The healthcare system is deemed to change in the near future, based on the current trends and the demographic dynamics experienced in the United States. With this anticipation, there comes a concern about the nursing practice. The field of nursing is also expected to transform in terms of not only practice but also leadership and education for it to be on par with the changing environment of care. It is therefore imperative to talk about these transformations, and that is what this presentation is all about. Most of the changes that are experienced in healthcare provision are centered on the Patient Protection and Affordable Health Care Act (PPACA) of 2010. The underlying focus of this legislation includes cost reduction and quality healthcare.
Until 2010, the system of healthcare in the United States was fragmented and void of any defined responsibilities for the coordination of service. In a bid to resolve this, the PPACA was enacted to allow incentives to support the Integrated Health Care Delivery Models and funds to assist in the provision of quality and coordinated care. To that effect, today’s presentation will involve me talking to you as a fellow nurse and nurse leader with the intention of discussing the concepts that will affect the changes in nursing including a continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
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Continuum of care is a model involving a system that tracks and guides the healthcare delivery over time through a full array of service that spans all levels and intensity of care. In other words, this concept refers to the connection that exists between the patient and the practitioner, which entails activities that transcend beyond particular episodes of illnesses ( Uijen et al., 2012) . In essence, a continuum of care focuses on two major components: the individual context and the client’s health requirements, and the period of care. As you all know how the medical care involves multiple caregivers and organizations, there is a need to maintain continuity of care that a client receives especially during transfer between the givers. There is a need to keep updated information about the care including the history of the patient and communicating this information to the different parties ( Uijen et al., 2012) . There are three types of continuum of care. First, management continuity refers to the consistent approach of managing a disease that is responsive to the changing client requirements. Second, there is relational continuity, which involves the constant therapeutic relationship between a caregiver and a client. Finally, we have informational continuity and this describes the effective utilization of information on past incidences and those on individual condition to make current care that is patient-centered ( Uijen et al., 2012) .
The second concept I would like to share is accountable care organizations (ACO). This is a network of doctors, hospitals, and other healthcare providers (including nurses), which functions voluntarily to provide high quality care that is coordinated to the patients who are Medicare beneficiaries ( Rosenbaum & Burke, 2011) . This coordination is important to the clients as it helps them get the right care at the right instance. The main objective is to prevent unnecessary duplication of services and avoiding medical errors. Nurses have to be taught about this collaboration as part of extending the benefits of the Affordable Care Act (ACA), of which ACOs are part ( Rosenbaum & Burke, 2011) .
Another concept is that of medical homes. Of importance is that this model is not a place, but a strategy to offer care. Also known as patient-centered medical home (PCMH), it describes the team-based healthcare delivery approach that is aimed at providing comprehensive and continuous care to clients with a focus on obtaining maximal outcomes ( Nielsen et al., 2014) . The main feature of this model is that it is patient-centered and designed around these needs to improve access to service, increase coordination, and enhance overall quality. When combined, all these help in reducing costs. This model is in line with the basic nursing education that is a holistic approach to putting the patient needs first.
The last concept is nurse-managed health clinics (NMHC) and these are primary healthcare centers headed by the advance practice nurse ( Auerbach et al., 2013) . This is an important model with the increase in state and federal funding. NMHC is a concept that involves offering the patient treatment that involves assessing the overall environment of care instead of just focusing on their disease ( Auerbach et al., 2013) . NMHC is important in advancing the nursing profession as it highlights its (nursing) importance. This concept is promising for the care of patients in critical care as they are suitable to serve the under-served populations. Of importance also is that these centers can serve as training facilities for nursing students.
The concepts discussed afore are essential in making sure that the nursing profession is at par with the dynamic healthcare system.
Nurses’ Response
After presenting my research to the nurses, I received mixed reactions towards the change process. It is imperative to note that the nursing field is the same as any other industry and how the people react to unprecedented change is the same. I shared my education resources with three nurses and noted their reactions in writing. Overall, it is apparent that most practitioners know that the healthcare system is changing and doing so at a fast rate. All the three professionals that I contacted knew that some changes were taking place but did not know in what areas of nursing, in particular, were they happening. In this regard, they appreciated the presentation on the three areas that I tackled. However, they experience the changes in healthcare delivery and work environment from the observations they have made in several instances. The practitioners comprehended the need for nurse leaders to create a safe working environment in all the settings that are affected by the changes and to all the nurses that are in various professional capacities.
