Demystifiying state health insurance marketplaces.

The state health insurance exchanges, mandated under the Patient Protection and Affordable Care Act, will impact how health care is delivered and reimbursed, and will touch the lives of nurses in all professional roles. The dynamics of how each model will operate within each state is currently a work in progress. Nurses have a tradition of providing voice and leadership in the health care reform arena from the unique position as both consumers and health care professionals. The time is right to contact state legislators and advocate for nurses to sit on the governing boards of the state health care exchanges. Communication between nurses in all states should be an ongoing dialogue through specialty and state nursing organizations to ensure nursing is aware of both issues and best practices nationwide.

Using a social capital framework to enhance measurement of the nursing work environment.

AIM: To develop, field test and analyse a social capital survey instrument for measuring the nursing work environment. BACKGROUND: The concept of social capital, which focuses on improving productive capacity by examining relationships and networks, may provide a promising framework to measure and evaluate the nurse work environment in a variety of settings. METHODS: A survey instrument for measuring social capital in the nurse work environment was developed by adapting the World Bank's Social Capital - Integrated Questionnaire (SC-IQ). Exploratory factor analysis and multiple regression analyses were applied to assess the properties of the instrument. RESULTS: The exploratory factor analysis yielded five factors that align well with the social capital framework, while reflecting unique aspects of the nurse work environment. CONCLUSION: The results suggest that the social capital framework provides a promising context to assess the nurse work environment. Further work is needed to refine the instrument for a diverse range of health-care providers and to correlate social capital measures with quality of patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Social capital measurement of the nurse work environment has the potential to provide managers with an enhanced set of tools for building productive capacity in health-care organisations and achieving desired outcomes.

Medicaid expansion: the dynamic health care policy landscape.

The Supreme Court decision of June 2012 left states free to decide on how to undertake Medicaid expansion without facing the substantial financial penalties envisioned by the Affordable Care Act. Currently, 25 states and the District of Columbia are moving forward with the expansion; 22 have decided not to move forward and the remaining 3 are still debating the issue. The evidence to date suggests Medicaid expansion would have several benefits to states including improved population health from expanded coverage, improved financial positions of hospitals and other providers, and economic benefits such as increased employment and tax revenues. Because of these potential impacts of Medicaid expansion on patients and providers of health care, the nursing profession may wish to play an educational or advocacy role in the ongoing debate.