Evolving Practice of Nursing and Patient Care Delivery Models

Good morning ladies and gentlemen? I am a registered nurse whose been working out of the E.R for nearly thirteen years. I have the privilege to share with you an educational piece concerning the imperative transition of the nursing practice from the current episodic system into a more patient based system. I shall share on the concepts of continuum of care, accountable care organizations (ACO), medical homes as well as nurse-managed health clinics

Why Should Nursing Practice Change?

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The current healthcare system in America, has for the longest time been limited to primarily delivering services to patients with acute conditions in hospitals. Health practitioners treat acute conditions without following up the patient. The main concern has always been to cure the condition. No emphasis has been placed on the patient outside of the outstanding condition he suffers from. Hence, in a bid to be a part of the healthcare revolution, nurses have to observe patients holistically. Therefore, the focus now has to be put on wellness programs, prevention methods as well as establishing relationships with the patients we encounter.

Continuum of Care

The concept of continuum of care is a revolutionary development in the healthcare system. Nurses are able to intricately scrutinize their patients while offering intense quality care in all stages of their life. This concept ensures that there is continued medical support for the individuals by offering prevention plans as well as establishing wellness programs . Continuum of care offers delivery of health services over a period of time some may say an entire life span. Continuum of care is characterized by the unique needs of every patient. Hence, healthcare is provided for all levels and stages of care required.

Continuum of care aids nurses to achieve the satisfaction levels in their work as there is a general improvement of health among patients. For the patients, continuum of care offers good health at a reduced cost as well as assisting them to get quality healthcare. Patients with chronic illnesses benefit greatly from continuum of care as nurses will be able to properly monitor their progress periodically. Nurses are able to offer manageable solutions through intense tracking of the patients health histories. Therefore continuum of care is vital in providing comprehensive healthcare deliveries in all stages of a patient’s life.

Accountable Care Organizations (ACO’s)

Under the affordable Care Act, the Centres for Medicare launched the ACO’s among other programs. Accountable Care Organizations are a group of doctors, nurses as well as other health care experts who come together voluntarily to give high quality medical care to their medicare patients.( Smith, 2018)

 Nurses have a duty to maintain a high standard of accountability. ACO’S have a policy for joint accountability where performance of the joint organization is rated as opposed to the performance of an individual physician. Incentives are shared based on this joint performance. The caregivers share the financial risks as well as the benefits of the ACO contract with the hospitals together. Therefore, this model prompts health care experts to approach their patients with the utmost precision to detail about their conditions. 

ACO’s ensure the quality of their medicare patients through effective quality measurement. Practitioners are paid for their performance. Patients are able to rate their doctors or nurses which enables them to receive bonuses for exemplary services provided to patients.

Therefore, ACO’s will play an integral role in the dynamic metamorphosis that the nursing practice needs to take as they maintain a high degree of accountability to the wellness of their patients in their entirety. (Smith, 2018)

Medical Homes

The concept of the medical homes is patient centered. It is an approach that provides comprehensive primary care that fosters on building relationships between the patient and the caregiver. (Lipson et al., 2011) A  practice-based care team which is collectively responsible for the health of the patient is assigned to him. In this approach quality care is measured while being coordinated across care disciplines. Therefore it is evident that healthcare improves tremendously when patients have consistent source of care from a primary care practice.

Nurse Managed Health Clinics

These health centers provide health care for thousands of people in the U.S.A where the access to healthcare is difficult. The clinics offer treatment to individuals who are uninsured living in areas that are underserved. They are community based non-profit organizations formed to meet the needs of communities with limited primary healthcare. Therefore nurse managed health clinics will increase the patient centered services that the nursing practice strives to achieve.

Feedback from 3 Nurses in my Unit

Nurse A

Nurse A observed that a visit to a Nurse Managed Health Clinic costs less than treatment in a primary care facility. Through the NMHC’s the community surrounding these clinics will cut the cost of healthcare seeing as a large percentage of the people there are uninsured or are under Medicaid. (Kovner, Walani, 2010)

The United States government established affordable healthcare through the Affordable Act in 2010.  Through the act, NMHC’s have moved the government closer to achieving this feat by ensuring that health delivery services are provided in underserved areas in the U.S.A.  

