Changes in the Practice of Nursing

The health care in the United States is changing, patients need and demand outstanding services delivery. So we as nurses are called up onto deliver this service. With the shift in the health care sector nurses will be even more in demand. This demand will be tied to skill levels and education. This is why it is so important for all nurses to commit to furthering their studies, it will make them more marketable. There will be many new job opportunities due to the restructure of the United States health care system.

Providing health insurance to an additional 30 million people will likely make access to care a problem because of inadequate availability of primary care providers to meet the expected increase in demand. This is calling for innovative new ways on how to deliver health care in the United States.

A few delivery systems are: -An accountable care organization (ACO) is a group of care providers who coordinate health care for a patients.

This could include Doctors, Hospitals, Specialist and other health care providers. The idea is to keep health care cost down and avoid unnecessary test and procedures, but provide high quality care. (Gold, 2013) -Nurse Managed Health Clinics (NMHC) emphasize health promotion, education and disease prevention. It is a facility which is based in a community and staffed with advanced practice nurses as leaders. It provides primary healthcare services to the community. (Kovner & Walani, 2010) –

Another module or philosophy of primary care is a medical home. It is a team-based facility, which is patient-centered, comprehensive, coordinated, accessible, and focuses on quality and safety.

(“hrsa,” n.d.) All patients should receive the best coordinated care possible, especially the chronically ill, to get the right care at the right time is the purpose of these new modules. At the same time we should avoid unnecessary duplication of services and preventing medical errors –

For example:

The growth of chronic illness and aging populations, in particular, has placed a substantial burden on the healthcare system. Very popular is the patient-centered medical home model that emphasizes continuous coordinated patient care. It has been shown to lower costs while improving health care outcomes. The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.” Medical homes can lead to higher quality and lower costs, and can improve patient’s experience of care. Nurse Managed Health Clinics are led by advanced practice nurses to provide basic primary healthcare and screening.

This could possibly be very cost effective if operated to their full potential. But let’s not forget that we also see and increasing demand of Nurse Practitioners (NP) in the hospital setting. We all know our two co-workers who went back to school and completed their NP program and now work in our Emergency Department as NP’s. Many hospitals also started using NP’s to take care of their in-patients. To keep up the demand of these facilities nurses with higher education are the future of the new health care system. Continuity of care is needed, it is the process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care. Better quality care is given by higher educated nurses, so to stay marketable and to provide the best possible care to our patients it is in our interested to further our knowledge and our education.

Nurse 1:

The new health reform not only impact everyone as an individual, but it will also impact businesses as a whole. One of the main points of the new health care reform is to ensure that all Americans have insurance. With insurance not having been mandatory before, Americans who were uninsured had to deal with several financial problems when it came to paying medical bills. There are several individuals that do not have any medical insurance because they either do not have a job or the job that they do have does not offer insurance. And even some people who have the option to have insurance may not buy it because they don’t want to pay for it. And then these same people who have the option to have it but choose not, may end up using a government program to obtain medical services.

This cost all tax payers more money for people who have the option to obtain insurance for them but choose to use a government facility. With this new reform it will be mandatory for every individual to obtain at least some sort of basic medical insurance for themselves. Without insurance, people can sometimes not get the proper care that they deserve. And even though most hospitals do not turn away people without insurance, they do not cut them a break and still stick them with the high medical costs for the medical services that were administered. Americans who did not previously have insurance will now have obtained it. With the increase of insured Americans, the demand for health care providers will increase substantially. A huge percentile of practicing physicians and nurses are over the age of 50.

Therefore the medical schools will need to recruit more students to become health care providers. Moreover, this will require additional professors as well as additional medical schools in order to handle the increase in enrollment. I am hoping that this can start our country down a better road with our health care situation. With the layout that has been provided, I can see that the idea is for everyone to benefit from this in one way or another. First, every American will benefit from having the insurance and being able to seek medical attention when needed. Insurance companies will benefit from claims. Doctors will benefit from receiving increased patients. Medical schools will benefit from having an increase of enrollment.

Nurse 2:

The changes to the nation’s health care system will affect nursing practice as we know it. We see change daily in our current practice. To prepare myself for the challenges and prospects that lie ahead, I am invested in advancing my education by being enrolled in an MSN program, I should complete this program by the end of this year. I do my best to step up to a more advanced leadership positions, currently fulfilling the role of a day shift supervisor in our Emergency Department. I try to stay current about the hospital and unit policies and procedures. I assist staff and physicians with changes, additions, and updates to our computer charting program system.

My future plans for changes in my practice include earning certification in Emergency (CEN).I am trying right now to gain more understanding of the legislative process that helps shape health care policies. I needed to write a paper for school and found this subject fascinating. To meet society’s future healthcare needs, changes are necessary in the way nurses function and we need to improve and advance our education, so that we can development nursing management capabilities. To help progress science, and be qualified to meet the needs of many types of patients, nurses need to be leaders, while providing excellent care. Collaboration among healthcare professionals is a requirement in an ever-changing and complex system. It is vital that nurses take ownership, step-up and be personally involved in helping transform health care and hospitals, into a safer place, which is accessible, fiscally responsible, and comprehensive in its care.

Nurse 3:

The rising cost of healthcare in today’s economy is in desperate need of a reform, we all know that. Because of this enormously cost many people are unable to receive medical care. People are sicker due to the inability to receive medical attention when it’s needed, so there wait and often the problem is getting much worse by the time there seek medical care. I am very worried about the increasing demand of nurses and the nursing shortage. If we do not address the nursing shortage very soon I see that in the future quantity will replace quality in nursing. Nurses will burn out and leave there position due to the increased demand and increased patient work load. Nurse to patient ratio is increasing, due to financial cuts from hospitals.

Hospitals need to work more efficient to be able to keep their doors open. This is not very helpful to job satisfaction. We need to address these issues now. A few ideas would include for hospitals to pay for nursing school and have the student sign a contract to work for the hospital and every year worked 5000 dollars are forgiven in there loan. Also the demand is for everyone to continue with their education and obtain a BSN, MSN or doctorate, this cuts down on the quality of life in itself. Hospitals should give paid hours each week, to each nurse who is obtaining an advanced degree (like 4 hours a week).


I think each of my Co-Workers had a little different view on what is health reform meaning to them. In general each one had some kind of understanding about it and each nurse choose to share the point which is most dear to them about the reform. I agree mostly with all of them. The nursing shortage needs to be addressed and a larger more qualified nursing work force needs to be created. Nursing will have a huge impact on how we form the new health care system in the United States. Advanced practice in clinical settings seems to be the most reasonable way of addressing the need of the public. Managed health care can be a solution to decrease the enormously cost of health care nowadays.

. Med-Surg Nursing, 23(1), 61-6. Retrieved from Accountable Care Organizations . (2013). Retrieved from Gold, J. (2013). ACO is the hottest three-letter word in health care. Retrieved from Kovner, C., & Walani, S. (2010, January). Nurse Managed Health Centers . nursing research network. Retrieved from M. Colette Carver,Anne T. Jessie. (2011, May). Patient-Centered Care in a Medical Home. The Online Journal of Issues in Nursing, 16(2). Retrieved from Swan, B. A. (2011, Nov.-Dec.). Health Care Reform: Current Updates and Future Initiatives For Ambulatory Care Nursing. Nursing Economic, 29(6), 331-4. Retrieved from What is a medical home? Why is it important? (n.d.). Retrieved from

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