Comment 1

Diane Black is a register nurse who represents Tennessee in Congress.  Mrs. Black was the first woman to chair the influential House Budget Committee. She serves on the House Ways and Means Committee and was quick to establish herself as a leader.  She is focused on dismantling the president’s health care law and advancing true market-based, patient-centered reforms that will bring down the rising cost of care by increasing private sector competition and consumer choice.Her goal was to reform the U.S. tax code which has not been initiated in over twenty five years. She was selected to chair the Ways and Means Education and Family Benefits Tax Reform Working Group during the 113th Congress.  During her career as a nurse, she saw a loophole in the Patient Protection and Affordable Act (PPACA)that allowed some higher paid middle class Americans to receive Medicaid benefits. She pointed out that the PPACA, unintentionally, would allow a couple who made close to $60,000 in income to qualify to receive Medicaid benefits. This loophole would allow for individuals whose incomes were up four hundred percent of the federal poverty level to also qualify to receive Medicaid benefits. The PPACA set a new income formula to calculate the income levels and make the determination for Medicaid eligibility. This formula did not include incomes received from all Social Security benefits including Supplemental Security Income, Supplemental Nutrition Assistance Program (food stamps), Temporary Assistance to Needy Families, and public housing.  After her election to Tennessee representative, Mrs. Black started lobbying to change the bill H.R 2576. She made her claim that Medicaid should only be used for those who are in the most need and Medicaid needed to get back in line with all other public assistance. Mrs. Black made her claim to Congress that by passing her bill that America would save $13 billion dollars over ten years. She made it clear that they would be saving this money without taking away any benefits from anyone who currently has Medicaid. Mrs. Black’s bill was passed and signed into law. She was the first member of Congress to have legislation signed into law that repeals the health care provision in Obamacare.

Comment 2

Congresswoman Mrs. Deb Soholt is some of the current nurses who are currently serving in Congress. Mrs. Deb Soholt is an RN and also a senator in South Dakota (American Nurses Association, 2015). She is a Senate for South Dacota congressional District 14 before joining politics.
She had sponsored several bills that have influenced health care. For example, “the Senate Bill 61 is to update, revise, and repeal certain provisions relating to nurse practitioners and nurse midwives” (South Dakota Legislature, n.d.). The bill can help redefine the role and function of nurse practitioners and nurse midwives to change the health care delivery and resolve the health provider shortage. Health care can be more accessible and affordable.
The nurse role gives the legislators the ability to understand and recognize nursing and health care issues. Therefore, the legislators who are also nurses can use the political power to alter and guide the direction of health care delivery in an optimal way. Health policies at the state level impact the health and safety of the state’s residents, as well as lead the nursing and other health professions’ scope, practice, and performance through the state’s professional practice acts (Cherry & Jacob, 2016) “The federal government’s role in health care includes significant funding for health and disease prevention and research; supplemental funding for education for health professionals, including nurses and physicians; and paying for individual health care services “(Cherry & Jacob, 2016, pg. 400). Therefore, the legislators in the federal level will focus on these categories to shape health care delivery.
She firmly believes that there is a strong need for more healthcare professionals in Congress. After all, health care is at the forefront of many political debates. Since she was the nurse, she sees the importance of having lawmakers with the healthcare background, that way the issues could better be addressed. In 2011 she was the first to engage in the debate on the Affordable Care Act.

Comment 3

The legislator that I consider to answer the above question is Erin Murphy. Murphy has a long career advocating on legislation related to health care and childcare issues.  As a nurse, Murphy serves as state representative in the Minnesota of Representatives. The new elected representative participated on the Health and Human Services Finance Committee.

In that capacity, she was instrumental and active to help craft reforms to “Minnesota’s health care system that aimed to expand access to affordable coverage and care” (Diane, S., 2017).  The legislator has worked on various health care reforms such as women’s health, affordable childcare, and expanding access to health care for school employees.

