The coronavirus pandemic has had a profound impact on the lives and livelihoods of individuals and institutions around the world. The cumulative civic and social costs have been devastating, exacerbated by the economic ramifications of a worldwide recession and tumultuous unemployment landscape.
While the impact of recessionary pressures and new professional and financial circumstances is by no means limited to the healthcare field, medical professionals on the front lines have been placed in the difficult position of simultaneously handling extraordinary workplace challenges and navigating personal difficulties.
For Certified Registered Nurse Anesthetists (CRNAs) across the United States, those challenges can be particularly acute. Many CRNAs work as 1099 independent contractors, essentially making themselves business owners hired on an as-needed basis. While 1099 status can be more lucrative, it traditionally offers less professional security and predictability than full-time employment. But with some of the nation’s largest health systems forced to implement significant COVID-related layoffs, shutdowns, or furloughs, even the traditional “safe” route provides less professional security.
CRNAs play a vital role within the ecosystems of healthcare institutions. And at a time when CRNAs are focused on taking care of both their patients and their own families, the last thing they need is a new set of financial difficulties to manage. What follows is a brief overview of the tips, tactics, priorities, and best practices that CRNAs should be aware of as they navigate their evolving financial situations in a post-COVID-19 environment:
Crack Open the Window of Opportunity
While CRNAs are often phased out of being able to contribute to a Roth IRA due to their income level, pandemic-related income reductions may have a silver lining. Current circumstances may allow some CRNAs to either qualify for a contribution in the current year or even convert old retirement plans to a Roth IRA with smaller income tax ramifications. While it is true a Roth Conversion will create some short-term tax liabilities, the potential long-term benefits of this move are significant—perhaps even dramatic. Additionally, the passage of the CARES Act included provisions designed to give additional access to funds for those who have had their health or finances impacted by the pandemic. The IRS is waiving the 10% early withdrawal penalty for anyone under the age of 59 1/2 that withdraws money from traditional and employer-provided IRA accounts. Individuals still need to pay taxes on those early withdrawals, but the legislation allows payment over three years instead of right away.
The pandemic has wreaked havoc on regular spending and savings habits. While some have struggled, others actually find themselves with more discretionary income available due to less spending on travel and entertainment. One of the most impactful things you can do is to step back and take stock of your spending and your new circumstances. Evaluate your habits (both good and bad) and reassess your long-term financial planning strategies. More cash flow might give you more flexibility and investment options, and lower income levels obviously necessitate behavioral changes. Recognizing that more people lose money from bad habits and behaviors than bad investments is an empowering insight that leads to new opportunities.
Don’t Tax Yourself
Between new legislation and a higher-than-usual degree of income variability, there is more opportunity than ever before to move strategically between different tax brackets to optimize your tax planning. Prioritize proactive planning, as the most valuable opportunities require preparation for next year’s taxes.
Harvest Your Losses
Every market presents an opportunity. Seasoned investors recognize the ups and downs of the market, which dropped an eye-opening 30-40% in the early days of the pandemic before recovering in subsequent weeks, provide opportunities for some to harvest their losses and take advantage of a wide range of alternative strategies designed to not just mitigate losses, but yield meaningful gains.
Leverage Institutional Flexibility
Most CRNAs entered the business to care for people. But times like this can be scary or feel overwhelming and may even prompt some introspection about career plans and timelines. Those who may be reassessing things like life and disability insurance, or retirement timing will be gratified to discover that some financial institutions have recognized frontline workers for their work, introducing new flexibility with regard to underwriting, or terms and conditions around preexisting conditions. Now is not the time to assume that because you could not qualify for these protections in the past, you will not be able to qualify after the onset of the pandemic. Do your research and due diligence.
Above all, recognize that financial planning is fluid: a process, not an event. Economic and regulatory situations are constantly changing and working with a trusted advisor who can keep abreast of those changes is essential. If possible, seek out financial professionals with demonstrated experience working with CRNAs and an intimate understanding of the industry—from education and testing timelines, to the credentialing process and even managing your student loans—and the financial obstacles and opportunities they present. The best professionals understand the value of CRNAs and can help you navigate post-COVID financial complexities and planning pains so that you can focus on what you do best: taking care of your patients, your family, and yourself.
