Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced within the last 5 years to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years in response to upcoming trends or predicted issues in health care.

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Sample Expert Answer and Explanation

Health Care Delivery Models and Nursing Practice

In 1912, Roosevelt ran on a campaign agenda in which he promised to reform the American healthcare system by advocating for the adoption of the social insurance programs that would help cushion the poor against health issues. While Roosevelt failed the 1912 elections, his ideas inspired the adoption of programs that contributed to increase in access to health care.

The passage of the Affordable Care Act (ACA) in 2010 was a culmination of the past efforts focused on transforming the U.S.’s healthcare system. Even with the passage of a new act, new issues emerge, necessitating the need to find solutions. This is noticeable with the ACA in which the steady increase in premiums has discouraged economically disadvantaged groups from enrolling for the health cover plans.

The Emerging Health Care Law or Federal Regulation to restructure the Aspects of Health Care Delivery

Some of the flaws seen with the ACA have prompted the U.S.’s government take certain measures aimed at improving healthcare access. For Instance, President Biden’s administration is in the process of retaining the tax credit program that allows the socially and economically disadvantaged Americans to access health cover at discounted premiums. Under this program, a low income earner pays less for the premium than a person that earns above the poverty-index level (Li, Chen, & Ding, 2023).

With this program, poor Americans that would have been locked out of the insurance schemes like Medicaid, have the opportunity of accessing care by paying lower premiums. Given that policy solution is required to extend the premium-based benefits, Biden’s administration is pursuing policy efforts to extend the program which will expire in 2025.

The Impact of Quality Measures and Pay-for-Performance on Patient Outcomes

Pay-for-Performance (P4P) among other quality measures is associated with optimal patient care outcomes. Under the P4P model, payers compensate providers for meeting quality targets or for complying with recommended best practice such as the use of evidence-informed interventions. With this model, still, providers are penalized if they provide substandard care or if the health services they deliver causes health concerns. If a hospital fails to meet the desired goals, for instance, the payer opts for non-payment, implying that the hospital ends up using its resources without earning income from the resources (Diaconu et al., 2021).

Given these penalties and the monetary incentives that come with meeting the required targets of safe care, providers are likely to be committed to delivering safe care. However, putting pressure on providers to provide quality-based care can lead to physical and mental breakdown, rendering them less productive. It may cause low performers to lose morale, resulting to work-related stress.

How the Quality Measures affect Nursing Practice

The quality measures have significant implications on nursing considering that they ensure nursing interventions align with quality standards and guidelines. With the adoption of the measures by healthcare facilities, nurses engage other professionals, collaborating and coordinating care with the intent of improving patient experience. For nurses, participating in activities linked to the quality measures offer them an opportunity to learn and to gain new experience, which cumulatively contribute to their professional growth.

When nurses are more skilled and more experienced, they are likely to provide safe and quality care. In the context of nursing practice, the implementation of measures adopted to help improve the quality of health services is likely to translate to more efficient nursing workforce (Martin et al., 2020). This is because these measures compel nursing professionals to adhere to the protocol established to help inform clinical decisions. In addition, they make it possible for nurses to stay informed about the ways of delivering effective care.

The Expectations and Responsibilities of the Nursing Role

When it comes to applying the proposed measures into practice, nurses play crucial role considering that they pursue career advancement goals to learn new skills, which they employ in meeting patients’ needs. The measures equally influence nurses’ decisions, compelling them to seek leadership opportunities so that they lead quality-based initiatives. Because nurses can mobilize colleagues to push for the change of policy, they are in a better position to advocate for patients and for themselves (Chiu et al., 2021).

For instance, they may call for better staffing ratios in different units which would essentially make the workplace safer for nurses, and reduce adverse health events in clinical settings. Furthermore, nurses engage with other professionals, sharing ideas that can help them to better implement the quality measures.

