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Evolving Practice of Nursing and Patient Care Delivery Model

Health care reforms shape the current and future of nursing practices in the United States. The driving factors that cause healthcare transformation include unsustainable treatment costs, fragmentation, suboptimal outcomes, and access problems. Nurses should have adequate knowledge on the evolving nursing sector to ensure they adapt to future changes in nursing practices that involve shifting from acute care hospital to community-based care. This research highlights the consistency in the knowledge of nurses about evolving nursing roles or practices with already existing literature. Nurse’s understanding changes and growth in the nursing field within the United States plays an important role in ensuring their adaptation in the future.

The Informal Research

There exist significant changes in nursing practices. Understanding the evolution of nursing practices aids nurses to adapt to transformations that occur in their work. The causes of the transformation relate to the need of ensuring quality and reducing treatment cost. The Affordable Care Act 2010 serves as the main cause of transformation in nursing. Nursing jobs increase in community base care, while jobs in acute care hospitals reduce. The Affordable Care Act 2010 advocates for quality and affordability that reduce disparities in health care and increase continuum care and continuity. Development of nurse-managed health care clinics increases medical coverage in the United States, especially in the rural areas. The clinics enable nurses to become their own managers. The driving forces that caused the implementation of Affordable Care Act include mobility, profitability, and need to improve the quality of treatment. Accountable care organizations ensure that regardless of the shift from acute care hospitals to community-based care, nurses maintain high-quality patient care. In fact, work shortage affects operations in acute care hospitals. Community-based care guarantees better patient care because the risk to health that occurs due to acquired infections is reduced. Medicare and Medicaid have become extended to nurse-managed healthcare clinics that have been offering opportunities to more nurses. Moreover, advancement in technology ensures efficient coordination of healthcare practices in community based care. The shift from acute care hospitals to community based care results in lack of staff in acute care hospitals. However, this transference offers more opportunities for nurses through broadening the range of nursing practices. Moreover, the increase in the elderly population enhances profits and opportunities in community based care. Thus, nursing practices shift to patient centered care where payments become determined by value-based care. Accountable Care Organizations ensure heath care prices align with quality metrics. Home-based care reduces transmission of monomial infections due to reduced nurse-patient contact.

Extending Medicaid and Medicare payments to nurse-managed health care clinics leads to the increase in the establishment of nurse-managed health care clinics, especially in rural areas within the United States. The shift from acute care hospitals to medical homes reduces treatment cost and maximizes health care outcomes. Moreover, the evolution in nursing practices boosts government involvement in health care because the government covers Medicare and Medicaid payments. Accountable Care Organizations formulate the joint payments model that aids to ensure payments made to nurse-managed healthcare clinics align to quality. For instance, the organizations use patients’ experience and healthcare outcomes to determine treatment cost. Changes that occur in nursing practices require nurses to receive an additional training because their role is modified to self-management. Therefore, instead of nursing education focusing only on acute care hospitals, the educations should concentrate on community-based care. Nevertheless, the success of community-based care depends on the educating the community. Evolution of nursing practices results in redesigning American healthcare system, which leads to a change in payment system from free for services to value-based health care. Acute care hospitals deploy their staff that meets new opportunities in community-based care, which result in understaffing in acute care hospitals. The demand for community-based care increases due to the growth in population that needs to become served.

Summary of the Feedbacks Shared By the Three Nurses

The Affordable Care Act has brought a tremendous change in the health delivery method, which has caused a significant patients shift from acute care hospitals to community-based care. Nurses become tasked with a wide range of healthcare responsibilities due to the increasing population that needs medical provision under the Affordable Care Act. Acute care hospitals experience understaff issues due to shifting to community-based care such as the establishment of nurse-managed health care clinics and medical homes. There exists significant increase in the establishment of nurse-managed health care clinics due to the extension of Affordable Care Act regarding Medicaid and Medicare coverage to such facilities. The shift to community-based care ensures continuity and reduces disparities that exist in health care because there is the increase in growth of the number of elderly individuals in the United States.

Changes in nursing affect nursing education. Nursing graduates should become educated on how to adapt and become well acquainted with community-based care. The advancement in technology enhances community-based care delivery such as telecare, internet, mobile clinics, and mobile phones. The success of community-based care depends on educating the community. Nurses apply for further training such as self-management, cross-setting communication, patient-centered care planning, and care transitions counseling to adapt to evolving nursing practices. In fact, community-based care upsurge interprofessional teamwork in healthcare. Health care payment methods shift from free for free service to value-based healthcare payment, which improves patient care outcomes. Thus, Medicaid and Medicare payment becomes determined by care and payment delivery models. Acute care hospital redesigns health care delivery through redeploying workforce that adapt to a new setting and roles. New jobs emerge in community-based care that alters the roles of nurses, especially in managing patient care transitions, patient coaching, and population healthcare management informatics.