As the largest contingent within the health care workforce, nurses are vital to shaping the future of not just their profession but medicine as a whole. Even during the COVID-19 pandemic, seasoned nurses and those currently studying to join their ranks must come together to tackle the issues that are critical to the future of nursing.
The first step is gathering information and seeking to understand complex issues such as antibiotic resistance, environmental sustainability, and remote accessibility. Nurses who work in clinical environments must collaborate with nurses in non-clinical roles to formulate evidence-based action plans that include educating the general public.
The public places great trust in nurses, and while the media may choose to feature doctors in its coverage, regular people generally reach out to nurses for honest information and level-headed advice. Simply put, when nurses talk, people listen. The public trust they’ve cultivated puts them in a unique and powerful position to bring about change in nursing and propel the health care industry into the future. It is a challenging yet exciting time to be in the nursing profession.
Ask any nurse what their primary responsibility is, and they will likely answer that they have to protect their patients from otherwise preventable harm. The rise in antibiotic-resistant bacteria, also known as “superbugs,” is making this task more difficult. One of the most vital issues to the future of nursing is understanding how to protect patients from superbugs and educate the public about antibiotic resistance.
Antibiotic resistance occurs when, over time, bacteria adapt to drugs that are formulated to kill them. When the bacteria changes as a means of ensuring survival, this renders widely-used treatments for infections significantly less effective, and in some cases, completely ineffective. Medical professionals have linked drug-resistant bacteria to pneumonia, urinary tract infections, and skin infections. In some extreme cases, the patient has even died.
Unfortunately, because it is a naturally occurring phenomenon, antibiotic resistance cannot be stopped. However, it can be slowed. For this to happen, the public must be educated on the proper use of antibiotics. As one of society’s most trusted voices, nurses must lead the educational charge and raise awareness. Furthermore, since they make up the majority of the health care workforce, nurses’ commitment to proper cleaning, disinfecting, and sanitizing would go a long way in combating antibiotic resistance.
Like antibiotic resistance, another issue vital to the future of nursing is environmental sustainability. All industries have an ecological footprint, and the health care industry is no exception. In fact, the health care industry is one of the primary culprits. Currently, industry practices account for a large percentage of the country’s energy consumption and pollution emissions including 10% of the nation’s greenhouse gases.
When nurses treat patients with environmental-related illnesses, there’s a chance that it was the health care industry’s ecological impact that made them sick in the first place. Over the years, nurses and other health care providers have made efforts with sustainability, but there’s still more that needs to be done.
Nurses, perhaps better than any other medical professional, understand the limited resources their industry must contend with. This puts them in an influential spot to enact eco-friendly strategies such as using plastic more intentionally and promoting renewable energy.
One strategy nurses can use to embrace environmental sustainability and provide better care to more patients is prioritizing remote accessibility. Telemedicine, which relies on telecommunications, allows health care professionals to evaluate, diagnose, and treat patients without needing to be face to face.
Even before the era of social distancing, remote accessibility was in high demand. Cost and location force people to choose between their health and spending time and money to attend regular checkups. People living in rural communities disproportionately have inadequate access to health care. Nurse educators teach other nurses that preventative care is essential to the health and well-being of the communities they serve.
Improving accessibility could also help improve the overall efficiency of a health care organization. Nurses wouldn’t need to spread themselves as thin since people with symptoms that can be managed from home could be treated via telemedicine. With more people attending their regular checkups and showing up (albeit virtually) for follow-ups, there are more opportunities for preventive care that could also lighten nurses’ workload in the long run.
Remote accessibility, environmental sustainability, and antibiotic resistance are three of the most important issues demanding the attention of the health care industry. Change needs to happen, and nurses are the ones to lead it. Because of their trusted position, nurses can positively influence their medical colleagues as well as the general public. The future of nursing runs parallel to that of the health care industry, and if nurses step up and make a strong case for a particular course of action, they can determine the direction of both.
There are more than 9 million Veterans being cared for by VA. That adds up to a lot of X-rays, ultrasounds, CAT scans, and MRIs performed each year at more than 1,200 facilities across the nation.
None of these vital tests would be possible without our hardworking diagnostic radiologic technicians. With the assistance of these important members of the VA team, we’re able to diagnose disease in its earliest stages, monitor the progress of treatment, and help Veterans lead longer, healthier lives.
Help Care for Veterans
If you have experience in health care imaging, consider bringing your skills to VA, the nation’s largest integrated health care system.
