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Evolving Practice of Nursing and Patient Care Delivery Models

Evolving Practice of Nursing and Patient Care Delivery Models

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Over the recent years, the healthcare system in the U.S. has undergone tremendous transformations in a bid to improve service delivery to the average citizen. In 2010, a remarkable milestone was reached when Congress signed The Patient Protection and Affordable Care Act (PPACA) legislation into law (Grossman and Valiga, 2013). This law brought an entirely different dimension into the health care system by not only making services affordable and accessible but also setting the pace for the replacement of the ‘sick care’ system with an actual ‘health care’ system. Nevertheless, problems still abound in the health care system, and the reforms in the sector need to be an ongoing process. In particular, the nursing profession has to evolve from the usual mainstream practices to a comprehensive goal-oriented patient care. As time changes, technology becomes more advanced, and it is vital that the nursing profession embraces this change positively by undergoing the necessary reforms that will minimize medical error and increase patient satisfaction. This paper examines some of the reforms that will take place in the practice of nursing as a result of restructuring the health care delivery system.

Technology takes center stage when it comes to changes in the nursing profession, and nurses should positively embrace technology. Undoubtedly, technology has made a big difference in nursing with the introduction of informatics nurses who help in developing some of the modern technologies and go ahead to train other nurses on the latest systems in the field (Aiken et al., 2003). Nurses can remotely monitor the patients’ vital signs by use of machines, a factor that has greatly improved service delivery and patient care. Technology is likely to define the future of nursing because any problems arising in the field will stimulate experts to come up with technological solutions. Nursing schools have to interest heavily in technology so that the students can learn how to use the newest medical technology while still in school. For example, all the nursing schools should have state of the earth simulation labs that ensure the students are prepared adequately to face the real environment before graduating.

The type and quality of services patients receive is influenced by improvements in technology. A survey conducted in 2010 by the Institute of Medicine (IOM) revealed that apart from the competencies of the nurses, technology was the second major factor that influenced patient satisfaction (Cherry and Jacob, 2014). Today, telemedicine is widely used in hospitals to coordinate communication between doctors and the nursing staff in as far as the management of patients is concerned. With the emergence of new fields in medicine like genetics and genomics, the development of new machines is inevitable. The future of health care largely depends on technology. Therefore, a sustained investment medical technology is necessary. The introduction of new technology implies specialized training for the nursing personnel to ensure that they are competent enough to handle the technological tools (Benner et al., 2010). The importance of training cannot be underestimated because it is the only sure way of minimizing medical error.

The nursing education curriculum has to be redesigned in a bid to accommodate the changing medical environment (Benner et al., 2010). The nursing curriculum should not only impart advanced knowledge to students but also prepare them for licensure as registered nurses. The fact that one has passed a nursing examination should not automatically qualify him or her as a nurse. After graduating from the nursing school, graduates should sit for special examinations before being licensed as registered nurses. Such tests should be administered by the National Council Licensure Examination (NCLEX-RN). This measure will ensure there is a smooth transition between education and practice for the nursing personnel. One can become a nurse by simply pursuing an associate degree in nursing that runs for a minimum of two years. Nevertheless, only sitting for a licensure examination and passing it will enhance the provision of safer patient care by nurses.

Redesigning the education curriculum will also ensure that nurses acquire the basic competencies necessary for providing safe patient care in a diverse society (Grossman and Valiga, 2013). The current landscape of nursing education emphasizes on the acquisition of advanced knowledge by the learners. However, more emphasis should be placed on the quality of the services provided by nurses and patient safety. Furthermore, clinical training should constitute an integral part of the curriculum, and the training should be concerning multiple settings across the lifespan. Changing the scope of education is necessary so that the graduate nursing students can meet the increased demand for modern patient care upon completing their studies. Restructuring the education system entails forming partnerships with other academic institutions. These partnerships will enable nursing students to be open-minded, take up leadership roles, as well as bring a different dimension to the nursing profession.

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Accountable care organizations (ACOs) will spring up in the process of restructuring the health care delivery system. ACOs can be compared to a charity organization comprising medical professionals and other health care providers who work voluntarily to give quality and safe health care to patients(Cherry and Jacob, 2014). Such a Medicare program is important because it ensures that the chronically ill patients receive special attention and at the right time. Another advantage associated with the ACOs is that high-quality care is provided to the patients as opposed to what happens in regular hospitals. Furthermore, given the experience and the qualification of the medical personnel involved, the risk of medical error will be greatly reduced. Contrary to what goes on in general hospitals, ACOs focus on a particular group of patients and subject them to a comprehensive health care program throughout the entire period of illness. Nurses will be key players in the establishment of ACOs because they will be expected to take up leading roles in the coordination of health care.