The Professional Nursing Leadership and Management Roles that have emerged including their Importance in responding to the Emerging Trends and in the Promotion of Patient Safety and Quality Care in Diverse Health Care Settings

A number of nursing roles have emerged in the recent past in response to the need to adapt the nursing profession to the changing patient needs. The nurse informatics specialist is one of these roles, and under this particular role, the nurse manages and analyzes the health informatics technology to ensure that the information stored in the system is accurate and current. This particular role is important in the sense that it makes it possible for nurses to effectively use the informatics system to capture and access patients’ data.

The clinical nurse leader is the other role that has emerged, with a nurse within this role being involved in directing the delivery of care in clinical situation (Guibert-Lacasa & Vázquez-Calatayud, 2022). This role is crucial because it makes it possible for the nurse to integrate their ability to deliver care with leadership knowledge. This in turn results to effective management of patients’ clinical cases.

Ways in which the Practice of Nursing Roles will grow or change within the Next 5 Years in Response to Upcoming Trends

In the last two decades, technology has helped shape the delivery of health care, and it is projected that it will continue shaping the development of the nursing profession. As the Artificial Intelligence (AI) technology advances and nurses learn how it works, they will shift towards a practice in which they use data to inform decisions. Drawing on the experience of dealing with the covid-19 pandemic, nursing will shift towards preparing nurses to manage emergency medical cases, and to respond to abrupt spike in demand for health services (Hendel & d’Arville, 2022).  Additionally, nurses will begin prioritizing the development of skills that can help manage the health issues that come with aging.

Conclusion

In overview, the changes introduced into the ACA like subsidizing premiums for health cover have had positive effect in terms of encouraging poor Americans to enroll for the health insurance. With programs like P4P, patients have the opportunity to benefit from the quality care that comes with provider compliance with quality measures because these measures influence nursing practice by requiring nurses to prioritize quality when delivering care.

References

Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy Advocacy and Nursing Organizations: A Scoping Review. Policy, politics & nursing practice, 22(4), 271–291. https://doi.org/10.1177/15271544211050611.

Diaconu, K., Falconer, J., Verbel, A., Fretheim, A., & Witter, S. (2021). Paying for performance to improve the delivery of health interventions in low- and middle-income countries. The Cochrane database of systematic reviews, 5(5), CD007899. https://doi.org/10.1002/14651858.CD007899.pub3.

Guibert-Lacasa, C., & Vázquez-Calatayud, M. (2022). Nurses’ clinical leadership in the hospital setting: A systematic review. Journal of nursing management, 30(4), 913–925. https://doi.org/10.1111/jonm.13570.

Hendel, S., & d’Arville, A. (2022). Reimagining health preparedness in the aftermath of COVID-19. British journal of anaesthesia, 128(2), e100–e103. https://doi.org/10.1016/j.bja.2021.08.020.

Li, Z., Chen, Y., & Ding, J. (2023). Impact of health insurance equity on poverty vulnerability: evidence from urban-rural health insurance integration in rural China. Frontiers in public health, 11, 1328265. https://doi.org/10.3389/fpubh.2023.1328265.

Martin, B., Jones, J., Miller, M., & Johnson-Koenke, R. (2020). Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis. Inquiry : a journal of medical care organization, provision and financing, 57, 46958020917491. https://doi.org/10.1177/0046958020917491.

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Healthcare Reform and Nursing: Transforming U.S. Healthcare Delivery Systems

Introduction

The U.S. healthcare delivery system has undergone significant transformation over the past decade, driven by landmark legislation, evolving patient needs, and technological advances. At the center of this transformation stands the nursing profession—comprising over 4.3 million registered nurses who serve as the backbone of American healthcare. This comprehensive analysis examines the major reforms reshaping healthcare delivery and the pivotal role nurses play in implementing and leading these changes.

Major Healthcare Reforms Transforming the U.S. System

The Affordable Care Act: A Catalyst for Change

The Patient Protection and Affordable Care Act (ACA), enacted in 2010, represents the most significant healthcare reform in decades. An estimated 27 million Americans have gained health insurance coverage during the past five years thanks to the Affordable Care Act, fundamentally altering the healthcare landscape.

