Health Care Delivery Models and Nursing Practice
Current or Emerging Health Care Law or Federal Regulation
The Patient Protection and Affordable Care Act introduced various reforms in the American healthcare delivery system, particularly to lower the high costs of health in the nation. Former U.S. President Barack Obama signed the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, into law in 2010 (Kondo et al., 2016). The ACA overhauled the American healthcare systems, lowered national health insurance costs, and expanded Medicare eligibility. The law also offered subsidies to low-income individuals and banned health insurance companies from raising health coverage costs to tackle the ever-rising healthcare costs in the country. Moreover, it mandated all individuals above the age of 26 to possess insurance coverage or pay stiff penalties. The rationale behind the individual mandate was to reduce healthcare plans’ costs by widening the nation’s health insurance pool.
The ACA places a greater focus on nursing outcomes and has expanded nurse’s roles and responsibilities. According to Kondo et al. (2016), the law concerns nursing outcomes as one of its key aims is to elevate the quality of healthcare in the United States (U.S.). The ACA obliges nurses to provide effective nursing care, therefore, contribute towards reducing healthcare costs in the U.S. In 2012, the ACA established the Hospitals Readmission Reduction Program (HRRP) that tracks nursing care quality in American hospitals (Kondo et al., 2016). The ACA also increased the number of people insured by Medicare, therefore, able to access healthcare and has expanded the roles and responsibilities of nurses. Currently, nurses have to deal with more patients and work longer hours than ever, as the law’s enactment has resulted in inadequate nurse-to-patient ratios.
How Quality Measures and Pay for Performance Affect Patient Outcomes
Quality measures and pay for performance nursing schemes promote positive patient outcomes. Pay for Performance (P4P) schemes are healthcare payment strategies designed to improve health care quality through the issuance of financial incentives (Kondo et al., 2016). They tie financial reimbursements to metric-driven outcomes, proven best practices, and patient satisfaction, thus, nudges healthcare providers towards the issuance of value-based care. According to Robbins (2019), P4P schemes have a flexible payment system that allows for the incremental transition to value-based care, giving healthcare providers time to develop broader value-based systems and policies that can improve their patients’ outcomes. Moreover, the schemes emphasize on quality healthcare over quantity care, and this enables health service providers to concentrate on promoting positive health outcomes through best clinical practices.
Quality measures and P4P schemes emphasize nurses’ role in preventing complications and expanding their nursing expectations and responsibilities. According to Kondo et al. (2016), the tying of reimbursements to positive patient outcomes by P4P schemes magnifies the nurses’ role in patient care and the prevention of hospital-acquired complications, such as pressure ulcers. Emphasis on nursing care will improve nursing practice in the nation because these professionals will focus on implementing proven best practices in their treatment and handling of patients. Moreover, by focusing on nursing care, P4P schemes highlight the integral role nurses play in the American health system , therefore, improve how health service providers and leaders engage with them. Additionally, quality measures and P4P schemes widen the scope of nursing expectations and responsibilities because they heighten scrutiny on nursing practice. The schemes focus on nursing outcomes; thus, they are characterized by intense professional scrutiny on nurses’ individual and collective responsibilities regarding patient care.
Professional Nursing Leadership and Management Roles
Transformational and collaborative nursing leadership approaches and management roles have arisen in contemporary professional nursing practice. According to Thomas et al. (2016), transformational nursing leadership is a management style that focuses on motivating nurses and other health professionals in order to improve their nursing practice. Transformational leadership is inspirational, therefore, differs from the traditional hierarchical-based nursing leadership that focuses on the issuance of orders and instructions. Transformational nursing leadership is characterized by various management roles, such as goals setting and inspiring individual nurses. Collaborative nursing leadership engages all nurses from the bedside to the boardroom to identify and achieve common goals. Moreover, this type of leadership is inclusive and foster professional collaboration within and across various nursing disciplines.
Collaborative and transformational nursing leadership approaches aim to promote patient safety and quality nursing care in diverse health care settings. Transformational nursing leadership motivates nurses, who are committed to upholding proven best practices in the course of their professional practice. Moreover, transformational leadership creates a collaborative environment where nurses can professionally engage and come up with better nursing care practices aimed at improving patient outcomes. Collaborative nursing leadership encourages professional inclusivity that is integral to implementing proven best practices and positive patient outcomes. According to Thomas et al. (2016), collaborative nursing leadership groups nurses into teams, promoting the quick sharing of nursing information and competencies within the workplace, thus, promoting patient safety and quality nursing care. Collaborative and transformational nursing leadership are both flexible, allowing them to respond to emerging nursing trends promptly and effectively.
Telehealth and care delivery are some of the emerging trends that are slowly shaping contemporary health care practice. The COVID-19 pandemic and the travel regulations have promoted the development of telehealth and its wide use in healthcare delivery. Telehealth involves the use of digital information and communication technologies to remotely access health services (Robbins, 2019). Through telehealth, patients can consult with health professionals, be diagnosed, and offered medical prescriptions online. On the other hand, in care delivery, essential treatment interventions, such as ambulatory surgery, are offered to patients outside of the hospital setting (Robbins, 2019). Care delivery is done through modern health facilities such as ambulatory surgery facilities and retail clinics.
Future nursing practice will be based on mainstream health informatics and a reformed code of ethics to respond to the upcoming healthcare trends. With the widespread incorporation of information and communications technology (ICT) into healthcare, future nursing practice will be based on health informatics, which involves the use of health-based ICT services to collect and analyze data from patients and health professionals to improve nursing outcomes. Various forms of health informatics are being used on a trial basis, and within the next five years, nursing practice will be based on mainstream health informatics. Contemporary modern nursing practice is regulated by the American Nurses Association’s Code of Ethics for Nurses, which is narrow in scope and limiting innovation and invention in the nursing field. With constant developments in the nursing domain, the Code of Ethics will have to be revised to cover nursing practice advancements, such as health informatics.
Kondo, K. K., Damberg, C. L., Mendelson, A., Motu’Apuaka, M., Freeman, M., O’Neil, M., . . . Kansagara, D. (2016). Implementation processes and pay for performance in healthcare: A systematic review. Journal of General Internal Medicine, 31(S1), 61-69. https://doi.org/10.1007/s11606-015-3567-0
Robbins, K.C. (2019). The future of nursing as derived from the past. Nephrology Nursing Journal, 46(5), 551-555. https://search.proquest.com/openview/66afa5c3c68f933c2327ed9351a77f0c/1?pq-origsite=gscholar&cbl=45638
Thomas, T. W., Seifert, P. C., & Joyner, J. C. (2016). Registered nurses leading innovative changes. OJIN: The Online Journal of Issues in Nursing, 21(3). https://doi.org/10.3912/OJIN.Vol21No03Man03