Evolving Practice of Nursing and Patient Care Delivery

Evolving Practice of Nursing and Patient Care Delivery


EvolvingPractice of Nursing and Patient Care Delivery

EvolvingPractice of Nursing and Patient Care Delivery

Inthe present day, the healthcare systems have undergone a completetransformation in assisting better patient’s accommodation throughprovision of high quality care. The transformation is derived fromaffordable care act and patient protection that is inclusive ofdiverse provisions that intertwine the quality with cost effectivecare. The healthcare management lacks individual responsibility incoordination and insufficient care. Through the designing ofinducement for the integrated models and disbursing finds for qualitycare and coordination, the law has been attempting to restoreallocation of health care resource. In essence, the nurses mustbecome readjusted to the healthcare system that has been reorganizedsince they exist as intricate part patient outcome and care and thefundamental to attaining the emerging patient care delivery models(ANA, 2010). The letter aims to explain how the nursing practice isexpected to shift and discuss the accountable care organization,continuum of care, medical homes and nurse managed healthcare clinics(NMHCs).

Inmy presentation, hello deal nurses, welcome to the professionalsummit of the nurses. I am a registered nurse and I work at the bedside. I thought that I would retire as a staff nurse at the busylevel 1 center of trauma in the inner city. Nevertheless I havelooked up from the position of the bedside to see many opportunitieson my way. And I have a way of helping my community where I serve ina different role. The nursing practice has been changing, shiftingand growing and therefore transforming. Over the next 10 years, therewill be a shift in the acute care setting to the community.Additionally, I would also like to discuss the concepts of medicalhomes, accountable care organization, continuum care and nursemanaged clinics

AccountableCare Organization

Inregard to ANA, American Nurses Association, ACO is defined as apartnership between specialists, a hospital, physicians andadditional professional in health who accept the aspect of a combinedresponsibility for free and quality care delivery delivered to thepatients. If ACO meets the earmarks for particular savings andquality targets, the participants get monetary bonus. This modeltakes into consideration the partnership with the physicians on acoordinated platform for the patient. The practitioners of nursingand the specialists have a better chance in offering a considerabledirection within the model of ACO in granting services in communitiesthat are undeserved (ANA, 2010).

Thegoal of ACO is to ensure that the patients who are chronically illget the rightful medication at the right time while avoiding unneededservice duplication and preventing errors in medication. When itsucceeds in spending health care money wisely and delivering qualitycare, it shares in savings in achieving the medical care programs.Getting involved in an ACO is solely on voluntary basis. Differentorganizations are realized in different stages in their quest towardsand accountable care model. It tries to meet people where they are.


Medicalhome or the health home can be used interchangeably. The concept ofthe medical home is a concept that grants the patient with the basicprimary provider or practice that manages the care of the patientacross a setting. The healthcare providers may include pharmacists,nurses, specialist, dieticians, nutritionists, social workers, mentaland behavioral providers (ANA, 2010). Medical homes are similar toACO since they are mandated needs in regard to PPACA for monetary andpayment incentives. The model is dependent on the nursing for it tosucceed. The nurses have care that is coordinated among the differenthealthcare providers in the setting of a health facility, itselementary practice part. Nevertheless, they are now transposing theminto a diverse setting.

Continuumof care

Theirexpertise in organizing services will ensure that the continuum ofcare for the patient is maintained from the setting of acute care tothe outpatient arena. The nurses serve as teachers and leaders totheir inter-professional core workers (ANA, 2010). The healthcarelandscape has been changing. We are no longer treating illness. Thehealthcare system has changed to be one of the diseases wellness andprevention. With the signing of PPACA act, more than 30 millionpeople can access equitable and affordable health care. The risingcost of the healthcare and those needing it has amounted toreinvention of the care delivery models (Bowden &amp Greenberg,2010).

Nursemanaged health clinics

NMHCwere primarily established to afford the wellness and healthcareservices to low socioeconomic communities. The clinics are needed tobe overseen by practice that is more advanced for nurses (APN).Nurses have occasion and skills to reshape how the primary care ispresented. Wellness education, primary care, integration andcoordination of the building blocks of care and management of chronicconditions and diseases to reinvented system that functions andattempt to contain the costs while at the same time ensuring theoptimization of the outcomes of the patient (Turton, Bailey, Torres &ampRitter, 2010).

Thedelivery models for patient integrated care require the nurse. Thisis who they are as professions. We embody the core values that themodel try to strive to validating and thus we can be of great help toour nation in transformation of the healthcare. Clara Barton oncesaid that the door that no one else will go, swing widely open forus. We as nurses, we have a chance of venturing outside ourtraditional roles and thus claim the ownership to the exciting andnew course if we walk through the door that is opened wide


Aswe conclude, the current healthcare system has undergone a completetransformation in assisting better patient’s accommodation throughprovision of high quality care. The transformation is derived fromaffordable care act and patient protection that is inclusive ofdiverse provisions that intertwine the quality with cost effectivecare. The healthcare management lacks individual responsibility incoordination and insufficient care. The transformation is aimed tohelp the patient.

Thehealth services redesign amounts from the result provision that isset firm by PPACA which tries to decreases the cost of healthcare andimprove quality for the patient. The current health is not sufficientenough in quality care and coordination. Thus, the law is trying torestore allocations of resources and reward quality health overvolume of care. As a result, the need for the nurses to be better isacclimated to new system of the healthcare and is imperative sincethere is a massive entity to patient outcome and care and thefundamental to attainment of patient delivery models that istransforming (ANA, 2010).


