Informal Presentation: Changing Role of Nurses in Health Care Reform

Informal Presentation: Changing Role of Nurses in Health Care Reform


America is undergoing extensive healthcare reforms (Auerbach, Staiger, Muench, & Buerhaus, 2013). The process of transforming health care and the result of this collaborative and conscious effort among all stakeholders will expand the scope of practice and the roles of nurses in this country. This paper provides an informal presentation between a nurse and colleagues. The informal presentation seeks to share information with nurses on the likely new roles that will accompany the health care reform. Further on, the paper will describe in summary the impression, views, and opinions of three nurses in their new roles due to the healthcare reform.

Informal Presentation: Changing Role of Nurses in Health Care Reform

Colleagues and friends as the country continue in the effort to transform the health care reforms in what has come to be popularly known as the health care reforms, our role as nurses cannot be understated. We, nurses, are the spine of the health care system in this country. That statistic alone means we are a major ball player I the reform process. An analyst from various quarters sees a future health care system where our roles as nurses will be expanded to not only the acute care centers that many of us have become accustomed to but also to the community (Auerbach, Staiger, Muench, & Buerhaus, 2013).  I believe these are news to smile about; I mean correct me if I am wrong but the new changes are bound to provide more jobs for our nurses.

Compared to other non-health care professionals, the demand for registered nurses (RN) will continue to grow with the health care reform. The increasing demand of the RN will be down to the continuous increase in the population of Americans; one community group I particular that is the culprit to this upsurge in demand is the aging population (Hassmiller, 2017). I believe a majority of you have come to the realization that more and more Americans over the age of 65 years are increasingly showing up in our workplaces to seek care. As I had noted earlier there increased demand for RNs is likely to be felt least in the acute care settings. There will be a shift from the acute care facilities to outpatient care provision centers.

Moreover dear friends, these outpatient settings will experience the most rapid growth in employment for RNs. To be specific, we will see a lot of RNs getting employed in the physician offices and the home health care settings (Glazer & Fitzpatrick, 2013).  Important to observe is the fact that in these outpatients settings we will take up multiple roles. Nurses will be expected to serve as the chronic care specialists, case managers, and patient educators. Happy are you who are highly skilled in these areas or have additional degree programs or certificate programs tucked away for you shall have a significantly added advantage. I wouldn’t want to turn up for an interview with such fellows…

Moving on, I will talk about Accountable Care Organizations (ACOS). Now, these are health care workers who join up in groups and work in teams that through coordination of the care of a group of patients try to achieve affordable, patient-centered and quality health care.  I believe I have just about covered it unless anybody has an addition or a query. I agree that ACOs put a lot of emphasis on giving better health care by improving the quality while reducing the cost of health care throughout the continuum of care (Auerbach, Staiger, Muench, & Buerhaus, 2013). From my experiences with them, I have learned that they try to inspire a change in culture to one that will enable them to achieve their fundamental three goals of improved, high quality and cheaper health care for Americans.

Quite often I have compared the health care from ACO to that from the traditional Medicare. I can’t help but feel that ACOs puts in a lot of effort to provide health care that is smooth, continuous and high quality as compared to the fragmented care in Medicare’s current fee for services model. I hold no bias by the way. What’s more, nurses have an integral role to play acting as providers of an advanced level of care, communicators, and coordinators of care. Then there are medical homes otherwise known as patient-centered medical homes (PCMHs) (Glazer & Fitzpatrick, 2013). The PCMHs are mainly primary care health facilities where patients get access to interprofessional, interdisciplinary and coordinated health care. In such facilities, patients get personal health care providers that initiate and maintain a continuous patient relationship, handle management of the care team and are accountable for the continuum of attention.

Such teams consist of doctors, APRNs, and the other cadres of nurses who try to provide patient-centered care that is integrated. PCMHs utilize multiple strategies such as information technology, teamwork, collaboration, and self-management (Sullivan, 2013). Care in such facilities s tailored to meet both the long term and short term goals of the patient; this is regardless of the settings, life stages, and levels of care. It might interest you to know that APRNs can and have been taking charge of PCMHs in some states that have authorized nurses to lead practice. Boy, I’m I glad…there are efforts in place to change the rather restrictive policies in the remaining stats to allow us to take the mantle when and where we are qualified to take (Auerbach, Staiger, Muench, & Buerhaus, 2013). We play a critical role in these PCMHs through coordination of care especially when there is a transition in care. We add a lot of value to these PCMHs for all you doubters, for instance, the concept of holistic care; many physicians lack that but we nurses bring that to the table.

