Health Care Delivery Models and Nursing Practice

Examine changes introduced to reform or restructure the U.S. health care delivery system.
In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role
of the nurse within this changing environment.
Include the following:
1.) Outline a current or emerging health care law or federal regulation introduced to
reform or restructure some aspect of the health care delivery system. Describe the effect of
this on nursing practice and the nurse’s role and responsibility.
2.) Discuss how quality measures and pay for performance affect patient outcomes. Explain
how these affect nursing practice and describe the expectations and responsibilities of the
nursing role in these situations.
3.) Discuss professional nursing leadership and management roles that have arisen and
how they are important in responding to emerging trends and in the promotion of patient
safety and quality care in diverse health care settings.
4.) Research emerging trends. Predict two ways in which the practice of nursing and
nursing roles will grow or transform within the next five years to respond to upcoming
trends or predicted issues in health care.
You are required to cite to a minimum of three sources to complete this assignment.
Sources must be published within the last 5 years and appropriate for the assignment
criteria and relevant to nursing practice.

Health Care Delivery Models and Nursing Practice

In the recent past, changes introduced to reform and restructure the care model applied across
America has been brought about by factors such as problems in access, fluctuation in costs,
fragmentation, disparities, and suboptimal outcomes. These have been coupled with concerns
over the prices and quality of health services provided, changes in the type of disease, and
demographics (Salmond & Echevarria, 2017). Additionally, necessary care and payment of
medical treatment for patients with chronic illnesses have continually become a significant
concern that has created immense urgency and the need for change in care model and operations
carried out by practitioners.
As such, the occurrence of these transformative changes has facilitated the positioning of
nursing practitioners to lead and contribute to further developments. Nevertheless, for nursing

practitioners to become major players and stakeholders in shaping these changes, they are
required to comprehend the various factors driving the change, the competencies, and the
necessary skills and knowledge base to achieve success (Salmond & Echevarria, 2017).
Therefore, this paper aims at discussing actions taken and changes introduced to reform and
restructure the care model and operations carried out by practitioners.
Current Law or federal Regulation introduced to reform some aspects of the Health Care
System and its Effects on Nursing Practices
In 2015, the senate in the state of California passed a bill into law that sought to increase
and improve the access and equality of care delivered to the residents. The bill, Senate Bill 4,
stipulated by Senator Ricardo Lara, targeted the extension of the scope of the benefits provided
by the Medi-Cal program in California to incorporate all children despite their immigration
status (First 5 la, 2015). Most of the targeted entailed those from poverty-stricken backgrounds,
and the bill sought to create room to extend healthcare benefits to them and their families,
especially undocumented adults depending on the resources provided under the caped budget
(First 5 la, 2015). Although the budget during that financial had not been approved when the bill
was proposed, the committee responsible for such operations had suggested the allocation of
approximately forty million dollars to cater for the expansion of the coverage to undocumented
Similarly, the enactment of the Senate Bill 4 into the Health for All Act necessitated the
department of health care services in California to offer a waiver request that allowed
undocumented immigrants to pay for medical coverage through the Covered California initiative.
Nevertheless, the provisions outlined by the American care Act (ACA) were enacted a few years

later, and they did not allow an exchange of health benefits to incorporate coverage to
undocumented individuals (Mims, Pederson, & Gold, 2014). As such, the Health for All Act
differs from the ACA in that the latter was enacted to address issues such as patient protection,
healthcare education, and reconciliation, to improve access to health services for millions of poor
people in California. Conversely, the enactment of the Health for All Act served as an
improvement of ACA as it brought about an extension of health services to undocumented
immigrants, majority of whom are poor and cannot afford regular care due to factors such as lack
of insurance coverage.

Effects of Quality Measures and Pay for Performance on Patient Outcomes and Nursing
The enactment of the Health for All Act in California entailed a well-thought-out strategy
that aimed at addressing the issue of limited or inadequate access to health services among
residents. As a result, the regulation brought about significant benefits that include the
facilitation of access to much-needed care services and at affordable costs. Initially, most of the
children and adults from poor immigrant families were vulnerable to the contraction of diseases
associated with living in deplorable conditions (First 5 la, 2015). Similarly, their welfare
deteriorated as a result of the inability to access proper health services due to lack of medical
insurance coverage. Nonetheless, the enactment of the Health for All Act restructured the
previous standards and policies applied in the Californian care system through the introduction
of a reform that improved access to all people regardless of their residency status.

