NRS 440 Health Care Delivery Models and Nursing Practice
NRS 440 Health Care Delivery Models and Nursing Practice
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:
Outline a current or emerging health care law or federal regulation introduced 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.
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.
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.
Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
Healthcare is continually changing, growing, improving, and nurses are also growing. It is essential strategic planning provides the structure to make day-to-day decisions that follow a larger vision, create a direction for your practice, and maximize your options for influencing your environment (Pract, 2009). Strategic planning occurs in a nurse’s day-to-day activities and sets short to long-term goals. For example, a nurse must plan their routine to ensure each patient is taken care of each day. Applying strategic planning skills is the cornerstone of a leadership or management position, it can be described as the conceptual framework of looking into the future and strategically planning the approach for what the future will look like in the short term and in the long term (Whitney, 2018). As a staple of strategic planning, SWOT analysis uses a mix of quantitative and qualitative information, most of which should be gathered and analyzed before the planning meeting (Pract, 2009). SWOT analysis is a tool used to identify strengths, weaknesses, opportunities, and threats. All healthcare team members should be included in the process of developing strategic planning. Good communication is essential for strategic planning success because all the healthcare team needs to be involved.
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. An abstract is not required.
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.
Health Care Delivery Models and Nursing Practice – Rubric
Criteria Description
The need to deliver quality and affordable care implores stakeholders to continually enact legislations to reform and restructure the health care delivery system with the aim of attaining better outcomes. Nurses are critical players in these reforms and restructuring since they are patient advocates. The new delivery models emerge to offer quality care at the greatest value for patients and stakeholders like nurses (Gott, 2018). The purpose of this paper is to examine changes aimed at reforming or restructuring health care delivery system through a current law or federal regulations. The paper also discusses effect of quality measures and pay for performance in patient outcomes and nursing practice. The essay also discusses professional nursing leadership and management roles in response to emerging trends and in patient safety and quality care promotion.
Current or Emerging Health Care Law or Federal Regulation
The need to improve nursing education and practice is critical to care provision in the U.S. health care system. Imperatively, the Nursing Workforce Reauthorization Act 0f 2019 is essential as it would update, reauthorize and enhance critical programs to help grow and support the nursing workforce as one of the largest labor force in the country. The Nursing Workforce Reauthorization Act of 2019 focuses on enhancing nursing education, practice and programs to retain nurses to meet the growing national demand due to an aging population and subsequent retirement of baby boomers’ nursing generation (Merkley, 2019). The law offers many programs to nurse practitioners to enhance nursing care, services and improve the overall wellbeing of these practitioners. The focus of this act is to provide more accountability to the nurse and improve scope of practice to allow increased satisfaction in the profession and lead to better retention rates.
The act will assist in aligning the nursing field within its profession as nurse get opportunity to advance their education and serve in both rural and urban areas, especially among underserved populations and communities. The act ensures that nurses will have increased skills to practice based on their level of education, training, and specialty. The act implores nurses to be more accountable in their role as primary care providers, especially in rural and underserved communities (Congress.GOV., 2019). The act ensures that the American nursing workforce is well positioned to meet care need now and in the future and can address access to care challenges in the populations where they serve.
Quality Measures/ Pay for Performance
Economic changes are essential for health care delivery in the country to remain sustainable while offering quality patient care. The Centers for Medicare and Medicaid Services (CMS) develops measures to lower the cost of care and increase access. Pay for Performance is a component of quality measures aimed at rewarding healthcare entities and providers that focus on quality care and enhancing patient outcomes. Pay for performance stresses the important of quality of care and not quantity which increases the possibility of using best clinical practices and supports promotion of good health. Pay for performance increases transparency while encouraging providers to remain accountable and enhance their overall reputation.