One of the bills that Murphy sponsored and supported is the “Health Care Homes.” This specific bill is part of a “statewide health care reform initiative” (2017). The legislation embraces and endorses a health care strategy that focuses primarily on prevention, self-management, and community services. This health care model guarantees better outcomes and quality of life people with chronic and acute health conditions.    

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I put 4 comment here because in this class the teacher ask for (4 comments only) no 6 as in the previous class. You can write 75 words in each and if you know about the theme or comment and you have substantive answer like your own comment you can write without references. Thanks.

Comment 1

Six articles that I have chosen to summarize for my research include the following:

1. Establishing a Nurse Mentor Program to Improve Nurse Satisfaction and Intent to Stay. This article used Benner’s novice to expert theory as a tool to develop a nurse mentor program in an Emergency Department.  The Benner Theory is focused on five levels of expertise five levels of proficiency: * novice * advanced beginner * competent * proficient * expert and the process nurses use to mature in the nursing profession. The nurses volunteered feedback about their experience in the nurse mentor program (Jones, 2016).
2. Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. This paper summarizes and reviews the strategies that support retention of nurses through creation and enhancement of positive work environments in the clinical setting (Twigg, D., & McCullough, K., 2014).
3. 2018 National Health Care Retention & RN Staffing Report . This article looks at the value hospitals put on their staff and the correlation to commitment, confidence, and engagement. Hospitals believe that retention is a key strategy and the focusing of enhancing the culture that supports this belief (Colosi, B., March 2018).
4. The impact of nurse residency programs in the United States on improving retention and satisfaction of new nurse hires: An evidence-based literature review.      A focus on entry level newly graduated nurses and the work conditions that may affect retention and satisfaction with job. This literature is aimed at the use of a one-year nurse residency program compared to the traditional orientation and its effects on turnover rates (Eckerson, C. M., 2018).
5. Factors related to the intention to leave and the decision to resign among newly graduated nurses: A complete survey in a selected prefecture in Japan  This study looks at the factors related to intention to leave and the decision to quit among newly graduated nurses (Tei-Tominaga, M., 2012).
6. An Evidence-Based Protocol for Nurse Retention  This article focuses on nurse leaders and the positive relationship and the effects on employee retention and satisfaction (Gess, E., Manojlovich, M., & Warner, S., 2008).

Strengths related to using these articles for research are that they all portray relevant information regarding the retention of newly hired nurses and data related to staff retention. The information received from participants would be confidential, so views could be given free from judgement or fear of retaliation.

Weakness may be related to the amount of information specific to night shift retention. A Potential weakness may be finding willing participants to collect enough data to form a conclusion.

Comment 2

Chen, Y. Y., Chi, M. M., Chen, Y. C., Chan, Y. J., Chou, S. S., & Wang, F. D. (2013). Using a criteria-based reminder to reduce the use of indwelling urinary catheters and decrease urinary tract infections. American Journal of Critical Care, 22(2), 105-114.
The article intends to reveal criteria based reminders are useful in the diagnosis and cure of urinary tract infections.
Strength: This article is only focused on urinary catheters and discusses every minute detail
Weakness: It does not mention other vital methods for prevention
Clarke, K., Tong, D., Pan, Y., Easley, K. A., Norrick, B., Ko, C. … & Stein, J. (2013). Reduction in catheter-associated urinary tract infections by bundling interventions. International journal for quality in health care, 25(1), 43-49. DOI: http://dx.doi.org/10.1093/intqhc/mzs077
            The author here proposed interventions to prevent urinary tract infections.
Strength: the author has not lengthened the article despite proposing several things
Weakness: Without any substantial comparison, an author has regarded one intervention as best of all others
Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., & Pegues, D. A. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31(04), 319-326.
 
