Introduction
The United States healthcare landscape has undergone various reforms ever since the nation’s adoption of federalism to advance the quality of care administered to its citizens. These reforms have, in turn, significantly impacted nursing practice and roles. This paper discusses the Affordable Care Act (ACA), a legislation that has reformed and restructured nurses’ roles within the health care system. It also addresses emerging leadership and management roles in nursing and how nursing will adapt to cope with predicted trends in health care. ACA, also known as Obamacare, was enacted on March 23, 2010 (Congressional Research Service, 2017). Its primary purpose was to ensure that more Americans received health insurance coverage.
ACA and its effects on Nursing Practice and nurses’ roles and responsibility
The enactment of ACA was a significant step towards lowering healthcare costs and providing quality care. The legislation pushed for improved quality of care, increased care coordination to reduce spending in repeated diagnostic testing and unnecessary visits to the emergency department and hospitalization, and reduced multiple prescription-related costs (Salmond & Echevarria, 2017). These changes involve nurses who act in leading roles and as participants.
Nursing practice and roles change to cope with healthcare’s shift from the traditional fee-for-service system-based care to patient-centered care. Thus, ACA involves, among others, Essential Health Benefits (EHB) and Value-Based Purchasing (VBP), which aid in achieving its aim of patient-centered, affordable, and quality care (Congressional Research Service, 2017). These approaches emphasize systems that reward healthcare providers according to measurable quality results and patient experiences.
In light of the outcomes mentioned above, nursing practice has to be reformed. The changes in the healthcare landscape require nurses with new or improved set of skills in caregiving (Salmond & Echevarria, 2017). Additionally, nursing practice has to reaffirm its commitment to care coordination, patient-centered care, and improved care quality. It is also expected of nurses to develop good relations with patients and their families better understand the patient’s social environment and, in turn, administer the best care. Therefore, it is clear that nurses will have to undertake roles and responsibilities to cope with the Affordable Care Act legislation reforms.
Quality Measures and Pay-for-Performance (P4P)
Quality measures and Pay-for-Performance (P4P) are some of the significant reforms in healthcare. These initiatives aim to improve the quality, effectiveness, and value of health care. Mendelson et al. (2017) assert that P4P initiatives reward or punish health care providers according to how they perform on quality measures. Proper utilization of Pay-for-Performance plans is likely to improve care quality and reduce hospitalizations in the healthcare landscape.
However, there is little evidence to conclude that P4P measures improve patient outcomes (Mendelson et al., 2017). Still, P4P efforts have probably been successful in other areas, especially in enhancing the care process. The absence of evidence in their role in patient outcomes may be attributed to inadequacies in study methods of their effects (Mendelson et al., 2017). There is also the possibility that it takes quite a while for changes in process-of-care to be interpreted to improve patient outcomes.
Pay-for-performance strategies and other quality measures put a strain on nursing practice. It pressures nurses to develop approaches to ensure all patients receive quality care. The plans reallocate resources to best performing hospitals and pressures the administrators into conserving their budgets and earning more money by funding up for reallocation. Due to this pressure, the nurses only deliver patient care that qualifies for the above-mentioned reallocated funds. Also, a lot is expected of the nurses since P4P reimbursement to hospitals heavily relies on their ability to reduce preventable occurrences and enhance patient satisfaction. The quality measures require excellent nursing skills to be achieved. The nurses’ skills and participation are essential for the new quality healthcare reforms.
Professional Nursing Leadership and Management Roles
Nursing leadership and management evolve with the reforms in the healthcare sector. New leadership roles emerge, and as a result, there is a need for innovative leadership techniques, policies, and ideas. For instance, managing health-related data now involves using advanced and complex E-Systems. Therefore, digital literacy and competence are becoming crucial in the nursing profession and healthcare.
Nursing leaders and managers need to be well acquainted with some of the digital literacy elements, such as data analytics, to aid them in navigating complex modern healthcare (Solman, 2017). This is because the accuracy of the collected data heavily relies on nurse leadership. On the other hand, the data influences decisions on patient flow, their varying needs as indicated by the predictive workforce plan (Solman, 2017). It also recognizes cost drivers and advises nursing leaders of safety in the healthcare environment.
Emphasis on patient-centered care (PFCC) is another emerging role in the healthcare sphere. In this context, nursing leadership is required to exercise the highest levels of professionalism to ensure that they utilize all available resources for the adequate care of patients while including their families (Solman, 2017). PFCC ensures that health practitioners treat patients and their families with dignity and respect, share all unbiased information and collaborate with them while developing policies and programs. Incorporating these activities achieves culturally sensitive and quality care that encompasses the beliefs, needs, values, and wishes of the patients and their families.
Emerging Trends in Nursing Practice and Roles
Trends in nursing result in rapid changes in the healthcare system, which stresses population health, improved care quality, and the value of delivered services. The trends are related to reforms in nursing practice, the societal changes or changes in other professions such as medicine and psychiatry with which it shares close relations. As such, a shift to community-based care is one such trend. A significant number of registered nurses have embraced public and community health and are thus conducting care coordination in the community (Ross, 2018). Also, more nurses are leading innovative reforms. As innovators, the nurses initiate change to push processes and policies to offer quality and more affordable care for society. Other nurses have ventured into politics to also initiate change in the profession.
Even though nursing is one of the most flexible professions in healthcare, the changing landscape of the health care trends will require nursing practice and roles to undergo a fundamental transformation to cope with the changes within the next few years. As such, nurses will have to employ consistently skills relating to ever-learning healthcare such as transitional and coordination care. Nurses will need to quickly learn and make the best use of electronic medical data to cope with advancing technology. They will also have to collaborate with other professionals from other professions to better understand the trends and engage them. In community-based healthcare, nurses will integrate family caregivers, who include friends, relatives, and neighbors, into the patients’ care plans.
References
Congressional Research Service. (2017). Patient protection and Affordable Care Act (ACA): Resources for frequently asked questions. CreateSpace Independent Publishing Platform.
Mendelson, A., Damberg, C., Kondo, K., Low, A., Motuapuaka, M., Freeman, M., O’Neil, M., Relevo, R., & Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care: A systematic review. Annals of Internal Medicine, 166(5).
Ross, S. (2018). Emerging trends in nursing. American Nurse Today, 13(9).
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12–25.
Solman, A. (2017). Nursing leadership challenges and opportunities. Journal of Nursing Management, 25(6), 405-406.