Efforts to restructure health care in the country are driving changes in nursing and associated sectors. The focus of the new health care reforms is to provide a system that will enable universal access to a cost effective health care. Lack of ability to pay for health care and lack of access to health care facilities were identified as barriers that prevent people from getting timely health care services. Today, the healthcare delivery system in U.S is made of four functional components: Financing, Insurance, Health Care Delivery and Payment. Thus, health care delivery is one of the components of the managed care system. This system was established with the aim of addressing concerns associated with rising health care cost. (Mbamedical.com, 2012)
Managed care is a system of health care that integrates health delivery with other functional components of this system. The system has mechanisms to control health care utilization and payment. Such a public health care system will ensure universal access to health. Similar centralized systems are already functional in other developed countries, and are managed by the respective governments of these countries. This will help to reduce health care cost, that is very difficult to achieve with privatization.
Currently, there are 39.6 million Medicare beneficiaries and 41.4 million Medicaid beneficiaries. On the other hand, the health care workforce has only~ 3 million nurses to handle these patients. This scenario, is likely to cause a shortage of nurses who will be available to deliver care in the coming future. Excessive workload and demand for nurses are important concerns of the healthcare system today. The federal government, nursing organizations and philanthropy organizations are making efforts to promote nursing education, by offering scholarship and convenient educational plans, that will encourage students to opt for nursing.
Both private and public financing of health care has increased the opportunity to avail health care services. The health care reforms are made with the goal to prevent health care disparity, that arises from lack of resources and financing. Medicare and Medicaid, are public sector financing that pays for medical and clinical procedures of the public. Employer and private sector based medical insurances also help people meet health care expenditure. These changes that are happening in health care financing have enabled patients to meet the high cost of health care. Nationalized health system will help overcome the imperfections in the current system. It will prevent third party insurance and multiple players who make the system inaccessible to the disadvantaged community. (Mbamedical.com, 2012)
If the nurses have to effectively manage this new health care system, then they have to understand this new system. Understanding the shift happening in health care and the new regulations, will help identify new opportunities. There is also need for training to empower nurses in the new healthcare system. The new system has interdependent and interrelated components that are established with the aim of achieving quality health services and health care equity.
Health care services will no longer be confined to the physician’s office or hospitals where health services were traditionally provided. In the future, care will be provided in a new setting like at home, subacute care units and outpatient surgery centers. These new settings have emerged in response to the changing health care system, and financial incentives provided to the patients and health care. Nurses will have a dominant role to play in all three categories of care setting: curative, restorative and prevention. The function of health care is not just restricted to providing a cure, but also to restoring functionality to the damaged body and in prevention of diseases. Through community health care services; preventive measures like prenatal care, mammograms and immunization can be made accessible to the population.
There is a need for new models for nursing and practice. The conventional method of classroom based unidirectional education would not be sufficient to meet the challenges of the future. There is a growing cultural diversity in the population and the medical needs of these cultures are different. A culturally competent approach to health care is required to practice a patient centered care.
