Evolving Practice of Nursing and Patient Care Delivery Models How the Practice of Nursing is Expected to Grow and Change: The Future of Nursing has a few healthcare delivery challenges unique to it, but there are several such issues that commonly occur in other nations, as well. Population aging is one issue that generates demand for increased healthcare services. A growing number of individuals, from all age groups, suffer from chronic illnesses; about 50% of U.S. citizens have been diagnosed with arthritis, diabetes, cardiovascular diseases, mental disorders, and hypertension (Reinhard & Hassmiller, n.d.).

A 2009 report by the AARP (American Association of Retired Persons) pertaining to chronic problems notes that patients and caregivers have firsthand experience of the absence of patient care-related coordination amongst healthcare workers, typically leading to needless repeat hospitalizations, repeat procedures and examinations, and arduous hospital-to-home moves. An acute dearth of professionals (such as nurses) is being experienced already, especially in low-income neighborhoods and rural regions. These deficiencies will likely aggravate with retirement of the existing workforce and mounting healthcare demands (Reinhard & Hassmiller, n.d.).

Nurse Managed Health Clinics

Healthcare staff transformation is needed to deal with these challenges. The solution isn't as simple as just increasing the number of clinicians. The health sector requires professionals well-prepared in caring for patients suffering from multiple chronic problems in every setting. Also, these providers should be capable of delivering care as best as they can, corresponding to their training and educational qualification. Since nurses constitute the largest share of healthcare professionals, and possess adaptive capacity and scientific knowledge, they need to spearhead necessary healthcare transformations. For doing so, they have to take on re-conceptualized and enhanced roles in transitional care, health-related coaching, quality enhancement, chronic illness management, and prevention activities (Reinhard & Hassmiller, n.d.).

The ground breaking IOM (Institute of Medicine) report published in 2010, regarding nursing's future, stated that, with the anticipated millions of additional patients to access healthcare services, thanks to the ACA (Affordable Care Act), a significant role needs to be played...

The report, which resulted from an RWJF-sponsored (or Robert Wood Johnson Foundation) program, revealed that research-generated data on APRNs as well as experiences of Kaiser Permanente, Geisinger Health System, Veteran Health Administration, and other healthcare institutes that have enhanced nurses' patient-care-related responsibilities and roles, demonstrate that APRNs deliver high-quality and safe primary patient care. The report's authors, however, also alerted lawmakers of numerous restrictions (e.g. those in Medicaid and Medicare reimbursement policies and state-level practice Acts) preventing effective nurse response to swiftly evolving healthcare backgrounds and system. These obstacles should first be surmounted, ensuring effective positioning of nurses to head change and bring about health advances. One of IOM's recommendations was elimination of obstacles from nursing practice's scope, enabling nursing practice to take place in the utmost extent of nurses' training and education (ANA, 2011).
Continuum of Care and Accountable Care Organization (ACO)

Positive outcomes in terms of healthcare value, quality and access can be attained through expansion and re-conceptualization of nurses' roles, and maximization of nursing practice's scope in relation to education and training. Kaiser Permanente Patient Services Program Office's vice president, Marilyn Chow states, in the IOM report, states that while their organization reflects the future of healthcare, it isn't seen everywhere. The Veteran Affairs Department (VA), Kaiser Permanente, and Geisinger Health system are examples of healthcare institutes, which have successfully maximized nursing practice's scope. These institutes put into operation such initiatives that led to practical proof of the positive impact of nurses, who practice at their utmost scope-of-practice levels, on patients as well as the overall care delivery system (Ridge, 2011).

VA's shift from a clinic-based system to an organization focused on primary care is founded on NPs' (nurse practitioners) maximization as providers of primary care. At VA, NPs practice across a care continuum within an organizational culture that endorses professional teamwork. Consequently, by the year 2007, patients of the organization received considerably more economical and higher quality care as compared to similar populations enrolled in Medicare. Geisinger, a private not-for-profit organization, has, according to the report, changed from a specialty-centered, expensive medical center to a high-value one. Its vision encompasses making employees work to the maximum level of their corresponding license and redistributing care-providing work for reducing cost and improving quality. Call center nurses, under this system, transitioned to primary patient care…