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Evolving Nursing Practice and Patient Care Delivery Models

The transformation of healthcare system is inevitable, considering the increase in population and the discovery of new treatment and prevention methods. This process requires the input of the government and organizations of various healthcare professions. Such an integrated approach can guarantee a coordinated progress in the healthcare system without any conflict of interests. Thus, nurses from academic and practice settings can contribute immensely to the transformation of healthcare since they form the largest part of the healthcare workforce (American Association of Colleges of Nursing, 2016). Therefore, as nurses contribute to this initiative, the nursing profession is expected to change inevitably. Moreover, the perceptions of nurses regarding healthcare transformation are likely to change as well. This paper analyzes healthcare reform, focusing the expected growth and changes in the nursing profession, and then examines the impressions of nurses regarding the anticipated variations and their consistency with the facts about health reform.

Expected Growth and Changes of the Nursing Practice

Most nurses practice in acute care settings and provide essential treatment and prevention services to patients. However, the transformation of healthcare system is expected to diversify their practice. For example, in 1980, 66% of registered nurses worked in hospitals (American Association of Colleges of Nursing, 2011). However, in 2008, the number of nurses reduced to 62.2% (American Association of Colleges of Nursing, 2011). This decline occurred because of the health reforms that had taken place within the nursing care delivery system. These reforms focused on improving the quality, affordability, and accessibility of health services, which forced many nurses to divert to other areas that also needed nursing services. Therefore, nurses should expect to deliver improved nursing care services in other places such as schools, communities, and various companies.

One of the aspects that can lead to changes and improvements in the nursing practice is disease prevention. As Marvasti and Stafford (2012) assert, adequate disease prevention strategies can result in the reduced costs of seeking health care and the reduction of patient population in hospitals. Subsequently, these benefits can guarantee appropriate staffing and lead to the decrease in problems, associated with nurse shortage, such as medication errors. Accordingly, the US healthcare reforms have focused immensely on various prevention strategies. For instance, the Affordable Care Act is committed to promoting wellness and proper health of the American people by focusing on prevention of chronic illnesses (, n.d.). Currently, nurses manage most patients with chronic illnesses with the help of medication. However, this reform can make more nurses venture into prevention strategies such as health education and disease surveillance. In the future, this reform can reduce the number of nurses, who practice in the hospitals, and increase the number of nurses in disease prevention programs. Eventually, nurses will know more about researching prevention methods, which can also advance evidence-based practice in prevention initiatives.

Other factors that can lead to changes and growth of the nursing practice include transition and continuum of care. These aspects of healthcare involve delivering medical and nursing services to patients across various healthcare settings and in their homes. Nurses are expected to deliver health services to patients and implement various follow-up measures to prevent complications that develop from chronic and acute diseases. Thus, Naylor et al. (2011) contend that the US health care reforms have ensured post-discharge follow-up and community-based care that nurses continue to embrace in healthcare settings. Accordingly, the coordination of nursing services across hospitals, primary care settings, and communities is bound to improve as opposed to the current system. Nurses are expected to acquaint themselves with various services delivered by different institutions. Additionally, nurses are to deliver more transitional care, thus enhancing the unity among nurses.

Finally, health reforms will guarantee improvements in inter-professional collaborations even outside the healthcare system. For instance, nurses run various medical homes (American Association of Nurse Practitioners, n.d.). Beneficiaries of Medicaid and Medicare receive services from these institutions. Therefore, nurses will need to enhance collaboration with insurance companies for reimbursement, both in medical homes and nurse-managed health clinics. Moreover, nurses require the services of doctors for them to initiate proper nursing interventions. Consequently, their participation in Accountable Care Organizations is expected to increase to enhance their relations with physicians. These anticipated modifications in nursing care delivery can improve the nursing practice.

Response from Three Nurse Colleagues

I shared my research about health reforms and the anticipated changes in the nursing profession with six nurses. However, the response of three nurses will be considered for this paper. The first nurse was a new entrant to the profession. He had just been employed for five months. Therefore, he did not have much experience with the way health reforms had changed nursing care. I told him about the anticipated changes regarding prevention strategies and the reduction of nurse population in hospitals. Then, I asked the nurse to tell me his views about the expected change. The nurse said that he was aware of the Affordable Care Act since he had learned much about it in school. He said that such a move could help him find time to give quality care to patients because the nurse-patient ratio would be adequate in hospitals. Moreover, I asked him about the changes in medical homes and improved collaborative efforts. The nurse said, “Such a change is necessary for the nursing profession. We have to integrate other professions in the service delivery because health is a broad subject that encompasses even the people who are not concerned with it. Other sectors, such as insurance companies, will help us to deliver services efficiently.”