Communities, as I have stated will be the new employment haven for the majority of nurses due to the health care reforms. They will come in the shape of Nurse-Managed Health Clinics (NMHCs). NMHCs will be sited accessible for services, mainly wellness care and/or community-based primary care that will overlook the patient’s ability to pay for the services.  They NMHCs will provide care in communities that are underserved. The nurses will be responsible for a majority of the care provision. The care team will be inclusive of APRNs and RNs, plus physicians where and when there is an indication (Sullivan, 2013).

Summary of Feedback

My interaction with my colleagues yielded fruitful information from which we got a better understanding of the changing and expanding roles of nurses due to the health care reform. The three nurses were largely in agreement with my findings that the health care reform would broaden the role and practice scope of the nurses.  One of the nurses rightly noted that the, unlike the RNs, the ARNs were designed to promote continuity of care ideally within an eight-hour schedule for five days in some hospitals in the state. This role, they said, was made to be constant throughout the patient’s experience. The nurses noted that the patients were now able to see the care provider before admission and post discharge. This new system was observed by the nurses to be different to anyone they had seen before especially because after evaluation of their work they realized that the ARN had made a significant contribution to improving quality and the satisfaction of the patient (Hassmiller, 2017).

The nurses were in agreement that the ARN was just one of the multiple new roles for nurses due to the changing health care system. They said that the new roles were empowering them to play a greater role in lowering the cost of health care while improving the patient experiences and population health. The nurses further reported having noticed a reduction in unnecessary and expensive hospitalizations and medical errors due to their new roles. Also, the nurses were providing cheaper, convenient, and patient-centered primary health care services in the community health care facilities.  Among their new roles, the nurses cited coordination of attention among many providers, management of caseloads of patients who had intensive care needs, plus helping clients to in transitioning from the hospital setting to their homes as particularly exciting and challenging.

They even gave accounts of their colleagues working as a nurse in other states who had become health coaches who prevented illness and promoted wellness of their populations in their new role. Particularly exciting were the new paths being charted in emerging fields like informatics, telehealth, genetics and genomics for nurses as scientists in society (Glazer & Fitzpatrick, 2013).  Among the nurses were traditional RNs and APRNs, and even they felt they had not been left out of the reform process. They reported expanded roles as well. After interacting with these nurses once gets the impression that despite the fact that they were once perceived as subordinate and subservient they are now working as full partners who are essential to the success of the interdisciplinary teams.

The fact that APRNs can open Nurse led primary care facilities without any form of supervision from a doctor bodes well with his lot, in fact, there is a very conscious desire to have these scope widening laws enacted in all the states in the country. The nurses see the health care reform as an opportunity for clear benefits with better clinical performance and patient experiences included in the package. In a nutshell, this information I shared with these three nurses received a welcoming reception. All were in harmony and total agreement that the health care reforms are the best thing to happen to the scope of practice and roles of nurses in a long time. The nurses even added me a couple of benefits the reform has brought and would bring to nurses working in America.


In conclusion, this article has provided an informal presentation that has described in detail, the changing function of the nurses due to the health reform. The nurses have embraced the process because of the expansion of their roles in bettering the health care system. Nurses’ scope of practice and role has been expanded to community settings and home-based care settings. The reform is likely to increase the rate of employment for nurses. Also, the papers have given a detailed summary of the reactions of three nurses to the impact the health care reform has had on their roles and scope of practice.




Auerbach, D., Staiger, D., Muench, U., & Buerhaus, P. (2013). The Nursing Workforce in an Era of Health Care Reform. New England Journal Of Medicine368(16), 1470-1472.

Glazer, G. & Fitzpatrick, J. (2013). Nursing leadership from the outside in (1st ed.). New York: Springer Pub. Co.

Hassmiller, S. (2017). Nursing’s role in healthcare reform – American Nurse TodayAmerican Nurse Today. Retrieved 8 February 2017, from

Sullivan, D. (2013). Rising to the Challenge of Health Care Reform With Entrepreneurial and Intrapreneurial Nursing Initiatives. Creative Nursing19(3), 166-167.