This article is based on the prevention types for catheter-associated urinary tract infections
Strength: It describes all reasons which may lead to the development of infection
Weakness: it does not figure out ways in which this infection may get severe
Hebden, J. N. (2014). Nurse-directed catheter removal protocols to prevent catheter-associated urinary tract infection: Strategies for implementation. American journal of infection control, 42(6), 670
The article provides deep insights into how individuals can benefit from nurse-directed catheter removal protocol
Strength: It helps gain insights into types of urinary tract infections that patient can encounter
Weakness: it does not declare a suggested method to be an effective one
Magers, T. L. (2013): Using evidence-based practice to reduce catheter-associated urinary tract infections. AJN The American Journal of Nursing, 113(6), 34-42.
            The author has mentioned real life and practices to reduce catheter-associated urinary tract infections
Strength: The author motivates its prevention
Weakness: substantially, no prevention methodologies are mentioned
Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: focus on nurse-directed catheter removal. American journal of infection control, 41(12), 1178-1181.
            In this article, Author has discussed and tried to measure the role of a nurse in catheter removal
Strength: the charts and diagrams presented are viable for understanding pain units
Weakness: It has less practical implication due to the non-addition of any possible solution

Comment 3 3DQ2

Two methods for evaluating evidence would be Randomized Controlled Trials and Observation research. The Observational research such as surveys and qualitative studies can be a platform for informing practice. This type or research measures but does not control the variables. Randomized studies between control groups is random (Reinhardt, 2010). This design is the random assignment of study participants to either a group that receives the treatment being studied (the “treatment group”) or a group that does not receive the treatment (the “control group”).

We may also need to determine whether the article supplies Qualitative vs Quantitative information. Depending on what type of data is required to defend the hypothesis.

Quantitative – Quantitative research is measurable and uses data and statistics to form basis for hypothesis (Grove, Gray, and Burns, 2015).

Qualitative- “Qualitative research is a systematic approach used to describe experiences and situations from the perspective of the person in the situation. The researcher analyzes the words of the participant, finds meaning in the words, and provides a description of the experience that promotes deeper understanding of the experience” (Grove, Gray, and Burns, 2015).  This type of research is based on perception and emotions.

Comment 4

For the evaluation of evidence, the use of quantitative and qualitative methods is the ones on which a medical practitioner can rely. In qualitative methods, use of literature is made along with previous studies to provide viable arguments. Comparatively quantitative methods are wise enough to generate data and compare statistics and then coin any particular verdict to the evidence. One cannot say that one is superior over others as both come with pros and cons. Qualitative methods often make use of interviews and often believes in professional advice for generating the result. They do not go into any in-depth study to find out if opinions are valid or error-free. Quantitative method is known for conducting data and experiments and processing the data while correlating them to reach a possible solution (Creswell, 2007). Hence regarding medical aspects, quantitative data is more appropriate to rely on than qualitative analysis. Qualitative methods, however, is essential for increasing knowledge about any aspect. Though for proper evaluation and for proving a point, the need of quantitative analysis has reached to a higher point, without numerical data, it is not wise to make health care related decisions as it directly affects a life.
Evaluating different evidence methods: There are several methods of evaluating evidence methods are present, but the two most common methods of evaluating evidence are Meta-Analyses and Systematic Reviews. These two methods can help in the determination of the relevance and validity of the evidence. During the evaluating evidence both these systematic reviews and meta-analyses methods as well as similar and different.
Similarities:
Both the Systematic Reviews and Meta-Analyses are considered the highest quality of evidence for clinical decision making and can be used above all the other methods of evaluating evidence.
Both the methods for evaluating evidence are similar because they involve the collection of data from different sources and summarizing all the evidence and results of the studies.
Differences:
While systematic review collects and summarizes all the empirical evidence, the meta-analysis uses statistical methods to summarize the results of the studies.
Second, Meta-analysis is a statistical method used to combine the numerical results from such studies, if it is possible to do. On the other hand, a systematic review is a formal, systematic and structured approach to review all the relevant literature on a topic.
Third, the rationale for Meta-analysis is that through the combination of samples from different studies the overall sample size is increased, while the rationale for systematic reviews is that when data is pooled together from different sources, greater reliability would be obtained.
Creswell, J. W., & Plano Clark, V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage
Melnyk BM, Fineout- Overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: psychometric properties of two new instruments. Worldviews Evid Based Nurs. 2008;5(4):208-216.

