The Impact of Healthcare Reform on Nursing Practice
Healthcare reforms will continue to have a significant effect on nursing practice across the United States. There is no doubt that the delivery of health care will be a fundamental factor in the growth and change of nursing practice. In the past, nurses have focused on treating clients for acute conditions without emphasizing on the general wellness and follow up. This situation will change since the health care system is evolving towards continuity care. Promoting care across continuum is necessary (Salmond & Echevarria, 2017). There will be a great focus on all life aspects of the patient including their socioeconomic status as well as family history. Nurses will focus on the patient holistically, mainly those with chronic illnesses. It will be desirable for the practice of nursing to be built towards offering care that spans an entire lifetime. Health care stakeholders will agree that continuity of care will require nurses to track a patient by offering various social, health and mental health services.
Changes in roles and orientation of the practice of nursing should be expected. The Accountable Care Organizations (ACO) might be the drivers of this change. Even so, it is not clear how the ACO might interfere with nursing roles in the future. But for sure, there will be an enhancement of roles, relocation of services, substitution and increased delegation. Nurses will be transferred from one setting to another, and there will be the utilization of liaison nurses across settings. Coordination and partnership between providers in both acute and primary care settings will increase (Pittman & Forrest, 2015). So the Interprofessional collaboration will grow as the healthcare continues to reform. Some providers are still wondering whether ACOs will continue to be relevant in improving patient outcome. This uncertainty will be solved because the ACOs will start engaging providers to change their practice and encouraging patients to assume an active role in their care through decision making.
Nurses will not be surprised that medical homes will shape their practice. The patient, as well as their family, is always looking up to the provider for improved outcome. This aspect has led to the establishment of patient centered medical homes. Medical homes will influence the nursing practice because it has several specific benefits. Patients who have enrolled in patient centered medical homes report benefits in quality of care, increased communication with practitioners and reduction on the use of emergency services (Aktan, 2016). Whether medical homes will become integral in the healthcare system is not a matter of discussion. Nurses have already experienced this change, and it is expected to expand more and more. They will have to establish cost saving initiatives and enhance the quality of care offered to diverse clients. As nurses envision the future, the need to extend care to low socioeconomic populations should not be ignored. They understand nurse-managed health clinics have a fundamental role in serving low-income and uninsured populations (Sutter-Barrett, Sutter-Dalrymple, & Dickman, 2015). Nurse-managed health clinics will experience an expansion in their roles as they serve uninsured populations.
Changing Roles and Orientation of Nursing Practice
Nurse One
In the future, nurses will have to express the value of being a nurse and integrate it with skills, competencies and passion when offering care across different settings. The role of nursing practice in a hospital setting will revolve around dismantling barriers between professions. As such, nurse one noted that their role would be influenced by the increased and effective collaboration among providers in a hospital setting. A hospital setting will offer the nurses a chance to offer evidence-based care for multiple conditions rather than managing an acute condition. Nursing roles in the community will also change substantially. Nurses will conduct a holistic assessment to determine the patient’s lifestyle and living conditions. The report of this assessment will then help nurses to develop treatment plans for physical, emotional and psychological problems. The nurse stated that community-based care was very fundamental in improving access to care and will continue to expand in the future. Although the nursing roles in the community will change in future, nurse one, stated that the themes would remain unchanged. In clinics, the nurse expects their role to change from just offering care to determining appropriate treatment. Medical errors tend to occur in clinics due to wrong treatments (Khoo, et al., 2012). According to the nurse’s impression, a significant part of her time in the clinic will be spent in identifying the best possible treatment. The primary role in medical homes will be to coordinate care based on the complexity of the patient needs.
Technology will ease the nursing practice in hospital settings. The nurse’s roles will be influenced by advancements in ICT (Rouleau, Gagnon, & Côté, 2015). The practice of nursing will entail capturing of the patient’s information accurately, sharing it with a specialist and getting real time feedback. According to this nurse, technology will relieve the burden of roles and make the nursing profession more attractive. Nurses will take a leadership role in enhancing community-based care. A leadership role will allow nurses to expand the services offered to different populations and expand access. Besides, nurse two noted that they expected to assume a role of a coach instead of a caregiver in the community. This nurse argued that the modern nursing practice aims to offer care to chronically ill persons in the community. As the healthcare system expands and grows, taking a caregiver role in the community will not be sufficient. Assuming a coaching role will support care continuum in the community. Further, nurse two insisted that some themes of the community will have to be transferred to clinics. When a patient presents in a clinic, the nurse’s role will be to promote health and prevent extended hospitalization. In medical homes, the nursing role will mainly be offering information and education. Nurses will offer continuous information on clinical status, progress and prognosis. The second nurse also argued that her role will include offering information to enhance self-care and autonomy.
Patient-Centered Medical Homes and Nurse-Managed Health Clinics
Nurse three noted that they would have an increased responsibility and accountability in hospital settings. Specifically, they will have to facilitate transitional care. The nurse noted that her role in facilitating transitional care would mainly involve educating the patient and their family. They acknowledged that technology would play a fundamental role in educating the patients (Thimbleby, 2013). Nurses will also focus more on enhancing the technological competence of the patients to allow them access information through Telecare on demand. In communities, the roles of the nurses will continue to change. Instead of managing and care for people in communities, nurses will have to move from home to home offering care and education. Nurse three argues that even in communities, the roles will entail educating people how to stay healthy. This role is based on the fact that people in the community understands and acknowledges the value of a healthy lifestyle. The role of nurses in clinics will be to prevent the occurrence of hospital-acquired illnesses and adverse outcomes rather than treating the primary illness of the patient. Nurses will experience an increased burden of work as they strive to execute this role. Nurse three argued that their role in medical homes will be based on emotional support and reduce fear and anxiety. They noted that patients experience fear and anxiety because of illnesses. This role would entail addressing anxiety over the financial implication of the illness. The nurses will achieve the goal managing anxiety offering personalized cognitive behavioral therapy (Tselebis, et al., 2016). It is notable that the role of nurses, in this case, would have changed substantially.
The impressions of the nurses are consistent with the research. The impressions have several common themes which are the advancement of roles, use of technology, increased patient education and delivery of evidence-based care.
References
Aktan, N. M. (2016). Transforming nursing practice: The patient-centered medical home. ANA Journal , 11 (8).
Khoo, E. M., Lee, W. K., Sararaks, S., Samad, A. A., Liew, S. M., Cheong, A. T., et al. (2012). Medical errors in primary care clinics – a cross sectional study. BMC family practice , 13 (1), 127.
Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in Pioneer Accountable Care Organizations. Nursing outlook , 63 (5), 554-565.
Rouleau, G., Gagnon, M.-P., & Côté, J. (2015). Impacts of information and communication technologies on nursing care: an overview of systematic reviews (protocol). System Review , 4 (1), 75.
Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic nursing , 36 (1), 12-25.
Sutter-Barrett, R. E., Sutter-Dalrymple, C. J., & Dickman, K. (2015). Bridge Care Nurse-managed Clinics Fill the Gap in Health Care. The Journal of Nursing Practitioner , 11 (2), 262-265.
Thimbleby, H. (2013). Technology and the Future of Healthcare. Journal of public health research , 2 (3), e28.
Tselebis, A., Pachi, A., Ilias, I., Kosmas, E., Bratis, D., Moussas, G., et al. (2016). Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatric disease and treatment , 12, 297-328.
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