Evolving Practice of Nursing and Patient Care Delivery Models

This paper makes and informal presentation that can educate nurses about how the practice of nursing is expected to grow and change. It will include the concepts of continuum or continuity of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics. This presentation follows the realization that, as the U.S. focusses on restructuring its health care delivery system, opportunities will continue to expand for nurses to play an essential role. The underlying expectation is that there will be increased availability of nursing jobs, especially in the communities, while availability of these nursing jobs will experience a reduction in the acute care hospitals. According to Jacobs (2012), there is a likely increase in demand for several health care professionals, especially in the nursing practice. There will, also, be expanded roles and essential set of skills for the current professionals. This is due to continuing health care reforms combined with the aging population and aging health care workforce. It is essential to note that the current demand for registered nurses is lower than the current supply, which reflects lower rates of vacancies and lower number of retiring registered nurses. However, as the population continues aging, it would become difficult for the present levels of graduates in the nursing practice to meet the demand of the future.

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The growth and expansion of the practice of nursing is expected bring change in the roles of nurses in order to facilitate continuity or continuum of care. It is essential to note that everyone has a right to receive the kind of care that is responsive and respectful to his/her specific needs. In this case, therefore, it is worth noting that as the nursing practice grows and expands, nurses, also, should aspire to acquire the necessary skills, capacity and expertise that can enable them take up leadership roles in order to support and enhance patient-centered care in the whole continuity of health care services and experiences (Barker, 2012). In this case, such leadership roles include case manager, telehealth nurse and nurse navigator. Nurse navigators do have varying roles, but fundamentally, they require facilitating and promoting continuum of care between health care providers and across different care settings by sharing information regarding the current goals, plan of care and situation of client. Case managers, on the other hand are registered nurses whose leadership role entails coordination of case management process. Case management roles entail provision of assessment, discharge planning, evaluation of outcomes, advocacy, reassessment, monitoring, service planning and implementation for clients. Finally, telehealth nurse roles entail delivery of health information, expertise and services over distance by utilization of communication and information technology (Barker, 2012). Telehealth, therefore, facilitates timely access to health care by clients and promotes community and inter-professional involvement across the continuum of care.

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Accountable care organizations comprise an essential concept on the horizon of health care. In regard to the future of nursing, there is a high likelihood that the accountable care organization will enable nurses in accessing expanded opportunities not just as care providers, but as managers of care. Therefore, for nurses to be able to position themselves for the future in line with this evolving new health care model, they need to understand the policies, concepts as well as economic principles upon which the ACO model bases (Barker, 2012). Medical homes, also, comprise an essential concept in the practice of nursing. They constitute some of the changes that the health care sector continues to embrace in order to attain the expected growth and change in health care services. In this regard, nurses require improving value, coordination, patient experience and quality through improved prevention of health risks. Medical homes will, also, refresh the attractiveness and satisfactory levels of primary care. As the practice of nursing continues growing and changing, the significance of nurse-managed health clinics continues increasing. Mostly, in areas where physicians have been in short supply, nurse-managed health clinics have always served as points where clients can easily access health care. They are sometimes interchangeably referred to as nurse-managed health centers and, as the name suggests, they are managed by advanced practice nurses. They comprise a crucial point in the nursing practice due to their capacity to offer disease prevention, health promotion, and primary care services to patients who may be less privileged to access continuing health care services (North & Hughes, 2012). The population that nurse-managed health clinics serve comprise all ages of clients who could be living in poverty, underinsured, uninsured, or members of ethnic minority and racial groups.

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This section of the paper presents the feedback of three nurse colleagues in the department of critical care nursing who were asked to offer their impressions regarding the anticipated changes in the health care delivery. It is essential to note that critical care nursing is an integral department in the field of nursing that deals with life-threatening problems. The main responsibility of critical care nurses is to ensure that optimal care is administered to patients who are critically ill. When nurse critical care nurse colleagues were asked to give impressions of the anticipated changes to health care delivery, they had a number of observations to make. They observed that there is need for developing patient-focused, non-fragmented, and efficient health care delivery systems. Referring from the assertions of North and Hughes (2012), they claimed that the anticipated changes should incorporate partnership negotiation in order enable wise utilization of resources. They observed that the anticipated changes should provide each nurse with the accountability, authority, and responsibility for evaluating, planning and organizing nursing care in the entire patient episode. They, also, recognized that the anticipated changes will increase complexities in the health care environment, which will demand specific, abilities, values, skills and knowledge.

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It is worth noting that as the anticipated changes in the health care delivery system continue to take effect, the role of nurses in hospital settings, communities, clinics and medical homes, also, continue to change. In regard to the role of nurses in hospitals, it is essential to note hospitals in the U.S. continue facing increasing demands to involve in a broad range of activities that can lead to quality improvement. It is at this point that the new findings by the Center for Studying Health System Change (HSC) indicate that the influence and role of nurses in quality improvement continues increasing (North & Hughes, 2012). In regard to the role of nurses in the communities, it is essential to note that the value of nurses, especially community health nurses continues increasing due to their willingness and adaptability in regard to provision of care in various settings including health clinics, communities, homeless shelters, churches, and schools. Advanced practice nurses will be expected to create and apply corporate wellness programs in order to support employee productivity and health. In regard to the new role of nurses in clinics. It is essential to note that nurses will continue giving support to doctors in clinical setting. After the doctor sees the patient, clinic nurses will play a critical role of making follow-ups and arranging meetings with specialists where necessary. The new role of nurses in medical homes will entail enhancing care transitions, coordinating care, and reducing fragmentation for the most complex and critically ill patients.

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The feedback from the three critical care nurse colleagues are consistent with what this writer has researched regarding U.S. health reforms. Following the passage of the Affordable Care Act (ACA) way back in 2010, financing and care delivery systems began undergoing essential transformations whose acceleration was expected to mount in 2014 following the implementation of the key provisions of the legislation (Barker, 2012). These led to the establishment of accountable care organizations (ACO) to improve transition of patients across continuity of care, enhance care coordination, and streamline of the objectives of reorganization of health care delivery. Besides, the current health reforms will shift the current focus of the delivery system from acute care and concentrate it on prevention of chronic conditions.

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In conclusion, this paper made an informal presentation that can educate nurses about how the practice of nursing is expected to grow and change. It, also, included the concepts of continuum or continuity of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics. The growth and expansion of the practice of nursing is expected bring change in the roles of nurses in order to facilitate continuity or continuum of care. Accountable care organizations comprise an essential concept on the horizon of health care. The three nurse colleagues observed that there is need for developing patient-focused, non-fragmented, and efficient health care delivery systems. It is worth noting that as the anticipated changes in the health care delivery system continue to take effect, the role of nurses in hospital settings, communities, clinics and medical homes, also, continue to change.

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