The Affordable Care Act and its Impact on Nursing and Healthcare Organizations

The Affordable Care Act and its Impact on Nursing and Healthcare Organizations


The passage of the Affordable Care Act (ACA) created health reforms in the United States and affected nursing practice in many ways. The ACA, also known as Obamacare, is a law that was approved in 2010 and it aimed to ensure that more people in the United States had health insurance coverage, improve the quality of health care, regulate health insurance, and diminish health care spending in the country (Galan, 2018). Nine years after the passing of the law, it remains at the forefront of healthcare issues. With more people having health insurance, this health reform created a significant impact on the nursing workforce. Currently, the rate of uninsured in the country is steady at its historic low of 8.8 percent (Coombs, 2018). The ACA placed a high demand for nurses and nurse practitioners with more people having the means to seek for healthcare needs.

The Effect of the Affordable Care Act in the Organization

            In the past five years, Baptist Health System, the organization where I am currently employed has felt the impact of the ACA. The volume of the patients in the emergency department decreased, and acuity increased. The ambulatory services in the organization have greatly increased, so there is a shift of patient visits from the emergency rooms to urgent care facilities and primary care services. The expansion of health insurance led to improved access to health care services reducing the need to use the emergency rooms as a primary source of health care, especially for patients that received public insurance programs.

The Organization’s Response to the Effect of the Affordable Care Act

            Now that more people have increased access to health care, many organizations are making modifications in their healthcare system’s delivery of care. Pittman and Scully-Russ (2016) stated that in response to the ACA, healthcare organizations are adopting concepts of moving staff to ambulatory and home care settings, generating new jobs that involve care coordination, and developing new modes of healthcare delivery to address consumerism. Some of the said changes are evident in the organization where I currently work.

Baptist Health System, in response to the increasing demand for nurses, created a nursing residency program. As a charge nurse of the A&R department of my facility, one of my roles is to facilitate the training of the resident nurses. The residency program sponsors the training of new graduates with their choice of nursing specialty where they are given didactic and clinical training within 3 weeks and providing them basic salary during the program. The program helped encourage new nurses to work within the organization, allowing them to work in specialty areas even without prior experience, and promoted retention due to the contract of three years that they have to fulfill after graduating from the program. Many of the new nurses were employed in psychiatry department.

With regards to adopting of new healthcare settings, TMH, within the last five years, opened ten urgent care facilities, six primary care centers and recently opened a free-standing emergency department to help cater to the increasing needs of patients to access health care. Current staff nurses of the organization were prioritized to transfer to the new ambulatory care settings.

ACA also resulted to generating new jobs that involved care coordination (Pittman & Scully-Russ, 2016). In my facility, new nursing positions like case management and transfer center nursing coordinators were opened to serve as care coordinators to the new healthcare settings.

Moreover, to support the new ambulatory settings, the organization granted scholarships and tuition reimbursement programs for current employees interested in furthering their education with masters and doctorates in nursing for family or acute care nurse practitioner track. Graduates of the program are then hired in any facility within the organization to work as nurse practitioners, also encouraging retention of nurses within the organization.

In addition, with staffing shortages resulting from the ACA, it is difficult for single primary care professional to effectively and efficiently manage patient care needs (Norful, de Jacq, Carlino, & Poghosyan, 2018). A new care delivery of two primary care professionals such as a physician and a nurse practitioner co-managing a patient helps to meet the increased demands for health care. To date, 15 nurse practitioners are working in the organization who availed of the scholarship and tuition reimbursement programs.

With all the change initiatives within the organization due to the ACA, the importance of the leaders effectively communicating to the staff the major changes in the delivery of care of the organization play a significant role. Communication and knowledge are crucial for the team to embrace the major innovations. Many employees were initially resistant to change. The directors, managers, and supervisors in my facility went to leadership and sensitivity training to help the staff cope with the rapid changes. According to Marshall and Boone (2017), for innovations to happen, leaders should empower their employees to be involved and contribute to the change. By keeping the staff informed and making them a part of the change, leaders can obtain their support to welcome the changes.


            The ACA has affected healthcare in many ways. Healthcare organizations were affected and are continuously changing to adapt to the effects of the ACA. Leaders have a crucial role to help with the changes be made acceptable to the staff.


Coombs, B. (2018). Rates of uninsured in US hold steady at historic low 8.8 percent. Retrieved from

Galan, N. (2018). The affordable care act: An update. Medical News Today. Retrieved from

Marshall, E., & Broome, M. (2017). Understanding contexts for transformational leadership: Complexity, change, and strategic planning. In Transformational leadership in nursing: From expert clinician to influential leader (2nd ed., pp. 37-62). New York, NY: Springer.

Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner-physician co-management: A theoretical model to alleviate primary care strain. Annals of Family Medicine16(3), 250-256. doi:10.1370/afm.2230

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health14(56), 1-15. doi: 10.1186/s12960-016-0154-3

Response 1

The Patient Protection and Affordable Care Act, which is also known as the Affordable Care Act (ACA), and popularly referred to as Obamacare is a comprehensive health care reform law that was passed by Congress in 2010 (, n.d.). The law reform of the Affordable Care Act (ACA) has three primary goals. The three primary goals are to make affordable health insurance available to more people, expand the Medicaid program to cover all adults with income below 138% of the federal poverty level and to lower healthcare cost by supporting innovative medical care delivery system (, n.d.). In early 2017, the Affordable Care Act repeal and replacement budget reconciliation bills in the Ways and Means and Energy and Commerce committee was introduced (Jost, 2017). The budget reconciliation bills titled the American Health Care Act was passed by both houses of Congress to prepare budget reconciliation legislation to replace the Affordable Care Act (Jost, 2017). What this means is that the legislation’s tax cuts will give wealthy Americans, health insurers, and providers tax breaks, dismay for Medicaid recipients and state Medicaid programs, federal funding for Medicaid steadily reduce, and bad news for the poorer and older individuals that live in areas where health care is expensive (Jost, 2017).

The United States is known for having the best health care system in the world; however, it leads the world in health care spending with its residents sicker and more likely to die of preventable conditions that are in other wealthy countries (Schneider & Squires, 2017). Some of the most advanced specialty health services in the world are offered in the United States, yet most Americans cannot afford the high-quality health care, making the health care outcomes worse than other high-income countries (Schneider & Squires, 2017). Healthcare professionals such as nurses are always being faced with not only assessing the community to address health issues but are also in an environment of scarcity, competing for funds with limited resources.

It is, therefore, crucial for nurses to know their importance in health care and the integral role they play in patient-centered care, better outcomes, and the impact on the cost of health care. Nurses play an essential role in the health care policy by advocating for patients and individuals. From the bedside to the Congress, nurses can help shape the health care system. Nurses play a crucial role in delivering care and leading changes, especially in the Affordable Care Act (American Nurse Today, 2010). Knowing part of how to be engaged and be part of the solution for a better patient outcome at reasonable health cost is crucial for nurses (American Nurse Today, 2010). Nurses need to be prepared for the future to provide care across all settings. According to the American Nurse Today (2010), for nurses to be prepared to help lead the country to a healthcare system that is more equitable and provides a higher quality care nurses must address challenges such as using nurse-led innovation, generate evidence and engage in research. Nurses must also redesign nursing education, expand the scope of practice, diversify the workforce, embrace technology, foster interprofessional collaboration, develop leadership at every level, and be part of the discussion. Nurses today are at the historical juncture in the health care delivery where they can play a pivotal leadership role to support the health of families and communities (Wakefield, 2013).











American Nurse Today. (2010). Nursing’s role in healthcare reform. Retrieved from (n.d.). Affordable Care Act (ACA). Retrieved from

Jost, A. (2017). Examining The House Republican ACA Repeal And Replace Legislation. HealthAffiars.

Retrieved from

Schneider, E. C., & Squires, D. (2017). From Last to First-Could the U.S. Health Care System Become

the Best in the World? The Commonwealth Fund. Retrieved from

Wakefield, M. (2013). Nurses and the Affordable Care Act: A call to lead. Retrieved from


Response 2

significant part of having quality healthcare and excellent patient outcomes is having the right type and number of clinicians (Squires, Uyei & Jones, 2016). Another aspect of this shortage is the economic situation of the country. Economists indicate that the nursing job market runs counter to the overall economy (Alameddine, Baumann, Laporte & Deber, 2014).  In short, when there is an economic downturn, there is a surge in healthcare demand (Spetz, 2015). Nurses who exited the field during economic booms can return back when there are financial hardships as part-time or full-time workers (Spetz, 2015). Presently, 2.7 million RNs are working in the country. However, close to half a million hold licenses but are not working in the field. Various factors such as job satisfaction, the impact of their job on their health, demanding work environments are all reasons why nearly 34% of nurses leave within two years of graduating (Spetz, 2015).

Geography is a critical factor to consider. Some regions are more affected by the nursing and overall healthcare professional shortage. Rural areas especially struggle to attract healthcare professionals (National Conference of State Legislators [NCSL], 2017). APRNs are believed to be able to cover the gap of a lack of primary care physicians in some of these areas that have limited access to primary care. These areas are unable to bring in and retain these APRNs causing greater disparities in rural areas and other underserved populations (Hain & Fleck, 2014).

