Nurses make up the largest segment of the health care workforce in the United States. There are more than 3.1 million registered nurses nationwide and about 85% of these RNs are employed in nursing. Yet, some states are predicted to experience a nursing shortage during the next decade as the result of changes in health care policy, an aging population, and nursing schools struggling to make space for more students.
A report from the Georgetown University Center on Education and the Workforce titled, “Nursing: Supply and Demand Through 2020,” predicts a shortage of approximately 193,000 professional nurses by 2020 based on the age of the current nursing workforce, the size of graduating nursing classes, and nurses’ career decisions. A 2012 report titled, “United States Registered Nurse Workforce Report Card and Shortage Forecast,” concurs. It predicts a nursing shortage by 2030 throughout the country, especially in the West and South, because of projected changes in population.
[email protected] online FNP program created the graphic below based on data from a 2014 HRSA report, “The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025,” to show which states will have a shortage of nurses and which will have a surplus.
To learn more about the nursing landscape, visit [email protected] website to read the original blog post.
Ever wonder why you might think about earning a certification? In honor of Certified Nurses Day, we asked Karen S. Kesten, DNP, RN, APRN, CCRN-K, CCNS, CNE, associate professor at George Washington University School of Nursing in Washington, DC, as well as the chair of the American Association of Critical-Care Nurses Certification Corporation board of directors her opinion on the matter.
What follows is an edited version of our Q&A.
How long have you been in the nursing field and what certifications do you hold?
I have been a nurse since 1974. My first certification was in 1980 as a CCRN. Now I hold these certifications:
- CCNS (Acute/Critical Care Clinical Nurse Specialist, Adult) – 2004 to present
- CCRN-K (Acute/Critical Care Knowledge Professional, Adult) – 2015 to present
- CNE (Certified Nurse Educator) – 2012 to 2017
Why do you think it’s important for nurses to get certifications? What does it do for them? For the field?
It is so important that nurses become certified because it demonstrates that they have the knowledge, skills, and attitudes to provide high quality care to patients and their families. A certified nurse is a lifelong learner who cares about the quality of care they deliver. Nurses who are certified feel more confident that the care they are delivering is based on the most up-to-date evidence. Certified nurses are proud of their achievement and are role models for nurses and other health care professionals. Certification shows that nursing is a profession that cares about safety, quality, and excellence of health care delivery.
What’s the difference between board certification and being certified in a specialty?
Board certification means that certification is required for licensure, such as in the example of advanced practice registered nurses (APRN). In this case, a board of experts at the state level in the field of nursing examines the credentials and qualifications of a nurse in order to determine eligibility for licensure. Certification in a specialty indicates that a nurse has acquired additional knowledge, skills, and expertise in a specialty area of nursing such as acute and critical care.
How do you know you’re ready to become certified?
Preparation for certification requires that the nurse meet the eligibility requirements such as gaining experience in providing direct care for a required period of time for the relevant patient population. It also involves setting certification as a specific target goal, studying, and acquiring the knowledge needed to pass the certification exam. There are courses, study materials, and practice tests that can help a nurse to prepare for certification. Progress on self-assessment practice exams can help nurses know if they are ready to sit for the exam to become certified.
Do you need additional education to become certified? What are the requirements to apply?
To become certified as a critical care nurse (CCRN) or progressive care nurse (PCCN), a nurse does not need additional formal education. However, it is helpful to prepare—and there are prep courses, study materials, and practice tests that can help prepare for certification. You do need additional education at the master’s or doctoral level in order to become certified as an advanced practice registered nurse (APRN), such as an adult-gerontology acute care nurse practitioner (ACNPC-AG) or adult-gerontology clinical nurse specialist (ACCNS-AG).
What does it take to maintain your certification?
Nurses who maintain their certifications must meet renewal criteria that involve continuing education and, in some cases, continuing practice experience and an unencumbered nursing license.
What have been the greatest rewards for you that happened because you earned your certification?
Earning my certification makes me feel proud of the care that I deliver; it makes me feel more confident and self-assured. Certification enables me to feel more satisfied with my career—that I’ve provided competent care. It’s also opened doors to opportunities that I might not have had otherwise. Certification has introduced me to knowledgeable compassionate nurse mentors and to a community of nurses who care about delivering excellent care to acutely and critically ill patients and their families.
