Healthcare Delivery Models & Nursing Practice
Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
Healthcare and Nursing Policies
The healthcare sector is a complex system with numerous elements that are integrated to provide patient-centered care and the general population’s wellbeing. The healthcare system requires changes for quality improvement by developing policies, regulations, and strategies to counter ill health. In the United States, healthcare is placed on the shoulders of the healthcare providers regulated by the state and federal agencies. The nurses and physicians are known to be the engineers of the policies, supported by the fact that they clearly understand the health needs and priorities of the American population and how effective some of the laws can enhance the quality of care for the citizens. This paper will discuss the several changes that have been made to improve the structure and functionality of the healthcare system in the United States.
One of the most recent and current federal legislation in the United States is the Model APRN Compact Legislation. According to Kaplan (2021), the federal legislature adopted the APRN Compact on August 12, 2020, to allow the APRNs to hold one multistate license that would give them the authority to practice in the other compact states. This policy was introduced amid the COVID-19 pandemic, with a high demand for healthcare services and the healthcare professionals within some states being few to meet the high demand for quality healthcare services. Before the legislation, the healthcare providers, especially the APRNs, were licensed to operate within a single state. This shows that the new legislation improves the level of practice for nurses by increasing their region of operation, that they can provide care in more than one state without the need to obtain additional licenses. The benefit of this policy is increasing access to care, especially in the states facing health emergencies. The licensure increases the ratio of nurses to patients and thus increases the quality of healthcare within the compact states. The policy retains the states under the ultimate control of the nursing practices, with the nurses required to be accountable and responsible for their practices.
Quality Measures and Pay for Performance
The quality measures are intended to ensure that healthcare services meet a certain level of quality, below which a healthcare provider is accountable. The quality of care is largely determined by the safety of nursing practice, the timeliness of recovery, the cost of care, and the effectiveness of the care provided by the healthcare provider. The pay-for-performance provides the financial rewards or sometimes penalties for the healthcare providers at the individual, group, or institutional level according to their performance as measured against the healthcare measures of quality (Mendelson et al., 2017). The performance pays highly improves the quality of care for patients. In some regions where healthcare providers are reluctant to achieve a higher quality of care, they are forced to upgrade their quality of services to receive payments for the services provided and thus increase the quality of care. The quality measures also improve the quality of health and control the cost of care in a community. Patient hospitalizations, reinfections, readmissions, and poor health are associated with poor health quality and increased cost of care for both the patient and the institution. By focusing on the quality of care for reimbursements, the department of health increases the quality of health of the population, the general performance of the healthcare providers and lowers the general cost of health care. Inequality in the provision of healthcare services is highly reduced by equalizing the quality of care. According to Mendelson et al. (2017), pay for performance cuts across all levels of care, and thus, every healthcare provider is required to provide quality healthcare and thus reduce care inequalities in society.
The healthcare providers are responsible for advocating for a quality healthcare environment, policies, and cost-effective care that would improve the quality of care. The quality of care measures and the payment for performance program increases the level of accountability to healthcare providers on healthcare provision. The healthcare providers are expected to focus on the quality measures such as safety of care in reducing any care adversities that may lead to new complications or chronicity of the patient’s health. The healthcare provider is required to control hospital-acquired infections as a measure of ensuring patient quality. Healthcare providers must ensure close monitoring of the patients to ensure that they effectively follow the care instructions for recovery. Healthcare providers are also required to provide cost-effective care in improving access to care. In improving the quality of care, care collaboration and coordination is important in a healthcare organization.
Professional Nursing Leadership
Numerous nursing leadership and management roles have cropped up to increase the quality of care within the healthcare system. Considering that the healthcare system is shifting to quality and cost-effective care, there is the position of Patient Care Director, a supervisory position combining both administrative and nursing roles. The patient care director has a key role in ensuring high quality of patient care through the smooth running of the patient care activities. The role of the patient care director is to handle complaints from the patients or their family members, maintain detailed patient records, evaluate the performance of the healthcare employees, and maintain compliance with the federal and state regulations and health standards. This role is essential in healthcare to enhance care quality to ensure that they comply with the P4P quality standards. The patient experience director also provides similar administrative roles. The Patient Experience Director receives and acts on complaints from patients or their families on the quality of care, billing, and general experience. These two roles are some of the numerous leadership positions that enhance the quality of care in the healthcare system by monitoring the quality of care.
Future of Nursing
There are various trending issues in the nursing field that influences the roles of the nurses. One of the trending issues is implementing the full authority of practice for NPs in the United States. Most of the states in the country have passed the bill for increasing the nurses’ authority in their practice from restricted to independent practice. Even for the states that have achieved the full authority of practice for the NPs, the nurses are pushing for more privileges such as inclusion in the reimbursement programs for primary care providers by the Medicare and Medicaid health insurance programs. This shows that nurses in the United States will function as primary care providers in full, equal to the physicians in the future. This is a great opportunity to increase access to healthcare and lower the cost of care. According to Depriest et al. (2020), the full authority of practice for NPs increases access and lowers the cost of care.
There is a great shift from hospitalization to home-based care. In decongesting healthcare institutions, many organizations have their nurses registered for family-based care, where nurses make appointments with the patients for health evaluation and care. Due to the changing trend, healthcare organizations will be unable to satisfy the needs of the patients under the home-based care programs. With the increasing technology, I predict that in the future, many nurses will be registered for telemedicine or telehealth programs to suit the emerging demand for home-based care. Nurses will be required to educate their patients on self-care programs and then follow-up and monitoring through the telehealth programs.