The restructure of the U.S. health care delivery system does not eliminate nurses, and they are going to play an important role in health care process. Even though more and more nursing jobs are going to be offered out in the community with the less availability in acute care hospitals, nurses are going to play a central role in health care delivery system. Paying attention to the growth and shift of nursing responsibilities the following issues are to be covered, concepts of continuity or continuum of care, accountable care organizations, medical homes, and nurse-managed health clinics.
According to the reform in the US healthcare system signed by President Obama on March 23, 2010, and the American Recovery and Reinvestment Act of 2009, a number of the initiatives were going to be implemented. One of the main changes affected nurses was primary care medical homes and accountable care organizations which were wholly dependent on them. Thus, registered nurses became really important in the health care system. Most of the work with primary care medical homes and accountable care organizations became nurses’ responsibility. The changes in the US healthcare made nurses the center of the care system as they became responsible for taking care of others. Considering the changes and the role of nurses there, one strategy seems to be the most crucial one, the patient-centered medical home which is “an enhanced model of primary care through which care teams attend to the multifaceted needs of patients and provide whole person comprehensive and coordinated patient-centered care” (Sochalski, & Weiner, 2011, p. 377). This innovative system addresses the following aspects which were inappropriately treated in the past, namely, a patient-focus, chronic illnesses directed, and payment reliable.
Speaking of continuity or continuum of care, many steps were taken in order to improve the existing system and to apply innovative technologies there. One of the main techniques offered was the “intervention developed through partnerships between different health care providers” (Baker, 2011, p. 13). The role of nurses in this process has become essential with the reform implementation. The changes in the health care organization have created the necessary conditions for personalization of care. Thus, each nurse now has particular number of patients he/she is responsible for apart from newcomers. This innovation makes it possible to keep the serious cases of chronic diseases under constant control by one nurse who is aware of the history of the disease and other supportive measures. Patient care becomes coordinated and controlled from different perspectives. According to the National Committee for Quality Assurance (NCQA), in case of using the services of a patient-centered medical home “patients have a direct relationship with a provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the care provided to the patient, and arranges for appropriate care with other qualified providers as needed” (National Committee for Quality Assurance, 2011).
The advantages of nurse-managed health clinics are greater from the financial point of view. Using these services, patients are guaranteed quality and low cost services compared to other aspects. Thus, the patient-centered medical homes are aimed at increasing the coordination of health care delivery, accountable care organizations have the wider role shifting it not only to patients and nurses, but broaden it across the whole care continuum, “from physicians to hospitals to other clinicians” (Longworth, 2011, p. 579).
In conclusion, it should be stated that the changes brought by the healthcare reform are significant. Registered nurses have been assigned with greater roles in the health care delivery system that increases their importance. Now, the nurses are valued due to the quality of their services, therefore, the general care giving has improved.
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