Student response

      Lois Workin" rel="nofollow">ing in" rel="nofollow">in healthcare for greater than twenty years has afforded this future nurse practitioner (NP) the opportunity to see a plethora of approaches regardin" rel="nofollow">ing the challenges of healthcare delivery. Providin" rel="nofollow">ing safe, effective and affordable quality healthcare is a challenge is today's healthcare economy; regardless of bein" rel="nofollow">ing for profit, non-profit or a government in" rel="nofollow">institution such as the Veterans Admin" rel="nofollow">inistration (VA) hospitals. That bein" rel="nofollow">ing said, this future NP cannot begin" rel="nofollow">in to understand how such a large in" rel="nofollow">integrated health system such as the VA system can overcome their challenges of bein" rel="nofollow">ing "broken" when smaller, more organized health systems struggle every day to main" rel="nofollow">intain" rel="nofollow">in streamlin" rel="nofollow">ined, standardized and process driven organizations. In August 2011, the VA system had 152 hospitals, 804 community outpatient centers and 280 Vet Centers with approximately 8 million veterans receivin" rel="nofollow">ing health care (Nayar, et al., 2013). In addition, the VA struggles to main" rel="nofollow">intain" rel="nofollow">in economic viability while strugglin" rel="nofollow">ing with a fixed "brick and mortar" mentality. One such way the VA is attemptin" rel="nofollow">ing to overcome bein" rel="nofollow">ing "top heavy" with high-salaried staff as well as a very large admin" rel="nofollow">inistrative staff is to attempt to in" rel="nofollow">increase enrollment in" rel="nofollow">into the VA system by qualified veterans (Weeks, W & Auerbach,D, 2014). However, such a move also in" rel="nofollow">increases the need for more qualified providers and potentially more facilities to be opened. Another way in" rel="nofollow">in which the VA has attempted to improve is the implementation of an electronic health record (EHR) system that can be utilized system wide by any provider accessin" rel="nofollow">ing the veterans medical record; thus, hopefully allowin" rel="nofollow">ing a more streamlin" rel="nofollow">ined plan of care. From a personal experience, seein" rel="nofollow">ing patients for women's health care (who are veterans) presents a challenge of first obtain" rel="nofollow">inin" rel="nofollow">ing a referral letter from a VA physician to obtain" rel="nofollow">in speciality services (e.g., well-woman exam). Also, reimbursement by VA to clin" rel="nofollow">inics and hospitals are extremely delayed, thus puttin" rel="nofollow">ing a fin" rel="nofollow">inancial burden upon the patient. Another area of concern is the access to mental health care and the need for more mental health providers. Lobbyin" rel="nofollow">ing at the local and state level would be beneficial to expedite access to care of these much needed services. This future NP is in" rel="nofollow">in a unique position of havin" rel="nofollow">ing a large military in" rel="nofollow">installation nearby, along with a large population of retired military personnel. References: Nayar, P., Apenteng, B., Yu, F., Woodbridge, P., & Fetrick, A. (2013). Rural veteran's perspectives of dual care. Journal of Community Health, 38(1), 70-77. DOI: 10.1007/s10900-012-9583-7 Weeks, W.B., & Auerbach, D. (2014). A VA exit strategy. The New England Journal of Medicin" rel="nofollow">ine, 371(9), 789-791. Retrieved from http://prx-herzin" rel="nofollow">ing.lirnnet/login" rel="nofollow">in?url=http://search-proquest-com.prx- herzin" rel="nofollow">ing.lirn.net/docview/1558120346?accountid=167104   Benjamin" rel="nofollow">in PTSD adversely affects the lives of many veterans and their families and is a direct result of servin" rel="nofollow">ing in" rel="nofollow">in the military and in" rel="nofollow">in combat. Assimilation can be difficult for those even without PTSD; a heightened sense of vigilance and awareness as well as the dependable structure within" rel="nofollow">in the military can make civilian life uncomfortable and difficult (Department of Veterans Affairs, 2016). Policies should provide for more than simple psych evaluations, they should provide for a slower in" rel="nofollow">integration back in" rel="nofollow">in to society, and acknowledgment of the issues vets may have. I personally would love to see job train" rel="nofollow">inin" rel="nofollow">ing offered for those who served in" rel="nofollow">in jobs that do not directly translate to the civilian world, and in" rel="nofollow">incentives for companies to hire veterans comin" rel="nofollow">ing straight out of service. Privatization is a double edged sword. It would most defin" rel="nofollow">initely in" rel="nofollow">increase efficiency within" rel="nofollow">in the system, however, the fear lies in" rel="nofollow">in if the quest for in" rel="nofollow">increasin" rel="nofollow">ing profits would adversely affect the care given to our veterans. I do not believe this question can be answered. Access to and efficient provision of care to veterans must be improved, offerin" rel="nofollow">ing population outcome based reimbursement may provide the in" rel="nofollow">incentive to cover both efficiency and quality care. There is some discussion of movin" rel="nofollow">ing VA dollars in" rel="nofollow">into Medicaid or Medicare and providin" rel="nofollow">ing coverage for veterans in" rel="nofollow">in this way Zin" rel="nofollow">inberg, 2017). This may possibly work as health care systems already accept these as payment, but given the number of VA hospitals there would need to be additions to private health care to absorb these patients without impactin" rel="nofollow">ing everybody. I have worked with the VA system and outside it and a huge step would simply be for the VA system to be run in" rel="nofollow">in the way private systems are, where efficiency and excellency are rewarded, where we are supposed to come under budget not blow the budget. I have personally witnessed gross negligence and waste within" rel="nofollow">in the system that would cause employment termin" rel="nofollow">ination in" rel="nofollow">in the private sector and resulted in" rel="nofollow">in nothin" rel="nofollow">ing. References: U.S. Department of Veterans Affairs. (2016, October 4). What Is PTSD? Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp Zin" rel="nofollow">inberg, J. (2017, January 09). Trump's path to privatizin" rel="nofollow">ing VA hospitals - by the numbers. Retrieved July 10, 2017, from http://thehill.com/blogs/pundits-blog/healthcare/313280-trumps-path-to- privatizin" rel="nofollow">ing-va-hospitals-by-the-numbers