provide nurses with
information regarding evidence-based practice,
trends in the field, and approved standards of spe-
cialty practice. Links to nursing organizations may
be found at nursingsociety.org/career/nursing_orgs.
html or http://www.cna-nurses.ca
Health Care Today
Among the industrialized countries of the world,
the United States is the only one that does not pro-
vide basic health-care coverage to every citizen
(Lieberman, 2003). Forty-seven million Americans
have no health insurance (ANA, 2008a), yet the
United States has technologically advanced, highly
sophisticated health care and spends more per
capita (per person) than most countries.
If the United States has the most advanced
knowledge and equipment and spends a great
deal of money on health care, then why the cause
for alarm? What is wrong? Why doesn’t everyone
have health-care insurance? Why are people so
worried about the quality of care? The answer is
complex.
For most people, health insurance comes
through their place of employment. One problem
with this is that many employers are motivated to
keep the cost as low as possible or transfer much of
the cost to the employee. Another problem is that
if one loses one’s job, health insurance is also lost.
Managed care was originally designed to reduce
the amount spent on health care by emphasizing
prevention. Some have said that it has become a
way to limit choices and ration care (Mechanic,
2002) rather than prevent illness.
As managed care plans grow and spread across
the country, these companies become powerful
enough to be able to negotiate reduced rates (dis-
counts) from local hospitals (Trinh & O’Connor,
2002). They can, in effect, say, “We can get an
appendectomy for $2300 at hospital A; why should
we pay you $2700?” If hospital B does not agree,
the hospital may lose all the patients enrolled
in that managed care plan. This pressures hospital B
to reduce costs and spread staff even thinner than
before.
Similar price pressures come from Medicare,
Medicaid, and other health insurance companies. To
keep costs under control, some states have cut bene-
fits for people receiving Medicaid (state-supported
health benefits for low-income people) (Pear, 2002).
With the upsurge in for-profit health plans and
the purchase of not-for-profit hospitals by for-
profit companies, U.S. health care has become
increasingly “corporatized.” It was thought that this
would yield a highly efficient, responsive system
(“the customer is always right”). That has not hap-
pened because the “customer” who pays for insur-
ance coverage is actually the employer or the gov-
ernment, not the individual patient. The care
provided by the for-profits, in general, appears to
be of lesser quality than the old not-for-profit or
fee-for-service plans (Mechanic, 2002).
There is a limit to the extent to which cost cut-
ting can increase efficiency without endangering
patients. A series of important research studies has
shown that increasing the number of RNs provid-
ing care in a hospital has a direct effect on improv-
ing the outcomes of patient care.
For many years, the United States has been try-
ing to fix its health-care system by applying patch-
es over its worst cracks, but this has apparently not
worked very well. Does the system need a major
overhaul? Yes. But first, there needs to be a clear
vision of what it should be and what it should do
(O’Connor, 2002). Whatever way that vision devel-
ops, it is certain that nurses will have an important
role in a future health-care system. As Aiken and
colleagues (2002) wrote, “nurses contribute impor-
tantly to surveillance, early detection and timely
interventions that save lives” (p. 18).
The ANA, among others, has described the cur-
rent health-care system in the United States as
“sick” and “broken” (ANA, 2008a). As stated before,
forty-seven million Americans, including 9 million
children, have no health-care insurance. Even