Using data on quality measures established in collaboration with the Agency for Healthcare Research and Quality (AHRQ), organizations and providers get financial rewards for enhancing patient care and reducing costs. Through the intervention, CMS can hold organizations and providers accountable for their shortcomings. The pay for performance is a value-based model and uses patient satisfaction and proven best practices as quality measures. Hospitals and providers report quality metrics to the public using the Hospital Consumers Assessment of Health Plan Survey (HCAHPS), and quality measures associated with falls, infections, morbidity, and mortality in different patient settings (Lee & Nathan, 2018). Providers and organizations use the Healthcare Effectiveness Data and information Set (HEDIS) for reporting these measures in outpatient settings.
Nurses, including advanced practice registered nurses (APRNs), leaders and administrators have direct influence on quality programs and patient outcomes. Nurses should know and understand the current concepts on quality that include a selection of quality measure, data collection and measurement, data reporting and effective evaluation (Gott, 2018). Nurses need to be aware of and understand as well as promoted their roles and the impact they have on high quality patient care and outcomes. They need to advocate for resources, foster a safety culture, participate in policy and decision making concerning best practices and lead in the implementation of quality initiatives.
Leadership and Management Roles and Emerging Trends
The nursing profession is in a strategic position in the health care reforms and transition taking place and development of effective patient care models. The advent of these novel care models that aim at preventive measures and health promotion across have led to emergence of new roles among nurses and other healthcare providers. These novel positions and managerial roles include being care coordinators, primary care providers, virtual care nurses, bundled care coordinators and working in retail clinics, especially in health care deserts in rural settings (Sarkar et al., 2020). All these roles are essential since patient care continues to become complex and extending beyond the confines of healthcare settings.
Nurses are becoming primary care providers and leading the provision of care in rural settings and among different patient populations, especially vulnerable populations and communities. As health care coaches and patient advocates, they help patients set wellness goals, especially those with chronic conditions. New roles like being patient navigators ensures that patients go through their complex care journeys with increased hope and better advice from nurse practitioners (Lee & Nathan, 2018). As such, nurse leaders and managers must be visionary and use evidence-based practice interventions to enhance care delivery a. The emerging act implores nurse managers to understand the financial implications of healthcare and care for communities in a more cost-effective manner than before.
Emerging Trends in Technology and Holistic Care
Different trends will continue to define healthcare provision and care plans in the healthcare system. Among these trends include the shift to nurses as primary care providers due to a decline in primary and specialty care physician, emerging technology’s increased use, and focus on holistic care interventions. The shift to APRNs and RNs is due to the need to maintain public health coverage and increase access, especially as states continue to change laws and increase the scope of practice authority for nurses. Emerging technology will continue to define, design, and shape care provision as more patients become reliant on telehealth and telemedicine through virtual nurses and physicians (Gott, 2018). The emergence of infectious diseases and the need for increased disease surveillance and control of such spread underscore the need for better preparation among health care providers, especially nurses.
Another trend is the emergence and development of Patient Centered Medical Homes (PCMH) as part of offering better access to holistic care. many of these settings are managed and staffed by advanced practice registered nurses (APRNs) and registered nurses (RNs) (Sasangohar et al., 2018). These trends imply that there will continue to be a shift in the entry level into nursing with more institutions requiring baccalaureate level to be hired by hospitals and the medical homes. The use of telehealth and telemedicine applications will imply that more nurses will specialize in nursing informatics.
Conclusion
Nurses are positioned strategically to transition patient care through advocacy, advanced education, training, policy making and leadership. Nurses must keep pace with emerging delivery models to offer safe, effective, and quality care for all patients and ensure that they get the best value outcomes. Nurses should understand the emerging trends and seek effective ways to prepare strategically as critical players in the current reforms.
References
Congress.GOV. (2019). H.R.728 – Title VIII Nursing Workforce Reauthorization Act of 2019.
https://www.congress.gov/bill/116th-congress/house-bill/728/actions
Gott, M. (2018). Telematics for health: The role of telehealth and telemedicine in homes and
communities. CRC Press.