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DQ 1

Comment 1

An internal method for dissemination of my EBP project results would be scheduling a short meeting with nurse managers of the unit to discuss the findings through questionnaires and interviews. External may be to schedule meeting which includes the nurse managers and staffing personnel. The importance of including all these persons in one meeting would be to provide a connect with the data and information that is discussed daily with regard to staffing and the hiring of nurses to fill vacant positions. Providing visual displays of the research that provides a clear picture showing the impact of nurse turnover and the orientation process. This meeting would be a platform for discussion and information that involves staffing, hiring and retention of staff and the impact on the unit/facility. According to  the  Agency for Healthcare Research and Quality (AHRQ) (2014),  all dissemination should have a purpose and promote the project development. This can be accomplished by raising awareness, informing and educating, engaging and involving, and promotion of the results.

Staffing levels and nurse retention is in the news daily and involving the community in discussions would offer clarification. Yes, the community is aware of the shortage, but do they know what avenues of change are taking place in the facility that hopefully will affect their healthcare now and in the future.

Strategies of communication for each group focuses on the delivery of information. Internal information transfer is effective through conversation and visual evidence. External needs to be concise and factful with a clear plan of implementation that is also visual. Time constraints for both groups is evident so many short meetings for the internal dissemination would benefit both staff and the managers/leaders of the nursing unit. The external group would also have time limitations so being concise and thorough with a limited time frame is a challenge.

Comment 2

An important part in delivering “high-quality patient care is nursing implementation of evidence-based practice (EBP); institutional leadership, such as nurse managers (NMs), plays an integral role in the implementation of EBP on nursing units” (Kueny, Shever, Lehan, & Titler, 2015, p.1). Thus, one internal method would be meeting with the NM of the unit to discuss my research findings regarding the implementation of acuity based tools specific for the unit to adjust staffing appropriately to improve patient outcomes, improve quality of care and decrease nurse burnout. Addressing the importance of measuring acuity, provide different tools that measure acuity and how to implement the use of these tools with proper education and directions. NMs are an important part of driving change, they can lead EBP projects, provide resources and educational activities to promote change and schedule workshops to assist nurses with the changes.  According to Kueny et. al (2015), “NMs have the potential to remove some of the autonomy in decision making for EBP recommendations” (p. 37). NM’s can help with culture of expectations, empowering their nurses to implement EBP to improve patient outcomes and improve nurse burnout.

An external method would be contacting a professional nursing organization, such as the American Psychiatric Nurses Association (APNA). Contacting the APNA via the internet would provide me with feedback on the next steps I need to take. Becoming a member of APNA or joining a committee, would allow me to take action addressing the importance of using acuity based tools in measuring safe staffing levels to improve patient outcomes and improve quality care. There is a lack of studies or research regarding staffing inpatient geriatric psychiatric units. The APNA (2015), encourages nurse researchers to study both populations, in order to establish specific nurse-to-patient ratios for inpatient psychiatric units and to foster the development of innovative, effective, recovery-oriented and safe-staffing models. Thus, it would be beneficial to address these populations, providing evidence that implementation of acuity based tools for safe staffing levels has improved patient outcomes.

Strategies for communication would be different for internal methods versus external methods. Internal methods require a more personal approach, addressing the problem, reviewing evidence for solutions to the problem with the NM, outlining the project, asking for feedback, projected costs involved to implement EBP, time constraints, and required nursing education on implementing acuity based tools for the unit. Promoting nursing feedback and shared governance in the decision making process and areas that need to be addressed in regards to safe staffing and equitable nurse workloads. External methods require a less formal approach, writing to APNA, would require addressing the problem, providing a solution with evidence based research, evaluating nursing practice, quality of care, improving nurse’s mental health, minimizing nurse burnout, reducing health care cost, and improving patient outcomes.