What would you say to someone considering becoming certified in any field?
I would encourage anyone to seek certification in their field to demonstrate they have the competence, knowledge, and skills to excel in their profession.
Nurses often enter their profession to save lives. This is what nursing is most often advertised as to the average consumer. You show up and do whatever it takes to help your patients improve their health and discharge out of the hospital either to home or to rehabilitation. Unless you are working in hospice, it’s infrequent that the acute care nurse will experience a patient reaching the end of life without a fight. This does, however, occasionally happen. Perhaps a patient in the ICU has been terminally extubated. Perhaps treatment did not go well for an acute illness and the patient and family have decided they want to let things run their natural course. You, as the nurse, will be expected to know what to expect and how to explain it to the family.
Here are five signs that death will occur soon.
1. The patient stops eating and drinking.
This is often a gradual process, with appetite and thirst diminishing in the final weeks of life. Once a person stops eating and drinking completely, they will likely only survive between seven and ten days. This greatly depends on the previous hydration status of the patient. A person who suddenly stops eating and drinking may have a better amount of fluid reserved in their tissues to draw from, and therefore may survive longer. Alternatively, a patient who has been taking only sips of fluid and a bite or two of food for weeks prior may last less than a week once all intake stops. It is a very individual process for each patient, and the family often needs reassurance that it is normal and expected.
2. The patient is exhibiting increased amounts of sleep and periods of unresponsiveness.
As a person approaches end of life they have little energy to expend, and their sleep needs increase drastically. It is not uncommon that a person is only awake for a few hours per day in their last weeks of life, and they may choose to spend these awake times in the company of only certain family members and friends. It should not be taken personally by family and friends. The patient simply has little energy left and conserves it for the things they feel are most important to them at the time. A patient will most likely become completely unresponsive in the last few days of life, but reassure family that although they are witnessing these changes, the patient can often hear them until the very end of life.
3. The patient is having changes in mental status, perhaps seeing things that are not there, or having visions of people who have passed on before them.
This is all very common at the end of life and can be alarming for family and friends. There are medications, often benzodiazepines, that can be used if these visions or hallucinations become upsetting to the patient; however, patients often find peace and happiness in these visions. They may speak freely with visitors about family members who have come to visit them from “the other side.” Encourage family members and other visitors to try not to challenge the patient’s experience and to be accepting that what the patient is experiencing is real to them.
4. The patient is presenting with tachycardia and hypotension, or changes in breathing patterns.
The patient may also have some changes in body temperature regulation. Toward the last few days of life, there are often changes in vital signs and respiratory patterns. The blood pressure will often drop below the normal range and the pulse will speed up. This is a product of the regulatory functions of the autonomic nervous system shutting down, as well as one of the common sequelae of dehydration (related to not eating and drinking, as mentioned in number one). It is normal and expected, but can be very alarming to family members. The main goal of the nurse should be to assure that the patient feels comfortable and stays safe while these changes are occurring.
5. The patient is mottling.
Mottling is often a late sign of impending death, and happens when peripheral circulation, especially in capillaries, is poor. Blood flow tends to slow down and causes purplish or reddish patches on the lower extremities. The extremities may be cool to touch as well, but not always. Mottling sometimes can come and go, but more often progresses in nature as a patient approaches end of life. Reassure the family that this is a normal process and is not at all painful for the patient.
With the right knowledge of what to expect, the nurse can be a key player in helping a patient and their family approach the end of life with comfort and confidence.
On March 19, nurses everywhere can honor the extra work they have put into getting certified as the nation celebrates Certified Nurses Day.
Sponsored by the American Nurses Credentialing Center and the American Nurses Association, Certified Nurses Day offers a chance to acknowledge nurses’ extra efforts to gain the board certification that establishes advanced knowledge and specialization in specific areas.
Nurses can earn certification in everything from national healthcare disaster certification to cardiac rehabilitation to nursing case management, sharpening their skill set and therefore improving the patient care they provide. But certification takes work. Nurses must pass a credentialing exam and complete continuing education to maintain certification every few years.
Registered nurses are able to practice nursing, but nurses who earn certification status in various specialties are valuable to employers for additional reasons. Their extra motivation and willingness to become certified signals a dedication to nursing and to patient care. Earning certification shows they pursue their passions to advance their skills and go above and beyond typical job duties.
