The Impact Of Reforming The U.S. Health Care System On The Future Of Nursing

The health care industry has encountered changes over the past resent years mainly due to enactment of new legislations; changes in patients needs; and changes in health related illnesses. In March 23, 2010, President Obama signed the health reform legislation (Stolberg, 2010). The legislation and the American Recovery and Reinvestment Act of 2009 include a number of clauses aimed at redesigning the organization, sponsorship, and provision of health care in the U.S (United States). In line with this, several programs, such as Accountable Care Organizations (ACOs) Medical Homes, have been introduced (Stolberg, 2010).Majority of those programs have a direct impact on the scope of nursing practices thus their growth is expected to have an impact on the nursing profession. In addition, implementation of these health system reforms necessitates development of superior health information technology (HIT) platforms that will promote exchange of information across communities and potentially change the scope of nursing practices in vast ways. Below are some of the projected transformations in the health systems the over the next few years and their impact on the nursing practice:

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Advanced Care Management Models

Care management encompasses a number of evolving strategies used to improve the care given to chronically ill patients whose care requires long-term management. Among those strategies is Accountable Care Organizations (ACOs). ACOs are groups of physicians, hospitals,and other health workers who voluntarily come together with a common goal of offering high quality care to their patients (Sochalski& Weiner, 2010).ACOs have improved cost control through financial reorganization and through provision of a system through which institutions can be held financially accountable for the funds they receive for the purposes of healthcare provision. They also conduct regular performance measurement to provide insight on quality and cost progress to ensure that cost control does not reduce the quality of care delivered (Fisher,2009). The growth of ACOs will help improve the quality of care offered to patients and ensure that funds are managed soundly.

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ACOs success is dependent on availability of electronic health records (EHRs) and reliable means of sharing information across health providers on timely basis. In addition, ACOs care management strategies require Registered nurses (RN) to be closely connected to the patient to ensure accurate reporting. ACOs aim to reduce the amount of time patients spend in hospital, reduce visits to the emergency rooms and eliminate costly specialist services (Fisher, 2009). This might cut down on hospital’s income significantly thus posing a potential risk that hospital will not be able to employ as many nurses as they do today. However, RNs with care management qualifications are likely to find employment in the ACOs or in contracting care coordination organizations where they would be responsible with care management of the chronically ill patients and their care transitions.

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Adoption of Health Care Support Technologies

President Obama signed economic stimulus legislation that covered a substantial investment to develop the HIT. Incorporating HIT into the healthcare system will have a profound impact on the ways that RNs consolidate, distribute, record, and analyze medical care (Institute of Medicine, 2011). Moreover, the amount time RNs allocate to various tasks is also likely to be affected since they will spend significantly less time on administration activities. While HIT can be seen to have its greatest impact on the way RNs record their care only, the entire health system will be progressed by digital workflow and better information management.

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In the future almost every aspect of the nursing practice will have a significant digital influence. Data collection will be computerized and other aspects of healthcare provision, such as diagnostic tests, prescriptions and therapies, will be generated, managed and dispensed with the help of computers (Institute of Medicine, 2011). Devices that interface directly with the patient will be used to collect and store patient information. Automating care documentation, RNs will be expected to focus on complex tasks, such as communication and patient guidance, which cannot be accomplished using HIT.

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HIT makes it possible for nurses to stay in touch with patients electronically, which will eliminate the necessity for “real-time” contact. Digital networks will mean that patients and nurses will not need to be at the same location or schedule. The effects of this change on nursing practices are yet to be fully understood (Abbott & Coenen, 2008). However, it will likely cause a significant improvement in the quality of care provided today. Nurses need not be in the same locality with their patients but they will need to have computer technology use skills for them to provide effective care. These efficiency gains may help ensure that there is continuous caring relationship between patients and their healthcare providers hence promoting the continuum of care concept.

Expanding Primary Care Capacity

The Affordable Care Act stipulates improved health security for Americans by engaging health insurance reforms that will expand health care coverage. The sum of nurse practitioners and physician assistants matches that of family physicians who deliver primary care. This means that a considerable share of the expected growth in health care demand following the expansion in health coverage will surge the demand for nurses (Antman et al., 2004). Furthermore, the growth of an aging population and rise in cost of accessing healthcare has led to emergence of new settings within the health care continuum. primary care settings such as Nurse‐Managed Health Clinics (NMHCs), movements of devoted nursing professionals who take health care services to vulnerable communities, and Medical Homes, a philosophy of health care delivery that inspires health providers to meet patients in their residents, are increasingly becoming popular (Barnes‐Boyd, Fordham & Nacion, 2011). These primary care settings will not only increase accessibility to quality and cost effective health care but they will also increase demand for RNs. Other settings and services, such as home-based primary care and workplace wellness programs, aimed at promoting access to primary care will also create job opportunities for RNs.

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Nurse‐Managed Health Clinics and Managed Homes demand nurses with skills in other fields such as behavioral science, clinical epidemiology, and management. They should also have the ability to apply those skills to specific populations. These concepts should be integrated into the nursing curriculum to ensure that the health care system does not suffer shortages of these skills in future.

There have been considerable changes in the health care industry over the past resent years and more changes will continue to be experienced. Nurse lecturers and trainers will be required to prepare student nurses and nurses for the rapidly changing health care setting, shifting demographics, technology development, as well as globalization of health care.

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