Evolving Practice of Nursing and Patient Care Delivery

The RN to BSN program at Grand Canyon University meets the requirements for clinical
competencies as defined by CCNE and AACN using nontraditional experiences for
practicing nurses. These experiences come in the form of direct and indirect care
experiences in which licensed nursing students engage in learning within the context of
their hospital organization, their specific care discipline, and their local communities.
As the country focuses on the restructuring 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 fewer will be available in acute care hospitals.
1.Write an informal presentation (500-700 words) to educate nurses about how the practice
of nursing is expected to grow and change. Include the concepts of continuity or continuum
of care, accountable care organizations (ACO), medical homes, and nurse-managed health
2.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.
3.In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss
whether their impressions are consistent with what you have researched about health

4.A minimum of three scholarly references are required for this assignment.

Evolving Practice of Nursing and Patient Care Delivery Models

Part 1: Informal Presentation

The nursing profession is dynamic and has been gradually evolving. Today, nurses are
entrusted with a wider range of healthcare responsibility. It is evident that the practice of nursing
is continuously evolving and transforming and tendency indicate that nursing will shift from
acute care to community care. The nursing practice is anticipated to evolve not only in terms of
nursing exercise, but also education and leadership to achieve its goal in offering health care in
the United States (Hamric et al., 2013). Nursing practice is no longer about treating illness, but
has changed to prevention and disease wellness. The notions regarding continuity of care play an
important role in primary care in tandem with other ideologies such as coordination of care,
patient-centered care, as well as integration of care.

Continuity of care fundamentally refers to the connotation existing between a patient and
a practitioner, of which it goes outside the boundaries of illness (Nyweide et al., 2013). To define
the concept of continuity, we must consider its two major aspects; the focus on health necessities
of the client, individual content, as well as care over time that is, the past, present, and future.
The restructuring process of the U.S delivery system will lead to change in the practice of
continuity of care to mostly cover discharge arrangement ensuing acute care, from hospital care
to community or self-care.
The primary goal is to ensure the sustainable and reliable approach to care between
nurses is attained to customize care to suit the changing necessities of a patient during
medication. This types of continuity encompass management continuity referring to a consistent
approach to management of a patient’s illness that tend to be responsive to varying requirements
of a patient. Relation continuity, which is continuous therapeutic relationship that exists between
a nurse and the patient. And finally, an informal continuity, which encompasses the use of past
incidents information and individual circumstances in tailoring the present care to be relevant for
every patient.
A medical home is also one of the methods used today in delivering enhanced primary
care. The model is currently being tested globally and is expected to gain prominence in the
coming years. The model is gaining more popularities due to the rapid evolution of Accountable
care organizations (ACOs) where medical practitioners, health care centers, and other
stakeholders join hands to voluntarily offer coordinated quality care to their clients (Bao et al.,
2013). The purpose of ACOs is to ensure that patients who are chronically ill access the right
care at the right time, whilst deterring medical errors and circumventing any unnecessary
duplication services. Coordinated quality care tends to be more effective when offered on the

basis of the medical home model where the ACO patients will be cared for efficiently and hence
generation of shared savings (Pham et al., 2014). Many researchers have published medical
home care model success stories where the model have been used in controlled settings.
Nurse-Managed Health Centers (NMHCs) is another popular model that is gaining
prominence in delivering enhanced primary care. This model is community-based primary
healthcare services which is run by an advanced practice nurse with other nursing professionals
to provide the much-needed health care to vulnerable communities. Their main areas of concern
include health education, disease prevention, and health promotions. Nurse-managed health
centers deliver primary care at low prices since they are non-profit organizations.
In conclusion, the nursing practice will continue to change. However, there are certain
aspects of nursing that would remain the same such as caring for patients, advocating for
patients, and ascertaining that patients are able to get the right primary care services. Due to the
dynamic nature of nurses, it is imperative that nurses keep abreast with changes in order to
understand emerging challenges and master the skills requisite to cope with them.

Part two: Feedbacks from Students

Student Feedback one
The role of registered nurses has been evolving over the years. Healthcare bodies
continuously give new guidelines that affect the nursing practice. I have been working as a
bedside nurse for the past 3 years. At first, I thought that I will work as a staff nurse in a trauma
center for a very long time. However, there are many opportunities that have been presented
opening doors for me to serve the community better in a different role apart from working at the
bedside. It is true that community care is gaining prominence and nursing practice will be
perceived based on community setting rather than acute care setting only. Our responsibilities are

