The New Health Care Act: Implications for Ambulatory Care Nursing

Welcome to ViewPoint’s new column on health care reform and policy. There could not be a richer environment or context for such a column given the enactment of the new Patient Protection and Affordable Care Act (Public Law 111-148) that was signed into law by President Barack Obama on March 23, 2010. The media has touted the length and complexity of this new law, but there has been little discussion about provisions that affect nursing, specifically the implications for ambulatory care and ambulatory care nursing. A bill that provides access to health insurance and thus access to care for more than 40 million uninsured Americans will certainly increase demand for ambulatory care services. A bill that expands the focus on primary care and prevention again will increase patient volume in ambulatory care. In addition, there is the expectation that many chronically ill persons will now have access to insurance and health care. This, too, will increase demand for ambulatory care and ambulatory care nursing in such areas as care coordination, community referral, teaching, and telehealth. The bill also has provisions that speak to new models of care delivery such as the medical home as well as cost-effective, quality care, which again have implications for ambulatory care nurses. I am currently teaching health policy at the graduate level at Loyola University of Chicago, and I will be focusing in class on this act and its implications for patient care and nursing practice. This column will provide an opportunity to share information with a much broader audience. My students will also work with me as I develop and write the column.

The media has touted the length and complexity of the Patient Protection and Affordable Care Act, but there has been little discussion about provisions that affect nursing.

New Provisions Help Nurses Continue Education

Given that this is an end-of-summer issue when many start to think about returning to school, completing a degree, or retooling for new career opportunities, I would like to briefly focus on some provisions of the Patient Protection and Affordable Care Act (Public Law 111-148) that are very supportive of nurses continuing their education.

  • Nurse Loan Repayment and Scholarship Programs (NLRP): Section 5310 (p. 513) expands the Nurse Loan Repayment and Scholarship Programs (NLRP) to provide loan repayment for students who serve for at least two years as a faculty member at an accredited school.
  • Nurse Faculty Loan Program: Section 5311 (p. 513) increases the Nurse Faculty Loan Program amounts from $30,000 to $35,000 in fiscal years 2010 and 2011 and declares that the amount of these loans will thereafter be adjusted to provide for cost-of-attendance increases for yearly loan rate and the aggregate loan.
  • The legislation also permits the Department of Health and Human Services (HHS) to enter into an agreement with unencumbered RNs who have already completed, or are currently enrolled in, a master’s or doctorate training program for nursing. Under such an agreement, for individuals who spend four out of six years as a full-time faculty member at an accredited school of nursing, HHS would provide up to $10,000 per year to master’s recipients and $20,000 per year to those who earn a doctorate (American Nurses Association, 2010).

What does this mean for you? If you are already in a graduate nursing program, you should inquire as to whether your school participates in either of these federal programs. If you are applying to a graduate nursing program, inquire if these programs are available and whether you will be able to apply for funding. The Nurse Faculty Loan Program provides a means to access a loan for tuition and fees, and the loan will be forgiven if the graduate spends four of six years post-graduation as a full-time faculty member. There is a very real need for ambulatory care nurses to pursue further nursing education and graduate education as well as to consider teaching. We will not be able to solve the nursing shortage in the United States (one that is compounded by a nursing faculty shortage) unless we use many more ambulatory care learning opportunities. To do this, we need nurses in ambulatory care settings who are prepared to mentor and supervise students. The Core Curriculum for Ambulatory Care Nursing, 2nd Edition, is an excellent starting point for nursing student experiences in ambulatory care, but experienced, expert ambulatory care nurses must be there to facilitate learning (Haas, 2009).

Sheila A. Haas, PhD, RN, FAAN, is a Professor, Niehoff School of Nursing, Loyola University of Chicago, Chicago, IL. She can be reached at

American Nurses Association. (2010). Health care reform. Retrieved from PublicLaw.pdf?docID=1241&verID=1

Haas, S. (2009). Priming the pipeline: Creating aspirations for new graduate nurses to enter ambulatory care nursing roles. Nursing Economic$, 27(1), 58-60.