Evolving Practice of Nursing and Patient Care Delivery Models

Part 1: Growth and Change in the Practice of Nursing

The nursing profession is expected to adapt to many changes ensuing in the healthcare landscape. These include changes in relation to disease morbidity and mortality as well as healthcare costing. For instance, the burden of chronic diseases has been on the rise and is expected to even move higher with changing lifestyles and increased risk factors in the environment (Grossman & Valiga, 2016). An aging population is also likely to be a greater concern moving forward, with the demand for nurses and primary care expected to skyrocket. More importantly, provision of Medicare to about 30 million people indicates that access to care is likely to become a serious problem. Nurses will be overwhelmed by the number of people seeking primary care following coverage and shall need to adapt to these situations (Puetz, 2013). This necessitates growth and change in the practice of nursing with new healthcare delivery models abounding. This paper discusses how nursing practice is expected to grow and change, with reference to various healthcare delivery models.

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One of the growth and change areas expected in the nursing profession is expansion of their responsibilities and scope of practice. Nurses are expected to be stand alone healthcare professionals who can offer primary care without restrictions on scope of practice and supervision of physicians. In the present day, many states in the US have restrictions on what nurses can do independently and are viewed as only care givers in the presence of other higher ranking consultants. The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) recommended the removal of such restrictions to allow nurses to practice in the full scope of their education and training (Grossman & Valiga, 2016). This will lead to emergence of healthcare delivery models such as the Nurse managed health centers (NMHCs) that are headed by advanced practice nurses. Therefore, the role of nurses will change from being dependent on supervisory powers of other professionals to a self-sufficient, expanded one.

Nurses are also expected to be full partners in coordinated care as part of the changes and growth. The nursing workforce is the largest in the healthcare system and outnumbers other professionals. However, in situations of coordinated and interdisciplinary care, nurses are often given reduced roles, largely restricted to the point-of-care services (Blegen et al., 2013). Due to increasing numbers of persons with Medicare, there shall be higher demand for coordinated care. There shall be no sufficient physicians and other traditional leaders to interdisciplinary teams and as such nurses will be required to step up as equal partners in coordinated care. Accountable Care organizations (ACOs) wherein healthcare professionals come together to offer care to Medicare beneficiaries shall have a prominent role for nurses. The medical home and other healthcare delivery models that value coordination will also have a profound nursing role. Nurses will of course need to further their education in order to gain leadership and other relevant skills to fit in their new shoes. However, there is no secret that they shall now be equal partners in the context of coordinated care.

In conclusion, the changing healthcare landscape is likely to trigger reactionary changes in the nursing profession. The patient population is growing just like the number of persons with Medicare. This implies a more expanded responsibility and scope of practice for nurses – as well as equal partnership in coordinated care.  Nurses shall be stand alone professionals devoid of supervisory authority of other professionals and take a more prominent role in coordinated care.

Part 2: Feedback from Nurse Colleagues

Nurse 1: Nurses will play a huge role in Transforming Healthcare

            The first nurse who was engaged underlined the fact that nurses shall be integral to the transformation of the healthcare system at the macro level. In the past, physicians and other healthcare professionals monopolized leadership and strategy in healthcare, with nurses only left with clinical duties. However, in the future, nurses shall have both the professional capacity and authority to lead strategy and change in healthcare. She alluded to the fact that education of nurses will play center stage going forward, with more of them getting into advanced practice through second and Doctorate degrees (Grossman & Valiga, 2016). This will equip them with special skills both in the technical and organizational sense hence allow them to lead change in the profession. As correctly noted in my presentation, higher education levels and pressure from population health shall force states to review scope of practice and allow nurses to act independently rather than under the strict supervision of physicians. Therefore, they shall play a key role in transformation of healthcare due to advanced education and the newfound authority.

            The nurse also indicated that healthcare delivery models are likely to change in a way that increases the prominence of the nurse roles. She noted that medical homes and Nurse Managed Health Clinics were likely to emerge as leading delivery models. Both models are patient centered and to a great extent community based, focusing on among other things, disease prevention, wellness, behavioral change and education (Puetz, 2013). The flexibility required in these models in line with patient needs falls squarely within a more prominent role of nurses. Patient centered care cannot be achieved without nurses who can adapt according to patient needs. Such healthcare delivery models shall therefore be nurse dependent and indeed change and expand the role of nurses in healthcare.

Nurse 2: Nurses shall have New Working Environments

            The nurse practitioner noted that the changes expected in the nursing profession shall force nurses into new working environments, specifically within the community. At the moment, a huge percentage of registered nurses work in primary care environments which are basically hospitals and other health facilities. In this setting, they work together with other several healthcare professionals in coordinating care and delivering desired outcomes. However, the increased risk factors, disease burden and healthcare insurance shall increase the demand for healthcare services to unprecedented proportions. Thusly, there shall be a paradigm shift towards preventive medicine, patient centered care and nursing education. These are duties that are carried out in new avenues rather than primary care settings and shall thus necessitate nurses to be deployed within communities. Due to growing issues of access and equity, Nurse Managed Health Clinics and other healthcare delivery models that rely on the nursing workforce shall be prevalent in remote areas, bridging the evident gaps (Grossman & Valiga, 2016). Therefore, the nurse anticipates a geographical shift for nurses, operating in rural rather than urban areas where the majority of their roles shall shift to. On the negative side, the nurse intimated that nurses may operate in lots of unchecked autonomy that may be unhealthy for the patient population. It was their suggestion that the extension of scope of practice and increased responsibilities implied in my presentation be backed by additional frameworks to guarantee quality outcomes and advance patient safety. This would guarantee that the change and growth in the nursing profession shall not come at a cost of health outcomes.

Nurse 3: Improved Status of the profession

            The nurse reiterated the ideas of the first and second nurse with respect to the report on the change and growth expected in the nursing profession. They agreed that nurses are likely to play central roles in the transformation of healthcare but emphasize more on coordinated care. In this context, they argued that nursing leadership was likely to emerge as a prominent role for advanced practice nurses who shall be not only autonomous, strategic and equal partners in coordinated care but also the driving force for change in healthcare (Puetz, 2013). They were optimistic that nurses would be allowed in various states to expand their scope of practice and shoulder the additional responsibilities. Ultimately, the dignity of nurses in the profession was likely to grow. They would no longer be considered as subordinates to other professionals requiring to be supervised. Notably, most professionals in the healthcare environment have a larger degree of autonomy than even advanced practice nurses. In coordinated care settings, nurses would be regarded as equals and shall make care decisions that would be binding to other professionals and only subject to logical review. In the end, nursing practice would gain more dignity amongst other peers in the healthcare industry through expanded roles and bestowed authority.


Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., & Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration43(2), 89-94.

Grossman, S., & Valiga, T. M. (2016). The new leadership challenge: Creating the future of nursing. FA Davis.

Puetz, B. E. (2013). The future of nursing: leading change, advancing health. Journal for nurses in professional development, 29(2), 51-51.

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