tremendously evolving. Nurses no longer treat illness only but also perform other duties such as
disease prevention and wellness.
I believe that the concept of medical homes is revolutionary. Accountable care
organizations (ACOs) can use medical home models to provide more personalized care to people
who are seriously ill and are unable to visit the hospitals. Medical homes provide a conducive
setting to provide personalized care to the aged, and clients with health problems such as obesity,
cancer among others. Therefore, the model should be implemented within the United States
Delivery System.
However, sustainability of nurse-managed health centers may face barriers because many
managed care bodies are not willing to certify nurse consultants as primary care providers. As
such may limit these centers from obtaining compensation from private insurers.
Student feedback two
Hello, my name is Jean, I joined nursing to help people in the community by relieving
them their pain through primary care. Initially, I thought that I will be providing primary care in
a hospital setting. However, there are opportunities that give nurses better ways to serve the
community in various ways. The dynamics of healthcare and continual research have
transformed the practice of nursing and nursing practice is slowly moving from providing acute
care to community care.
Medical homes are becoming to be implemented in the U.S delivery system. Its
implementation will lead to enhanced healthcare and generation of savings because it will
remove any unnecessary duplication of services to patients. Patient care is much more enhanced
with a more personalized therapeutic relationship between the nurse and the patient,
understanding of patient history as well as providing care to patients.

Affordable and healthcare act is now active and patients are finally able to obtain
affordable healthcare and affordable insurance through programs such as Obama care. Health
policy maker’s belief in the notion that expenditure should be lowered and that healthcare
provision should be non-profit. Medical home and nurse-managed health clinics are in a better
position to advance this ideology and enable the United States citizens to access quality
healthcare at an affordable fee.
Implementation of nurse-managed healthcare clinics will also provide primary care to the
poor and less privileged people in the United States. The model framework in where nursing
professionals collaborate to provide the much-needed health care to vulnerable communities.
Nursing professionals to provide the much-needed healthcare services such as health education,
disease prevention and health promotions to vulnerable communities will see that people get
better access to medical care. Nurse-managed health centers deliver primary care at low prices
because they are non-profit organizations which is in tandem with Affordable Care Act.
These reinventions of healthcare models in the health care delivery system are also in line
with the Patient Protections and Affordable Care Act (PPACA) whose main purpose is to
provide equal, affordable and accessible healthcare to all Americans.
Student responds three
It is true that nursing practice is rapidly evolving because of reforms and technology
advancement. The new healthcare delivery models are shaped on the basis of portability and
mobility. Use of technology has helped in extending patients’ lives and nurses are finding ways
to support the hold at their homes through medical homes and other modern primary care
delivery models.

Many nurses have been educated to deliver primary care service at the institutional level.
These move of healthcare services from hospitals to nursing homes and provision of primary
care services at home requires additional knowledge and skills to handle the new challenges as a
result of the move of nursing practice from the acute care setting to the community setting.
However, the newly reinvented healthcare delivery models will drive the cost of
healthcare down and enable the United States to achieve its goal of providing accessible health
care at an affordable price and in an equitable manner. The demand for nurses will increase so as
to fill in the spaces in the different healthcare delivery models.
From the three student feedbacks, it is evident that nursing practice is evolving and
projections indicate that the future of nursing practice will shift from the acute care setting to
community care setting. Each student impression indicates that the new model will contribute in
the provision of quality care that is an affordable and equitable manner as provided in the
Affordable Care Act and the Patient Protections and Affordable Care Act (PPACA).


Nursing practice plays a significant role in the reformation of the United States health
care delivery system. The streamlining process will provide more opportunities for nursing to
work in a community setting as compared to acute care hospitals. The new delivery models have
improved continuity of care as it has taken primary care to the grassroots through medical
homes, accountable care associations and nurse-managed health clinics (Bao et al., 2013).
Professional medical practitioners, nurses and health care centers are providing more coordinated
quality care to patients through organizations such as accountable care organizations and nurse-
managed medical clinics.

These new healthcare delivery models tend to bring valuable benefits such as reducing
the cost of healthcare, increasing access to healthcare especially to the less privileged in the
society (nurse managed medical clinics), contribute to shared savings (the case of accountable
care organizations) and ensuring equitable access to healthcare in the United States of America.
However, careful consideration and due care should be taken when implementing the new
delivery models to ensure that they seamlessly fit the healthcare system.


Nyweide, D. J., Anthony, D. L., Bynum, J. P., Strawderman, R. L., Weeks, W. B., Casalino, L.
P., & Fisher, E. S. (2013). Continuity of care and the risk of preventable hospitalization
in older adults. JAMA internal medicine, 173(20), 1879-1885.
Bao, Y., Casalino, L. P., & Pincus, H. A. (2013). Behavioral health and health care reform
models: patient-centered medical home, health home, and accountable care
organization. The journal of behavioral health services & research, 40(1), 121-132
Pham, H. H., Cohen, M., & Conway, P. H. (2014). The Pioneer accountable care organization
model: improving quality and lowering costs. JAMA, 312(16), 1635-1636.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013).Advanced practice
nursing: An integrative approach. Elsevier Health Sciences