Changes in Health Care Delivery Systems Chapter

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Evolving Practice of Nurses

Dear Fellow Nurses,

The nursing profession is currently experiencing revolutionary changes that are expected to transform nursing practice today and in the future. These revolutionary changes in nursing profession and practice are largely influenced by the fact the changing role of nurses in the modern healthcare environment. The nursing role in the modern health care sector is changing because patient care delivery or caring for the sick is becoming more complicated, which force nurses to assume a wider range of health care responsibilities (Tiffin, 2012). Moreover, nursing profession and nursing practice is experiencing significant changes because of the ongoing restructuring of the United States health care delivery system. Actually, as the country continues to transform is health care delivery system, the nursing profession is expected to continue playing an important role in this process. The growth and change in nursing practice will generate new models of patient care delivery because of health system reform.

The first model to emerge in this process is the Accountable Care Organizations (ACO), which is basically the collaboration between a hospital, primary care clinicians, specialists and other health professionals towards enhancing the quality and costs of care delivered to patients. Accountable Care Organizations are expected to dominate patient care delivery in the future because of shared savings between ACO and Medicare program. Actually, if these organizations achieve certain quality and savings goals, their members will receive a financial incentive or bonus. Moreover, the various stakeholders in ACO will assume the role of leaders in the coordinating and implementing care. During this process, these professionals will have an opportunity to offer patient care in underprivileged areas (Haney, 2010).

The second model of care delivery that will evolve because of the ongoing restructuring of the health care system is medical or health homes, which can be described as the mechanism to ensure patients play a key role in primary care practice or provider coordinating care across settings and providers (Haney, 2010). This system is likely to be promoted through a capitated payment or provision of other financial bonuses to providers to encourage preventive care and management of chronic care. As this model of care delivery develops, it is increasingly likely to lessen dependence on emergency and specialist care. The health team will assume a major role in providing or facilitating primary care services that provide and coordinate access to health promotion and preventive services.

The third model of care delivery due to ongoing restructuring of the health care system is nurse-managed health clinics, which can be defined as nurse-practice arrangements that need to be headed by advance practice nurses. These nurse practice arrangements will be established in order to provide detailed primary care and well-being services to vulnerable and underprivileged populations across the country. However, such arrangements must be associated with a university or department of nursing, school, college, social services agency, independent non-profit health agency or federally accredited health center. These nurse practice arrangements will enable nurses to practice to the total extent of their professional scope that will contribute to enhanced outcomes and value-centered health care practices.

These new models of care delivery amidst restructuring of the health sector demonstrate the important role nurses will play in health reform. As evident in the discussion, the health care system is increasingly moving from acute care to preventive care because of the increased focus on disease prevention and well-being. The continuum or continuity of care during this period will be based on reinvention of care delivery models and systems. Generally, the reinvention or overhaul of care delivery models and systems is largely influenced by provisions of the Patient Protection and Affordable Care Act that was enacted in March 2010. Nurses will play a vital role in the restructuring process with regards to bridging the continuum of care, establishing an increasingly coordinated health care delivery system, and offering high-quality patient care while lessening costs as well.

Thank you.

Nurses Impressions of the Anticipated Changes and their Consistency

Following the informal presentation of the anticipated changes in the practice of nursing as discussed above, nurses expressed different impressions regarding the anticipated changes to health care delivery. Moreover, nurses had different impressions regarding their new role in clinics, hospital settings, medical homes, and communities. Prior to the informal presentation, nurses were increasingly wondering the impact of health care reform on their daily practice and nursing activities. However, they had been anticipating tremendous changes in the nursing profession and nursing practice before the enactment of the Patient Protection and Affordable Care Act since health reform had been brewing for a long period of time.

One of the impressions expressed by nurses regarding the anticipated changes to health care delivery and new roles in different settings is that nursing practice will become more about providing care management and coordination.

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One of the nurses argued that these changes will imply that their role will become more centered on offering care management coordination instead of the conventional role of conducting patient care activities and duties. Despite acknowledging this change, this nurse colleague is still very task-oriented as reflected in her sentiments on her willingness and readiness to assume the new role. She expressed her satisfaction with the role of clinical leadership, which is primarily based on performing the various patient care tasks and reservations regarding the new role.

The second nurse colleague argued that the current nursing education does not effectively prepare nurses and other health professionals to assume the new role with regards to changes in health care delivery and emergence of new roles in patient care. He stated that the current nursing education seemingly focuses on the role of performing patient care tasks that has traditionally dominated nursing practice. The nurse stated that the effective realization of this new role would require an overhaul on nursing education. He pointed out that health care reform initiatives have largely been centered on nurse practice settings and relatively ignored nursing education, which is a crucial element in the delivery of patient and ensuring nurses are effectively prepared for the nursing field. He further argued that achieving these goals will be relatively difficult because current nursing education does not prepare nurses for such roles. Generally, this nurse was very skeptical about the practicality of the new roles relative to the existing nursing education.

The third nurse stated that the new role is a suitable measure for enhancing health care delivery given the increase in patient demands in the past few decades. She argued that the conventional role of nurses has not been effective in responding to the existing patient demands and meeting the population's health care needs. She disagreed with the second nurse by arguing that while focus on enhancing nursing education is important, transforming the health care setting is more important because of the need to improve interactions between patients and health care providers. The changes in the delivery system and new roles in different settings would help in establishing a multidisciplinary team approach through which patients also play a vital role in care. Through these changes, nursing practice would not only be centered on health care providers themselves but also incorporate the patient or consumer as a partner in the care process. As different health care providers coordinate care services, the role of the patient in this process is transformed as he/she is more involved in decision making in order to improve patient outcomes and the quality of care.

As evident in this discussion, some of these nurse impressions are consistent with existing health care reform objectives and initiatives while others are not. The reform initiatives basically contribute to establishment of nursing practice where nurses' role is more centered on providing care coordination and management rather than simply performing patient care ("Nursing: A New Paradigm," 2013). The major change brought by these anticipated changes in nursing practice is the shift from conducting patient care activities to offering care management and coordination. To this extent, the nurses were consistent with health care reform initiatives because care is shifting from acute care settings i.e. hospitals to diverse settings like medical homes and communities.

Despite the fact that nurses are still increasingly task-oriented, the establishment of such settings will generate new demands, which will force them to focus on care coordination rather than clinical leadership. The nurses' views were also consistent with health care reform initiatives and objectives in the sense that these changes would make patients or consumers of care services to act as partners in the care process rather than simply consumers. The development of medical homes and nurse-managed health clinics is geared towards ensuring that health care delivery is more patient-centered in order to enhance outcomes and care quality.

However, the view that reform initiatives have not focused on nursing education is inconsistent with health reform. Actually, in order for nurses to work to the complete extent of their license, they are required to shift from clinical leadership roles to care coordination roles. Health reform initiatives not only focus on….....

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