There are multiple revolutionary changes and reforms that are being witnessed in nursing. The question remains what the effect of the revolution is to the profession both today and in the near future. Predicting the future of the profession is viable through a cross examination of the current trends. Despite the presence of controversial issue that are being witness presently, nursing remains to be the vibrant and charming career that it once was. We anticipate it to be even more interesting in the new future with the adoption of the new technology at the workplace. Considering the enthusiasm that is driving the change for both the patient and the nurse, it is without doubt that the profession is taking off for the better. The new guidelines that are being provided by healthcare associations serve as the driving forces that are steering this sector forward. The important aspects to consider for the expected growth to be effective include the concepts of continuity, the nurse-managed health clinics, medical homes and the accountable care organizations.
Accountable Care Organizations
We have witnessed the exploitation of patients as well as the nurses over the past decades. This is in terms of either being overworked for little pay or in terms of patients received poor quality care at high costs. This prompted the implementation of the Patient Protection and Affordable Care Act. The Act provided a way forward to help hospitals, physicians and other caregivers in the improvement of safety, access and quality of care in the process of decreasing costs and bringing about accountability. The Accountable Care Organizations are a making of the U.S. Department of Health and Human Services with rules and regulations to coordinate the care of Medicare patients (Christensen, Flyer, & Vijayaraghavan, 2013) . The organizations have considered the needs of the patients first, and this is a milestone and the basis for improved quality of care.
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Nurse-managed Health Clinics
Gone are the times when nurses used to take all instructions from the physicians on call. With the advent of the advanced nursing studies, nurses are now in a position of handling medical procedures that were once reserved for the doctors. It is now a matter of when not if the nurses should be allowed to take charge of clinics. The future looks bright since there will be a decrease in the doctor patient ratio as some of the patients will be attended by nurses. It should be understood that the provision of health insurance to an additional 30 million Americans will mean an inadequate availability of primary care providers. This is why we shall witness upspring of nurse-managed health centers across the country.
The Concept of Continuum of Care
The past practice of nursing care involved an episode management of the patient. Patients were treated acutely and then discharged without anyone bothering to address the long term complications of the conditions. With the continuum of care concept, the patients are now and shall be in a position to receive holistic care. Nurses are expected to address the socio-economic circumstances of the patients as well as pay close attention to the patients with chronic conditions to prevent the development of complications. It is cheaper and convenient for an insurer to pay for ongoing primary care that supports the wellness and health of an individual rather than paying for high-cost emergency room interventions that may be fatal to the patient (The Sentinel Watch, 2015) . The array of services that come with the continuum of care concept will bring about the desired change to the nursing profession.
Evidence-Based Practice
We are living in a time when any intervention to the patient should have been proven to work with other patients. Things are not done routinely with a repetitive nature since this will increase errors. Take an example of the success story of the Magnet hospitals by the Magnet Recognition Program. They have their nurses comply with the policies of the institution which include adhering to the evidence-based practice. At present and in the near future, evidence based practice will serve as the foundation for the management of diseases (Saver, 2006) . The nurses are expected to be in the forefront as the management and prevention of diseases is their responsibility.
Response: Mixed Reactions the Future Prospect
What about Evidence-Based Practice
As much as the future of nursing is focusing on evidence-based practice, not all the nurses are in agreement with the idea. One of my older colleague nurses spoke with fury claiming that an old dog cannot be taught new tricks. To some point, this is a true fact given that they have been in the industry for a relatively longer period of time and have their way of doing it. I mean they are experienced and do not need much directives for them to work. But again, Porter-O’Grady concludes that evidence based practice is more than a buzz term as it is all about getting a handle on that which is done and is valuable. It is about doing a concept one time and the second time right, and getting it even better over and over again. This is where the profession is headed and this concept is meant to do away with the mortalities associated with repetitive errors.