Lee, J. S., & Nathan, H. (2018). Quality measurement and pay for performance. Surgical
Oncology Clinics, 27(4), 621-632. doi: 10.1016/j.soc.2018.05.003.
Merkley, J. (2019). Merkley, Burr Introduce Bipartisan Nursing Workforce Reauthorization Act
of 2019. https://www.merkley.senate.gov/news/press-releases/merkley-burr-introduce-bipartisan-nursing-workforce-reauthorization-act-of-2019
Sasangohar, F., Davis, E., Kash, B. A., & Shah, S. R. (2018). Remote patient monitoring and
telemedicine in neonatal and pediatric settings: Scoping literature review. Journal of medical Internet research, 20(12), e295. doi: 10.2196/jmir.9403
Sarkar, R. R., Courtney, P. T., Bachand, K., Sheridan, P. E., Riviere, P. J., Guss, Z. D., … &
Murphy, J. D. (2020). Quality of care at safety‐net hospitals and the impact on pay‐for‐performance reimbursement. Cancer, 126(20), 4584-4592. https://doi.org/10.1002/cncr.33137
Current or Emerging Health Care Law or Federal Regulation and Effect on Nursing Practice, Role and Responsibility
Health outcomes typically depend on health care delivery models and population-based interventions for healthy living. Progressively, as situations necessitate, massive changes have been introduced to reform or restructure the U.S. health care delivery system to ensure better services to individuals and communities. These reforms have prompted many changes in the practice environment hence the need for nurses to understand current and possible developments in the future. Their roles in the changing environments will also be changing as reform occurs. The purpose of this paper is to examine changes introduced to reform health care delivery and the nurse’s role in the changing environment.
Current Health Care Regulation for Reforming Health Care Delivery
Federal regulations have been instrumental in health care reform to ensure people get accessible and affordable care. When the COVID-19 pandemic broke out, access to care was hampered as the government provided many directives for reducing transmission, including restricting movement and physical interaction. Since people still required health care services for other illnesses amid the pandemic, the US Centers for Medicare & Medicaid Services (CMS) authorized waivers to expand telehealth services for Medicare beneficiaries. Approved in March 2020, these waivers allowed more use of telehealth services, including in-home visits and care services in urban areas (Suran, 2022). The CMS further allowed audio-only interaction via telehealth for some health care services.
Health care reforms have significant effects on nursing practice. According to Suran (2022), the waivers by the CMS in 2020 intensified the use of telehealth services, implying an increased demand for remote health care services. In response to the increased demand for remote care, health care organizations should implement the appropriate technological infrastructure to support telehealth and related technology-related services. As Ford et al. (2020) suggested, a robust technology infrastructure is crucial to prevent risks associated with telehealth in patient care, primarily security and privacy breaches. As these developments occur, health care organizations should also expect more demand for remote health care services hence the need to adjust their delivery models to accommodate appropriate changes.
The nurse’s role and responsibility include appropriate adaptation, supporting technology-driven practice, and promoting a culture of change in the workplace. According to Triana et al. (2020), telehealth use is hampered by negative attitudes, particularly among providers without the appropriate technological skills to implement it safely and effectively. To reduce possible risks, nurses should embrace teamwork when offering tech-based services. A culture change is necessary to ensure that nursing teams are more open to change and can readily embrace new technologies to support patient care. Importantly, nurses should encourage and support patients to embrace telehealth for higher outcomes.
Quality Measures and Pay-for-Performance
Quality measures include processes and outcomes for assessing whether health care services achieve the desired outcomes. As a result, health care professionals use quality measures to assess performance and make decisions that increase the probability of achieving the desired outcomes (CMS.gov, 2021). On this premise, quality measures are a foundation of high-quality care since they guide nurses in improving outcomes. Pay-for-performance (P4P) encourages value-based care. In P4P schemes, health care providers are incentivized based on how they meet predefined targets for quality care (Kyeremanteng et al., 2019). Consequently, providers intensify measures for positive patient outcomes to get maximum incentives.