The professional colleagues reiterated that the changes are supposed to be checked from all angles because they seem to be beneficial to the nursing profession while at the same time having myriad challenges. Of importance is the transformation that will take place in healthcare delivery for the benefit of the patients and the nurses. The colleagues highlighted that the system of healthcare was moving towards the community as opposed to the conventional hospital setting. In this way, the nurses will have an opportunity to offer their skills in broad and new ways. There are changes in the provision of services as facilities such as ambulatory surgery centers and retail clinics tend to serve patients outside the hospital setting. This means that the nurses have more opportunities in many places than in the past. As a result, more practitioners will be able to apply for jobs in the ambulatory care, nursing homes, or home care. One of the colleagues noted in particular that the nursing profession might be heading to where it first started. Traditional nurses were visiting people in their homes and interacting with the community at large instead of being confined to the hospital setting. Community and home-based services are on the rise and with the changes, the practice may be in a better position for the maximum provision of care.
With the increase in attention towards preventive care, the nursing roles will be broadened. Nowadays, the medical field and the insurance payers are in a collaboration to encourage patients to live healthier lifestyles thus preventing several non-communicable diseases that have been rampantly on the rise. With this in place, the nurses will be in high demand to offer coordination with other practitioners and professionals including psychologists, physical therapists, and nutritionists. Part of the changing healthcare models is the introduction of ACOs and its pillar is an interdisciplinary approach to disease management. This means that collaboration has become a preferred form of care delivery. This makes the nurses have a good chance of owning and being part of the decision-making process.
In addition to adopting the advancing technology, nurses will increasingly join forces with colleagues and other professionals outside the nursing field on a regular basis. This means that the care delivery team will comprise a large group that includes pharmacists, social workers, and caseworkers, among others. This means that the top-down approach of patient care is no longer applicable in the modern times when the organization wants to be at par with the requirements of the ACA. The nurses have to lead from the frontline, as they are the ones who spend more time with the patient during their period under care.
With all the benefits, the change offers to the nursing practice, the colleagues also saw the other edge of the sword and the need for concern. Apparently, the profession has experienced several challenges from the past that need to be addressed. They include the problems of understaffing and burnout, to perceptions about the nursing practice as a whole. The nurses that I talked to appreciate that there is a dire need to reconcile the past constraints that the practitioners have been facing since the inception of nursing. This comes at a time when the roles of nurses in the healthcare system have received several backlash and biases that make the profession look subordinate to others. For a long period, it is always believed that nurses act as the helpers of doctors and that they are not allowed to diagnose a disease or order for referral for occupational or physical therapy. While this is not experienced in the entire nation, there are states that have stringent restrictions towards nursing practice.
With these still in place, the nurses I contacted feel like it would not be easy for the nursing profession to keep up with the changes. For example, when looking at the nurse-managed health clinics, it is imperative that the Advance Practice Nurse (APN) will make most of the decisions. It baffles one’s mind how, with all the restrictions that exist in the practice, such a nurse will navigate the rough road towards this change. On the other hand, the colleagues felt that the role of the PPACA is to ensure that the gaps are filled. They are confident that with the introduction of such changes, the perception of the nursing practice will be different from what it used to be. Their confidence lies in the fact that the NMHCs will be an avenue for the nurses to prove that they are capable of managing a healthcare facility. Of great concern was the need for the nurses to continue their education and understand what is required by the changes. The colleagues felt that lack of knowledge was a drawback in achieving most of the transformation goals.
In conclusion, there was unison in the fact that the changes that are taking place in healthcare are inevitable as the government pushes them. Thus, the professional nurse has to be ready to embrace the transformation because it leads to the redefinition of nurse roles in various settings.
References
Auerbach, D. I., Chen, P. G., Friedberg, M. W., Reid, R., Lau, C., Buerhaus, P. I., & Mehrotra, A. (2013). Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage. Health Affairs , 32 (11), 1933-1941.
Nielsen, M., Buelt, L., Patel, K., Nichols, L. M., & Fund, M. M. (2014). The patient-centered medical home’s impact on cost and quality. Annual review of evidence , 2015 , 202014-2015.
Rosenbaum, S., & Burke, T. (2011). Accountable care organizations. Public Health Reports , 126 (6), 875-878.
Uijen, A. A., Schers, H. J., Schellevis, F. G., & van den Bosch, W. J. (2012). How unique is continuity of care? A review of continuity and related concepts. Family Practice, 29(3), 264-271.