Adding to this issue is the aging of the US population. According to the United States Census Bureau (2018), by 2030, all of the baby boomers will be 65 years and older. Thus, the older population will expand significantly such that older people are projected to outnumber children. Rowe, Fulmer, and Fried (2016) write that with the increasing aging population, the health needs of this population, and the existing infrastructure to support their health has to be revisited. Older adults compared to the younger cohort are more likely to have chronic health conditions like arthritis, diabetes, hypertension, heart disease and much more (Rowe et al., 2016).

Furthermore, one of the main ethical concerns with this issue is that in an attempt to provide more care to more Americans, the healthcare system has become overwhelmed. The ACA may have underestimated the number of Americans who would leverage the changes in the law (Gleid & Jackson, 2017). These changes mean that the current workforce and the future workforce may struggle to provide quality care to the patients that now have access to care (Gleid & Jackson, 2017). Thus, healthcare executives and lawmakers have a responsibility to consider the impact the increased coverage is having on the healthcare workforce.

Experts indicate that APRNS can cover this gap in physician shortage. Yet, in many states APRNs are not allowed to practice to the full extent of their training which limits these professionals and ties doctors in physician agreements that take up time that they could be using in direct patient care and ties it up in supervisory roles over APRNs (Hain & Fleck, 2014). Bodenheimer and Smith (2013) report that there is sufficient evidence to show that interfering with full practice and prescribing authority is harmful to patients and creates more gaps in care that can otherwise be covered by APRNs.



Alameddine, M., Baumann, A., Laporte, A. & Deber, R. (2013). A narrative review on the effect of economic downturns on the nursing labor market: implications for policy and planning. Human Resources for Health,10(23). doi:10.1186/1478-4491-10-23

Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American Journal of Public Health, 107(4), 538-540. doi:10.2105/AJPH.2017.303665

Hain, D. & Fleck, L. M. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. The Online Journal of Nursing, 19(2). doi:10.3912/OJIN.

National Conference of State Legislators. (2017). Healthcare workforce shortages and maldistribution. Retrieved from

Rowe, J. W., Fulner, T. & Fried, L. (2016). Preparing for better health and health care for an aging population. Journal of the American Medical Association, 316(16), 1643-1646. doi:10.1001/jama.2016.12335

Spetz, J. (2015). Too many, too few, or just right? Making sense of the RN supply and demand forecasts. Nursing Economics, 33(3), 176-179

Squires, A., Uyei, J. S. & Jones, S. A. (2016). Examining the influence of country-level and health system factors on nursing and physician personnel production. Human Resources for Health, 14(48). doi:10.1186/s12960-016-0145-4


Response 3

Hi Semiloore,

I currently work in a mental health outpatient program, but prior to a year ago I was an emergency room (ER) nurse and I absolutely felt the impact of the Affordable Care Act (ACA) over the 4 years I took care of patients at the hospital facility where I worked. But not in the same way that you have described the impact that your healthcare facilities ER felt during the shift when more patients began to receive healthcare insurance coverage. The ER’s would fill with patients daily and wait times increased steadily; with more patients insured, it appeared that more patients would come to the ER versus going to an urgent care or primary doctor for non-critical medical attention. Of course, this impacts workflow, patient care, and staffing needs.

I have also recently taken on a per diem position for a home health care agency, and as you have mentioned and according to Pittman & Scully-Russ (2016), healthcare systems are beginning to change the method of care delivery to the community, based on the individual need for its citizens by providing home care and ambulatory services.

In my own healthcare facility, regarding the inpatient units and departments in the hospital, nursing leaders and administration have been working for several years now on how to support their current staff with severe nursing shortages while also preparing for the continued scarcity of registered nurses for the future. It is imperative that our nursing leaders prepare and plan for the future changes of our healthcare delivery to the public while managing our staffing ratios and employee retainment, with the ability to continue to provide consistent, safe, quality care to our patients. According to Marshall and Broome (2017), change agents are the leaders and supporters of a new environments that can enact the change that is in a healthcare organization. There are many steps to the process which include understanding the urgency for change, forming a coalition, creating and communicating the vision for that change, empowering and planning the change, and solidify and promote the new idea or approach (Marshall & Broome, 2017). I completely agree with you that our nurse leaders are the key factor to help facilitate this transformation across healthcare systems nation- wide and can help preserve the quality of patient care while continuously considering the impacts these changes may have on nursing staff. Great post!



Marshall, E., & Broome, M. (2017). Understanding contexts for transformational leadership: Complexity, change, and strategic planning. In Transformational leadership in nursing: From expert clinician to influential leader (2nd ed., pp. 37-62). New York, NY: Springer.

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health14(56), 1-15. doi: 10.1186/s12960-016-0154-3

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