Instituteof Medicine. (2011). the future of nursing: Leading change, advancinghealth. Retrieved from http://www.nap.edu/catalog.php?record_id=12956

AmericanNurses Association. (2010). new care delivery models in health systemreform: Opportunities for nurses &amp their patients. Retrieved fromhttp://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf

Hansen-Turton,T., Bailey, D. N., Torres, N., &amp Ritter, A. (2010). Nurse-managedhealth centers. AJNThe American Journal of Nursing,110(9),23-26.

Bowden,V. R., &amp Greenberg, C. S. (2010). Childrenand their families: The continuum of care.Lippincott Williams &amp Wilkins

Evolving Practice of Nursing and Patient Care Delivery Models

Evolving Practice of Nursing and Patient Care Delivery Models

EVOLVING PRACTICE OF NURSING 4Evolving Practice of Nursingand Patient Care Delivery ModelsEvolvingPractice of Nursing and Patient Care Delivery Models

As the more reforms takes shape in the healthcare industry, the roleof nurses will also significantly change, grow and expand in linewith the requirement of the healthcare system. The introduction ofthe Affordable care Act (2010) has heralded unprecedented expansionof the healthcare sector to broaden such health aspects as continuumcare, health insurance, case management and reliable healthcareprovision. With the Affordable Care Act, the healthcare system hasopened new opportunities for many patients who seek continuum carefor chronic and non-chronic ailments. In addition, there are moresenior citizens requiring focused and patient centered care whichmeans the role of nurses need to expand and change in line with thediverse care requirements.

The Affordable care Act (2010) has heralded new opportunities fornurses to serve in the delivery of an integral role leading tochanges in healthcare. As such, RN needs to expand their skills andknowledge in line with providing timely and reliable healthcareservices to the increasing base of patient. RN need to go foradvanced learning in order to improve their nursing skills so thatthey are in sync with the reforms experienced in the health caresector. Healthcare reforms has see the integration of healthcareinformatics and this means RN need to learn and understand how towork with electronic health records (Auerbach, Chen, Friedberg, Reid,Lau, Buerhaus &amp Mehrotra, 2013).

Similarly, with more people demanding good healthcare especially forsenior citizens in nursing homes, RN need to grow their skills onevidence based nursing care for patients. Under the new healthcarereforms, it is a requirement that RN provide patient centered careand this calls for good knowledge in nurse-case management andcontinuum care. In order to address the prevailing health careproblems especially chronic diseases, RN need to prepare and be partof the solution for better patient outcomes (Staiger, Auerbach &ampBuerhaus, 2011). To this end, there is need for nurse-led innovationsthat enhances the expansion of access and quality care of patients atlow costs. Innovative models of nurse-managed health practice need tobe embraced in order to suit the changing needs of healthcare such ashome visits care for elderly.

As more reforms takes place, there is need for more evidence andhence the need for nurses to engage in more research. Nurses shouldcollect data that is relevant in improving their practice as part ofthe broader approach of improving healthcare. Additionally, in orderto improve the skills and competences of RN, there is need forre-designation of nursing education. It is imperative that nursesposes skills and competences necessary for addressing andunderstanding the demands of diverse society (Bodenheimer &ampSmith, 2013).

Advanced training should focus on enhancing the quality, safety,research, leadership and evidence based nursing practice. There isneed for an expansion in the scope of nursing practice this meansthat nurses should be allowed to practice according to theirlicensure and education. It is when the scope of nursing is expandedthat RN is able to perform optimally across diverse healthcare areasand this could help solve the problem of primary care shortage. Asmore reforms are embraced in the healthcare sector, nurses need toteam work and collaborate with others for seamless high quality care(Everett, Thorpe, Palta, Carayon, Bartels &amp Smith, 2013).

Furthermore, it is through teamwork and collaboration that RN acquiremore skills and knowledge on matters of evidence based practice foraccountable care and facilitates the quality of continuum care givento patients. The end result of increased RN skills, evidence basedpractice in the provision of continuum care is the development ofnursing leadership. Nursing leadership is important in providingquality, expanded access and reliable care for all patients innurse-managed healthcare clinics and continuum care in medical homes(Institute of Medicine, 2010).


Auerbach, D.I., Chen, P.G., Friedberg, M.W., Reid, R., Lau, C.,Buerhaus, P.I., &amp Mehrotra, A. (2013). Nurse-managed healthcenters and patient-centered medical homes could mitigate expectedprimary care physician shortage. Health Affairs, 32(11),1933-1941.

Bodenheimer, T.S., &amp Smith, M.D. (2013). Primary care: Proposedsolutions to the physician shortage without training more physicians.Health Affairs, 32(11), 1881-1886.

Everett, C., Thorpe, C., Palta, M., Carayon, P., Bartels, C., &ampSmith, M.A. (2013). Physician assistants and nurse practitionersperform effective roles on teams caring for Medicare patients withdiabetes. Health Affairs, 32(11), 1942-1948.

Institute of Medicine. (2010). The future of nursing: Leadingchange, advancing health. Washington, DC: National. AcademiesPress.

Staiger, D.O., Auerbach, D., &amp Buerhaus, P.I. (2011). Health carereform and the health care workforce – The Massachusettsexperience. New England Journal of Medicine, 365(12), e24.[Epub]