NH can be ‘First in the Nation’ in high-quality affordable care

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Stand up. Speak up. It’s your turn.

New Hampshire has been at the forefront of efforts to make health care accessible and affordable. Yet health care costs and accessibility remain barriers that disproportionately affect New Hampshire’s rural communities.  Nurses provide leadership and support the many efforts at state and federal levels to find solutions for today’s patient populations as well as preparing for our future health care needs

New Hampshire’s nurses have demonstrated leadership by providing novel, quality solutions to healthcare challenges for many years. In 1985, Nancy Dirubbo, a family nurse practitioner, opened one of the nation’s first primary care practices owned and operated by a nurse practitioner in Laconia. She offered primary care for women with an emphasis on prevention for over 30 years. New Hampshire’s residents recognized the value of these services which influenced change. In 1991, regulators permitted Advanced Registered Nurse Practitioners (NPs) to operate independently in our state. And in 2002, Governor Shaheen enabled Certified Registered Nurse Anesthetists (CRNAs), another type of advanced practice nurse, to do the same. This open-minded approach to care has yielded many new opportunities in New Hampshire’s health care system

This forward-moving approach is what we need to continue if we are to bring health care costs under control while promoting access to care. The Commonwealth Fund reported in 2018 that New Hampshire has the highest average out-of-pocket healthcare costs (premium + deductible) in the nation.  It is especially important to prioritize rural health care in New Hampshire, as 8 out of 10 counties in the Granite State are considered rural by the USDA.  According to research done at the University of North Carolina, 120 rural hospitals in the United States have closed their doors since 2010. A different study by Navigant Healthcare reveals that 20 percent of rural hospitals are in danger of closure. New Hampshire has bucked the trend so far, but right now, there are five hospitals in our state that are identified as being at “high risk.”  If any of New Hampshire’s rural hospitals close, families must travel far greater distances to obtain essential care. We cannot let this happen.

Efforts to keep our rural hospitals open are multifaceted. Reduction in operational costs and improved efficiency of quality health care is essential. Successful solutions will address access, flexibility, quality, and cost-effectiveness.  One component can include the collaboration of small facilities with more extensive hospital networks to capitalize on economies of scale. Implementing technology, such as telehealth, where providers and families can use various technologies to connect are especially effective in rural areas. Utilizing all providers, including advanced practice registered nurses (APRNs) to the full extent of their educational preparation, as recommended by the Institute of Medicine in 2011, is a simple way to maximize affordability. 

New Hampshire must continue to lead the way toward minimizing regulatory burdens that prevent providers from using all their skills. Cottage Hospital, a critical access hospital in Woodsville has recently opened a geriatric behavioral health unit in which psychiatric nurse practitioners provide 24/7 care. This is an excellent example of how facilities are finding ways to provide needed service in a cost-effective, high-quality manner by maximizing the skills of advanced practice nurses. 

Keeping our rural hospitals open is also essential to encourage younger populations to live, work and raise their families in New Hampshire. Healthcare facilities provide employment opportunities and tax revenue for New Hampshire’s towns.  Nursing care is the foundation of the health care in our communities both in-patient and out- patient providing full ranges of services for all members of the community young and old. 

Nurses are excited to be a part of this conversation.  We proudly serve on the front lines of health care delivery every day.  The safety and well-being of our patients and their families are the reason we are in this profession. Nurses are answering the call to advocate for solutions to today’s challenges regarding health care cost and access.  Let’s tackle these challenges together.

Rae Ritter is President, Board of Directors, NH Association of Nurse Anesthetists