Consequently, the improvement of the access to the necessary health services brought
about various effects on the quality measures, pay for performance initiative, and nursing
practices. On the one hand, the improvement of access to health services meant an increase in the
demand for the commodity. As such, the rise in demand jeopardized quality measures as the flow
of patients in health care facilities exceeded the number of nursing practitioners available
(Brandon, 2016). Similarly, the pay for performance initiative translated to personalized care for
those who could afford to access the services in private facilities or at the comfort of their homes
without being subjected to the long wait at the emergency room.
Most fundamentally, these occurrences adversely impacted patient outcomes, as the
quality of care provided was insufficient. Besides, they brought about a dramatic shift in nursing
practices as practitioners carried out activities that were not in their job description. Moreover,
these occurrences led to work overload for the nurses in the various facilities, thereby driving a
significant portion to quit, retire early, or seek other sources of employment (Alberto Diaz &
Castilla, 2017). For instance, due to the increase in demand, nurses were forced to take up roles
meant for physicians and other qualified personnel, thereby leading to errors, substandard care,
morbidity, and mortality rates.
The emergence and importance of Professional Nursing Leadership and Management roles
in responding to emerging trends in the promotion of safety among patients and ensuring
quality in the health services offered across Diverse Settings
Based on the expansion of the scope of the health care system in California to incorporate
more people, the roles and responsibilities of the nursing practitioners have continually changed,
thereby leading to the emergence of leadership and management positions in different settings.

More precisely, the Health for All Act remedied the pitfalls in the healthcare reforms introduced
under the Obama administration (Mims, Pederson, & Gold, 2014). However, due to the increase
in demand for health services, most nursing practitioners have been forced to take up roles meant
for qualified physicians (Salmond & Echevarria, 2017). Additionally, the incorporation of
undocumented immigrants through the increased access to health services has brought about an
emergence of leadership and management roles such as nurse managers, advocates for patient
and family, and chief nursing officer, to mention a few.
The importance of these leadership and management roles in responding to emerging
trends and promoting patient safety entails the provision of advanced skills in addressing the
needs of the population and ensuring wellness based on the prioritization of care that focuses on
patients, coordinated operations, analysis of data, and the enhancement of quality. Most
fundamentally, due to the changing roles and dynamics in the care process, the emergent
leadership and management positions will an integral role in the transformation of health
services through leveraging the contribution of the care providers who work at the full scope of
practice (Brandon, 2016). Similarly, they will significantly contribute to the achievement of
patient-centered and coordinated care that necessitates collaboration between professional. These
factors will further lead to an opportunity for nurses to shine as they will be included in the
decision-making and problem-solving processes.
Emerging Trends and the prediction of ways in which Nursing Practice and Roles will
transform in the next five years
The transformation of the health care system in California and America, in general, is
expected to bring about notable changes, particularly in the roles and responsibilities of nursing

practitioners and care providers. Among the emerging trends that will drive these changes to
include sophistication of medical technology, higher prices for health services, and an increase in
the consumption of prescription drugs (Alberto Diaz & Castilla, 2017). These are coupled with
the absence of peer accountability measures, underdeveloped quality improvement
infrastructures, inconsistency in the use of guidelines and tools, or supporting decisions made by
providers. Additionally, factors such as the inadequacy of clinical information systems that can
obtain and utilize digitalized information in the improvement of care will lead to the emergence
of concerns in the quality of care services provided.
As such, over the next five years, organizations that fail to apply and incorporate
stringent measures that impact quality will perpetuate the dysfunctional culture that inhibits
progress (Salmond & Echevarria, 2017). Consequently, nursing practices and roles will shift to a
care system that optimizes wellness and prevention through programs and initiatives that address
environmental and social triggers of preventable conditions. These will be coupled with the
embracement of approaches that include patients as partners, families, and communities by
orienting them to assume responsibility for themselves and managing diseases.



Alberto Diaz, C., & Castilla, R. A. (2017). The Future of Nursing: Assumption of New Roles
and Responsibilities. Journal of Community & Public Health Nursing, 03(01).
Brandon, W. P. (2016). Reinventing American Health Care: How the Affordable Care Act Will
Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, and Grossly
Inefficient, Error Prone System. Journal of Health Politics, Policy and Law, 42(1), 197-

  1. Doi: 10.1215/03616878-3702818
    First 5 la. (2015, July 31). Lawmakers for Children: Q & A with State Senator Ricardo Lara.
    Retrieved from
    Mims, A. D., Pederson, J. C., & Gold, J. A. (2014). Healthcare Changes and the Affordable
    Care Act: A Physician Call to Action Quality Improvement Organizations. Healthcare
    Changes and the Affordable Care Act, 13-31. Doi: 10.1007/978-3-319-09510-3_2

Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for
Nursing. Orthopedic Nursing, 36(1), 12-25.

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