Likewise, globalization of health, requires that a standard protocol, based on evidences be used to treat patients. Nursing practice has grown from a traditional intuition based practice to evidence based practice. It is important that nurses keep themselves up to date with the advances happening in knowledge and technology. Better health has increased the lifespan of the people, and this has increased the number of aged people in the population. There is a demand for nurses who can meet the health care needs of the aged population. Nursing education has to keep pace with the shifting patient demographics. Likewise, nursing professionals also need to evolve to meet the new health care expectation of the changing system. Nurses today are expected to play complex clinical, faculty and leadership roles. Nursing education is faced with the pressure of training nurses to meet these complex roles. (Models, 2015; Larson & Tobin, 2000)
Being a front line professional, nurses are instrumental in helping the government to realize the objectives of affordable care act. The Affordable Care Act, will provide insurance to millions of Americans, and this implies that there will be an increase in demand for healthcare services in the near future. A detailed assessment will be required to understand and quantify the gap in the capacity of the nursing workforce. This will aid in meeting the demands of the reformed health system. Following this, innovative measures need to be taken at national and local levels to develop skills of the work force. In fact, the Robert Wood Johnson Foundation in partnership with the Institute of Medicine, has made such an assessment and identified vital roles for nurses in the new healthcare system. The committee also recognized the shortage of nursing staff, the need for training in new technologies and other societal issues that are impeding nursing care progress. There is a demand for nurses in primary care, acute care, ambulatory services, long term care, community health and public health. There is an urgent need to expand the strength of the nursing workforce in terms of both numbers and skill. (Models, 2015)
The vision of new health care reforms is to make quality healthcare accessible to the diverse population of the U.S. New reforms are expected to improve health outcomes in the whole population and eliminate health care disparity. Nurses have an important role in achieving this vision. They can ensure that care is delivered effectively, safely and compassionately. As they have a scientific understanding of health care practices, they can work in partnership with other professionals in the field, to achieve improvement. Presently, lack of nurses with higher education prevents their active participation in advanced healthcare practices. Many scholarships have been introduced to promote higher education among nursing students. Nurses who opts for higher education are given incentives to pursue higher education. An improved education system is planned to enable entry level nurses to face the challenges in healthcare. (Haney, 2010)
There are different models of care in nursing. In the ‘total patient care’ model, nurses are responsible for planning, organization and performance of all care related activity. This model is commonly observed in ICU and post anesthetic care unit. In functional nursing model, nurses are trained in one particular skill and assigned to that task only. In ‘Team’ model of nursing, different team of nurses headed by a nurse manager, provides care to group of patients. This model is important and found useful in providing high quality care. Another highly sought after model of practice is ‘patient centered model of practice’. Patient come directly to the nurses, and the nurses are supervised by a Registered Nurses (RN). The RN nurses are responsible for higher level of functioning and are accountable for wide range of services. Currently, the major challenge with this model is the lack of skilled RN, who can take responsibility and accountability for a wide range of services. There is a serious deficiency of nurses in leadership roles. The nurse leader is expected to act as a manager in this model. The nurse manager will be responsible for patient care, respiratory facilities, transportation, housekeeping, ECG admission, patient discharge, phlebotomy, physical/occupational/speech therapy, financial counselling, supply management, etc. This model is highly valuable is delivery best care to patients. The number of RN recruited have also increased over the years. ‘Case Management’ is also similarly valuable healthcare model. This model is usually used for the care of chronically ill patients, who needs a regular follow-up. This model requires nurses to undertake assessment, planning, evaluation, implementation and interactive roles in the clinic. (Haney, 2010)
Presently, the regulation that exists in many states may prevent nurses from practicing advanced services. The regulations, prevent nurses from examining and prescribing medication to patients without the physician’s supervision. These restrictions also prevent nurses in practicing to their fullest capabilities that was achieved through education and training. All the same, restrictions have already been lifted in certain states to meet the increased demand for healthcare practitioners. In the future, many more States will allow nurses to practice to their fullest ability. So, it is necessary that nurses be prepared to meet the opportunities provided to deliver better services. Nurses participate with other health care professionals in designing health care policies in the United States. In the future, their participation is expected to increase and their accountability for each responsibility will also increase. Over the years the standards and thoughts, in nursing have evolved dramatically. This change and growth is seen also in the quality of care given by nurses and their importance to society.
Haney, C. (2010). New Care Delivery Models in Health System Reform: Opportunities for Nurses & their Patients. Bethseda.
Larson, D., & Tobin, D. (2000). End-of-Life Conversations. JAMA, 284(12), 1573. http://dx.doi.org/10.1001/jama.284.12.1573
Mbamedical.com,. (2012). Healthcare Reform and Your Medical Practice. Retrieved 22 January 2016, from http://mbamedical.com/healthcare-reform-and-your-medical-practice/
Models, E. (2015). RESEARCH SYNERGY: Evolving Practice of Nursing and Patient Care Delivery Models. Researchsynergy.in. Retrieved 22 January 2016, from http://www.researchsynergy.in/2015/03/evolving-practice-of-nursing-and.html