Patient Care and Nursing

Growth in the Practice of Nursing and Patient Care Delivery Models

The practice of nursing is expected to continue growing and changing given the reform initiatives that are taking place in the healthcare system. Some of the factors that are contributing to these changes and growth in nursing practice include the restructuring of healthcare delivery system, increased healthcare costs, increase in demand for nurses, nursing shortage, and increase in the patient population. Given these factors, nurses are expected to continue assuming a wide range of healthcare responsibilities because of the complexities in patient care delivery or caring for the sick (Tiffin, 2012). It is expected that as nursing practice continues to change and grow, new models of patient care delivery will emerge. As nurses, we need to understand these changes/growth and the emerging patient delivery models in order to enhance our practice.

One of the patient care delivery models that will emerge because of expected changes and growth in the practice of nursing is Accountable Care Organizations (ACO). ACOs entail the collaboration between healthcare facilities, primary care clinicians, clinical specialists, and other healthcare professionals towards improving the quality and costs of care delivered to patients. Patient care delivery in the future will be dominated by ACOs given the increased shared cost savings between these organizations and Medicare programs (Haney, 2010). ACOs are likely to receive financial rewards and bonuses if they achieve some quality and savings objectives. The dominance of ACOs in future patient care delivery processes will be supported by the leadership roles assumed by their stakeholders towards coordination and implementation of care, especially to disadvantaged populations.

Secondly, patient care delivery in the future will be dominated by medical homes whose role will involve coordinating healthcare services across different settings and between different providers, especially in primary care practice. While medical homes are similar to ACOs, their emphasis will be on care and services that are specifically within the scope of nursing practice. Through medical homes, nurses will be recognized and become crucial leaders and members of the healthcare team. The basis for the emergence of medical homes will be to provide and/or facilitate health promotion and preventive services in the primary care setting.

Third, the practice of nursing in the future will be dominated by nurse-managed health clinics as patient care delivery models, which are nurse-practice arrangements that are led by advance practice nurses. The focus of nurse-managed health clinics will be the provision of comprehensive primacy care services and ensuring wellness services are provided to vulnerable and disadvantaged populations throughout the country. As the arrangements are linked to educational institutions, social services agencies and other health-related agencies, they will enable nurses to practice to their optimal professional scope. The enhanced nursing practice because of nurse-managed health clinics will in turn contribute to better patient outcomes and value-oriented care practices.

The emergence of these patient care delivery models in the practice of nursing is also based on the concept of continuity of care. Unlike in the conventional healthcare setting, continuity of care in future nursing practice will entail multidimensional approaches because patients' healthcare needs can rarely be met by a single professional in today's healthcare system (Gulliford, Naithani & Morgan, 2006). Multidimensional patient care delivery models will continue to be developed to help in meeting patients' healthcare needs through integrating, coordinating, and sharing information between healthcare providers.

Nurses' Impressions of these Expected Changes/Growth

The above presentation of the expected growth and changes in the practice of nursing and patient care delivery models was well received by the nurse colleagues. The three nurse colleagues stated that they expected the future of nursing to undergo tremendous changes in attempts to enhance patient care delivery and meet the evolving needs of patients. They stated that the enactment of the Patient Protection and Affordable Care Act in March 2010 is an indicator of the changes that have started taking place in the practice of nursing. In their view, nurses will assume an indispensable leadership role in healthcare teams as multidisciplinary care teams are formed to provide patient care.

One of these three nurse colleagues stated that the emergence of new patient care delivery models like medical homes, nurse-managed health clinics, and Accountable Care Organizations will significantly change the role of nurses in delivery of patient care. He argued that the emergence of these models will imply that they we have to focus more on care management and coordination. In addition to the restructuring of the healthcare system, this nurse stated that the changes and growth of the practice of nursing will force nurses to seemingly abandon the traditional role of carrying out patient care activities and responsibilities. As nurses abandon these roles, their activities and duties will be to coordinate and manage care delivery processes and activities. However, this colleague was skeptical on whether the nurse practitioners are adequately prepared to assume this leadership role in care management and coordination. He felt that current nursing education and preparation does not adequately prepare nurse practitioners for the new roles brought by changes and growth in nursing practice.

In concurrence with the first nurse colleague, the second one expressed concerns on whether the current nursing curriculum is designed to effectively prepare nurses for the changing role in nursing practice. She stated that current nursing education largely focuses on preparing nurses to carry out certain tasks and activities relating to patient care delivery. Therefore, nurses increasingly focus on carrying out these tasks while collaborating with other members of the healthcare team, especially physicians. Based on current nursing education, physicians assume a leadership role while nurses play a supportive role in delivery of patient care. For nurses to be effectively prepared to be adequately prepared to assume leadership roles based on the changes and growth in the practice of nursing, there is need to overhaul nursing education. This nurse colleague expressed optimism regarding the future of nursing education with regards to the changing nursing practice. He believes that nursing education will also undergo changes that reflect the growth of nursing practice so that nurses become efficient and effective in their duties and responsibilities. He stated that the entire nursing profession including nursing education is experiencing changes that will help transform nursing practice and preparing nurses for their new role in care management and coordination.