DQ 2

Comment 1

An important challenge to any evidence-based practice project evaluation is whether it was effective. I came across an article discussing the use of a premortem plan to identify outcomes and their success. In the healthcare arena we have all heard of postmortems where we discuss what happens after a sentinel event or adverse patient outcome. A premortem addresses the anticipated failures of the project before implementation. By doing this we can develop strategies that would aid in successful implementation according to Ginex (2018).

Since my project relates to staff retention and turnover on the night shift, seeing staff be successful using mentor/mentee programs after the original orientation period would offer proof the program change is working. Evaluating the cost of orientation and the cost of loosing qualified staff due to inadequate or ineffective orientation would also provide positive feedback and data. Follow up interviews with staff who have left or changed shifts would offer information related to differences in shift orientations. Also, the number of staff participating in mentor/mentee program would show the level of acceptance and commitment to the project change.

Comment 2

One way that I would evaluate whether my project made a difference in practice would be to implement some of my findings, such as talking with the DON and supervisor of my facility about scheduling equal nurse-to-patient ratios. I currently work on a sub-acute unit of my facility and there are about 6 patients that have pressure ulcers and all of them are at risk for pressure ulcer development. I have worked at the facility for a year and some pressure ulcers have developed while those residents were in the facility. All of the resident require total care and to ensure that they are changed and turned in a timely manner, there must be an appropriate staff-to-patient ratio. This means that each nurse should not have more than 7 patients because, they also only have on CNA. Each CNA has up to 14 patients, so they heavily rely on the assistance of the nurses. If the nurses feel overworked, then it shows in their patient care and the residents are at more risk for pressure ulcer development. According to Hartmann, Mills, Pimentel, Palmer, Allen, Zhao, and Snow (2018), positive interactions between the staff and patients contributes to better quality care and better patient outcomes.

I would also talk with the wound care nurse, DON, and supervisor to provide in-services to teach the staff how to implement the wound care orders properly. The wound care nurse only works from 0800-1630 and although he tries to change the dressings every day, the orders also include changing the dressing PRN if they become soiled. Many of the wounds are located on the sacrum region. All of the residents are incontinent of bowel and bladder and require total care. Orders constantly change depending on the status of the wound and there have been times when the dressing gets soiled and requires changing. I often work the even shift and there are times where I do not see the wound care nurse. I and my coworkers that work the evening and night shift have needed to change the dressing based on the order in the MAR. there have been times in which the directions of the order were unclear and/or we did not have the correct supplies. The wound care nurse only works during the week, so if we do run out of supplies, we do not have access to the storage unit that has them or the facility has run out. When there is a change in an order, it would be very helpful if the wound care nurse holds in-services to show the nurses how to perform the dressing change and make sure that at least half of the nurses from the evening and night shift know how to change it as well, so they can help their co-workers if needed. Knowing how to properly change the dressings improves wound healing and prevent worsening of the wound.

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Comment 1

The PPACA was aimed to improve the health care system, offering affordable health insurance to more Americans, expand the Medicaid program to cover all adults that live below the poverty level, and to support innovative medical care delivery methods designed to lower the costs of health care generally (Lampert, 2009). The PPACA mandates that everyone that is legal will have health coverage in the United States or a penalty will have to be paid at the end of the year. With the influx of people now receiving healthcare, they will be seeking medical attention where in the past they would not. The increase in people seeking medical attention will result in a needed increase in nurses to take care of these patients and more training to gain more expertise and skills to be able to manage the emerging needs and diseases.

