Evolving Practice of Nursing and Patient Care Delivery Model

Evolving Practice of Nursing and Patient Care Delivery Model

In the contemporary health care industry, change is the only constant factor. As such, the role of the healthcare professionals, nurses included will change as time elapses. In essence, this discussion aims at establishing the roles of nurses in the emerging health care delivery models. Central to the achievement of this goal is as an informal presentation that enlightens nurses on their roles in the evolving health care industry. Also, the determination of the nurses’ perceptions towards their roles in the new health care system is of the essence to this discussion.

Informal Presentation

With the imminent changes in the medical world, nurses must be ready to take up new expanded roles in the health care issues. That is the case given the existence of several reasons for this much-needed change. For instance, going into the future, the expectation is that the number of patients seeking health care services will increase due to the provision of Affordable Care Act (ACA) of increasing health care insurance coverage. Such a provision requires that more nurses are available to offer care to the high number of patients. However, that is not possible due to the already thinned proportion of nurses that are currently attending to the patients(Hussung, 2016).

Furthermore, new health care technologies will necessitate that nurses develop adaptive measures to keep pace with this change. Such is the case due to the focus of health care system on telemedicine especially for persons in rural areas or underserved regions of the country. Also, the need to embrace the digital way of storing information, electronic health records, is another technological demand that nurses must meet as they wait to see what the future brings(Hussung, 2016).

That notwithstanding, the current emphasis on providing quality and affordable care to patients is another reason that will demand more from nurses as they work to meet this expectation. For instance, with the focus on value-based payment (pay-for-performance) initiatives, the nurses have no option but to continue streamlining their roles as the clock ticks down(Hussung, 2016).

Finally, the nurses’ urge to further their educational level is another reason that is likely to see a change in fortunes and expectation from the nurses as they put theory into practice. That is the case because with advancement in the nursing education translates to more responsibilities given their increased competencies(Hussung, 2016). As such, the nurses will have more expanded roles as they practice what they have learned.

With such reasons, the nurses have no option but to accept their new roles in the evolving health care delivery models. Having established the reasons why the change is inevitable, it is worth noting the nurses’ roles in the new health care delivery models. The emerging health care delivery models of interest are Accountable Care Organization (ACO), medical or health homes and nursing-managed health clinics.

To begin with, the ACO model of health care delivery is one that brings together primary care clinician, a hospital and other specialists that accept to part of this team. The driving force of this organization is to secure Medicare benefit after attainment of a certain level of quality. One of the nurse’s opportunities in this model of health care delivery is to collaborate with primary care nurses as they provided a coordinated care plan for patients. Additionally, this type of delivery will open the door for nurse practitioners and clinical nurse specialists to offer central organizational leadership within this model especially in underserved regions (Haney, 2010).

Secondly, within the medical/health homes delivery model, nurses also have opportunities that are worth noting. According to Haney, (2010) nurses must play a leadership role in the medical homes given that nurses-led medical homes perform much better than those led by other health care professionals do. Moreover, the nurses have the task of coordinating care within the medical homes as they interact with other members of the health care team and patient. Besides, the nurses are the leading propagator for patient education within this care delivery model.

On the contrary, the nursing-managed health clinics (NMHCs) offer nurses certain opportunities that are also of the essence to note. In this type of delivery, underserved and most vulnerable population, receive primary care and wellness services. The NMHCs must have an association with a college, school, a department of nursing or a federally approved health center. Under this model of delivery, the expectation is that nurses must take charge of the primary care and wellness educational services for their patients. Management of chronic diseases, coordination, and integration of care are all part of the nurses’ responsibilities in NMHCs (Haney, 2010).

Lastly, it is also important to note how nursing will ensure the continuity of care in the changing health care industry. The concept of continuity of care in the emerging health care delivery models is not in danger given the development of new roles for nurses that will ensure the maintenance of continuum of care. For instance, the introduction of attending registered nurses (ARNs) who are responsible for the patient on a continual basis during the hospital stay and after discharge (Naylor, Aiken, Kurtzman, Olds, & Hirschman, 2011). Such a practice will ensure the maintenance of the continuum of care.

