The traditional approach to healthcare generally, including in the USA was reactive in nature as opposed to being continuous. The hospital was a place for the sick while a meeting with a healthcare official would be avoided unless it was very necessary. The cost implications of modern healthcare in America augmented this reactive approach with patients afraid that interactions with healthcare professionals would cost them more than they can afford. This traditional approach is currently being replaced with a more proactive approach under the modern restructuring of the U.S. health care delivery system. The new structure will see healthcare become relational in nature, a fact that will augment the already critical role then nurses play in healthcare (Wager, Lee & Glaser, 2017). Under the new role, concepts such as continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics will gain more prominence. The growth of such sectors will, in turn, increase nursing opportunities in healthcare necessary, although the traditional roles in acute care may not be affected inordinately.
Continuity or Continuum of Care
Under the most modern definition, a continuum of care refers to a cycle of care that follows a patient from birth to death. Under continuum of care, clinicians constantly and carefully follow up on the patient, instead of members of the community seeking for medical attention as and when they feel a need for it (Wager, Lee & Glaser, 2017). The concept combines traditional approaches such as acute care with more modern concepts such as ambulatory care on the one hand and public health approaches such as outreach, wellness, and even housing. Under such an approach, the interpersonal relationship between the nurse and the patient as under the concept of care continues even when the patient leaves the hospital (Wager, Lee & Glaser, 2017). Automatically, more nurses will be needed under this approach.
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Accountable Care Organizations (ACO)
Among the major players in a successful continuum of care system, is the accountable care organizations (ACO). An ACO is essentially a voluntary conglomeration of medical practitioners, hospital and other healthcare stakeholders to provide healthcare to a community (McWilliams et al., 2016). The philosophy behind ACO is that treatment is exponentially cheaper of ailments when intervention is timely. ACO seeks to either prevent ailment or catch and mitigate ailment in good times. For example, controlling hypertension is cheaper before the condition exacerbates and causes a heart attack or stroke. Early diagnosis and proper management at a community level can thus save a lot of money that would otherwise have been used in acute care. Successful ACO operations will cut cost for public health systems such as Medicare which savings the ACO can then share (McWilliams et al., 2016).
Medical Homes
Patient-centered medical home (PCMH) also called medical home is a concept of providing comprehensive and continuous care through professional coordination. Under the traditional approach, different specialists would provide different aspects of care for a patient. Under the medical home concept, the different professionals would exchange notes and coordinate in order to provide harmonious care for the patient. The principles of medical homes include having a continuous relationship with the patient that combines continuous and comprehensive care (Wager, Lee & Glaser, 2017). However, the cost of medical homes has been criticized for the cost implications for patients. Despite heightened costs, medical homes are superior in patient outcomes when compared to ordinary, mainly reactive care.
Nurse-managed health clinics
Nurse-managed health clinics are in America is primarily related to cost-mitigation for patients who cannot afford modern healthcare costs. The main clientele for nurse-managed clinics is the uninsured and the under-insured. Under the concept, a healthcare model centered on advanced practice registered nurses (APRN) is created (Auerbach et al., 2013). The center is then affiliated to a standard hospital or a university. Normally, the APRN is qualified, competent and certified to carry out most of the healthcare obligations traditionally limited to physicians and other specialists. The APRN will thus lead other nurses to take care of patients a fact that exponentially lowers costs for the patient. Further, the nurse-managed healthcare liberates the numbers of nurses needed in a healthcare institution from the numbers of doctors or other specialists that nurses support (Auerbach et al., 2013). The instant concept thus exponentially augments the demand for nurses in America.
Discussion on the Acute Care Perspective and Conclusion
It is evident from the totality of the above that the restructuring of the U.S. health care delivery system will augment nursing opportunities in America. Nurses who are already trained will find employment easily while the demand for more nurses will rise. Concepts such as the continuity or continuum of care, accountable care organizations (ACO), and medical homes, will increase the demand for nurses per unit patient. Conversely, concepts such as nurse-managed health clinics will ensure that the numbers of nurses that can be hired are not dependent on the numbers of other professionals. Better quality of care combined with early detection and management of ailments because of the restricting above is bound to mitigate exacerbation of ailments. An argument can thus be made that the new demand for nurses will be countermanded by reduced demand for nurses in acute care. However, this may not necessarily be the case. Whereas early mitigation may prevent many patients from having acute conditions, modern lifestyles are also increasing the propensity for ailments that may lead to acute conditions. For example, lifestyle-based conditions such as hypertension and diabetes, which happen to be primary drivers for acute conditions are on the rise. From the totality of the above, the demand for nurses seems to be increasing from all perspectives both from traditional acute care and from the modern concepts defined above.
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.
McWilliams, J. M., Hatfield, L. A., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine , 374 (24), 2357-2366.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: a practical approach for health care management . Hoboken, New Jersey: John Wiley & Sons.
