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Evolving Practice of Nursing


As society develops, the needs of people become more elaborate. Similarly, technology pushes forward almost every sphere of human activity. Healthcare is one of such areas where change always persists. Innovations touch mostly upon the equipment that makes the work of nurses, doctors, and patients easier. However, the organization and focus of the whole healthcare system in the US are also prone to develop. New models of healthcare delivery emerge, and nurses need to be aware of them, which is why it is paramount to review the most recent and most popular alternatives.

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Continuum of Care

Continuum of care is a concept that represents a model of care that addresses care provision on all levels across the life span, from birth to senior age. This model guides all kinds of patients and offers services and advice in a variety of environments. In addition to standard hospitals, the healthcare system provides services at homes, and in communities. It not only provides help when it is needed but also prioritizes disease prevention and health literacy raising the level of wellbeing across the nation. Such a model also outlines multilevel cooperation between different healthcare units, ensuring that health services are coordinated and timely. Information exchange here is of utmost importance. The future of nursing might as well be in this model that is already implemented and integrated across the states.

Accountable Care Organizations

In the sphere of coordination and optimization, a new improvement emerges in the face of accountable care organizations (ACO). These organizations act under Medicare national policy and deliver care in a way that prevents medical errors service duplications from happening (CMS, 2017). Essentially, this model of care unites professionals and organizations from different spheres and levels of the system through voluntary participation for the purpose of providing high-quality care at a lower cost. This is achieved through lower amounts of administrative force, which allows decreasing operational costs. This model indicates a trend of drifting towards servicing patients on a community level offering tailored payment schemes. According to McWilliams, Chernew, Landon, and Schwartz (2015), the ACO system seems to be extremely effective at saving money.

Medical Home

A medical home or patient-centered medical home (PCMH) stands for a healthcare delivery model that provides care within one institution and targets comprehensive treatment of patients. This model centers on patients and all who surround them receiving the best care possible. That is achieved through concentrating the efforts of a single professional on a single patient. PCMH emphasizes the mutually beneficial partnership between a patient, healthcare provider and a patient’s family in order to achieve the best health outcomes. Hoff, Weller, and DePuccio (2012) note that this approach to healthcare delivery showed promising results and with continued evolution is able to become even more efficient.

Nurse-Managed Care

There is a new trend in care delivery that focuses on empowering those who facilitate that delivery first-hand. Nurse-managed clinics offer a wide variety of high-quality services avoiding unnecessary structural overcomplications, which allows focusing more effectively on the most vulnerable groups of populations locally. Such nurse-managed care facilities address the healthcare needs of the specific community, patient, and his or her family. For nurses, such clinics provide high levels of autonomy, which, as self-reported data gathered by Pron (2013) suggests, results in better job satisfaction.

Feedback Summary

Those who shared their feedback were very keen to know about the idea of such a form of addressing the knowledge gap. Most of the nurses whom the presentation was delivered to were quite busy and often did not have time to get acquainted with the latest organizational discoveries in the sphere that does not concern their practice. Thus, most of them considered this little research quite helpful and educational. Some of them even proposed sharing such studies more often in order to raise awareness of the problems that may not be obvious to other people. In that way, they hope to promote healthy and well-round professional education.

As for the content of the message delivered, many nurses noted that the promotion of the changes in the care delivery systems is timely. Moreover, most of the nurses suggested that improvements in the way administration works are most necessary due to the fact that it is often the case when overcomplicated and bureaucratized procedure of healthcare delivery hinders the possibilities of nurses to deliver the best quality services. In that regard, nurses noted that nurse-managed care is a way to go, especially when primary care is in question. Almost all of the nurses agreed that higher degrees of autonomy would allow them to perform more effectively. The amount of paperwork they deemed as the most depressing issue, which is a more self-reliant environment should not be an issue anymore.

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They also considered it noteworthy to mention that care delivery models that prioritize a single professional caring for an individual patient and addressing a variety of issues would be ideal for community-led healthcare. Such an approach can save time on researching the patient’s history of illnesses and other necessary information when addressing basic healthcare needs. The debate arose, however, about families. The question was whether personal nurses should take responsibility for treating relatives with conditions dissimilar from their primary patients. Most agreed that they should, but others believed that it would be wiser to consider age group as a basis for a choice of professional.

Nurses sensed the need for community-based models because they allow closer monitoring of their population, which could potentially result in a more tailored approach to prevention, health literacy, and general outreach. Additionally, patients of all ages seem to feel more comfortable seeing familiar faces. This not only benefits the community’s health but also creates a friendlier environment for nursing teams, which could save up a lot of energy and nerves.

Those who mentioned the continuum of care in their response referred to it as just another name for the old system. They believe that healthcare officials often outlined the need for interprofessional collaboration between nurses and other personnel but unless major changes in the legislation occur, nurses will still be viewed not as equally skilled and professional workers but just as subordinates. The latter seems to irritate many new nurses in the field. The general belief was that a ground for cooperation should be established at the local level, where spheres of interest could be narrowed and tailored for each professional with more precision.

As far as medical homes are concerned, many nurses noted the positive impact that the emphasis on the multilevel partnership could make. They mentioned that a more openhearted conversation between all parties involved in the process of admission, treatment, and rehabilitation could greatly benefit health outcomes, as no information will be held back. The team approach with multiple professionals of different backgrounds did not seem to arouse much enthusiasm as many nurses noted that there could be much more doubts and quarrels than actual treatment as each professional could have an opinion distinct from others.

Accountable care organizations were generally commended and recognized for the fund-saving effects they produced. Though not seen directly, that money, as many nurses suggested, could help the healthcare system develop. Some people even suggested that hourly payments could get more substantial. Above that, there were those who considered joining the ACOs themselves and seeing how it works from the inside and whether it is better than conventional practice.


I was not sure at first that the information I gathered and delivered to my colleagues would arouse such interest among them. As I suspected, nurse-managed care became a sphere where many people wanted to be a part of in the future. Generally, I am inclined to believe that despite them stating that they were not aware of the information I presented to them their feedback revealed a high level of expertise in the matters of healthcare. Yet, all of them vividly expressed a desire to continue their education in every way possible. I also anticipated that the trends in healthcare delivery are shifting towards community-based approaches, and that would find a keen response among colleagues. However, I did not assume that so many colleagues rejected the continuum of care as a prominent model of care delivery. All things considered, the self-benefit from the research I conducted and has been multiplied by the fact of sharing it with other professionals. Their feedback enabled me to look at some issues at another angle filling the gaps in my education.


Center for Medicare & Medicaid Services (CMS). (2017). Accountable care organizations (ACO). Web.

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Hoff, T., Weller, W., & DePuccio, M. (2012). The patient-centered medical home: A review of recent research. Medical Care Research and Review, 69(6), 619–644.

McWilliams, J. M., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2015). Performance differences in year 1 of pioneer accountable care organizations. New England Journal of Medicine, 372(20), 1927–1936.

Pron, A. L. (2013). Job satisfaction and perceived autonomy for nurse practitioners working in nurse‐managed health centers. Journal of the American Association of Nurse Practitioners, 25(4), 213-221.

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