The ‘Patient Protection and Affordable Care Act (ACA)’ was passed into law in the year 2010 and it initiated the healthcare system transformation. This is because it emphasizes on the primary care, promotes quality care and also funds community health initiatives (Rosenbaum, 2011). Due to the underutilization of the preventive care the people spend more on chronic diseases such as heart disease, diabetes, and hypertension. This is because they don’t receive effective treatments like drug therapies which help them manage their conditions effectively. The ACA addresses all the areas where reforms are needed in the current healthcare system. Its emphasis is on preventive services thus provides insurance coverage to millions of people (Naylor & Kurtzman, 2010).
The utilization of leadership skills by the nurse leaderis required so as to improve the patient’s outcome, develop policies that improve services and removes practice barriers, and in the creation of care delivery models that meet the demand for services. The ACA emphasizes on provision of preventive medicine and primary care through insurance reform, funding to educate the providers of healthcare, and increased reimbursement for the primary care providers. The challenges that affect the implementation of ACA include but are not limited to the need for more healthcare providers and more approaches for its implementation (Naylor & Kurtzman, 2010.
Legal and ethical issues in practice
Delegation in nursing practice is an aspect that is inevitable and only wishful thinking can assume its absence, while the required nurse hold s the overall responsibility of the patient’s health, the registered burse cannot perform all duties and thus must at one time or another delegate some functions to the staff nurses, nursing students in practice, assistant practitioners or healthcare assistants. In these instances, the registered nurse is not in away way accountable for the actions of the delegate (Cipriano, 2010). Apparently, the care tem comprises of a diverse workplace with equally diverse range of skills and knowledge. It is important to note that not all aspects of delegation work as expected especially due to wrong decisions making owing to the variety of dilemmas that are apparently in the patient care process (Anderson & Twibell, 2006).
An example of a wrong delegation that tuned into a legal dynamite is an instant where a healthcare assistant (HCA) was assigned the role of managing diabetes patient. In the process of dressing the patent in appropriate clinical attire, the HCA noticed a wound on the shoulder of the patient. While the HCA did not possess the appropriate skill to manage wounds, he decided to dress the wound as well as provide some painkillers. Thirty minutes upon dressing and medication, the patient developed a fever and started sweating profusely. By the time the Registered nurse as informed the patient was in a coma upon which he as immediately transferred to the ICU for further checkup. The Registered nurse noticed the dressed wound and asked the HCA if the wound was dressed prior to delegation or where the HCA had performed the act. The HCA admitted to the dressing and medication. The HCA was dismissed on that same day. The dismissal was justified on several grounds; on one aspect is the fact that the CHA did not have the authority to initiate any further processes that would alter the health status of the patient without the approval and guidance of the Registered Nurse and secondly the HCA did not have the appropriate skill and knowledge to dress and manage the would as required Anderson & Twibell, 2006). The HCA was thus considered as having overlooked some protocols as well as performing a task beyond their scope of practice (Cipriano, 2010).
Anderson, P. S., & Twibell, R. S. (2006). Delegating without doubts. American Nurse.
Cipriano, P. (2010). Overview and summary: delegation dilemmas: standards and skills for practice. The Online Journal of Issues in Nursing [Internet].
Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public Health Reports, 126(1), 130.