Delivering Obamacare: Obstetrical Nursing and Patient Care Under the Affordable Care Act

• In Event: 413 - Section on Organizations, Occupations and Work Refereed Roundtable Session. Table 01. Culture and Organizations
  In Refereed Roundtable 100min: Table 11. Law and Policy

Abstract

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, more commonly referred to as the Affordable Care Act (ACA) or simply Obamacare. This paper examines how the ACA has affected hospitals and, particularly, those individuals arguably most important to patient care: nurses. Specifically, I examine the experience of nurses in the obstetrics unit of a small community hospital, Etherow Hospital, during a time of turbulent organizational change. In this paper, I do three things. (1) I trace the effect of the ACA on hospitals in general and (2) specifically on Etherow Hospital. (3) Using ethnographic observations (223 hours) of and in-depth interviews (n=19) with obstetrical nurses conducted between June 2013 and December 2015, I preliminarily analyze the experiences of nurses during a period of organizational change. I use resource dependence theory and strategic-contingency theory to suggest that the ACA has caused uncertainty for the hospital and that the obstetrics unit is powerful compared to other hospital units due to its increased revenues (as a consequences of the integration of two new physician-midwife practices and more patients) that allow the hospital to best manage increased uncertainty. However, even in a powerful unit, nurses are not protected from the negative consequences of working in a resource-scare organization, such as dependencies on struggling and understaffed units and dealing with increased patient loads.

Author

• Theresa Morris, Texas A&M University