Nursing and Patient Care Delivery Models


The US healthcare system has experienced huge economic changes in the last few decades. However, there has not been a conclusive and consistent solution to the elementary problem of cost control. The per capita expenses on health increases at about 6% per year, with cost on health care, increasingly taking up a higher proportion of the GNP (Hassmiller, 2010). Deducing from the OECD (Organization for Economic Co-operation and Development), the US spends a per capita of about $ 8,508 on health every year.

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This figure is the largest amount of all world countries. However, the results are not commensurate to the amount spent since the United State’s longevity and mortality rates are not even close to the other developed nations. Hence, restructuring is prevalent due to the government’s plan to cut health funding.

Changes in Nursing

One of the major criticisms of the incumbent healthcare system is that it focused too much on the provision of episodic care. In episodic care, nurses are unable to view patients holistically, especially due to the patient’s financial constraints. Sick people with unremitting ailments are susceptible because of the impediments and unfavorable situations they encounter in their life. The insurer ends up catering for the costly emergency room interventions.

Thus, to avoid such complexities, a continuum of care, ACOs, nurse-managed health clinics, and medical homes have been introduced. The main all-inclusive explanation of ‘continuum of care’ is that the plan is a patient-oriented health structure, which is helpful for the whole of an individual’s natural life. It involves integrating health mechanisms and services while at the same tracking and guiding patients through a thoroughly comprehensive alignment of health, social services, and mental health across all divides of caregiving.

The enhancement of continuum of care has also positively influenced nursing. The various elements that have been captured when establishing a continuum of care depend on the treatment area of expertise. The elements include community-based services, health information systems, disease management programs, and case management services. In society-oriented services, domestic caregiving agents assist in the development of continuum care by going to check the sick people’s progress at their residences to carry out essential appraisals while at the same time offering important counseling.

Duties of telemedicine such as distant examination of the sick can also develop the continuum by paving way for intercessions and synchronization of services for inhabitants in countryside regions. Secondly, a continuum of care offers disease management programs whereby patients with diseases such as congestive heart failure or diabetes benefit from specialized disease management, a plan that aims at promoting self-management of chronic diseases (Rittenhouse et al., 2010).

On the other hand, ACOs were incorporated in the health reform law of 2010, namely, the Affordable Care Act. An ACO is a group of medical providers such as hospitals or nurses who work together to guarantee the provision of services for all Medicare beneficiaries. Therefore, ACOs have been established to provide first-class, faultless, and sick people-based management, as opposed to the payment-for-attention health plan.

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The ACO requires 5000 patients for it to be active. Hence, for a medical facility to offer such services, a huge number of nurses need to be employed. Moreover, in medical homes and nurse-managed health clinics, many nurses are also required to enhance the smooth flow of medical services. Caregivers also enhance the smooth shift of services, for instance, via end-of-life and patient emancipation improvement. Besides, care-giving informaticians contribute significantly to the integrated information structures since they augment a smooth shift along with the health sector.

Also, employment has been made available for caregivers who focus on health management. Such an employment chance suits caregivers who are proficient in terms of devising transitional care frameworks. Moreover, as the Electronic Medical Record (EMR) becomes increasingly essential, new nurse informaticians will be required. Therefore, with the US healthcare system reconstruction, many nursing jobs will become available.

As a result, nursing will grow exponentially since the majority of the citizenry will tend to opt for ACOs, nurse-managed health clinics, a continuum of care, and medical homes. According to Hassmiller (2010), the 2010 Healthcare Reform Act gives nurses new opportunities to provide care and/or play a pivotal role in leading change. Moreover, colleagues in the workplace have supported these changes based on their anticipation of not only a higher number of nurses to be hired but also an improvement in the quality of medical services that nurses provide. The section below presents the feedback from such colleagues.

Feedback Summary

The colleague’s categorized nurses into two, namely, intrapreneurial and entrepreneurial nurses. Entrepreneurial nurses serve as independent health providers, massage therapists, and other business roles while intrapreneurial caregivers are employees who serve in a work environment where they treat the job as their business in terms of motivation and drive. The workplace colleagues also expressed the important role of primary care nurses to chronic illness patients and the elderly, including the tendency of nurses’ preferential choice of entrepreneur treatment, rather than in-house nurses in acute care hospitals.

