Evolving Practice of Nursing and Patient Care Delivery Models

Evolving Practice of Nursing and Patient Care Delivery Models

Hello everyone! I Ishwari Basnet,I am a registered nurse and work in medical \surgical\mental health unit for more than ten years. I would like to welcome you all in this informal education session. Today, I would like to discuss about the changing role of nurses and concept of continuum of care and the new health care delivery models such as Accountable Care Organizations (ACOs), medical homes, and nurse -managed health clinics. Evolving Practice of Nursing and Patient Care Delivery Models

Evolving practice of Nursing and Health Care Models

Health care system is changing; it is not just focused on the curative care but the disease prevention and wellness. Also, the new healthcare reform has approach to the development of healthcare delivery models with the changes in nursing role from acute care settings to community health care. Patient Protection and Affordable Care Act (PPACA) formed at 2010 support the establishment of ACOs, medical homes and nurse-managed health clinics; also new payment policies. With the formation of Affordable Care Act (ACA), health has transformed from traditional treating approach to the preventive and wellness. Nurse’s role has also changed from front-line caregiver to the care integrators and coordinators and help in providing the health services to the underserved people. All the health models are focused on the concept of continuity of care which is defined as “a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care” (Evashwick, 1989). It covers the delivery of healthcare over a period of time and for all levels and stages of care. Let’s talk about the three types of health care delivery model. Evolving Practice of Nursing and Patient Care Delivery Models

Accountable Care Organizations (ACOs)

In accordance to the Center for Medicare and Medicaid services, “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (Cms.gov, n.d.). The ACO is the new unit built by the ACA; the health reform law 2010 which take care of the cost and quality of the care received by the patients. The main aim of ACO is to deliver flawless and high-quality care at the right time to the patients, especially the chronically ill patients. The ACO include the specific group of providers and suppliers assigned by the ACA and they encourage the active participation of nurse practitioners (NPs), clinical nurse specialists (CNSs) etc with physicians and physician assistants. As nursing leadership is encouraged in ACO, registered nurses can lead in quality assurance and develop the improvement initiatives (Nursingworld.org, n.d.). Evolving Practice of Nursing and Patient Care Delivery Models

Medical Home/Health Home

Medical homes (patient-centered medical homes, PCMH), similar to Accountable Care Organizations are primary health care delivery model focused on the deliverance of the primary care that is patient-centered, managed, synchronized, accessible, ample and believe in quality and safety.  “The medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs” (Pcpcc.org, n.d.). This medical health model helps in solving the health care costs problem with the support of primary care providers such as physicians, nurse practitioners and certified nurse-midwives. Nurses being front-line healthcare workers play a vital role in this model as they can actively participate in health promotion and disease prevention, order and interpret laboratory tests and other studies and refer the patients who need specialized care. Evolving Practice of Nursing and Patient Care Delivery Models

Nurse-Managed Health Centers (NMHCs)

NMHC is another initiation developed by ACA to promote the primary care, disease prevention and control of chronic conditions in the medically underserved and rural areas of United States. NMHC’s are managed by the nurses that include all the nurse practitioners, clinical nurse specialists, nurse midwives, and public health nurses. They provide many health services especially in the needed communities such as diagnosis and prescription to illness, pre- and post- natal care and referral to specialists (About Nurse-Managed Care, n.d.). This care model maintain the nurse managed clinics with the aim of enhancing access to primary care in the communities of medically underserved and/ or vulnerable populations, boost up the nursing practice and leadership for the nursing students by serving as clinical training sites and maintain the patient and workforce data. Evolving Practice of Nursing and Patient Care Delivery Models

To conclude, ACOs, medical homes and NMHCs are the concept of new health care delivery model created by the ACA to minimize the issues of health care cost and easy access of quality health care. These models are mainly patient-centered, competent, accessible and cost effective. The establishment of these types of health care delivery models has changed the role of nursing and set new parameter for the nurses. Nurses have advanced beyond the role of front-line healthcare workers to become care coordinators, efficiency experts and prove to be the backbone of most of these delivery care models. Nurse play as a care integrators and focused on the continuum care from the acute care to the community health settings through these models. Moreover, with the advancement of health technology and health reforms, preventive base health care has taken the priority than the curative care and nurse role is very important towards preventive health care too. Therefore, the opportunities for the nurses are increasing and the demand of the educated, skilled and professional nurses are vital during this changing time of health care system. Evolving Practice of Nursing and Patient Care Delivery Models

Thank you for hearing me and participating in this session. If you have any queries, please feel free to ask. I would look forward to hearing your opinion.