According to the ANCC, Certified Nurses Day is celebrated on “the birthday of Margretta ‘Gretta’ Madden Styles, the renowned expert of nurse credentialing. An accomplished advocate for nursing standards and certification, for more than two decades Styles advanced nursing practice and regulation worldwide.”
Nurses who are board certified in any specialty can help educate other nurses of the value of obtaining this extra designation. And the healthcare settings, patients, employers, and others for whom nurses form an invaluable part of the team can bolster the efforts and recognize the extra work it takes to earn and keep that certification.
If you don’t have certification in a specialty you’re particularly interested in or if you want to obtain another certification, the ANCC can help answer questions. Each certification has different testing and renewal requirements, so it’s best to check what you’ll need.
Many certified nurses appreciate the expertise recognition their certification confers. If you are especially interested in an area of nursing and have knowledge that people turn to you for, getting certified makes your knowledge and professionalism recognizable to others. Some nurses say they are reluctant to take the credentialing exam as they aren’t sure if they will pass. If that is your concern, take the extra time to study. If you don’t pass, you can take it again. Not everyone passes credentialing exams on the first try, but that doesn’t mean you shouldn’t refocus and take it again.
On Certified Nurses Day celebrate yourself and your colleagues who have obtained this extra education. Make plans to go out to lunch or just to say thanks to your colleagues who are making an effort to improve nursing care and their own professional skills. If you are thinking about getting certified in a specialty, take steps today to get the process started. You’ll advance your knowledge, your career, and your profession while providing the best possible patient care.
The nursing program at MidAmerica Nazarene University, with the help of Digital Third Coast, created an infographic depicting data on the perceived stigma of male nurses. Through their research, they gleaned quite a lot of interesting information.
For example, while it’s well-known that mainly men served as nurses in the past, their research indicates that “Due to associations with the military and religious orders, there was significant male representation in the nursing profession through the late 1800s.” The visual even shows a photo of famed poet Walt Whitman with his male nurse, Fritzenger.
When did this all change? According to the graphic, legal barriers in the early 1900s contributed to the scarcity of male nurses. In fact, many nursing schools would not even admit men. This didn’t officially change, though, until 1981 when the U.S. Supreme Court ruled that not admitting men to nursing schools was unconstitutional.
As a result, during the 1930s and 1940s, the percentage of nurses who were male decreased to its lowest point, which according to the U.S. Bureau of Labor was 1%. Not surprisingly, that percentage has risen over the years. As stated in the 2013 Census, out of the 3.5 million employed nurses, 78% are Registered Nurses (9.6% of these are male); 19% are Licensed Practical and Vocational Nurses; 3% are Nurse Practitioners; and 1% are Nurse Anesthetists (41% of these are male).
From these statistics, it can be concluded that men are more likely to become nurse anesthetists—which is the highest paid role in the nursing field. With women making up the majority of the nursing field, one would assume that they tend to make more in terms of salary, right?
Wrong. Female nurses make only 91 cents per every dollar that male nurses make.
For more fascinating facts about the perceived stigma of male nurses, check out the infographic here.
Although patient safety affects each and every one of us, it’s not always a topic people dwell on. But nurses do and they will join the National Patient Safety Foundation (NPSF) in celebrating Patient Safety Awareness Week from March 12 to 18.
“Everyone is a patient and patient safety is a public health issue,” says Sara Valentin, CMP for NPSF, assistant vice president and program lead for Patient Safety Awareness Week. “But unless you are in the health care field or a patient or a family member of someone who has experienced medical harm in some capacity, you wouldn’t know about it.”
Patient Safety Awareness Week aims to educate and inform people about patient safety with tips for taking charge of your own health or for working in a health care setting. “Preventable medical harm is one of our top issues we focus on,” says Valentin. “Wouldn’t that be wonderful if that never happened again?”
One look at the news shows new systems and approaches have significantly reduced the instance of medical harm, but it still happens. “We have made progress, but we still have a lot to do,” says Valentin. “This is a good time to stop and pause and look at the work people have done.”
NPSF generally chooses a few topics to focus on during each annual Patient Safety Awareness Week and communication and medication safety are especially noted this year. And while there are lots of events to participate in and educational and practical tips to learn and share, Valentin says the NPSF also says a little levity helps keep the topic fresh. The organization is encouraging anyone to spread the word that “We are all patients” by posting photos of themselves in hospital gowns or in patient care settings using #WeAreAllPatients.