A key nursing provision is the health care workforce loan repayment program (Section 5203). This section focuses more on children. It has a focus on pediatric medical or surgical and children mental and behavioral health care. The repayment program will offer psychiatric nurses, social workers, and professional/school counselors up $35,000 a year in loan repayments for their participation in an accredited pediatric specialty residency program.  A second key provision is public health workforce recruitment and retention programs (Section 5204).  This provision is aimed at eliminating the shortage of public health agencies. This provision has offered a one third repayment of loans for an exchange of a contract of employment acceptance with a public health agency for three years. This program is offered to eligible public health or health professions.

I know my nursing career will be affected by the provisions that were listed above along with all the other provisions listed in the PPACA. Offering loan repayments will give nurses the incentive to obtain higher degrees. Recruitment and retention would likely decrease the nurse shortage by new nurses coming in and showing loyalty to the season nurses.

Comment 2

The effect of the Patient Protection and Affordable Care Act (PPACA) resonates profoundly in the U.S. healthcare environment and among the public. Two key provisions of the act include: 1) Guaranteed issue prohibits insurers from denying coverage to individuals due to pre-existing conditions; 2) Section 5204 Public health workforce recruitment and retention programs.

           With the first requirement, health care setting experienced a rise in the number of new patients, as expected. Many of these patients were probably afraid or restricted from going to the hospital or seeking medical care due to the lack of healthcare coverage. The impact is that more people are seeking medical care. From my nursing practice, I observe some of these patients have chronic illnesses that have been neglected and thus require more care. Also, more patients come for medical services; emergency rooms fill with more patients. This increases patients’ population. In return, this affects nurse to patient ratios. Nurses have to care for more patients. They have to work extra time due to shortage of staff. The downsides is that nurse morale is low and the risks for medical errors are high.  

                The second nursing provision (Section 5204) retained refers to the established “Public Health Workforce Loan Repayment Program.” This provision gird to assure an adequate supply of public health professionals to eliminate workforce shortages in public health agencies. The positive impact of this provision is that government will repay up to “1/3 of loans incurred by a health professions student in exchange for an agreement to accept employment with a public health agency for at least three years” (CDC). Ultimately, this provision makes it easier to attract young people to the field of nursing. This will have a positive impact on the nursing shortage. It is an attract incentive for many current nurses to pursue their studies and opt for advanced degree in nursing. This is exactly what I am intended to do.

Comment 3

Nice post! Some important aspects of the ACA, include the consumer assistance program, which is a program that helps people enroll in coverage as well as file complaints if a person is denied payment for any type of healthcare service. There are also preventative healthcare services if eligible, paid by insurance. Seniors that are on Medicare who are struggling with prescription costs, can find assistance with discounts and rebates as well. The ACA also offers more options when choosing insurance coverage. There is also a pre-existing condition insurance plan for people who may have a disability or chronic condition, that were previously denied coverage under regular insurance options. In addition, parents are able to cover their children under the age of twenty-six if they are unable to get insurance. The ACA has given people the ability to choose any doctor they wish to see, whether or not they are affiliated with a network or not. Additionally, the Children’s Health Insurance Program (CHIP) will be extended from 2015 through 2019, providing coverage to children in low-income families (KHN, 2018).

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1-You made some good points Judy, but the U.S is not the only one struggling with the health care . I was reading different articles and realized there are so many countries going through the same things and maybe even worser. The Pakistan’s health profile portrays high maternal and child mortality, increase population growth rate, and the twofold burden of infectious and non-infectious diseases (WHO, 2007).Just 27% of the Pakistani people avail advantage from full coverage of health care that include armed force members, beneficiaries and government employees, whereas, the rest 73% of the population pay out of pocket (Settle, 2010).They are viewed as a country that is not really important and get overlooked and struggle with health care. People are still paying a crazy amount of money just to get the care they need to stay healthy. With everything going on it makes it hard and for people to reach out when they really need it and it progresses to where it can not be reversed and as a nurse it just sucks seeing people go through this and hope it gets better as the years pass. 