We employ diagnostic radiologic technicians all over the country – from the sandy beaches of Hawaii to the rural fields of the Midwest to the bustling city of New York – so there’s sure to be a job opening near where you live or where you’d like to go.
According to the U.S. Bureau of Labor Statistics, the radiologic technician field is projected to grow faster than the average occupation, increasing by about 7% over the next decade as the population ages and demand for testing rises.
At VA, you’ll be able to work on the forefront of your field, alongside colleagues who share your commitment to excellence and your dedication to serving Veterans.
We are always looking for new and innovative ways to bring the best care to those who have bravely served our country. At our first 5G enabled medical center in Palo Alto, we’re now able to turn CT and MRI scans into 3D images that can be projected on the patient’s body to improve precision and speed of surgeries.
Enjoy excellent benefits
When it comes to benefits, VA’s offerings far outpace the private sector. They include:
- A competitive starting salary. You’ll enjoy a strong initial salary based on education, training and experience. At VA, you can count on steady growth with periodic pay raises and other rewards for all your hard work and dedication.
- A commitment to work/life balance. From offering flexible scheduling to generous leave plans, we want to make sure our employees are happy and fulfilled.
- Continuing education support. We offer a broad range of scholarships, tuition reimbursement and loan repayment programs, and other educational opportunities to help you in your lifelong quest for learning.
- Robust health insurance and retirement plans. Take care of your health and your family with a range of health insurance plans, including vision and dental. Protect your future with our three-tier retirement plan, life insurance and long-term care insurance.
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Ready to pursue a career in radiology at VA? Discover a rewarding new opportunity and apply today.
Communication of all kinds is especially important in nursing. But this isn’t limited to conversations between nurses and patients, family, or staff. Another crucial form of communication is interoperability—when different technologies can communicate with each other.
Susan Niemeier, MHA, BSN, RN, is the Chief Nursing Officer (CNO) with Ivenix, Inc., a new infusion pump company whose vision is to eliminate infusion-related patient harm. “I guide our overall clinical direction and oversee its marketing and product efforts, working closely with the research and development teams,” Niemeier explains.
Niemeier, who has more than 25 years of experience in health care, took time to answer our questions about interoperability.
Please explain what interoperability is.
In its truest—and broadest—definition, interoperability is the ability to share information across multiple technologies. By ensuring that technologies work together, data is able to flow throughout and across the health system. When information flows freely and functions seamlessly, nurses are equipped to make smart decisions and achieve the best outcome for their patients. When done well, interoperability can lead to a new level of health care—a crucial step in optimizing quality of care.
How does interoperability matter in health care?
When health systems, devices, and applications seamlessly share information, nurses can make smart decisions about a patient’s care. Having a holistic view of this information provides insights to make crucial—and sometimes lifesaving—clinical decisions and adjustments earlier in the treatment process.
Interoperability also brings together critical patient information (i.e., medical and medication history, comorbidities, lab evaluations, etc.) from various sources. Nurses do not have to synthesize the information themselves, which is inefficient, error-prone, and limiting. Instead, they can spend more of their time caring for patients.
What are the various products (including EHR) that are used in interoperability?
Devices that are traditionally known to be interoperable include electronic medical records (EMR), department systems (i.e., labs, radiology, pharmacies), specialty focus systems (e.g., cardiology, pulmonary, etc.) and ancillary systems (i.e., billing, insurance, etc.).
I’m passionate about the interoperability of medical devices with other systems. Medical devices contain real-time data that is powerful for nurses when making decisions for patients. Whether it’s a patient monitoring device or a smart infusion pump, interoperable medical devices can elevate patient care practices.
Today’s infusion pumps are an example of a medical device that is capable of interoperability, but has not yet realized its true potential. Currently, many infusion pumps rely on nurses to manually program data into the pump. This may lead to errors and ultimately, adverse drug events. In fact, of the estimated 1.5 million adverse drug events reported to the FDA each year, 54% are related to infusion-pump errors, and 61% of those events are serious or life-threatening.
According to a 2018 Health Information and Management Systems Society’s (HIMSS) survey, 87% of HIMSS survey respondents considered interoperability as extremely or moderately important to what infusion pump they may use. A majority of respondents also considered the automation of programming and documentation efforts—facilitated by interoperability—extremely important for improving patient safety. Yet, less than 20% of respondents indicated actually having implemented EMR/infusion pump interoperability. Unfortunately, the greatest perceived barrier was projected cost with upgrading and connecting pumps with the EMR. We need to do a better job demonstrating that the cost is worth the effort in the form of patient safety, better outcomes, and overall efficiency.