NPSF is celebrating National Patient Safety Week in many ways. They will host a Twitter chat (@theNPSF), “Patient Safety: What Patients Want (and Need) to Know,” on Tuesday, March 14, from 1 to 2 pm (ET). Use #psaw17chat to participate.
According to the NPSF website, a free webcast, “The Voice of the Patient and the Public,” is set for Wednesday, March 15, from 2 to 3 pm (ET) and includes several prominent panelists. Registration is required online at http://bit.ly/psawweb17.
According to Valentin, “Medication itself is a big topic.” NPSF plans to offer information, resources, and facts to help people protect themselves from medication errors and to make anyone handling medications aware of where things could go wrong.
Good communication is a significant deterrent to medical errors, but in the hectic health care world, it requires constant diligence from everyone. Patients can look at their relationships with health care providers as partnerships where they should ask questions and clarify instructions until they really understand what the final plan is.
Nurses can give their patients the time to ask questions. Even when it seems like you cannot squeeze one more minute out of the day, spending a few extra minutes to make sure a patient understands the proper medication, the correct dose, and instructions for taking it is essential. She says, “You can ask, ‘Do you have any more questions,’ or ‘Are you comfortable with what we have talked about?’” Some patients are especially easily overwhelmed in a medical setting and might not listen to each and every thing you are saying. Giving one last opportunity to clarify things can prevent mistakes.
And nurses can continually tweak their own processes. Nurses also need to listen to each other carefully to make sure they are both communicating and understanding everything that is needed and being said.
And while this one week will highlights the critical importance of avoiding errors, Valentin says nurses know it’s a 24/7 issue. “Every day is patient safety day,” she says. “This is a week to celebrate, but it’s something we work on every single day.”
There’s no denying the correlation between nurse staffing levels and patient outcomes. As the Baby Boomer generation continues to retire, the need for additional medical attention increases (hospitals, aging facilities, etc). But because the nurse population mirrors the overall population, this means we also face a bubble of nurses entering retirement, reducing the number of experienced health care staff available to serve patients and creating new stresses on health care teams and health care facilities. A recent article in the Wall Street Journal stated that the United States is in the midst of a nurse retirement epidemic. These and other trends are creating exposures nurses are facing today and into the foreseeable future.
Risk experts at Nurses Service Organization (NSO) identified key risks for nurses as a result of staffing shortages:
1. Higher patient loads.
The Affordable Care Act has impacted the volume of individuals with health insurance, including individuals with complicated issues who once used to only seek treatment when necessary through the ER. This larger and more complex patient load places additional pressures on nurses. When care suffers, positive outcomes are negatively impacted, which only strikes down hospital reimbursement rates, making it all the more difficult for hospitals to be able to afford additional highly qualified nurses. It’s a vicious cycle.
2. Extended hours.
As shifts stretch (often last minute), fatigue becomes more of a factor, mental acuity may suffer, and the opportunity for an incident increases. When combined with increased patient ratios, nurses have more opportunities to, inadvertently, make mistakes and injure those they serve or themselves. These added hours also can create job dissatisfaction, which stresses health care teams and staffs.
3. Increased responsibilities.
Nurses are at the center of patient care, acting as an advocate between patients and physicians, and patients and family and friends. More and more, nurses are becoming accountable for the coordination of care and providing informed discharge notes for patients, which extend the potential to impact outcomes and the nurse’s exposure beyond the facility walls.
4. Greater likelihood of “floating.”
The nursing shortage creates gaps in coverage and the need for additional nurses to ‘float.’ Unfortunately, when nurses are assigned to an area they are unfamiliar with, or when a team of nurses has a professional from another department entering their zone, it can create confusion and issues. In fact, the most recent NSO claims report shows agency nurses (who often are sent to help facilities fill gaps in coverage) were involved in nearly 25% of the closed claims in the study. We can expect these workplace dynamics will continue to evolve as facilities move nurses as needed to address shortages on the fly.
5. New nurses entering the workforce.
The next eight years will see a steady stream of new nurses entering the workforce to replace those retiring. Much like nurses who float, these new nurses will need experience, on-the-floor training, and mentoring to acquire the skills needed to master their environment.
