At the start of the year, it is a time for new beginnings, a time when we can reflect on areas that require some work and develop an action plan for change. So many hospitals, as they embrace Magnet status, promote mindfulness and wellness among the nursing and hospital staff. Many of us start the New Year with resolutions for better health and exercise. Last year, my orthopaedic unit decided to have a competition for 5 months to see who could lose the most weight. I came in second behind someone who beat me by 1 lb. I was really happy with the health changes that we both had made and that it was a win–win situation for both health and appearance. Maintenance is not easy and must be worked at constantly to prevent the backsliding that hits so many of us.
Without being politically driven, I would say that we live in unsettled times in which the Affordable Care Act is holding on by a thread and causing significant angst to the president. Taking care of our patients has to be a high priority but always with the caveat that there is no free healthcare.
Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries. The average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas. It has been decided to reduce the number of mandatory geographic areas participating in the Centers for Medicare & Medicaid Services innovations in comprehensive care for joint replacements from 67 to 34 in the hope that this model aims to support better health and more efficient care for beneficiaries undergoing this common inpatient surgery. It is also being changed that this procedure should move from an inpatient setting to an outpatient setting. This change drives hospitals to develop outpatient centers that will adequately care for their patients preoperatively to optimize their care and at discharge to prevent the revolving door of readmission to the hospital. In the northeast of the country, there is one hospital that has hired a physical therapist to meet the patient as they arrive at home to determine a personalized rehabilitation plan and prepare the patient for home activities. Another model of care includes home health nurses who are asked to evaluate their patients and often use telemedicine to provide quality patient care. Either way we must be prepared to take care of our patients in a manner that equips the patient and the family for safe efficient discharge.
Two years ago, I had a knee replacement for bone-on-bone osteoarthritis. At that time, we had not developed our joint camp for patients with knee replacement at the hospital. However, because of good patient education both from the hospital and from my resources from NAON, great inpatient nursing care plus the determination that I would perform the necessary rehabilitation I was able to return to work in a timely manner and be able to perform my job as an orthopaedic/trauma nurse practitioner.