Infusion pump interoperability enables auto-pump programming and documentation of clinical workflows. Automatically programming the pump from providers’ orders reduces manual steps and variability in the medication administration process. Having the data flow seamlessly into the patient’s medical record reduces time spent in documentation and potential for transcription and/or omission errors. Clinicians are empowered and ultimately satisfied knowing the right drug is administered in the right dose, to the right patient.
However, infusion interoperability can do more to optimize workflows and support smart decision making. Infusion pumps can communicate with alarm management systems to help prioritize alarms and eliminate nuisance interruptions. It can also unlock timely data to advance analytics, ultimately, build insight to enable high quality, safe care.
What roles do nurses play regarding interoperability? Why should nurses advocate for interoperability?
Imagine safer, simpler, and less stressful infusion delivery for nurses and their patients. To achieve this, the infusion pump should have a meaningful conversation with your EMR—as well as other clinical information systems.
When an infusion pump and EMR are interoperable, pharmacy-verified physician orders are transmitted directly from the patient record to the infusion pump—no need for error-prone, time-consuming manual input. Moreover, the pump can send accurate, time-stamped infusion data to the patient record, reducing clinician documentation time and the potential for errors.
This year, nurses are working through unprecedented times, dealing with a global pandemic. As an industry, those who answer the “call to care,” need support from the technologies and devices they use regularly, including interoperable infusion pumps, to ensure they continue to improve care despite challenges.
Because of their important role in patient care, nurses have a critical voice in decision-making for technologies and medical devices. It is vital that decisions regarding interoperability include the voice of the nurse. Their perspective can shed light on what is really needed to help them be more effective in improving care and creating efficiencies.
Is there anything else you think is important for our readers to know?
It’s critical for the health care community and industry to understand that interoperability is not a destination, it’s a journey. We need to continue to work together to achieve seamless interoperability, especially with the help of nurses. Health technologies need to engage with and support nurses in decision-making based on the most comprehensive information. The 2018 HIMSS survey shared an estimated 70% of health systems plan to implement interoperable infusion pumps within the next four years. And, this is just one of the devices and systems that are being considered for interoperability use.
Ideally, we would already have these interoperable devices up and running, and integrated in every health system, we’re not there yet. But I believe we’re making great strides to ensure stronger patient safety practices and better care.
A women’s health nurse practitioner (WHNP) is an advanced practice registered nurse who cares for women through various stages of their life, with a focus on reproductive, obstetric, and gynecological health. WHNPs start their careers as registered nurses and education for entry into practice is achieved through both master’s and Doctor of Nursing Practice (DNP) programs, per the latest clinical guidelines from the National Association of Nurse Practitioners in Women’s Health (NPWH). WHNPs assess, diagnose, and treat conditions that relate to women’s health care and provide preventative care and education for patients across the lifespan. Examples of preventative care include:
- Well-woman exams
- Breast cancer screenings
- Papanicolau (Pap) tests
- Contraceptive care
- Fertility evaluations
- Prenatal visits
- Post-pregnancy care
- Menopausal care
Growing Demand for NPs
As the population continues to age and require more access to health care, the demand for advanced practice nurses will also increase. The Bureau of Labor Statistics expects the need for advanced practice registered nurses (APRNs), including NPs, to grow by 45% from 2019 to 2029. This is exponentially faster than the average across all occupations and means that an additional 117,700 positions will need to be filled by 2029. The average annual wage for NPs was estimated at $111,840 in 2019. Other surveys found that WHNPs see an average of 18 patients per day.
Advocacy for Women’s Health Care Rights
Serving as the professional organization for WHNPs, the NPWH states that their mission is “to ensure the provision of quality primary and specialty healthcare to women of all ages by women’s health and women’s health focused nurse practitioners.” This group supports WHNPs nationally with continuing education credits and access to standards of care, while also advocating for their role. Their main goal regarding advocacy for women’s health care includes “protecting and promoting a woman’s right to make her own choices regarding her health within the context of her personal, religious, cultural, and family beliefs.”