As the country continues to see an increase in the number of people ages 65 and up as well as more patients entering the health care marketplace, the nursing shortage will continue to be a concern. This rising concern has the potential to place all nurses into higher risk working conditions they need to protect themselves, and their careers, against.
As Black History Month draws to a close, now is an excellent time to reflect on all the nurses who paved the way for today’s increasingly diverse nursing workforce.
The numbers still don’t reflect the levels of diversity in the country as a whole, or even necessarily in the settings where they work, but African-American and black nurses are entering the nursing profession and earning advanced nursing degrees in greater numbers than ever before.
According to the Bureau of Labor Statistics, the nursing workforce is achieving greater diversity, but there’s still a long way to go. While the 2015 National Nursing Workforce Study stated 19.5 percent of nursing respondents reported a racial or ethnic minority background, the rate was even higher among newly registered nurses.
With a nod to early black nurses like Sojourner Truth or Harriet Tubman, who each paved the way for minority nurses to follow, nurses are expanding into many specializations and gaining higher degrees. With the current push to have 80 percent of nurses educated with a completed bachelor of science in nursing by 2020, higher ed and advanced degrees are an important part of getting ahead in nursing. Of the 176,000 nurse practitioners, 8.5 percent are African-American. And of the 3,102,000 registered nurses, 11.9 percent are African-American.
Minority nurses continue to make big strides in increasing the diversity of the overall nursing population. According to American Association of Colleges of Nursing (AACN) figures, the percentages of black or African- American nurses earning master’s or doctoral degrees has increased significantly in the past 10 years.
In 2006, 10.6 percent of those earning doctoral degrees were African American. In 2016, that percentage jumped to 16.2. And in those same years, the number of those earning master’s degrees also saw a percentage jump. In 2006, 11.3 percent of those going for a master’s degree were black. Ten years later, the percentage was 14.3. Overall, the percentage of minority nurses seeing nursing degrees hovers at about 30 percent of the total.
All that good news helps patients who say they want to see a diverse workforce in the healthcare professions. Many patients feel comfortable with someone who looks like them, but, more importantly, a diverse workforce helps spread culturally competent nursing practices. The entire nursing staff may not represent the ethnic diversity in a given setting, but they can learn from those who might understand certain cultural traditions, languages, or practices. All that understanding makes for better patient care and outcomes and an especially effective nursing staff.
So as Black History Month draws to a close, take a few moments to reflect on how far African-American and black nurses have come and the essential care and understanding they provide to the public. And take a moment to take pride in being part of that.
February is all about heart health—what you can do to improve it, ways to prevent damaging it, and finding out what heart-healthy habits work for your lifestyle. Stress is a big contributor to poor heart health, so relieving stress is a natural way to improve your odds.
But reducing stress, especially when you’re a nurse, is not always as easy as it sounds. Sure, you can try (and probably have great success with) yoga classes or even with the scientifically proven meditation. But if you want to find something a little off the beaten track, try these odd ways to give your stress the boot.
1. Bake Bread
Baking bread is such a huge stress reliever that some medical professionals tell their patients to try it. But you have to put the bread machine away for this one. This is bread baking the old-fashioned way. All the banging and kneading of the dough not only gives your upper body a workout, but the repetitive motion is incredibly soothing. Then call a friend to come over and share your wonderful loaf of bread.
2. Laugh Really Hard
There are lots of formal and informal laughing groups that gather strictly for the purpose of laughing. People get together and try to force a few big laughs, but the resulting honest laughter can really relieve your stress. You can also get your laugh meter going the old-fashioned way. If you want your laughs to come from something funny, tune your radio into some comedy stations, download some funny podcasts, or get some comedians’ CDs from the library. You might have to seek it out, but ticking your funny bone really is good for your health.
3. Carry a Fragrant Cotton Ball
This might sound weird, but carrying around a cotton ball infused with an essential oil can have a huge impact on your mood. Carry your scented cotton ball in a baggie or a small plastic container (remember the idea of this blog is weird ways to relieve stress!) so you can sniff it periodically throughout the day. Lavender is an excellent and well-known relaxing scent. Citrusy scents like lemon, lime, or grapefruit are invigorating and might help your brain out of an afternoon slump.
