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Nursing and Patient Care Delivery Models: Practice Evolving


Nursing and Patient Care Delivery Models: Practice Evolving

Nursing and Patient Care Delivery Models: Practice Evolving

In recent years, the practice of nursing has evolved substantially both in the United States and at an international level. In America, the introduction of the 2010 Affordable Care Act (ACA) served to herald a new frontier of growth for the nursing practice, particularly at the level of the roles that nurses were expected to play to successfully meet the demand for safe, quality, and affordable care across the country (Barton, Bevan, & Mooney, 2012; Yeung, Burns, & Loiacono, 2011). The aim of the first part of this paper is to provide an informal presentation aimed at educating nurses on how the practice of nursing is anticipated to evolve and change over the coming years. The second section of this paper summarizes the feedback shared by three nurse colleagues and also discusses whether their impressions are consistent with available scholarship on healthcare reform. Nursing and Patient Care Delivery Models: Practice Evolving


Informal Presentation

A multitude of dynamics have converged in the first decade of this century to not only fundamentally shift the context in which healthcare is provided and change the scope of the role and responsibilities of nursing professionals, but also to present novel conceptualizations of patient care delivery within and across healthcare settings. In my view, the evolving practice of nursing in the United States is intrinsically tied to, and associated with, the provisions of the 2010 Affordable Care Act, which seek to expand access to care and improve the quality of healthcare services at the disposal of the American public. The improved education and training opportunities for nursing professionals, along with their close proximity to patients and scientific comprehension of contemporary care processes across the continuum of care, have converged to provide nurses with an exceptional capability to not only act as partners with other health practitioners but also to be at the forefront in reformulating and redesigning the health care system and its numerous practice contexts. It is of immense importance to note that, in contemporary hospital and community settings, the nursing practice has continually evolved to cover a wide continuum of care ranging from health education/promotion and disease prevention to coordination of care, treatment, as well as palliative care in incidences where treatment is not tenable.

Models of patient care delivery are also expected to evolve and shift considerably, as nursing professionals engage in more education and preparation to successfully adapt to their new roles and contribute in the realization of a steadfast commitment to patient care, enhanced safety and quality, and superior care outcomes. In this context, the Accountable Care Organizations (ACOs’) have not only grown in popularity but have also demonstrated effectiveness in terms of enabling a framework for partnership among clinicians, hospital consultants and nursing professionals, particularly in accepting mutual responsibility for the quality and actual cost of care availed to patients in healthcare facilities. Nurses are also making immense contribution in medical homes, which is normally understood within the context of availing patients with a vital primary care provider (in this case, the nursing professional) who is charged with the responsibility of synchronizing the patients’ care across contexts and providers. Moreover, nurses are now expected to assume a greater role in the establishment of nurse-managed health clinics, which are expected to play a critical role in ensuring a reformed and better-integrated, patient-oriented health care system through the provision of comprehensive primary care and wellness services to susceptible populations in the United States. Nursing and Patient Care Delivery Models: Practice Evolving

Overall, it is evident that nursing professionals in various practice environments should embrace themselves for increased roles in their attempt to deal with the plummeting demand for safe, high-quality and effective healthcare services. Indeed, nursing professionals are today better placed to bridge the gap between coverage and access; however, they must be facilitated to practice in accordance with their professional training, not mentioning that they must be exposed to educational opportunities that prepare them to deliver patient-oriented, high-quality healthcare services to patients within the American healthcare system. Nursing and Patient Care Delivery Models: Practice Evolving

Summary of Feedback and Discussion

All the three nurses were in agreement that the ongoing reform in the American healthcare sector was providing increased opportunities for nurses; however, stakeholders had not demonstrated keenness on investing in the continuous education of nurses to enable them perform the new roles. One nurse professional was concerned that, while the evolving roles for nursing present opportunities for the American healthcare system to deliver patient-centered, equitable, safe, high-quality healthcare services through patient care delivery models such as medical homes and nurse-managed health clinics, stakeholders were yet to develop strategies to ensure engagement between physicians and nurses in the delivery of effective and efficient care. Another nurse colleague acknowledged that the introduction of nurse-managed clinics represented a paradigm shift in the way nurses provide quality and cost-effective care to patients. However, the nurse was unsure about the roles of nurses in such an arrangement and if the level of education and training provided to nurses was adequate to enable them fit into the evolved roles. The third nurse colleague was certain that the evolving practice of nursing would provide the needed impetus for nurses to take a central role in the delivery of care; however, the nurse was worried that a large proportion of nurses lack the necessary professional and leadership competencies to redesign the healthcare system and act as primary care providers in coordinating the patients’ care across settings and providers. Nursing and Patient Care Delivery Models: Practice Evolving

The impressions raised by the nurse colleagues are consistent with what is contained in the nursing scholarship on evolving practice of nursing and patient care delivery models. Available literature demonstrates that, for nursing professionals to fit well into their new roles and responsibilities in the reformed healthcare system, they must not only be facilitated to practice in accordance with their professional training but also provided with quality education that will be instrumental in preparing them to deliver patient-centered, unbiased, and high-quality healthcare services (Institute of Medicine of the National Academies, 2010). Exposure to continuous education and training opportunities is of immense importance in facilitating the nurses to engage with clinicians and other healthcare professionals in hospital settings, communities, clinics and medical homes (Yeung et al., 2011), and also in assisting them to internalize leadership competencies that would allow for the redesigning of the healthcare system (Barton et al., 2012).

Concerns were raised by the nursing colleagues about the actual roles of nurses in the new setup, but more specifically the nursing roles and responsibilities in nurse-managed clinics and medical homes. Research is consistent that, in the medical homes context, nursing professionals can provide care coordination, management, as well as patient education and evaluation. In the context of nurse-managed health clinics, nurses can provide importance services in “primary care, wellness education, management of chronic diseases and conditions, as well as coordination and integration of care” (American Nurses Association, 2010, p. 6). Upon closer reflection, it is acknowledged that such roles will go a long way in containing costs and optimizing patient care outcomes, particularly because the primary care delivered by nurse professionals is not only cost effective but also value-driven and quality-oriented.


Drawing from the above exposition, it is evident that the evolving practice of nursing presents the clearest opportunity for American citizens to receive cost-effective and patient-oriented healthcare in clinical contexts. However, continuous education and training need to be prioritized as a matter of urgency to provide the nurses with skills to take up the new roles and care delivery models.


American Nurses Association. (2010). New care delivery models in health system reform: Opportunities for nurses and their patients. Web.

Barton, T.D., Bevan, L., & Mooney, G. (2012). The development of advanced nursing roles. Nursing Times, 108(24), 18-20.

Institute of Medicine of the National Academies. (2010). The future of nursing: Leading change, advancing health. Web.

Yeung, W., Burns, H., & Loiacono, D. (2011). Are ACOs’ the answer to high-value healthcare? American Health & Drug Benefits, 4(7), 441-449.

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