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Evolving Practice and Patient Care Delivery Models

The practice of nursing is gaining more significance in the USA and is subject to a vast discussion among medical scholars. The scope of the nurses’ duties is constantly growing and they have to perform new activities all the time. As a result, people demand from nurses more than these healthcare professionals can give. The reason of such behavior is the fact that nurses spend much time with the patients. However, they cannot completely substitute physicians. The current essay discusses the recent changes and expansion of nursing practices and summarizes the feedback and impressions of three nurses, which are not completely consistent with the information delivered to them.

A current healthcare reform in the USA results in the growing scope of nurses’ duties. The main document of this reform is Obama’s “Patient Protection and Affordable Care Act of 2010 (PPACA), which contains many provisions, which seek to intertwine the quality of care with the cost of care” (American Nurses Association, 2010, p.1). The main goal of the document is clear and fair. However, the most important concern of nurses is the fact that their roles in healthcare sphere will dramatically change and expand. The PPACA introduces a number of new concepts, which all nurses should understand and accept. The first of them is “continuity of care”, which means that a nurse should provide continuous care for her or his patients across different settings (American Nurses, Association, 2010). Therefore, one of the primary tasks of the nurses will be coordination of the provided services.

The next set of notions includes accountable care organizations (ACO), medical homes, and nurse-managed health clinics. ACO is a collaboration of different healthcare specialists, who assume common responsibility for the quality of the provided care. The costs in this case are shared between ACO and Medicare (American Nurses Association, 2010). “The medical home is a team-based practice model in which patients see a primary care provider who coordinates all of their care” (Hansen-Turton, Bailey, Torres, & Ritter, 2010, p. 23). Finally, nurse-managed health clinics are planned to be created to solve the problems in primary care, in which the number of specialists is highly limited, and they will be staffed with advanced practice nurses (Hansen-Turton, Bailey, Torres, & Ritter, 2010). The given institutions will promote prevention and treatment of chronic states at much lower prices (Hansen-Turton, Bailey, Torres, & Ritter, 2010). The innovations are definitely aimed at creating more work for nurses and making them assume more responsibilities to guarantee a higher level of healthcare.

It is important to note that Barak Obama has offered not only a set of complex changes for American healthcare system, but also aimed at implementing a number of solutions to help nurses work normally. “The Affordable Care Act addresses nursing workforce challenges in several ways” (Wakefield, 2010, p. 11). They include the initiation of (1) the Nurse Faculty Loan Program, which offers loans to medical schools for nurses to obtain master’s or doctoral degrees; (2) Nursing Student Loan and the Nursing Workforce Diversity programs, which give a chance to the students with limited financial resources to study at a nursing school; (4) the Nurse Education, Practice and Retention Grant Program, which is focused on healthcare quality improvement. Therefore, the nurses are not completely deprived of the assistance to face all the challenges of healthcare innovations.

It is possible to conclude that the American healthcare reform is an important change in the healthcare system. A number and a scale of the innovations, which are planned to be implemented, may result in negative attitudes from the side of medical professionals, especially nurses. However, any healthcare reform has an aim to improve the existing system. The discussed changes will make the life of the patients easier and facilitate the access to healthcare for them. The opinion of the nurses is also important, as they will have to deal with the most significant burden of the innovations. Moreover, they will have to be financially supported in this situation.

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The opinion of practicing nurses is important for understanding how successful the innovations in American healthcare will be. The above-presented report of American healthcare reform was developed with the purpose of receiving a feedback from my nursing colleagues. Three of them were the most active and presented their opinions. Consequently, two of them are categorically against the enumerated innovations. They stated that the scope of the duties proposed to nurses includes the activities, which nurses cannot physically perform without appropriate support. My colleagues claimed that all the medical programs initiated by Obama do not directly solve the problems of nursing workforce.

Another reason of my colleagues’ indignation was the fact that primary care suffers most of all in the conditions of the reform implementation and promoting education for those nurses, who lack resources for studying, is not a solution of the problem. The nurses stated that the primary task in this issue is to encourage physicians to develop new strategies and to overcome using some of the old mechanisms. This point of view is quite common and supported by some scholars. Thus, Jacobson, & Jazowski (2011) state that “physicians and medical professional organizations should abandon their long-standing opposition to non-physician practitioners (NPPs) as primary care providers” (p. 934). Some routine care activities can be easily transferred to NPPs. Such opposition between the roles of NPPs as supplements of the physicians to their substitutes has already been existing in the USA for a long time. The nurses confirm that now it is the best time to stop it, because only when the compromise can be found, and healthcare reforms can pass successfully. The point of the report, which is unconditionally supported by these two nurses, is that the nursing profession should become well-paid. The distribution of finances between nurses and physicians should be properly managed.

The opinion of the third nurse was not as categorical as the one of her colleagues. She expressed a point of view that the primary concern of all healthcare professionals is making high-quality healthcare more accessible for patients. She considers Obama’s healthcare reform to be a step forward to creating a democratic medical system in the USA. However, she strives to express the opinion of all nurses and clarify their exact roles in all the innovations. Moreover, she does not neglect the challenges, which the nurses will experience. Such challenges include the mentioned expanded scope of practice, modifications of the medical educational system, and developing close collaboration with all healthcare professionals, with whom the nurses will work in a team. There is no doubt that all these new tasks are complex and cannot to be solved at once, but my colleague agrees that they will make the patients’ lives easier.

Besides the enumerated challenges for nurses, some more innovations were added by the two first speakers. The first of them is implementation of new technologies. This point of view is supported by Hassmiller (2009), who represents the American Nurses Association and states that: “We must learn to use the newest medical technology and electronic documentation systems to improve quality” (para.5). The second innovation mentioned in the course of the discussion by two first speakers is the increased level of workforce diversity. It has been already noted that the representatives of poor classes will have more chances to receive medical education in the context of Obama’s reform. This fact means that many representatives of different national minorities will occupy positions in nursing. It is good in the sense that they will be able to provide culturally sensitive and competent care to the representatives of different cultures. However, nurses will also have to adjust to working with their international colleagues, which may create additional problems in the course of their work.

The presentation for nurses was built in such a way that they could see all the advantages and disadvantages of innovations. It conveyed the information as it was formulated by the PPACA and contained some comments about the additional actions, which Obama’s administration plans to make. It is possible to conclude that the nurses showed a desire to understand what is waiting for them and expressed their feedbacks on what they have heard. There were some significant discrepancies in the way the nurses perceived the information and I concluded that they need more time to think about the situation and to see how the reform will work in practice.

Conclusion

To conclude, it should be noted that the impressions of three nurses were only partially consistent with what they have heard. Two of them saw additional difficulties only in the innovations, which Obama offered for American healthcare. The third nurse was completely guided by the main mission of nursing, which is based on assisting patients in receiving high-quality care and admitted that Obama’s reform had more advantages than disadvantages. In order for the nurses to understand the real situation and correctly evaluate it, they should clearly see why the reform was offered, what their function in the reform is, and what they are offered to compensate the moral and temporarily financial burden, which they will experience due to the planned changes.

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