4. Rest Your Eyes on Beauty
When there’s no way you can step outside or escape to the blue ocean of the Caribbean, find an app with a flickering fireplace or with soothing ocean waves or the bird songs in a rainforest. Spending a few minutes looking at something peaceful (bonus for added sounds) will bring your blood pressure down a few notches even if it’s not the real thing. You can spend just a few minutes gazing and then get back to your day a little more relaxed.
5. Watch a Sad Movie
This is not for everyone! But if you are one of those people who feels relieved after a good cry, you might want to turn on a good tearjerker. A good crying jag can release a lot of pent-up emotions and, in fact, get rid of some of the stress you’re holding in. But, if you’re someone who takes a long time to shake the sad feeling of movies that make you weep, skip this tip.
Finding out what makes you feel better is always good–even if it is a little out of the ordinary. In the end, what matters is your health, so find a great stress reliever and stick with it..
Hospitals will face a major dilemma if the current federal administration repeals the Affordable Care Act (ACA) without a suitable replacement. The ACA offers millions of Americans affordable health insurance, and hospitals have seen their revenues, and their quality of care, rise as those newly insured citizens access their services. If the ACA goes away, those health care patients and their accompanying insurance payments disappear, putting even more stress on today’s health care labor force. With profit decline comes employee decline, both in number and quality. This will first and foremost affect nursing staff, putting some out of work and others in-over-their-heads.
An Uncertain Health Care Future
Before enactment of the ACA, existing law required (and still requires) that health care facilities provide “stabilizing care” to any person who requests services, regardless of their ability to pay. Medicaid covered these costs. Without ACA coverage, many patients will be forced back to receiving only the substandard “stabilizing care,” and will not receive the services they need to regain their health.
In that circumstance, the medical facility will be forced to balance the volume of unsubsidized, stabilizing care offered against the revenues generated by paying patients, cost reductions, or staff workload increases. If they offer excessive unsubsidized care, they risk declining income levels, staff numbers and possible bankruptcy. If they provide too little, they risk losing their Medicaid/Medicare funding. In both cases, the facility, its staff, and America’s uninsured patients will suffer.
Unpaid Care Is Expensive for the Medical Office …
Every medical consultation generates a series of cost-creating actions, from those of the scheduling secretary to the attending medical professional, and all the way through to the deposits made by the final billing clerk. According to the American Hospital Association, hospitals provided $35.7 billion in uncompensated care to their patients in 2015 alone. When a hospital absorbs these losses, it is also forced to reduce the services it can afford to provide.
Consequently, it is not unheard of for doctors to reduce the size of their bills by limiting the services they provide or the number of recommendations they make, based on their perception of what the patient can afford. Other studies confirm that uninsured patients are checked into a hospital for shorter stays, and they are offered fewer interventions for their condition. For the health professionals, these painful decisions are in direct conflict with their oath to provide the best care possible for every patient.
… And Hard on the Staff
One group of hospital workers that will certainly absorb a significant percentage of additional work due to funding cuts are the nurses. Reduced funding often leads to reduced staff numbers; remaining staff end up working longer, harder shifts, with more responsibility and less break time. And nursing is already a challenging job, with a high demand for significant physical labor that also takes an emotional toll. In fact, between 2002 and 2012, nurses have reported the highest stress levels of all health care professionals.
Additionally, long hours may not allow nurses to get the sleep they need. Inefficient sleep has been associated with a deficit in performance, caused by cognitive problems, mood alterations, reduced motivation, increased safety risk, and physiological changes. These effects only get worse with total sleep deprivation, common among nurses who work consecutive shifts.
Additional Stress Factors
Research reveals that the changes in the nursing profession in particular and the health care system in general, contribute significantly to the problem:
- Sophisticated technology offers immense benefits but adds additional layers of responsibility on already overloaded schedules;
- Burnout is common, too. Protocols can change as resources ebb; nurses are compelled to follow evolving practices without the opportunity to add input regarding their patient’s care. A 2012 study published by the Canadian Federation of Nurses Unions found high levels of burnout correlated to lower ratings for quality of care.
- Reduced staff numbers also drive nurses to work even when they are sick. Many choose to potentially infect their patients rather than leave their colleagues unsupported on shift.
The reality for America is that, before the ACA, unpaid hospital bills were often eventually born by other elements of the system, including taxpayers and patients who incurred higher medical care costs. Repealing it won’t save the country money, but instead will add extra stress to the system and further erode the health of millions of its citizens.