Evolving Practice of Nursing and Patient Care Delivery

In spite of the extraordinary challenges faced in the nursing profession, the new Millennium has presented a number of growth opportunities as well as a vibrant reform agenda in the sector. The future nursing generation may indeed enjoy the vast opportunities that will be availed by the current reform agenda in the profession. For instance, it is pertinent to mention that there is urgent need to transform the current healthcare systems across the globe owing to the rising cost of healthcare, high rate of chronic infections and a large rapidly aging population. Needless to say, most developed economies (such as the United States and UK) have already embraced the aspect of continuum of care in order to meet the emerging challenges. One of the key areas of concern is the nursing profession bearing in mind that the delivery of care services is anchored in nursing. Continuum of care will ensure continuous and uninterrupted reform of the healthcare sector. This explains why the nursing profession will continue to grow. For example, more nursing jobs will be made available in the community. However, there is a possibility that most acute care hospitals might not be well stocked with nurses if a lot of focus is directed towards community care.

In order to meet the future nursing needs, Accountable Care Organizations (ACOs) are also expected to play a major role in redefining healthcare delivery services through nursing (Crosson, 2011). Medicare patients will be in a position to receive high quality and well organized care through the services of a unified healthcare team. The most vital role of ACOs in nursing is the pooling together of professional knowledge from other healthcare providers so that healthcare recipients can access the best healthcare services. When nurses, hospitals and doctors team up to provide care services, it becomes quite easy to coordinate and prioritize healthcare needs within any given community.

In regards to medical homes, the current reform agenda in nursing will indeed lead to the provision of primary or basic medical care to patients in the most efficient manner. One of the core objectives of medical homes is to redirect care services to patients (patient-centered) instead of focusing too much on the profession itself (Merrell & Berenson, 2010). Medical homes will also revolutionize the current accessibility level to nursing care services because it will be availed to patients in their homes. Medical homes are also highly likely to be well equipped with all the necessary tools required to offer various nursing services. For example, the team-based approach embraced in medical homes will continue to be the cornerstone for comprehensive care delivery in the nursing profession.

Through the nurse-managed healthcare clinics, the nursing workforce will receive additional capacity building and training program so that they can offer the highest standards of care services. Access to primary care will also be increased if the nurse-managed healthcare clinics are fully equipped (Coddington & Sands,n2008). The primary nurse practitioners and the Advanced Practice Registered Nurses are wholly charged with the responsibility of offering nursing care services in this type of clinic. Since such clinics often work alongside institutions of learning, there is a wide possibility of undertaking research-based activities. Besides, the interdisciplinary teams will be of great help in offering services to patients who can hardly access the mainstream healthcare facilities (Gardner, 2009).

Responses from colleagues

After conducting the above research activity on nursing reform, I interviewed three different colleagues regarding their perspectives on nursing reform. To begin with, a middle-aged coworker named Mohammed asserted to me that the current healthcare reform might not generate the anticipated results in the future if the government of the day does not inject additional funds and incentives into the healthcare sector. Mohammed reiterated that the current reforms have taken too long to yield any positive results because successive governments have never taken any leading roles to improve service provision in most healthcare facilities. To some extent, there is need for political will from the government and Congress as a whole so that adequate funds can be availed to train additional nurses, equip healthcare facilities with the necessary drugs and equipment, improve the overall working condition of nurses and also remunerate the profession attractively.

When I asked Mohammed about the philosophy of medical homes, he responded that such homes have indeed been beneficial to communities. However, the less affluent segment of the population might continue to suffer because they simply cannot afford the cost of medical care. It is apparent that the current healthcare reform that targets the nursing profession has not put into consideration the issue of poverty and how the latter affects delivery of care services. Mohammed added that the government should not be proud of the reforms whereas the rest of the population is not able to access care. Finally, Mohammed affirmed to me that both nurses’ and patients’ needs should be prioritized as part and parcel of the broad reform agenda.

My unit manager is called Sandy. I also interviewed her regarding the aspect of Accountable Care organizations (ACOs). Sandy observed that these organizations lack well coordinated systems that can facilitate efficient delivery of care services to patients. Both the short and long term goals of ACOs will only be attained if proper alignment or integration of clinical and financial services is firmly put in place. It is only through the provision of excellent medical outcomes that successful integration can take place. Sandy also reaffirmed that these organizations often stand out as alternative channels for the delivery of high quality care. Nonetheless, there are millions of American citizens who may still not be financially stable to access such high quality services.

In order to boost the process of integration, there are a number of barriers that ought to be eliminated in healthcare sector. According to Sandy, the formation of multidisciplinary groups cannot be ignored. Continuity of care can only be managed if the multidisciplinary groups are put in place across the country. In other words, each specialty should be aligned with its unique roles. Besides, Sandy was quite categorical that the patient population has also been a major challenge in the delivery of care services using specialized units. Meaningful outcome data can be generated if patient population is proportional to the number of different available specialized units. Sandy was of the opinion that outcome data are easily measured with a large population size of the healthcare recipients. However, the latter does not rule out the fact that specialized care providers. ACOs will continue to serve the nation in healthcare provision in spite of the prevailing barriers.

On a final note, I interviewed my evening relief nurse by the named Bintu. The nurse is still young in age. When I inquired her opinion about nurse-managed healthcare clinics, she was quick to respond that the nursing profession will continue to rely on the services offered by this segment of professionals. There are thousands of people who probably do not deserve to receive nursing care. Most of the primary care services can be provided in these clinics. Better still, individuals who suffer from acute and chronic infections have greatly benefitted due to the presence of nurse-managed clinics. For example, disease prevention and health promotion services are some of the services availed to patients who frequent these clinics. Moreover, healthcare recipients can also access services such as immunization, smoking cessation, osteoporosis screenings, diabetes, and cardiovascular checks.

To recap it all, Bintu also emphasized that the government should expedite the process of funding nurse-managed healthcare clinics because there are scores of needy patients who may not be able to afford these services. The government may subsidize the cost of accessing healthcare services in such facilities without necessarily transferring the tax burden to users.

From the above discussions and responses, it can be concluded that the practice of nursing will continue to evolve at a very fast rate irrespective of the slow reforms being carried out at the moment. The current patient care delivery models might not be comprehensive or applicable across the entire American population. Nonetheless, the working conditions of nurses should also be transformed alongside the restructuring process that is going on in the provision of care services. There are a number of underlying tenets that definitely determine the growth prospects of the nursing profession.


Coddington, J. A., & Sands, L. P. (2008). Cost of health care and quality outcomes of patients at nurse-managed clinics. Nursing Economics, 26(2), 75-83.

Crosson, F. J. (2011). The accountable care organization: Whatever its growing pains, the concept is too vitally important to fail. Health Affairs, 30(7), 1250-1255.

Gardner, D. (2009). The evolving voice of nursing in health care reform. Nursing Economics, 27(4), 255-259.

Merrell, K., & Berenson, R. A. (2010). Structuring payment for medical homes. Health Affairs, 29(5), 852-858.


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