As the country focuses on the restructure of the U.S. health care delivery system, nurses
will continue to play an important role. It is expected that more and more nursing jobs will
become available out in the community, and less will be available in acute care hospitals.
Write an informal presentation (500-700 words) to educate nurses about how the practice
of nursing is expected to grow and changes. Include the concepts of continuity or
continuum of care, accountable care organizations (ACO), medical homes, and nurse-
managed health clinics.
Share your presentation with nurse colleagues on your unit or department and ask them to
offer their impressions of the anticipated changes to health care delivery and the new role
of nurses in hospital settings, communities, clinics and medical homes.
In 800-1,000 words summarize the responses shared by three nurse colleagues and discuss
whether their impressions are consistent with what you have researched about health
A minimum of three scholarly references are required for this assignment.
While APA format is not required for the body of this assignment, solid academic writing is
expected and in-text citations and references should be presented using APA
documentation guidelines, which can be found in the APA Style Guide, located in the
Student Success Center.
I work in Surgery.
Evolving Practice of Nursing and Patient Care Delivery Models
During the 21 st Century’s first decade, various factors have contributed to the radical
alteration of the environment in which health care is offered and altered the nature of the
responsibilities and roles of nurses (Georges, 2013). As the nation focuses on restructuring the
health care delivery system of America, nurses will continue playing an essential role. In this
case, it is anticipated that more nursing jobs will be created in communities, and less present in
acute care hospitals. This paper focuses on exploring some of these changes with the main focus
on the current and possible impacts on the nursing profession. This informal presentation seeks
PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 2
to educate nurses on how the nursing practice is anticipated to grow and the changes involved.
Among the concepts to be considered include continuity of care, Accountable Care
Organizations (ACO), nurse-managed health clinics, and medical homes.
Modifications in the environment in which health care is offered have taken place more
swiftly in the 21 st Century’s first decade than ever. Hospital care that used to be the most
common and “normal” venue for the nursing practice, is now only among many opportunities for
the nurses. Presently, patients are in hospitals for much shorter periods and only those who are so
sick are hospitalized (Fulmer, 2011). As a result, hospitals are hiring nurses who are specialized
in the kind of care required by hospitalized patients. Departments that normally offered care for
“medical surgical” patients are frequently integrating telemetry, as well as, services which used
to be reserved for vital care units. A majority of patients who were initially cared for on
traditional medical surgical units are presently cared for either in their homes or in rehabilitation
centers. Long-period acute care units and/or hospitals have been created for those patients who
need care for much longer periods than the usual acute care facilities can now handle. Issues of
reimbursement have driven many of these modifications. In addition, the provisions of health
care reform based on the 2010 federal law have yet to be completely determined (Fulmer, 2011).
Some aspects of expected changes include more concern with preventive care, more people
having insurance to cater for primary care, and increased focus on community-based care. This
gives an opportunity for nurses to offer services and care in the community. It is expected that
resources for care in clinics and other settings will need to be increased in order to meet
customer needs and demands (Fulmer, 2011).
Technological advances are also affecting the type of services patients receive, as well as,
personnel competencies to manage the technologies (Pharris & Endo, 2007). New telemedicine,
PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 3
equipment, application of electronic health records, as well as, the effect of evolving fields such
as genomics and genetics are changing the health care landscape meaning that nurses should be
competent in the use of technological techniques and tools without losing focus on the patient as
the main of primary point of care (Wright, 2005). It is important to note that Accountable care
organizations (ACOs) would be created and implemented to focus on all-inclusive care all
through a complete episode of disease. The organizations would possibly include offices of the
physicians, acute care hospitals, clinics, home health agencies, and rehabilitation centers.
Services would be paid in relation to the whole of care instead of individual services that are
offered (Georges, 2013). Therefore, nurses would be major players in coordination of health
This part is a summary of responses of three nurse colleagues on their impressions of the
expected changes to health care delivery and the new role of nurses in hospital settings, clinics,
communities, and medical homes. In addition, it focuses on discussing whether the impressions
of the nurses are consistent with what was established earlier about health reform.
