¶ … Growth and Changes in Nursing Now that the Affordable Care Act (ACA) is the law of the land, nurses can expect to have even more responsibility and even more opportunities to use their skills. This paper reviews how the restructuring of the U.S. healthcare system impacts the nursing field. And this paper reflects on how continuum of care, accountable care organizations, medical homes and nurse-managed health clinics will be affected by the ACA.

Nursing Shortages

There already are critical nursing shortages in the United States, which is the reason that foreign nurses have become "…an integral part of the U.S. healthcare system" (Arnold, 2013). In fact, according to Arnold, healthcare organizations have been bringing nurses from abroad into the U.S. For "…over fifty years in response to cyclical nursing shortages" (1382). Now, with the Affordable Care Act in place there is expected to be an increased demand for foreign nurses; indeed, there were 267 international nurse recruitment firms in the United States in 2007, and it is easy to imagine that number growing as the shortage of trained nurses continues. The advantage for hospitals -- besides being able to fill their vacancies -- is realized in cost savings, Arnold continues: hiring a foreign-trained nurse could save a hospital up to $50,000 in a two-year period (1383).

Continuum of Care

The Affordable Care Act seeks to provide "a better continuum of care," one that is "person-centered" and that offers control while enhancing "quality" (Shugarman, et al., 2011). The ACA also sets out to improve the continuum of care in four domains: a) long-term care insurance; b) home and community-based services (HCBS); c) care coordination; and d) workforce reinforcement (Shugarman, 11).

The CLASS provision in the ACA (Community Living Assistance Services and Supports) provides, for the first time, people in the middle class with an "affordable opportunity to plan for and access supportive services," Shugarman explains (12). In fact CASS actually reinvents how healthcare professions view long-term care; in the past long-term care was identified as helping those in poverty, those very sick and lonely, Shugarman continues. But with the Affordable Care Act long-term care the idea is to provide services for the "near-poor and the...

The point of an ACO is not to solve all a person's problems, but rather to be "accountable for improving the quality of healthcare…while lowering costs" (Shugarman, 14).
In the peer-reviewed publication, Dispute Resolution Journal, the author reveals that the Centers for Medicare and Medicaid Services (CMS) has established protocols that are designed to "improve coordination and communication among doctors and hospitals," and improve the quality of care in the meantime (Ronai, 2011).

Medical Homes

D. Scott Jones writes in the peer-reviewed Journal of Healthcare Compliance that the growth of home health is driven in large part by the rapidly aging population in the United States. Also, more Americans are living longer and "more productive lives" and they wish to grow old at home rather than being institutionalized in any way. However, as positive as this program is under the ACA, there have been terribly abusive billing policies.

However, there are provisions going into the ACA that will ensure accurate compliance and patient accuracy when it comes to billing for medical home services. That is important because home health is a "robust and rapidly expanding segment of the healthcare industry"; as mentioned earlier, the American population is aging rapidly and the need for adequate nursing services and home care has never been greater (Jones, 40). Home health, as Jones explains on page 40, has "great potential to improve quality of life and care for patients."

Nurse-managed Health Clinics

The great need that has arrived along with the ACA is the need to deliver healthcare to poor people who will be getting insurance for the first time -- and nurse practitioners in "nurse-managed health centers are poised" to meet this need (Pron, 2013). This truly shows remarkable progress in the delivery of healthcare services because nurse practitioners provide nearly the same level of service as doctors, and "more NPs may choose employment" in nurse-managed clinics because they desire "job satisfaction and autonomy" (Pron, 213).

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