The, I spoke to a female nurse who had practiced as a bedside nurse for 12 years. Since she had much knowledge about the nursing profession, particularly healthcare environments, we shared much regarding the anticipated changes in the roles of bedside nurses. I asked her to explain the way she felt about nurses venturing into community-based care and the implementation of transitional care. She told me that she supported the idea fully. Then, she said, “I have discharged several patients, but we rarely do follow-up due to the staff shortage and the demands we have at work. This issue has resulted in many patients neglecting proper healthcare when they are at home.” She continued to explain the situation and said, “These reforms are necessary because they will reduce the number of chronic illnesses and enhance the service we provide to patients in the acute care settings.” Finally, the nurse had a plan of running a medical home and indicated that health reforms would make it easy for her to be reimbursed to continue offering healthcare services efficiently. This nurse was prepared to embrace all anticipated changes in the nursing practice.

The last nurse had been a professional nurse for 30 years. She had much experience in community health and acute care settings. Additionally, she was rather experienced in nursing leadership. I shared my research about health reforms with her and asked to explain her views regarding the anticipated changes. The nurse said that such changes were appropriate, but the government needed to focus more on the marginalized populations. According to her, marginalized communities suffered because of few policies that advocated improved healthcare among them. Accordingly, she indicated that even as nursing practice would improve, the government had to prioritize nursing services among such people. This nurse was ready for the changes, but mostly, her comments were centered on improving nursing practice in low-income areas.

Consistency with Health Reform

The ideas of the first nurse are consistent with what I have researched about health reform. For instance, the first nurse says that the anticipated changes regarding a decrease in the number of nurses working in hospitals and more nurses in working towards disease prevention would be beneficial. He indicated that he would find time to enhance his delivery of nursing services. Thus, two provisions of the Affordable Health Care Act encourage the promotion of disease prevention efforts in adults (, n.d.). Moreover, Estruch et al. (2013) mention that prevention efforts, for example, a Mediterranean diet, stop the development of chronic illnesses such as heart diseases. Eventually, the number of patients seeking care in hospitals reduces, thus improving the nurse-patient ratio. The improved ratio can enhance nursing care delivery. Therefore, the sentiments of the first nurse were consistent with the health reform facts.

The second nurse embraced the changes associated with the continuum of care. She said that it would improve nursing care from hospitals to patients’ homes. Health reforms target improving the care of people in communities (, n.d.). Marvasti and Stafford (2012) confirm that the continuum of care improves nursing care through follow-up. Therefore, the second nurse was conversant with health reforms and the anticipated changes in nursing practice.

Finally, the last nurse indicated that the reforms were appropriate but they needed to target the marginalized communities. Similarly, the reforms ensure that health becomes a human right to the disadvantaged in various communities (Christopher & Caruso, 2015). Therefore, the sentiments of the nurse were consistent with the facts about health reform.


Health reform is a broad subject that affects various health professions, including nursing. As the government implements numerous reforms in the health sector, the service delivery of nurses is expected to change. For instance, the efforts that promote prevention of diseases will see most nurses work on enhancing disease prevention strategies. Indeed, most nurses are aware of health reforms. Additionally, most of them are prepared for the changes that might take place in the nursing practice. Therefore, the success of various health reforms is guaranteed.


American Association of Colleges of Nursing. (2016). Advancing healthcare transformation. Retrieved from

American Association of Nurse Practitioners. (n.d.). Fact sheet: The medical home – What is it? How do nurse practitioners fit in? Retrieved from

Christopher, A. S., & Caruso, D. (2015). Promoting health as a human right in the post-ACA United States. American Medical Association Journal of Ethics, 17(10), 958-965. doi: 10.1001/journalofethics.2015.17.10.msoc1-1510

Estruch, R., Ros, E., Salas-Salvad?, J., Covas, M. I., Corella, D., Ar?s, F., … & Lamuela-Raventos, R. M. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 368(14), 1279-1290. doi: 10.1056/NEJMoa1200303

Marvasti, F. F., & Stafford, R. S. (2012). From sick care to health care – reengineering prevention into the US system. The New England Journal of Medicine, 367(10), 889-891.doi: 10.1056/NEJMp1206230 (n.d.). Prevention of chronic disease. Retrieved from

Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The importance of transitional care in achieving health reform. Health Affairs, 30(4), 746-754. doi: 10.1377/hlthaff.2011.0041