The introduction of medical homes, otherwise known as the patient-centered medical homes (PCMHs) will also alter the landscape of the nursing profession (Hassmiller, 2010). This model of health care delivery focuses on the specific patient needs and develops a comprehensive patient-centered program for delivering primary health care. For example, medically fragile children and high-risk pregnant women have unique care needs, and they will be subjected to different specialized care when admitted to a medical home. Therefore, nurses will have to undergo diverse and technical training on the various patient needs before being posted to medical homes. Moreover, nurses might be required to extend their working hours because, occasionally, patients will need to be attended to beyond the office hours. These ‘health homes’ are important because they improve the quality and efficiency of healthcare while reducing costs. It is worth noting that the success of the medical homes relies on the combined effort of the doctors, physicians, nurses and other social workers.

Nurses are central to the health care delivery system and improving this system implies an increase in the number of nursing personnel too. Consequently, nurse-managed health clinics (NMHCs) will spring up as the government purposes to improve access to health care. Lack of adequate health care providers has been a primary problem in the past, and NMHCs are expected to spread health care services to underserved areas(Grossman and Valiga, 2013). The head of an NMHC is normally a highly qualified and experienced nursing practitioner. NMHCs are community-based, and some of their primary roles include the promotion of health education and initiating disease prevention programs. Regular nurses have to prepare for the possibility of being posted to such centers to offer additional support in the provision of health care since most of the NMHCs are located in underserved areas.

A significant reform associated with the improvement of the health care delivery system is the concept of continuity or continuum of health care(Cherry and Jacob, 2014). Continuum of care ensures that a patient’s health records are carefully monitored over an extended period. In some cases, patients may be provided with quality health care from the moment they are born until the time of death. Managing and executing such a comprehensive health care program for patients at all stages of their lives requires a lot of nursing practitioners. A single nurse is assigned to a small group of patients, and he or she has to track the medical records and do a follow-up of those patients. Some of the specific services involved in the continuum of care include home care, outreach, ambulatory care and acute hospital care. The current health care system has recently come under criticism for its focus on ‘episodic care.’ Episodic in the sense that one a patient with an acute condition has been treated, no follow-up is done. However, the health care reforms aim at completely transforming the industry from ‘episodic care’ to a seamless continuum of care, a factor that will increase job opportunities for a lot of nurses.

Undertaking reforms in the social sector is always a costly project for any country(Grossman and Valiga, 2013). Therefore, proper planning and coordination are necessary for those in positions of leadership. The National Health Care Workforce Commission established by the government aims at analyzing the existing health care workforce. The primary role of this commission is to identify the areas of need and recommend the most efficient ways of deploying resources to such areas to the policy makers. For example, regions identified to be in dire need of nursing practitioners are replenished with graduates from nursing school. Similarly, the funds to facilitate the delivery of health care services enhance further training for the nurses and other medical personnel are approved by this commission. The commission also has to develop a centralized database that provides information regarding the number of health workers employed and their areas of employment. Ultimately, new nurses will be recruited to the profession, and they will undergo specialized training in patient care delivery.

To conclude, the reforms in the health care delivery system will undoubtedly alter the landscape of the nursing profession. For a long time, high costs have made health care delivery inaccessible to most of the average citizens. However, with the health reforms slowly gathering momentum, high costs, and poor quality health care will be a thing of the past. Incremental improvement in the delivery of health care is inevitable in the foreseeable future. It is worth noting that the reforms are beneficial to both the nursing practitioners and the patients. The health reforms might take a very long time to be fully implemented, but when they do, it will be a defining moment for stakeholders in the health care industry.


Aiken, L., Clarke, S., Cheung, R., Sloane, D. and Silber, J. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA 290(12), 1617-1623.

Benner, P., Sutphen, M., Leonard, V., Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco, Jossey-Bass


Cherry, B., & Jacob, S. R. (2014). Contemporary nursing: Issues, trends, & management. St. Louis, Mo: Elsevier.

Grossman, S. C., &Valiga, T. M. (2013). The New Leadership Challenge: Creating the Future of Nursing. Philadelphia: F.A. Davis Co.

Hassmiller, S. (2010). Nursing’s role in healthcare reform. American Nurse Today 5(9), pgs. 68-69.

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