NPWH additionally advocates for WHNPs in terms of laws affecting reimbursement including Medicare, guidelines for screening cervical cancer, and increased access to care for women that aligns with their mission statement and goals. They repeatedly advocate for women—especially in light of COVID-19—to promote improved care during these turbulent times.
Expansion of Scope of Practice
Scope of practice is determined on a state-by-state basis, with state and federal laws guiding practice authority for APRNs. In many states, scope of practice for APRNs occurs under the supervision and guidance of a physician. Over the last decade, there has been an ample amount of debate in legislation and policy regarding the expansion of scope of practice to allow WHNPs to fully practice using their skills and education to treat patients.
As of 2019, there are 28 states in the United States (as well as the District of Columbia) that offer full practice authority to NPs (some after a set number of practice hours under a physician’s supervision). This step forward is critical as it improves access to care, streamlines efficiencies, reduces costs, and protects patients’ choice of health care provider. This advancement requires a reform of insurance companies to provide direct reimbursement to APRNs who practice under state law. As WHNPs gain more autonomy through full practice authority, they will be able to reach more women with fewer barriers to practice and care for them across the lifespan.
Increasing Rural Access to Health Care
Rural and underserved areas of the population still need access to basic health care, preventative screenings, and treatment of medical conditions. Up to 77% of rural counties are experiencing reduced access to health care due to provider shortages. Rapid advancements in telehealth medicine sparked by COVID-19 are just one piece of the puzzle in reaching patients who are miles from healthcare access.
It’s essential for WHNPs to be available to patients in rural areas—especially in places such as Nebraska, where 13 of 93 counties do not have a single primary care provider. WHNPs and other APRNs can fill this large care gap for the people in these communities.
The Overwhelming Need for WHNPs
An aging patient population and health care reform demonstrate an increased demand for more APRNs, and WHNPs are no exception. It is essential for women to have access to health care providers throughout their lifespan who are able to meet their needs. As a whole, the nursing industry will need to continue emphasizing the importance of APRNs in filling the advanced provider vacancies that will develop over the next decade.
Offering strong financial and job security, WHNP roles focus on advocating for patient populations and participating in health care reform through engaging with politicians. Working toward policy change to encourage the expansion of scope of practice allows WHNPs to meet the needs of patients in rural and medically underserved areas who are in dire need of affordable access to care. With the pandemic accelerating technology advancements and legislation regarding healthcare, WHNPs will continue to step up and meet the needs of their patient populations.
At thousands of VA health care centers and outpatient clinics throughout the nation, employees are committed to serving Veterans.
The Veterans Administration supports and celebrates employees who want to take this dedication to the next level – whether that’s through flexible scheduling to accommodate volunteer activities, paid time off to fulfill reserve or National Guard duties, or by participating in a program that assists other VA facilities in an emergency.
Helping in a time of need
Through the Disaster Emergency Medical Personnel System (DEMPS), both clinical and non-clinical staff can volunteer to serve in the event of an emergency or disaster. DEMPS is a key component of our fourth mission to provide back-up health services to the nation.
When VA health care providers and support personnel are pulled away from their facilities to assist in events like hurricanes, earthquakes, floods and public health emergencies, these volunteers help fill in.
Recently, a team of 40 VA employees from around the country traveled to Muskogee, Oklahoma, to help care for Veterans affected by COVID-19.
“One thing this pandemic has shown is that when things get tough, VA health care staff do not waiver in their dedication to do whatever is needed to care for Veterans,” said Mark Morgan, Eastern Oklahoma VA Health Care System director.
The DEMPS team members, including nurse Lee Barela, were stationed at Jack C. Montgomery VA Medical Center.
“We are all here at VA to pay back to our Veterans for the services they have provided for us,” said Barela. “I think the presence of DEMPS brings a sense of comfort to Veterans. They know that as a country we are stepping up and doing a great job. We make sure that no matter what is happening, they receive their care without delay.”
Another group of DEMPS volunteers, including nurse Dorothy Barrow, were called to help an understaffed medical center in Whiteriver, Arizona. The center serves members of the White Mountain Apache Tribe, and Barrow helped ease the strain on night-shift family care unit staff.
“It was a humbling experience to be accepted into their cultural traditions while being helpful at the same time,” Barrow said.
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If you’re as committed to service as we are, consider a VA career. Our mission of caring for Veterans —and helping the nation in times of need — is second-to-none.