The three nurses clearly understand the health care reform and are impressed with the
expected changes. Legislation passed in 2010 by the U.S. Congress has the possibility to
considerably change the health care landscape of the United States. This is consistent to the
research findings on health care reform. Some of the alterations including insurance of parents to
cover college learners through age 26, have already been put in place. Other modifications are
expected to be adopted in the next five years. A majority of the recommendations do not
presently have funding, thus, their implementation is in question. Selected legislation provisions
PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 4
named the Affordable Care Act of 2010, which impact the practice of nursing should be taken
into consideration. The nurses feel that funding should be provided for community-based
learning for superior practice nurses, in collaboration of accredited graduate learning programs
and community-based centers of health care.
The nurses feel that there should be the establishment and maintenance of programs to
offer scholarships, loans, or grants to promote learning at all nursing education levels. Even
though this is among the goals of the reforms, the nurses felt that this should be emphasized if
effective results need to be achieved. In health care reform, various initiatives are focused on
promoting diversity in the health care labor force and deploying providers of health care to work
in undeserved regions. The nurses felt that this is aimed at creating more jobs for nurses at
hospital settings, clinics, communities, and medical homes. In addition, various programs are
aimed at providing education of care for patients and health care providers in areas that have
high needs for these including geriatrics, pediatrics, and public/community health.
The nurses believe that a patient-based outcomes Institute would be created to focus on
establishment, deployment, and the adoption of evidence-based guidelines of practice to promote
the quality of patient care. They hold that Accountable care organizations (ACOs) would be
created and implemented to focus on all-inclusive care all through a complete episode of disease.
The organizations would possibly include offices of the physicians, acute care hospitals, clinics,
home health agencies, and rehabilitation centers. Services would be paid in relation to the whole
of care instead of individual services that are offered. Therefore, nurses would be major players
in coordination of health care. The whole idea on these organizations has a positive effect on the
nurses’ attitudes towards the change as they feel that the changes are meant to improve the
practice of nursing.
PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 5
A National Center for Workforce Analysis or National Health Care Workforce
Commission is to be developed to guide the analysis process of the existing labor force. This will
enable educators and policy makers to establish areas of need and establish ways that most
efficiently deploy resources to achieve these needs. Presently, there is no centralized database
that offers information on numbers of health care personnel employed, their employment areas,
or the areas that are undeserved. The nurses believe that changes in funding from both the
government related and private sources are drastically impacting the nursing practice and the
services offered to patients. For instance, the Centers for Medicare and Medicaid Services
(CMS) is not offering reimbursement anymore, for particular kinds of circumstances that happen
in the acute health care settings. For instance, patients suffering catheter related urinary tract
illness, an injury associated to a fall or even pressure ulcers in their stay at the hospital have been
the recipients of what the CMS terms as must “never” happen. As a result, hospitals are now
required to cover costs related to any extra medications, care, or other treatment that patients
may need as a consequence of such complications.
Therefore, the impressions of the nurses are consistent to what was researched on health
care reform. There are, however, areas that the nurses suggest should be changed in order for the
changes to be effective. They believe that nurses should practice to the complete degree of their
training and education and should attain higher levels of training and education through
improved systems of education, which enhance faultless academic progression. Nurses should be
allowed to be full partners with health care professionals in restructuring the U.S. heath care
system. They recognize that effective labor force policy and planning necessitate better data
collection of data and an improved infrastructure of information. In this case, the government
should focus on removing scope of practice barriers, expand opportunities for nurses to diffuse
PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 6
and lead collaborative efforts of improvement, implement nurse residency programs and policies,
increase the proportion of nurses who possess a baccalaureate degree to 80 percent by the year
- They should also be the creation of infrastructure for the gathering and evaluation of inter-
professional healthcare labor force data. The number of nurses should be doubled in the future
and nurses should be prepared and be able to lead change in order to enhance health and ensure
that they engage in long-run learning. This way, the desired results are likely to be achieved at all
Fulmer, T. (2011). The Attending Nurse: An Evolving Model for Integrating Nursing Education
and Practice. The Open Nursing Journal, 5(1), 9-13.
Georges, H. (2013). Stupidity and the Evolving Health Care System. Holistic Nursing Practice,
Pharris, M. D., & Endo, E. (2007). Flying Free: The Evolving Nature Of Nursing Practice
Guided By The Theory Of Health As Expanding Consciousness. Nursing Science
Quarterly, 20(2), 136-140.
Wright, B. (2005). An evolving practice. Accident and Emergency Nursing, 13(1), 1.