Dean of the New York University Rory Meyers College of Nursing and Erline Perkins McGriff Professor of Nursing, Eileen Sullivan-Marx, PhD, RN, FAAN, emphasized the importance of combining empirical knowledge with ethics to plan and implement changes to federal health care policy.1

Rapid changes in the direction of health care policy and in the ideologies of appointed directors, secretaries, and advisors can result in uncertainty.

“This period can be fraught with policy mistakes or adoption of new policies that have unintended consequences, such as Medicare Part D’s ‘doughnut hole’ under the second Bush administration that left gaps in coverage of medications,” explained Sullivan-Marx.

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In an article published in the Journal of Gerontological Nursing, Sullivan-Marx appealed to nurses to use nursing’s fundamental ethical frameworks and principles to guide care and emerging policies, emphasizing that political ideology should not affect a nurse’s ability to advocate for quality, safety, and access to care.

Sullivan-Marx suggested using the American Nurses Association’s Code of Ethics as a guide when addressing policy issues relevant to gerontological care as health care policy changes go into effect at national and state levels.

The Code of Ethics states that a nurse practice with compassion and respect for the dignity, worth, and unique attributes inherent in every person, with a nurse’s primary commitment to the patient.

“A very practical example nurses may encounter is how to coordinate care for individuals who see a loss in Medicaid coverage, particularly older adults who are dually eligible under both Medicare and Medicaid,” explained Sullivan-Marx.

Under the Affordable Care Act, dually eligible older adults increased to more than 10 million people. This population has the most complex health care needs and usually lives below the poverty line. Potential state and federal reductions in access to Medicaid could result in patients in long-term care settings losing coverage.

“If a nurse determines her patient would not be safe without these services, what is her recourse?” inquired Sullivan-Marx.

“There are a variety of options, some more palatable than others, that range from advocating for care regardless of the patient’s ability to pay, all the way down to discharging the patient with advice on seeking new enrollment opportunities, and to call 911 if care is needed.”

Expected health care policy changes are most likely to affect access to affordable services, including screening and preventive services, long-term care, and rehabilitation for the elderly.

“Assuring that all persons have access to care regardless of ability to pay, citizen status, health condition, or disability, and support for autonomy of nursing practice including advanced practice nursing are policies that must be followed at local, state, and federal levels,” emphasized Sullivan-Marx.


1. Sullivan-Marx EM. Using ethical frameworks in times of transition and uncertainty. J Gerontol Nurs. 2017 Mar 1. doi: 10.3928/00989134-20170214-04 [Epub ahead of print]