2-Many American families have a limited access to health and are uninsured. Our healthcare system focuses more on treatment and medical services than preventive care. Health care spending has been increasing over the years, yet there isn’t a significant improvement in health outcomes (Kaiser Family Foundation, 2017). In 2013, $2.9 trillion dollars was spent on the healthcare alone, which is about $9,255 per person (Levitt, Claxton, Cox, Gonzales & Kamal, 2014). For insured families, insurance premiums have risen about 11% and household earnings only 3% increase from 1996-2003. Soon, family premiums will cost more than the family income by 2025 if trends continue. All that money spent, yet there coverage in limited/inadequate. Over recent years, insurance premium cost increases have slowed, but this places more of the financial burden on the family (Devoe, 2008).

In 2016, 27.6 million people are not insured. Many low income families cannot afford to pay for health insurance, so they gamble and delay any medical services in fear of how much it will cost them (Kaiser Family Foundation, 2017). Many fear that it could lead to financial ruin. Among families with health insurance, almost half of all personal bankruptcies were due to high medical costs (Devoe, 2008).

There is also the issue of people uninsured when they’re in between jobs or waiting for approval of Medicare/Medicaid. About 82 million Americans have these coverage gaps during a 2-year period (Devoe, 2008). Life is unpredictable, and something can during these gap periods.

References

Devoe, J. (2008). The Unsustainable US Health Care System: A Blueprint for Change. The Annals of Family Medicine, 6(3), 263-266. doi:10.1370/afm.837

Levitt, L., Claxton, G., Cox, C., Gonzales, S., & Kamal, R. (2014). Assessing the performance of the U.S. health system. Retrieved May 24, 2018, from https://www.healthsystemtracker.org/brief/assessing-the-cost-and-performance-of-the-u-s-health-system/#item-start

Kaiser Family Foundation. (2017, December 07). Key Facts about the Uninsured Population. Retrieved May 23, 2018, from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

3-I have found that the health care system in the United States is expensive and not easily obtained. There is much room for improvement. The concern about quality arises more from fear and anecdote than from facts; there is little systematic evidence about quality of care in the United States. We have no mandatory national system and few local systems to track the quality of care delivered to the American people. More information is available on the quality of airlines, restaurants, cars, and VCRs than on the quality of health care (Scuster, 2005).  The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating health care coverage for almost everyone. This can be difficult for someone who is working minimum wage and has a job that does not require to give employees benefits such as health care insurance. One could argue that minimum wage is not meant to be a long term job for an adult. Though the theory of minimum wage jobs might have originally been meant for minors, the reality of our nation is that many adults living in poverty are employed at minimum wage paying jobs. It should be our duty to provide affordable health care for all members of our nation regardless of our own personal beliefs. Obama Care may not be a perfect system because even though it is said to be afforable health care, it has shown to still not be as affordable as one might need based on their income. However, I believe that this was a good start and can be improved to fit our nation and every individual in it as needed. Health care is only getting more and more expensive with the new medications and technology that we are developing as time goes by. Our nation leaders need to think of someway to have health care available for everyone. One option could be to provide health care for everyone like Canada has for their citizens. Though this comes with problems of its own, I believe that it is a system that cares for all and would great individuals that cannot afford health care. Whatever the United States decides to do regarding the issue of so many Americans being uninsured, something needs to be done quick. With so many people being uninsured, many diseases go untreated or even diagnosed due to the financial fear individuals that are uninsured face. People would rather not see a doctor or a clinic because of the fear that they will bring financial burden to their family. As a nurse, this breaks my heart. 

Schuster, M. A., McGlynn, E. A., & Brook, R. H. (2005). How Good Is the Quality of Health Care in the United States? The Milbank Quarterly, 83(4), 843–895. http://doi.org/10.1111/j.1468-0009.2005.00403.x

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