Evolving Nursing Practice and Patient Care Delivery Models

Evolving Nursing Practice and Patient Care Delivery Models

Grand Canyon University: NRS-440VN

Evolving Nursing Practice and Patient Care Delivery Models

As the health care systems in the United States are evolving and changing, the nursing practice is also adjusting and adapting as well. The “baby boomer” generation is aging and the rate of chronic illnesses, like diabetes and obesity, is increasing. In order to combat these changes, the current disease-healing health care system must change to a patient-centered preventative health care system. The shift to a patient-centered preventative health care system requires an increase in the need for nursing care. This presentation will discuss the changes expected involving the concepts of continuity of care, accountable care organizations (ACO), medical homes, and nurse-manages health clinics (NMHC).

One of the main changes expected in the coming years is the continuity of care for the patients. According to the article “Different nursing roles in the continuum of care”, the continuity of care is defined as a patient-centered health care system that last the patient’s entire life span and care for every aspect of the patient through all levels of care (“Different Nursing Roles in the Continuum of Care”, 2015). The main objective of continuity of care is to ensure that the patient is cared for continuously and not on a symptom based aspect. By providing continuous care for the patient, the patient will be provided preventative health care and the patient’s health care will be more cost efficient. The nurse’s role will be expanded into different aspects of the continuity of care, such as community-based services, disease management programs, and case management services. For example, a disease management nurse will be needed to follow-up with patient with recent chronic disease diagnoses and assist the patients facing barriers in managing their new diseases.

Another change expected is an increase in the involvement of the Accountable Care Organizations in patient care. Accountable Care Organizations or ACO are group of health care professionals that work as an interdisciplinary team to coordinate care for patients in all types of settings. By providing coordinated care, the quality of health care and overall health of the patients can be expected to improve. Nurses are part of ACOs and could see to have expanded roles such as care coordinators, quality improvement managers, and communicators. For example, with the focus of care being shift towards the patient, nurses would be asked to analyze the data and seek inventive ways to improve the quality of care that the patients experience (“The Role of Nurses in Accountable Care Organizations”, n.d.). According to “The Role of Nurses in Accountable Care Organizations”, the nurse’s expanded role in ACO would create a continuous feedback loop, where the nurses would analyze the data and improve the quality of care the nurses deliver to the patients.

Thirdly, the implementation of medical homes would drastically increase the need for nurses in outpatient primary provider settings. The medical home model of health delivery provides patients with holistic care, which focuses on all aspects of the patient including the patient’s social and spiritual health. Advance practice nurses, such as nurse practitioners, can be the primary care provider in these settings and provide primary care services to patients (Aktan, 2016). Some of the primary care services include diagnosis of uncomplicated acute conditions, wellness and prevention check-up and management of chronic conditions like hypertension and diabetes. Additionally, nurses can also take on a role as patient care coordinator. The patient care coordinator oversees the coordination of medical services for a patient, and determines their risk (Aktan, 2016).

Lastly, nurse-managed health centers (NMHC) are community based health centers or clinics that are lead by nurse practitioners. The clinics would focus on wellness education, health promotion, and disease prevention (Hansen-Turton & Pohl, 2015). While the health centers would be run by the nurse practitioners, many other health care professionals would be involved in the care of the patient. These clinics would serve the patient population in underserved and uninsured areas to provide the primary health care that they lack. The role of the nurse is to be the primary care provider for underserved patients with no direct access to hospitals or physicians. NMHC ultimately increases the need for advance degree nurses and provides a way for advance degree nurses to maximize their training and education.


The first colleague that was given this presentation has worked on my unit for under a year. She currently holds her ASN and aspires to pursue higher education in order to become an advanced practice nurse practitioner. After the presentation, she recalled learning about the increase in demand for nurses during her recent time in nursing school. She stated that the presentation has further encouraged her to pursue her advanced practice nursing degree so that she can also be a part of the changes that are to occur. Due to her recent graduation from nursing school, she was very familiar with all of the changes to come to nursing practice and health care delivery systems. While she is afraid of the decrease of nurses in the bedside setting, she is also excited for all the opportunities she will have to explore different areas of nursing. She stated that the community based setting is an area of nursing that she wishes to explore and be a part of the growth of community based nursing. At the conclusion of the presentation, she was provided with additional resources to obtain further information on continuing her degree.

The second colleague is a BSN nurse, who has worked on a med-surg floor for a total of 10 years. He stated that he is currently not interested in pursuing a higher degree because this is his second career and he is close to retirement. Due to his disinterest in pursuing a higher degree, he admits he has been “out of the loop” and not aware of the changes that were coming to the nursing profession. Once receiving all the information, he said he would reconsider pursuing an advance degree. While he doesn’t see himself becoming a nurse practitioner, he stated his interest in nurse manager roles. When asked which change he was most eager to see, he explained that the autonomy of a NMHC is one of great interest to him. During his time in an acute care setting, he has always wished that nurses had more autonomy to provide interventions for uncomplicated issues. He also stated with the autonomy health care cost for patients will be lowered and patients would be provided higher quality care.

The last colleague is BSN nurse with three years of acute care setting experience. She is planning on pursuing to become a certified registered nurse anesthetist. She understood all these changes were coming to the nursing profession and believes that all nurses should prepare for it. At the same time, she also believes that it would require a lot change in the governments approach to health care before the nurses start seeing the full effect of these new health care delivery models. A great point she made was that it is important that younger nurses like herself be more vigilant in “taking over the reigns” of nursing organizations, such as New York State Nursing Association, from the older nurses. While the changes in the nursing profession will affect the younger nurses, only the older nurses are attending protests and hearing for these changes. She believes it is important for the younger nurses to be involved in their own future and help shape the nursing profession

The research for the presentation has provided great insight for the author of the presentation on the new health care changes that are to come. There are so many different changes coming to the nursing profession, especially in medical homes and nurse managed health clinics. As the last colleague stated the importance of being more involved in the changes of the nursing profession, it is important that all nurses, young and old, be involved with the changes. Only through active involvement of all the nurses, can the changes to the profession be adapted effortlessly and patients would be provides better, quality health care.


Aktan, N. (2016). Transforming nursing practice: The patient-centered medical home. American

Nurse Today11(8). Retrieved from https://www.americannursetoday.com/transforming-nursing-practice-patient-centered-medical-home/

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Hansen-Turton, T., & Pohl, J. (2015). Nurse-Managed Health Centers – American Academy of

Nursing Main Site. Retrieved from http://www.aannet.org/initiatives/edge-


The Role of Nurses in Accountable Care Organizations. (n.d.). Retrieved from