The colleagues acknowledged that nurses play a very important role in the continuum of care. They do intrapreneurial and entrepreneurial duties that involve serving the community’s primary care. According to nurse colleagues, new solutions are required to solve old problems that have prevailed in the nursing sector. Nurse intrapreneurs are part of the solution since they participate in primary caregiving by providing services such as preventive screening and routine health screening. The intrapreneurial nurses also provide care for patients who are stable but ailing from chronic illnesses such as diabetes, arthritis, anxiety, hypertension, or asthma.

In terms of child health care services and maternal health such as immunization and family planning services in primary care, the colleagues confirmed that nurse-led community services are used to provide care through nurses with advanced qualifications. The nurses supported their argument with evidence cited from the shift from the previous fee-for-service care to the patient-centered care, which is practically more efficient through models such as the transitional care model (TCM).

The TCM is an evidence-based solution to the challenges of poor management of the healthcare needs of older adults (Sullivan, 2013). If not checked, poor management has devastating economic and human effects. Intrapreneur nurses have been part of the producers’ consistent and competent primary care through an innovative program that improves medical practitioners’ attention to the elderly in the community. Therefore, the program enables the elderly to remain in their residential areas, rather than being forced to get into care facilities (Naylor & Buhler-Wilkerson, 2009).

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As the colleagues point out, this program will continue to be highly effective, efficient, cost-effective, and sustainable. The effectiveness of the entrepreneurial or intrapreneurial nurses who work in primary care can be evidenced by studies that show 93% quality levels that have led to client satisfaction (Coddington et al., 2011). For instance, a pediatric clinic managed by an entrepreneurial nurse enhances the clients’ therapeutic relationships with the medic or the nurse.

Hence, after advancing their range of duty, the caregivers will assume roles that were formerly only under the jurisdiction of medical practitioners. Therefore, nurses who work during this time of reforms will gradually remove the boundaries set between professional groups. The move will promote equality in terms of partnerships among health providers from various departments (Traynor et al., 2008). Also, nurse practitioners are being introduced in many states during these reforms.

The plan is expanding the primary healthcare workforce. Therefore, it is essential to have healthcare professionals to enhance the transition between and across the three levels of care, namely, primary, secondary, and tertiary. This strategy will guarantee the quality, economical, and equitable healthcare, which meets the consumers’ threshold. Hence, nurses are working to meet this quality of healthcare through intrapreneurial, entrepreneurial, and innovative roles in the three levels of care (Hewinson & Badger, 2006).


Based on the expositions made in the paper, it is evident that the restructuring of the US healthcare system is a positive step towards improving health service delivery to its citizens. Moreover, new job opportunities have become available to nurses. The nursing practice is currently growing within the different medical care frameworks such as ACOs and continuum of care among many others. Moreover, nurses enhance transition within the three levels of medical care for patients. Thus, the feedback shared by the colleague nurses is an accurate impression, which is practically consistent with the expected changes in healthcare reforms.

Reference List

Hassmiller, S. (2010). Nursing’s role in healthcare reform. Web.

Hewinson, A., & Badger, F. (2006). Taking the initiative: nurse intrapreneurs in the NHS. Nursing management, 13(3), 14-19.

Naylor, M., & Buhler-Wilkerson, C. (2009). Creating community-based care for the new millennium. Nursing Outlook, 47(3), 120-127.

Rittenhouse, D., Shortell, S., Gillies, R., Casalino, L., Robinson, J., & McCurdy, R. (2010). Improving Chronic Illness Care: Findings from a National Study of Care Management Processes in Large Physician Practices. Medical Care Research and Review, 67(3) 301-320.

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Sullivan, D. (2013). Rising to the challenge of Health Care Reform with Entrepreneurial and Intrapreneurial Nursing Initiatives. Creative Nursing, 19(3), 166-167.

Traynor, M., Drennan, V., Goodman, C., Mark, A., Davis, K., Peacock, R., & Banning, M. (2008). Nurse entrepreneurs’ a case of government rhetoric? Journal of Health Services Research and Policy, 13(1), 13-18.

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