Summary of Feedback

Concerning the anticipated changes in health care delivery, all the nurses that were the recipient of this information had a mixed reaction about the same. That is the case given that the nurses reported both strengths and weaknesses of the new delivery models. Firstly, on the positive side, all the nurses welcomed the idea of introducing the ACO care delivery model. They noted that this type of care delivery would transform health care. Such is the case given that the value-based payment adopted by this model will ensure that nurses’ contributions are to the maximal. Furthermore, they lauded the ACO model for its ability to enhance accountability and responsibility among health care professionals as they provide care to their patients. Additionally, the nurses also felt that the new health care delivery models had full government support. Such is the case given that they unanimously observed that the law, ACA in more specific terms, prescribed grants and financial incentives for the different models of health care delivery. To them, support of this kind meant that the government has the full commitment to quality care for patients.

On the new roles across the different health care settings, the nurses expressed some ideas that are worth mention. Firstly, the nurses felt that the new responsibilities in the new health care delivery settings offered them an opportunity to de-link from the hospital setting and participate in all other health care facilities. They felt that this would help improve the contribution of nurses since they will not have the restriction of limiting their services in one setting but instead to the various setting. Moreover, they expressed their satisfaction with the greater control that nurses would have on health care issues with the full implementation of the care delivery models. For instance, they noted that nurses’ role, especially in the medical homes and nurse-managed health clinics, would be of great value to the health care industry. Such services, which include providing wellness and behavioral telemedicine visits and coordination of care for chronically ill patients, will ensure that nurses participate more in health care proceedings as other medical counterparts.


Primarily, all the nurse’s positive ideologies about health care delivery models were consistent with the findings of various studies on this issue. For instance, Tu, Muhlestein, Kocot, and White, (2015) are of the opinion that with ACO care delivery model, an improvement of patient experiences and outcomes like reduction in readmissions and mortality rates are inevitable. Such an eventuality is because medical personnel working for ACO are more accountable and are working towards achieving quality standards that will secure them a financial incentive. Together with that, the nurses felt that the increased government support would benefit nursing services. Indeed, this is true given that with financial backing nurses have the motivation of ensuring that they offer quality services to the clients at all times. The ramification of this contribution is the improvement of the quality of care provided to patients and patients’ satisfaction (Tu, Muhlestein, Kocot, & White, 2015).

Similarly, the perception of the nurses on the new roles across different health care setting is reminiscent of findings from studies that have investigated this issue. The nurses welcomed the idea of an expanded role that will see them not only work in a hospital but also in other settings such as community, nursing-led clinics, and medical homes. The same is evident in another study in which the nurses exhibited their openness to working in multiple settings rather than being restricted to one. The study population stated their reasons for such a preference was in part due to the need for pursuing a new challenge in their career, breaking the monotony of working in one place all their lifetime and strict rules that limit their functionality (Fairman, Rowe, Hassmiller, & Shalala, 2011).

Lastly, the perception that the nurses would have a greater control of health care issues with the implementation of the health care delivery models is also consistent with findings by scholars interested on this matter. A case in point, Naylor and colleagues,(2011) highlighted that the full implementation of the delivery models of patient care would see ascension of more nurses to leadership positions and assumption in more expanded roles. With more nurses in leadership positions, a greater control of medical matters is inevitable. Such is the case since the nurse leaders will have opportunities to participate in policy formulation debates and control proceedings in various medical facilities such as health homes.


In closure, indeed, nurses ought to be amenable to change in health care delivery model given its inevitability. Such is the case due to the existence of factors like technological advancements that demands this change institutionalized with immediate effect. Additionally, the new health care delivery models promise to revolutionize nursing practice and change patient care for the best. As such, nurses need to embrace this wave of change, if they actually want to transform patient care. However, failure to do so will only see the rooting of the current challenges in the health care system for the unforeseeable future.




Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. New England Journal of Medicine364(3), 193-196.

Haney, C. (2010). New Care Delivery Models in Health System Reform: Opportunities for Nurses & their Patients. nursingworld.org. Retrieved 10 February 2017, from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf.

Hussung, T. (2016). The Future of Nursing: How Changes in the Healthcare Industry Affect Clinical Practice – Husson University. Husson University. Retrieved 10 February 2017, from http://online.husson.edu/the-future-of-nursing/

Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The importance of transitional care in achieving health reform. Health affairs30(4), 746-754.

Tu, T., Muhlestein, D., Kocot, S. L., & White, R. (2015). Origins and Future of Accountable Care Organizations. Retrieved 10 February 2017, fromhttps://www.brookings.edu/wp-content/uploads/2016/06/Impact-of-Accountable-CareOrigins-052015.pdf







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