Quality measures and P4P promote high care quality, which is a core objective of the nursing practice. As their role stipulates, nurses should always be committed to delivering comprehensive care. Accordingly, they should focus on value, efficiency, and quality, among other elements that define satisfactory care (Kyeremanteng et al., 2019). Nurses should expect more pressure from stakeholders and patients to provide a higher value as time advances. Their primary role is to use quality measures as the reference for continuous quality improvement. Nurses should also promote P4P by increasing value through practices that reduce adverse events and allow them to use health care resources efficiently.
Professional Nursing Leadership and Management Roles
The scope of nursing practice and professional roles changes gradually. In nursing leadership and management, health care leaders and managers are currently obligated to lead change in practice settings. This role typifies serving as change agents where nurse leaders identify practice problems, develop appropriate interventions, and lead the implementation process. The other critical role for nurse leaders and managers in the evolving practice is knowledge work. The role of a knowledge worker is characterized by gathering information and interpreting it systematically for improved health outcomes (McGonigle & Mastrian, 2021). These roles are pivotal in effective responses to emerging trends since they improve leaders’ readiness and responsiveness to change. For instance, change agents promote a culture of change to ensure organizations have the appropriate climate and resources for supporting new practices. As knowledge workers, nurse leaders use their theoretical and analytical knowledge to identify health care patterns and respond appropriately. Since each role encourages quality improvement and practice change, there is a higher chance of improved patient safety and high-quality care after implementing innovative practices.
Emerging Trends and Nursing Transformation
Nursing is an evolutionary practice that evolves progressively to address current and emerging patient care demands. Concerning emerging trends, increased use of technologies, such as artificial intelligence and telehealth, a nursing shortage, and the adoption of value-based practice dominate nursing. In response, nursing practice and roles must transform to respond to the upcoming trends effectively. One of the possible ways that nursing will transform in the next five years is an increased inclination toward technology-driven and data-driven practices. Currently, data analytics allow health care professionals to identify trends to provide the most possible patient-centered care (Batko & Ślęzak, 2022). Over time, there will be more use of artificial intelligence and remote patient care to ensure people in rural and remote locations are diagnosed and treated timely and cost-effectively. The other potential transformation of nursing is a team-based practice in health care settings. Teamwork promotes interprofessional collaboration, which will allow nurse practitioners to achieve the goals of value-based care.
Conclusion
Health care delivery models affect how nurses work, practice goals, and care processes. Federal regulations and health care laws continue to influence care delivery models, and more changes are expected in the future. In the current practice, federal regulations through the CMS have allowed more use of telehealth services by authorizing waivers. As technology evolves, nursing practice is expected to be more data-driven and technology-centered. Effective adoption of tech-based services requires organizations to invest in robust technological infrastructure to support innovative practices.
References
Batko, K., & Ślęzak, A. (2022). The use of big data analytics in healthcare. Journal of Big Data, 9(1), 3. https://doi.org/10.1186/s40537-021-00553-4
CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Patient%20and%20families%20use%20quality,likelihood%20of%20desired%20health%20outcomes.
Ford, D., Harvey, J. B., McElligott, J., King, K., Simpson, K. N., Valenta, S., … & Lenert, L. A. (2020). Leveraging health system telehealth and informatics infrastructure to create a continuum of services for COVID-19 screening, testing, and treatment. Journal of the American Medical Informatics Association, 27(12), 1871-1877. https://doi.org/10.1093/jamia/ocaa157
Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, D. (2019). An analysis of pay-for-performance schemes and their potential impacts on health systems and outcomes for patients. Critical Care Research and Practice, 2019, 8943972. https://doi.org/10.1155/2019/8943972
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. Jones & Bartlett Learning.
