Nurses' Role in the Evolving U.S. Healthcare System

Introduction

Nurses play a key role in the perpetually changing U.S. healthcare system and will be responsible for implementing many of the changes on both a strategic and a tactical level. For nurses to be most effective amid the wave of changes that will ensue, they first need to understand the opportunities that are present and how they can create solutions to achieve better patient outcomes at more reasonable costs. With the changes expected to occur, nurses will have a greater ability to prevent diseases in the community, provide chronic care management to aging patients, treat a more diverse population, offer end-of-life care that emphasizes comfort and compassion, and fulfill many other roles that are beneficial to the community.

Nurses will have the ability to provide expanding access to care, which will work to improve the availability and quality of healthcare for many community members who were previously underserved. Nursing-led innovations — such as nurse-managed health clinics, home visiting programs for low-income mothers, and the Transitional Care Model — are among the advances nurses can contribute to in this new environment. Mid-level healthcare providers are taking on an extremely important role in the healthcare system following the passage of the Affordable Care Act (ACA), and these providers will help shift many nursing roles from acute care hospital facilities into the community through a variety of expanded practices that can focus more on routine and preventative care for individuals and families.

Expanding Access to Care Through Nursing Innovation

In the emerging healthcare environment, nurses will have to take on more of a leadership role in many situations, requiring nurse-leaders to become competent in a wide range of new skills. For example, nurse-leaders will have to learn to delegate effectively and monitor their team's progress in completing tasks and achieving organizational objectives. Many experts agree that delegation is an essential element of the management process because much of the work accomplished by managers — at the first, middle, and top levels — occurs not only through their own efforts but also through those of their subordinates (Marquis & Huston, 2011). Therefore, as nurses move from roles in acute care settings to roles more embedded in the community, they will undoubtedly need to develop many new competencies, including effective delegation and team leadership.

If nurses can establish themselves as leaders in their new community health roles, there are many potential benefits to be gained at multiple levels. One specific area of improvement could come from reduced reliance on the crowded emergency department. Many homeless and low-income individuals often rely on the emergency department (ED) as their primary source of healthcare because they are not able to access alternative services (Savage, Lindsell, Gillespie, Lee, & Corbin, 2008). Furthermore, many of these low-income patients are not receiving the ideal level of care in the ED and are often overlooked so that staff can focus on more urgent conditions.

Nursing Leadership in the New Healthcare Environment

One study found that nurse-managed clinics can have a positive impact on reported vitality, mental health status, and substance use among homeless individuals, and also reported improvement in satisfaction with the quality and availability of care (Savage, Lindsell, Gillespie, Lee, & Corbin, 2008). Through nursing-led initiatives such as this, there will be a substantially greater opportunity for nurses to make a meaningful impact on the community in the evolving healthcare landscape.

Marquis, B., & Huston, C. (2011). Leadership roles and management functions in nursing: Theory and application. Lippincott Williams & Wilkins.

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