Analysis of the Consistency between My Research and the Nurses’ Feedback

Both nurses and my research agree that the 2010 passage of the Affordable Care Act raised emphasis on population health as the cornerstone of the new focus on healthcare. According to National Advisory Council on Nurse Education and Practice [NACNEP] (2016), despite current nursing graduates focusing on providing acute care in hospitals, healthcare organization demand nurses with the ability to prevent diseases and promote wellness in the community (p.5). The nurses stated that fewer nursing jobs exist in acute care hospitals, while the community experiences the increase in nursing jobs. NACNEP (2016) states that nursing job change drastically with the range of jobs expanding in community-based and ambulatory care settings that involve new responsibilities (p.9). Furthermore, Affordable Care Act creates a more patient-centered care, which creates more opportunities for nurses. There exists the transformation in nursing practices that include transition care, prevention of nosocomial infection, and providing the aging population with high-quality palliative care.

The patient protection Affordable Care Act increases the United States government involvement as a payer through Medicare and Medicaid coverage. My research and the feedback from the nurses show that the growth and change in nursing cause a significant impact on continuity or continuum of care and medical homes. Cost and quality fears act as fundamental motivating forces for transformation in nursing practices. Affordable Care Act increases opportunities in patient-centered medical homes with an aim of maximizing health outcomes through allowing team-based health delivery model that ensures continuous and comprehensive medical care. NACNEP (2016) provides an example of Early Childhood Visiting Program that targets risky pregnant families to ensure the improvement of child and maternal health, reduction of child abuse, and home health assessment (p.10). Therefore, the change mandates for alterations in nursing competencies and practices that focus on improving health outcomes. Establishment of medical homes reduces traffic in acute care hospitals and increases community-based care.

Health reforms enhance the development of nurse-managed health clinics. According to Ely (2015), with the government extending American Medicare and Medicaid coverage to nurse-managed health clinics, the initiative aids in ensuring coverage of additional 32 million Americans (p193). The nurses’ feedback aligns with my research in supporting the implementation of health reforms that reduces disparities and enhances continuity of healthcare. The changes and growth in nursing demand increase in training to aid nurses in adapting to evidence-based practices within the community. Ely (2015) states that advanced practice registered nurses extend their training to fill the workforce shortage in nurse-managed health clinics because jobs shift from acute care hospitals to nurse-managed health clinics (p.193). The integrated care model shows that nurse-managed health clinics increase quality and reduce the cost of treatment because the facilities enhance the capability of population to receive health care. The integration of the nurse-managed clinics in the United States reflects on the continuum and continual adaptation that aim at meeting the populations’ needs in swift shifting nursing and health care economies (Ely, 2015, p.194). Instead of the nurses focusing on administrative and conducting patient care in acute care hospitals, they should focus on community-based health care through establishing their own nurse-managed clinics.

According to my research, Accountable Care Organizations ensure value-based health care. Health care reforms in the United States allow a group of health practitioners to ensure third-party payer quality assurance through comparing the cost of care and quality metrics. The nurses stated in their feedback that payment become determined by payment delivery models that include Accountable Care Organizations. According to American Hospital Association [AHA] (2010), Accountable Care Organizations safeguard continuity while supervision cost hinges through aligning incentives to service delivery (p.3). AHA (2010) states that Accountable Care Organization’s framework addresses the limitations of Health Maintenance Organizations through formulating joint payment standards for all patient care providers that become paid by the third parties (p.4). The organizations ensure that emerging opportunities in the evolving nursing such as the shift to medical homes and nurse-managed clinics meet the high standards at accountable costs. The quality measures that regulate cost under the Accountable Care Organization comprise of care management, protective health, and the level of safety of the population.


My research aligns with the nurses’ responses regarding nursing practices shifting from acute care hospitals to community-based care. Community-based care changes the role of nurses such as medical homes and nurse-managed health care clinics that ensure continuity and affordable and accessible medical care. Accountable Care Organizations ensure that new nursing opportunities receive rewards based on value. The Affordable Care Act leads to redesigning acute care hospitals due to changes in payment methods that ensure hospitals redeploy their workforce that should meet new opportunities and setting. As a result, hospitals experience understaffing issues. Nurses need to opt for further training and learn to become self-managers to exploit new opportunities that provide advancement prospects in community-based care.


American Hospital Association. (2010). Aha research synthesis report: Accountable care organization. Chicago, IL: American Hospital Association.

National Advisory Council on Nurse Education and Practice. (2016). Preparing nurses for new roles in population health management. Retrieved from

Ely, L. (2015, July-August). Nurse-managed clinics: Barriers and benefits toward financial sustainability when integrating primary care and mental health. Nursing Economic, 33(4), 193-202.