Evolving Practice of Nursing and Patient Care Delivery Model

Evolving Practice of Nursing and Patient Care Delivery Model


  • The restructuring of the American healthcare system will result in numerous changes in the way healthcare professionals such as nurses deliver care to the patients. However, many nurses have no idea about how the healthcare reforms will affect their practice. These changes will bring about positive outcomes in their practice as well as challenges.
  • Nurses’ current roles will be expanded and new ones will also be created. Furthermore, a lot of opportunities will be available for nurses to take part in redesigning the delivery system (Buerhaus, Desroches, Applebaum, Hess, Norman, & Donelan, 2012). It is crucial for nurses to take part in implementing the changes as they are a vital segment of the healthcare workforce.
  • In order to ensure that patients get quality care in all locations, the health care reforms provide for changes in care delivery such that nurses will no longer be providing services in hospitals only but also in the community setting. This will ensure that all patients, including those in underserved communities, are able to access healthcare (Sochalski & Weiner, 2010). The reforms’ main aim is to promote healthcare in communities instead of the acute care setting. Therefore, more nurses’ practice settings will change from the hospital to community settings.
  • After the healthcare reforms are implemented, nurses will be required to provide continuity of care to patients with various conditions throughout all the phases of the illnesses. Nurses will be expected to ensure that as patients undergo transition from one care setting to another, the quality of care is not compromised (Sochalski & Weiner, 2010). Continuity of care will involve ensuring coordination and reducing disruption in care provision as different practitioners are involved in diverse care settings.
  • Accountable care organizations (ACOs) will be created to coordinate and manage care for Medicare beneficiaries. These ACOs will serve about 5,000 individuals and sufficient primary care providers must be assigned to them (McClellan, McKethan, Lewis, Roski, & Fisher, 2010). These organizations are accountable for the care, cost and quality of the beneficiaries. Nurses will be some of the professionals involved in care delivery in these organizations.
  • Medical homes will be expanded in order to improve continuity of care especially for people suffering from chronic conditions. Nurses will be expected to provide care to patients in these medical homes and especially in communities that are underserved (Sochalski & Weiner, 2010).
  • Health homes will be established in states to serve Medicaid beneficiaries suffering from chronic conditions. These health homes will be run by a group of healthcare professionals such as physicians, nutritionists, nurses and social workers. Therefore, nurses will be expected to work in collaboration with other professionals in order to provide the best care to individuals in health homes.
  • Nurse-managed health clinics (NMHC) will be funded and expanded and nurses will have more leadership responsibilities. Nurses working in these NMHCs have the authority to perform physician’s roles such as prescribing medication. Nurses will be able to provide care to vulnerable and underserved communities (Buerhaus et al., 2012).  Therefore, nurses will not only change their practice settings but they will also have sufficient funds and mandate to enable them serve these communities better by assuming  roles that they were initially not authorized to carry out (Fairman, Rowe, Hassmiller, & Shalala, 2011).


Nurses have diverse impressions regarding the changes that the healthcare reforms will cause in their practice. After sharing the presentation with three nurse colleagues, some of their responses were consistent with the findings on healthcare reform while others were not. One of the nurses concurred that the roles of nurses would change from the traditional task-oriented to outcome-oriented. Moreover, nurses would no longer work in isolation but they would have to partner with others such as physicians in order to deliver quality care in both community settings and hospitals (Sochalski & Weiner, 2010). They would also build longer-term relationships with the patients and other colleagues as well as perform important leadership functions such as managing interdisciplinary teams. In community settings, nurses will have to be flexible, self-directed, independent decision makers and critical thinkers because they will not be under the physicians’ supervision. They will be responsible for running most of the community based healthcare facilities and they will carry out all the functions in those centers. These reforms will bring positive changes to the nursing practice as nurses will develop more skills and handle more responsibilities. Nurses will have the opportunity to play a direct role in improving patient outcomes and improving the quality of their care through the introduction of ACOs, NMHC, medical homes and continuity of care (McClellan et al., 2010). This perception is consistent with the research on healthcare reforms.

Another nurse was excited about the healthcare reforms as this would allow them to fully take part in transforming the healthcare system. The introduction and expansion of NMHC, medical homes and ACOs will lead to more focus on preventive services and this will facilitate the shift to a delivery system concerned with preventing and treating chronic conditions (Buerhaus et al., 2012). ACOs will lower patient costs and improve the quality of care that the patients receive while medical homes will enable nurses to give patient-centered care to individuals with chronic conditions in communities (Sochalski & Weiner, 2010). The barriers that were preventing nurses from contributing to the changes have been removed by the reforms and their roles will be more advanced. Nurses will be very important in implementing the reforms as the increased number of patients will require more healthcare providers to attend to them, especially in the community settings (McClellan et al., 2010). Nurses will make a great contribution and help in resolving the problem of the shortage of physicians. Nurses have a great adaptive capability and scientific knowledge and can therefore perform physicians’ roles. Taking up the primary care roles of the physicians by the nurses will enable physicians to deal with more intricate cases that require their skills. Normal primary care roles will be left in the hands of nurses. Collaborating with other professionals to ensure continuity of care will improve the patients’ safety and quality of care (Sochalski & Weiner, 2010). It will also enable the professionals to learn from each others’ experience and skills leading to improved patient outcomes and satisfaction. The opportunity to run nurse-managed health centers will enable them to play a major role to meet the healthcare needs of the mounting number of insured patients. The views of the nurse were consistent with the research on healthcare reforms.

Another nurse was worried that the healthcare reforms would negatively affect the nursing practice. One of the challenges that nurses based in hospitals expect to face is handling more patients. The Affordable Care Act (ACA) aims to have every American enrolled in health insurance plans. This will increase the number of patients seeking treatment. If more staff is not employed, nurses will be overworked as they try to attend to all the patients. They will be fatigued and dissatisfied and this is likely to negatively affect the quality of care that the patients receive (Buerhaus et al., 2012). The nurse’s impression about the increase in the number of patients in hospitals is consistent with research on healthcare reforms and there is a need to come up with strategies to ensure that all the patients get quality care. However, the funding for the advancement of the nurses’ education proposed in the ACA will help in solving this problem (Fairman et al., 2011). Moreover, nurses will undertake more roles and this will solve the problem of the deficit in the number of physicians. Another impression by the nurse is that the healthcare reforms might lead to the loss of employment by some nurses. However, this is inconsistent with the research as more nurses will be required to care for the rising number of patients seeking medical care.

It is clear that the implementation of the healthcare reforms will have different effects on the nursing practice. Even though nurses are a significant group of healthcare professionals who make an important contribution in healthcare delivery, a number of them are not aware of the implications of the reforms on their practice. Therefore, there is a need to educate the nurses on how the reforms will affect them so that they can maximize on the opportunities and deal with the challenges brought about by these changes.


Buerhaus, P. I., Desroches, C., Applebaum, S., Hess, R., Norman, L. D., & Donelan, K. (2012). Are Nurses Ready for Health Care Reform? A Decade of Survey Research. Nursing Economics, 30(6), 318-330.

Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. New England Journal of Medicine, 364(3), 193-196.

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982-990.

Sochalski, J., & Weiner, J. (2010). Health care system reform and the nursing workforce: matching nursing practice and skills to future needs, not past demands. Institute of Medicine: The future of nursing: Leading change, advancing health, 375-400.


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