Key ACA provisions affecting healthcare delivery include:

• Coverage Expansion: Medicaid expansion and insurance marketplace creation
• Quality Incentives: Value-based care models replacing fee-for-service
• Prevention Focus: Emphasis on preventive services and population health
• Healthcare Access: The law also offers subsidies to low-income individuals to minimize healthcare costs. In addition, the ACA prevented health insurance companies from raising costs or denying coverage to people with preexisting conditions

Value-Based Care Models

Healthcare systems are transitioning from volume-based to value-based care, emphasizing patient outcomes over service quantity. This shift includes:

• Accountable Care Organizations (ACOs)
• Pay-for-performance initiatives
• Patient-centered medical homes
• Bundled payment models

Technology Integration and Digital Health

The integration of technology has revolutionized healthcare delivery through:

• Electronic Health Records (EHR) systems
• Telehealth and remote patient monitoring
• Artificial intelligence in diagnostics
• Mobile health applications

The Evolving Role of Nurses in Reformed Healthcare Systems

Advanced Practice Registered Nurses Leading Care

One of the primary opportunities to emerge for nurses is the demand for nurse practitioners to serve a growing population with increased healthcare access. Advanced Practice Registered Nurses (APRNs) now serve in expanded roles including:

• Primary Care Providers: Addressing physician shortages in underserved areas
• Care Coordinators: Managing complex patient cases across settings
• Population Health Managers: Leading community health initiatives
• Quality Improvement Leaders: Implementing evidence-based practices

Nurses as Healthcare Innovators

Nurses can capitalize on the purpose of the ACA to leverage their power to improve quality, create efficient delivery systems, and pioneer innovations in healthcare while advocating for equity for patients. This includes:

• Developing new care delivery models
• Leading interdisciplinary teams
• Implementing patient safety initiatives
• Advancing health equity programs

Care Coordination and Patient Navigation

Reformed healthcare systems emphasize seamless care transitions, with nurses serving as:

• Patient advocates and educators
• Care transition coordinators
• Chronic disease managers
• Healthcare navigators

Current Healthcare Workforce Statistics and Trends

Nursing Workforce Demographics (2024)

Healthcare Workforce Challenges

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Key workforce challenges include:

• Nursing Shortage: The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows
• Educational Capacity: Nursing schools struggling to expand enrollment
• Burnout and Retention: Burnout remains a critical issue. The intense demands of nursing, especially during the COVID-19 pandemic, have led many to leave the profession
• Geographic Maldistribution: Rural and underserved areas facing acute shortages

Impact of Healthcare Reform on Nursing Practice

Expanded Scope of Practice

Healthcare reform has led to expanded nursing roles across multiple dimensions:

Clinical Practice:

• Independent practice authority in many states
• Prescriptive privileges for APRNs
• Specialized certification requirements
• Evidence-based practice implementation

Leadership Roles:

• Chief Nursing Officers in executive positions
• Quality improvement team leaders
• Healthcare policy advisors
• Community health program directors

Patient-Centered Care Models

Some reports are good, such as job growth; whereas others stress that nurses have bigger patient loads resulting in diminished care for patients. Despite challenges, nurses are adapting through:

• Interdisciplinary collaboration
• Patient engagement strategies
• Shared decision-making processes
• Culturally competent care delivery

Quality and Safety Improvements

Nurses lead quality initiatives including:

• Infection prevention programs
• Medication error reduction
• Patient fall prevention
• Pressure ulcer prevention protocols

Challenges and Opportunities in Reformed Healthcare Systems

Current Challenges

Emerging Opportunities

Professional Development:

• Advanced degree programs
• Specialty certifications
• Leadership development initiatives
• Research opportunities

Career Advancement:

• According to the 2024 U.S. News & World Report list of the 100 Best Jobs, nurse practitioner takes first place
• Executive leadership positions
• Healthcare consulting roles
• Policy and advocacy positions

Future Directions: The Next Decade of Healthcare Reform

Anticipated Reforms

Policy Initiatives:

• Medicare for All discussions
• Prescription drug cost reforms
• Mental health parity enforcement
• Health equity legislation

System-Level Changes:

• Integrated delivery networks
• Population health management
• Social determinants of health integration
• Climate change and health initiatives

