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Nursing and Patient Care Delivery Models


The reform of health care delivery in the U.S. is aimed to eliminate health care disparities and provide cost-effective and qualified care to diverse socioeconomic groups of the population. Therefore, the roles of the registered nurses and their practice are expected to change significantly in the future. The purpose of this paper is to provide an informal presentation of the expected changes and the feedback shared by the nurses.

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Informal Presentation of Changes in Nursing Practice

The emphasis of health care reform on improving health outcomes resulted in changing and optimizing the models of primary health care. The development of accountable care organizations (ACO) has significantly influenced the methods of health care delivery. Such organizations are a part of the major strategy included in the Patient Protection and Affordable Care Act (ACA), which is meant to promote quality of care among providers and shift from fee-for-service strategy to equal health care provision. This model involves a collaboration of various health care organizations, which are responsible for a certain group of disadvantaged patients, as well as requires the enhanced deployment of nursing practice to shift from periodical health care to quality and continuous care. It is noted that “the need for care coordination and the adoption of a population-based focus, both key elements of ACOs, maybe changing the way RNs are used” (Pittman & Forrest, 2015, p. 556). Therefore, the practice of registered nurses might be influenced by changes in the delivery of primary care and cause nursing jobs moving from hospitals to ACOs and home health care delivery.

To increase access to primary health care, it is essential to expand the contribution of registered nurses and optimize their practice. It is a general opinion that this approach might be beneficial for promoting healthy work environments for medical professionals and improve population health. Some researchers state that “in the provision of direct patient care, RNs assess patient health status, develop nursing care plans that are implemented through medication administration and diagnostic test interpretation, and evaluate outcomes of care” (Smolowitz et al., 2015, 133). Thus, registered nurses are expected to improve direct health care delivery, provide coordination to medical assistants and licensed practical nurses, as well as practice leadership skills in the interprofessional teams.

It is possible to say that the approach of continuity of care is one of the main values for health care organizations at present. It is defined as a set of activities related to health care delivery according to the needs of a patient. This approach is regarded as fundamental for nursing practice as an outcome of the relationship between a nurse and a patient. It is stated that the efforts to improve the continuity of care such as family and patient education and interdisciplinary approach had improved health care satisfaction and increased earlier requests for palliative care among patients with life-limiting diseases (D’angelo et al., 2015). Therefore, the continuity of care includes interaction between providers and patients and their families and is meant to provide managerial, relational, and informational types of integrated care plans.

It should be noted that ACA also supports the implementation of Patient-Centered Medical Homes in medical centers. This model supports the coordination of care based on a team approach and capacity of patients to self-management to improve health outcomes. Nursing practices are widely utilized in this model to deliver primary and direct care of improved quality. Some researchers state that “nurse-led centers emphasize the holistic model of care and integrate an understanding of the social determinants of health” (Frasso et al., 2017, p. 35). Nursing practice plays a significant role in implementing new models of health care delivery to improve health outcomes and eliminate health care disparities caused by the high cost of medical services and lack of health care delivery in the remote regions.

Summary of Feedback Shared by Three Nurse Colleagues

The presentation of the anticipated changes in the health care delivery system and nursing practice resulted in several positive feedbacks among three nurse colleagues to whom this information was shown. They stated that these changes might be beneficial for enhancing the scale of nursing practice and result in increasing the number of jobs for registered nurses and improving job satisfaction and a healthy job environment.

The nurses who participated in the discussion of changes also noticed that these improvements would be beneficial not only to enhance the nursing practice but also to decrease health care costs and improve health outcomes for patients from diverse socioeconomic groups. They emphasized that sometimes the costs for health care are so expensive that relatives of a patient have to pay the bills long after the patient is dead. Some of them sympathized with those patients who had to worry about bills, could not focus on treatment activities, and experienced tension and negative health outcomes because of their nerves. A patient can’t predict all the diagnoses that one might experience in the course of one’s life, and health insurance might not cover them, especially if a chronic disease is diagnosed or a patient with a severe disease loses the job that provides health insurance. Thus, health care reform is a chance for such people to receive qualified and cost-effective health care.