Summary of the Feedback

After this author gave the presentation, all the nurse colleagues took part in discussion session about the benefits and changes that new health reforms and the health care models brought in health care system of the country. This paper will summarize the feedback received from three colleague nurses and forecast the role of nursing.


Nurses who took the active participation in the discussion have their own point of view regarding the healthcare reforms and change of nursing role. However, majority of the number have similar point of view about my presentation and support the new healthcare reform. They also appreciate the new health care delivery models and the role of nursing in these care models. Evolving Practice of Nursing and Patient Care Delivery Models

‘Nurse A’, BSN nurse graduated from Bangladesh and working here in United States at recent times, talked about her experience she had as a nurse back in Bangladesh. She expressed that it was totally different; nurses are the front-line caregivers and are not allowed to take any decision; only follow the orders of the doctors. The role of nurse in health care system differs according the location and time. The emergence of importance of community health is providing the opportunities to the nurses in developed countries like the USA and this new health reform is being following by many developing countries as well. She is very happy and ambitious with this new healthcare reforms and healthcare models. Moreover, the role of nursing has been changing from the front-line caregiver to the care integrators and from acute care settings to the community. Nurses’ role in community settings is the major advancement in healthcare system such as NMHCs. Nurses can work as a leader of the organization in the community setting with self directed, critical thinking, and independent decision making qualities. She focused on NMHCs, where nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. Therefore, new healthcare reforms help to provide nursing role a new perspective and lead to an innovation healthcare system. Evolving Practice of Nursing and Patient Care Delivery Models

‘Nurse B’ was also very excited about the healthcare reform as it believes on the potential of nurses for the transformation of US health care system. She focused on importance of the new health reform because of increasing chronic disease and cost and also taking on preventive care over the curative care. The new healthcare delivery models (ACOs, NMHCS, medical homes) will enhance the preventive care services leading the management of the chronic diseases in the community settings. This will help in reducing the problem of rising the cost of health services and can make aware about the disease prevention and health promotion. Moreover, preventive care services will require huge number of educated nurse workforce and leadership to improve the community’s health care. She further added up that the nurses are the fundamental to the patient-centered care delivery model. The nurses have the capability of building a strong relationship and coordination with the patients and the health care providers’ team and lead in organizing and functioning of different health care models. According to her, the concept of the new health care delivery model of providing the facilities to the underserved people is commendable. Evolving Practice of Nursing and Patient Care Delivery Models

‘Nurse C’ has different point of view regarding the healthcare reforms and healthcare models. She expressed her anxiety about the quality of the services provided by the hospitals and healthcare models when large number of people will be flooded into it for the treatment. She explained that Affordable Care Act (ACA) will benefit large number of people causing the crowd that will definitely affect the hospitals and health systems to take care of the influx of the new patients. That is increase in administrative cost, much more paper work, disease and care management, over-seeing and time dealing with Medicare for the millions of newly insured patients. She added that increase in number of patient will imply to the must increase in number of healthcare providers and nurses. If the strong and enough approach are not taken for the fulfillment of the need of nurses and healthcare providers then it will directly affect the quality of care. Moreover, it will affect the status and motivation of the existing nurse workforce. Therefore, she highly looked forward for the high-quality of health services provided to the patient that is she believed in quality rather than quantity.

To conclude, nurses are the major part of health care system and the role of nursing has changed and advanced with the implementation of the health care reform and health care delivery system. These types of reforms and models have transformed the entire health care system of the United States from acute care settings to community and benefitted many underserved people. However, knowledge and information of the health reforms should be given to everyone. Evolving Practice of Nursing and Patient Care Delivery Models


About Nurse-Managed Care. (n.d.). Retrieved February 24, 2016, from National Nursing Centers Consortium: http://nncc.us/index.php/about-nurse-managed-care

Cms.gov,. (n.d.). Accountable Care Organizations (ACO) – Centers for Medicare & Medicaid Services. Retrieved 23 February 2016, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/

Evashwick, C. (1989). Creating the continuum of care. Health matrix, 7(1), 30-39.

Nursingworld.org,. (n.d.). Accountable Care Organizations. Retrieved 23 February 2016, from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/ACOs

Pcpcc.org,. (n.d.). Defining the Medical Home | Patient-Centered Primary Care Collaborative. Retrieved 24 February 2016, from https://www.pcpcc.org/about/medical-home Evolving Practice of Nursing and Patient Care Delivery Models

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