However she expressed concerns over the cut funding of the NMHC’s by the Obama administration in a bid to cut federal spending. (Turtion, 2012) She argued that thousands of people were dependent on these clinics for affordable primary care and no funds could have catastrophic effects on the community. 

NMHC’s are the pillar of communities that are in badly need of primary care. These clinics not only treat patients but also examine the environment of the patients they interact with. Practitioners in NMHC’s spend time with their patients while providing solutions to the social problems their patients are facing. (Kovner, Walani, 2010)

Therefore,  the NMHC’s not only assume a curative role to disease, but also ensure they build relationships with their community in order to serve them better. These nurses are on the ground providing sufficient primary care for residents. In the absence of these nurses, residents would be forced to turn to the emergency room for primary care where they would receive less intense care. (Turtion, 2012)

Nurse B

Nurse B established that the medical homes model could lead to the improvement of the health status of elderly patients as well as patients with chronic illnesses. (Lipson et al., 2011) Due to the much needed care these patients require, thrust  in a conventional healthcare setting, the patient would  receive poor  treatment. Moreover, the medical homes model allows caregivers to provide a team of practice –based caregivers intent on the holistic wellness of the patient.

Additionally, the medical homes model ensures that care is coordinated by connecting the patient to medical as well as social resources in the community. For the elderly patients, access to care might be difficult on their own as their condition requires multiple caregivers. Medical homes model would provide round the clock access to care even through telephone.  It is a patient centered approach where the nurses would respect the beliefs of the patient while striving to safeguard their cultures.

Therefore, nurse B concurred that nurses could effectively use this model in the development as well as implementation of great nursing practices. Nurses working with patients using this model helped patients improve in health as well as reduce the cost of treatment. Connecting with the patients through building relationships with them ensures that nurses provide quality healthcare.

Nurse C

Nurse C applauded the ACO for incorporating the recommendations by the American Nurses Association into their rulebook. She reiterated that incorporating registered nurses in the leadership of ACO put nurses in the frontline to maximizing patient care.

Furthermore, she pointed out that the impact that registered nurses have on patient care coordination as well as quality of care was exemplary. Hence, the contributions that nurses would bring to the healthcare system in terms of innovation would completely revolutionize caregiving.

She was excited that nurses would be included in calculating the patient pool of ACO and that a lot of paperwork would not prohibit them from giving direct care to the patients. This would only be ensured by nurses assuming leadership roles in ACO.

Therefore she was confident that upon working together ACO would reach numerous numbers of patients with quality affordable healthcare. 

In conclusion, it is evident that nursing practices have evolved immensely from acute care in hospitals to a holistic approach in dealing with patients. Through the advancement of NHMC’s, nurses deliver quality care to the underserved communities. Nurses build relationships with their patients which in turn enables them to offer social solutions to their patients’ problems. The medical homes model enables practitioners to provide a practice-based team which collectively works to ensure improvement of the patient. Caregivers connect patients with medical and social resources in the community. All medical practitioners who come together so as to provide high quality healthcare for their patients are held accountable by ACO.  These organization ensures that caregivers approach patients with the sensitivity their condition requires. Therefore, the change that nursing practices has taken over the years enables the patients receive quality as well as affordable healthcare.


Kovner C, Walani S ( 2010) Nurse Managed Health Centres ( NMHCs). Retrieved from https://cmapaignforaction.org/resource/nurse-managed-health-centres-nmhcs/

Lipson D, et al., (2011) Ensuring That Patient-Centered Medical Homes Effectively Serve Patients With Complex Health Needs. Retrieved from https:pcmh.ahrq.gov/page/ensuring-patient-centered-medical-homes-effectively-serve-patients-complex-health-needs

Smith BD. (2018) Accountable Care Organizations. Retrieved from http://ushealthpolicygateway.com/vii-key-policy-issues-regulation-and-reform/patient-protection-and-affordable-care-act-ppaca/ppaca-and-the-health-industry/general-provisions-affecting-multiple-sectors/accountable-care-organizations/Turtion H T,(2012). Nurse Managed Health Clinics Provided Badly Needed Primary Care- But Without Funding, They and Their Patients are at Risk. Retrieved from https://www.rwf.org/en/blog/2012/01/nurse-manged-health-clinics-provided-badly-needed-primary-carebut-without-funding-they-and-their-patients-are-at-risk.html

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