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It was emphasized by the participants that expanding primary care will be beneficial both for health care professionals and patients. It will allow practicing communication and leadership skills when providing health education to patients and their families or participating in interprofessional groups. The improved quality of health care delivery and easy access to medical services will result in patient satisfaction, and nurses are the key actors in this process due to their practice skills.

The participants believed that the new roles adopted by the registered nurses might assist in the advanced practice of their skills and enhance the importance of their job leading to possible achievements in the research field as they would be able to promote and implement the evidence-based practice. They noted that the education of nurses is the key priority in the contemporary health care system, which significantly influences the quality of health care. The shifting from hospitals to home care and expanding clinical practice might give new opportunities both to nurse graduates and more experienced nurse practitioners.

These impressions are generally consistent with information found on the topic of health reform and the data based on the interviews with nurse practitioners and utilized for major studies in the field of improvement of health care delivery. Patient-oriented health care service and participation of patients in the shared-decision making are frequently mentioned as beneficial by research participants. It is also mentioned that one-to-one encouragement, outcome reports, and facilitating care are the key practices that might bring positive results in the model of medical homes practice. The structure of patient-oriented medical homes gives such opportunities as frequent team meetings and discussion of outcome reports, positive physical environment, and involvement of horizontal responsibility (Frasso et al., 2017). Nevertheless, complex patient needs and staff rolls are listed among the possible barriers to the implementation of medical homes practice.

According to ACO reports, nurse services are also highly required for communication in telemedicine practice. It corresponds to the feedback of nurses on new opportunities that appear for them with the implementation of health reform. It is noted that some ACOs implemented home care initiatives that include the services of registered nurses (Pittman & Forrest, 2015). These programs are used for home visits by teams that include a nurse and a social worker and implementing patient care plans. Still, the implemented changes face some challenges. The process of shifting from Health Maintenance Organization to ACO had many cultural challenges as it was difficult to make a nurse care coordinator or manager provide health care for free-for service patients and nurses are believed to adjust to the patient-nurse relationship too slow. Some nurses claim that they deserve higher payment as their responsibilities expanded. The participants who provided feedback on this presentation did not discuss the payment issues. Nevertheless, they expected that their job would be praised and well-paid.

Still, some ACOs face problems with billing the services of nurses and had to limit nurse visits because of this challenge (Pittman & Forrest, 2015). Lack of training in providing health care to the population is regarded as a problem as well. Therefore, the government makes attempts to promote new roles of nurses and guarantee equality in health care delivery through close collaboration with ACOs and medical institutions. The promotion of new job opportunities to registered nurses is found beneficial by all the participants who shared their impressions on health reform. Still, they understand that there are a lot of challenges and difficulties in achieving a decent quality of health and eliminating health disparities.


The given paper discussed the changes in nursing practice and provided a summary of feedback on these changes from three nurses. Their impressions were found consistent with the information found during the research. New approaches to nursing practice play an important role in patient autonomy and shared-decision making.


D’angelo, D., Mastroianni, C., Hammer, J. M., Piredda, M., Vellone, E., Alvaro, R., & De Marinis, M. G. (2015). Continuity of care during end of life: An evolutionary concept analysis. International Journal of Nursing Knowledge, 26(2), 80-89.

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Frasso, R., Golinkoff, A., Klusaritz, H., Kellom, K., Kollar-McArthur, H., Miller-Day, M.,… Cronholm, P. F. (2017). How nurse-led practices perceive implementation of the patient-centered medical home. Applied Nursing Research, 34(1), 34-39.

Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in Pioneer Accountable Care Organizations. Nursing Outlook, 63(5), 554-565.

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: Meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136.

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