Nursing’s Strategic Role

As the lead organization representing the interests of the nation’s 4 million registered nurses, ANA’s role is to articulate that voice at the highest levels in order to influence health policy. Future nursing contributions include:

• Health policy development and advocacy
• Healthcare innovation leadership
• Community health program design
• Global health initiatives

Evidence-Based Recommendations for Healthcare Leaders

For Healthcare Organizations

1. Invest in Nursing Leadership: Develop nurse executives and leaders
2. Support Professional Development: Fund continuing education and certification
3. Implement Technology Thoughtfully: Ensure adequate training and support
4. Address Workforce Shortages: Develop comprehensive recruitment and retention strategies

For Policymakers

1. Remove Practice Barriers: Eliminate unnecessary scope of practice restrictions
2. Fund Nursing Education: Support nursing school capacity expansion
3. Address Social Determinants: Integrate community health approaches
4. Promote Interprofessional Collaboration: Foster team-based care models

For Nursing Professionals

1. Embrace Lifelong Learning: Stay current with healthcare trends and technologies
2. Develop Leadership Skills: Prepare for expanded roles and responsibilities
3. Engage in Policy Advocacy: Participate in healthcare policy discussions
4. Focus on Quality Improvement: Lead evidence-based practice initiatives

Conclusion

The transformation of the U.S. healthcare delivery system presents both significant challenges and unprecedented opportunities for the nursing profession. The size of the FTE RN workforce is projected to grow substantially, from 3.35 million in 2018 to 4.54 million in 2030, positioning nurses as key stakeholders in shaping the future of American healthcare.

Success in this reformed healthcare environment requires strategic planning, continued professional development, and collaborative leadership. Nurses must embrace their expanding roles while advocating for policies that support both professional practice and patient outcomes. As healthcare continues to evolve, the nursing profession’s commitment to quality, safety, and patient-centered care remains the cornerstone of effective healthcare delivery.

The journey of healthcare reform is ongoing, and nurses will continue to be at the forefront of innovations that improve health outcomes, reduce costs, and enhance the patient experience. Through strategic leadership, evidence-based practice, and unwavering advocacy, the nursing profession will help realize the vision of a more accessible, equitable, and effective healthcare system for all Americans.

References

1. American Nurses Association. (2017). Healthcare Policy – Nursing Healthcare Reform. Retrieved from https://www.nursingworld.org/practice-policy/health-policy/
2. All Nursing Schools. (2023). How the Affordable Care Act Affects Nurses. Retrieved from https://www.allnursingschools.com/articles/obamacare-and-nursing/
3. American Association of Colleges of Nursing. (2024). Nursing Shortage Fact Sheet. Retrieved from https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage
4. Georgetown University School of Nursing. (2021). The Role of Nurse Practitioners in Health Care Reform. Retrieved from https://online.nursing.georgetown.edu/blog/aca-and-nps/
5. MASC Medical. (2024). 2024 U.S. Nursing Shortage: Current Trends, Impacts, and Effective Solutions. Retrieved from https://mascmedical.com/2024-u-s-nursing-shortage-current-trends-impacts-and-effective-solutions/
6. Maryville University. (2023). What Is the Affordable Care Act’s Impact on Nurses? Retrieved from https://nursing.maryville.edu/blog/aca-impact-on-nursing.html
7. National Council of State Boards of Nursing. (2021). The Future of Nursing 2020-2030. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK573922/
8. NurseJournal.org. (2023). The Affordable Care Act And Nursing. Retrieved from https://nursejournal.org/resources/affordable-care-act-nursing-guide/
9. Online Journal of Issues in Nursing. (2022). The Affordable Care Act: Considerations for Leveraging the Power of Nursing. Retrieved from https://ojin.nursingworld.org/table-of-contents/volume-27-2022/number-2-may-2022/leveraging-the-power-of-nursing/
10. U.S. Bureau of Labor Statistics. (2024). Registered Nurses: Occupational Outlook Handbook. Retrieved from https://www.bls.gov/ooh/healthcare/registered-nurses.htm