Suran, M. (2022). Increased use of Medicare telehealth during the pandemic. JAMA, 327(4), 313-313. doi:10.1001/jama.2021.23332
Triana, A. J., Gusdorf, R. E., Shah, K. P., & Horst, S. N. (2020). Technology literacy as a barrier to telehealth during COVID-19. Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association, 26(9), 1118–1119. https://doi.org/10.1089/tmj.2020.0155
5. Excellent
33 points
Discussion on emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is well-developed.
4. Good
29.37 points
Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is described. Some information or detail is needed for clarity.
3. Satisfactory
26.07 points
Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is summarized. There are some inaccuracies.
2. Less Than Satisfactory
24.75 points
Emerging health care law or federal regulation is incomplete. Effect on nursing practice and nurse role and responsibility is partially described.
1. Unsatisfactory
0 points
Emerging health care law or federal regulation is omitted. The law or regulation presented is not relevant to health care.
Criteria Description
Quality Measures Pay for Performance, Patient Outcomes, and Effect on Nursing Practice
5. Excellent
33 points
A thorough and insightful discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented.
4. Good
29.37 points
Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. Some information is needed for clarity.
3. Satisfactory
26.07 points
Summary on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. There are inaccuracies or slight omissions.
2. Less Than Satisfactory
24.75 points
Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is incomplete.
1. Unsatisfactory
0 points
Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is omitted.
Criteria Description
Professional Nursing Leadership and Management Roles
5. Excellent
33 points
A well-developed discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. The discussion demonstrates a thorough understanding of the nursing profession in emerging trends and patient care in a diverse health setting.
4. Good
29.37 points
A discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. Some detail or information is needed for clarity.
3. Satisfactory
26.07 points
A summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.
2. Less Than Satisfactory
24.75 points
An incomplete discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is presented.
1. Unsatisfactory
0 points
Discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is omitted.
Criteria Description
Predict Change in Nursing Roles and Nursing Practice
5. Excellent
33 points
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are thoroughly discussed. The predictions are based on evidence and highly relevant to emerging trends.
4. Good
29.37 points
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are discussed. The predictions are generally supported and realistic.
3. Satisfactory
26.07 points
Insert Satisfactory CoA summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are summarized. The predictions are realistic, but there are inaccuracies or slight omissions. ntent 2 Descriptor
2. Less Than Satisfactory
24.75 points
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are incomplete. The predictions are unrealistic or lack evidence for support.
1. Unsatisfactory
0 points
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are omitted.
Criteria Description
Thesis Development and Purpose
5. Excellent
8.25 points
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
4. Good
7.34 points
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
3. Satisfactory
6.52 points
Thesis is apparent and appropriate to purpose.
2. Less Than Satisfactory
6.19 points
Thesis is insufficiently developed or vague. Purpose is not clear.
1. Unsatisfactory
0 points
Paper lacks any discernible overall purpose or organizing claim.
Criteria Description
Argument Logic and Construction
5. Excellent
8.25 points
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
4. Good
7.34 points
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
3. Satisfactory
6.52 points
Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
2. Less Than Satisfactory
6.19 points
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
1. Unsatisfactory
0 points
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Criteria Description
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
5. Excellent
8.25 points
Writer is clearly in command of standard, written, academic English.
4. Good
7.34 points
Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.
3. Satisfactory
6.52 points
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
2. Less Than Satisfactory
6.19 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.
1. Unsatisfactory
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Criteria Description
Paper Format (use of appropriate style for the major and assignment)
5. Excellent
3.3 points
All format elements are correct.
4. Good
2.94 points
Template is fully used; There are virtually no errors in formatting style.
3. Satisfactory
2.61 points
Appropriate template is used. Formatting is correct, although some minor errors may be present.
2. Less Than Satisfactory
2.47 points
Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.
1. Unsatisfactory
0 points
Template is not used appropriately, or documentation format is rarely followed correctly.
Criteria Description
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5. Excellent
4.95 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
4. Good
4.41 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
3. Satisfactory
3.91 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. Less Than Satisfactory
3.71 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
1. Unsatisfactory
0 points
Sources are not documented.
Total 165 points