Safety and Quality
Programs that track the impact of the nurses on the patient care have shown that the current trend is just but a representation of the future. Rebecca Patton points out that the nurses are important in the delivery of high-quality and safe care as per the National Quality Indicator Database. The most fascinating part is the point where the government as well as other third party payors are rewarding healthcare facilities depending on the quality of care delivered to the patients. Nothing motivates any worker as a recognition by their employers for the work well done. The future is bright and the plane has already taken off. One of my colleagues concurred with me with regard to the accountable care organizations that have sprung up in the country to ensure that consumers are not exploit and ensuring that the Patient Protection and Affordable Care Act is followed to the letter. This is meant to ensure that there is a high quality of care and that the patients are managed safely all the time. Nursing has grown and changed and is still on the right track to transform completely to regain the prestige that was once associated with it.
Compromised Quality with Nurse-managed Clinics
It is sometimes difficult to explain why a nurse should be allowed privileges of a doctor and be left in-charge of a clinic. This is a point raised by one of my colleagues when discussing the role of nurses in bringing about the change and reformation. There is a lot of unwillingness to credential nurse practitioners as primary care providers resulting in a limited funding of such centers from private insurers. Nurses are in the forefront in the provision of the continuum of care. This means that they not only attend to the patients acutely, but should rather follow them up until they recover fully. There are patients who suffer from chronic conditions and if not followed up closely, they may end up developing complications and even suffer from serious side effects of the drugs that they are using. Studies have shown that it is cheaper managing the primary condition continuously rather than dealing with the emergency complications.
There is some sense in arguing against the nurses being in charge of clinics, but there are some things that have to be considered in the risk benefit ratio. First, it is an advanced nurse who is allowed to be in charge clinics. Their target audience is always the underserved and their role is emphasizing health education, promoting health and preventing disease. It is difficult for the current physicians to take care of the additional 30 million citizens who have been newly insured. It makes sense allowing some of our advanced nurses to take charge of other health facilities. This is meant to cater for the deficit that may result in the decline of the health industry. Recent data indicates that at least 200 nurse-managed clinics are operating in 37 states with a roughly estimated attendance of two million patients (Kovner & Walani, 2010) . This number is anticipated to rise drastically in the coming few years. There is a general positive atmosphere regarding the anticipated change and the acquisition of new roles by the nurses.
The Role of Nurses
We cannot deny the fact that the role of nurses is becoming more and more important amidst the dire need for change and transformation. There is an increased need for more healthcare attendants as indicated by the Center for Studying Healthcare Change (U.S. Department Health and Health Services, 2011) . More authority is being delegated to the nurses and as time moves, they will be solely responsible for all that happens in the clinics and become medical attendant champions. Within the medical homes, it is the nurses who have the responsibility of taking care of patients both acutely and in a long term basis. In the nurse-managed clinics, they are the centers of authority as they champion and advocate for a healthy work environment. It encompasses the strict observance of the codes of conduct that are geared toward bolstering quality and safe care of patients. Effective patient support will only prevail in an environment where unprofessional conduct and incivility are pruned from the nursing environment. It is anticipated that the nurses will take a new role in the hospital settings as they will become the managers of technology and be at the core of genetic adoption. Change does not only come but is a process that needs to be implemented. The change exercise requires the health care centers to be guided with steady authority, a reasoning value of obligation, significant input from all the stakeholders and a sense of healthcare championship.
References
Christensen, C., Flyer, J., & Vijayaraghavan, V. (2013, February 18). The coming failure of 'accountable care.' The Affordable Care Act's updated versions of HMOs are based on flawed assumptions about doctor and patient behavior. The Wall Street Journal .
Kovner, C., & Walani, S. (2010, January 26). Nurse Managed Health Centers (NMHCs). Campaign for Action .
Saver, C. (2006, October). Nursing – today and beyond. American Nurse Today .
The Sentinel Watch. (2015, July 21). Different Nursing Roles in the Continuum of Care. The Sentinel Watch .
U.S. Department Health and Health Services. (2011). Accountable care organizations: Improving care coordination for people with Medicare . Retrieved September 20, 2017, from Healthcare.gov: http://www.health care.gov/news/factsheets/2011/03/accountablecare0331 2011a.html
