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The Future of Nursing in an Evolving Health Care System

Owing to the ongoing health care reform, nurses in the United States are continuously being facilitated to practice to the optimum level of their proficiencies and capabilities with the view to assuming new roles in the health care delivery and becoming the main force behind the optimization of care for maximum patient outcomes (Wilson, Whitaker, & Whitford, 2012). It is anticipated that, as American policy makers, health care experts and other relevant agencies propel the health care reform agenda to meet its intended outcomes, the practice of nursing will continuously shift and grow in major ways and health services will become increasingly accessible to those in need (Hart, 2012).

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Today, more than ever before, it is evident that education for practicing nurses has increasingly shifted from nursing schools to non-traditional learning approaches that include exposing the professionals to direct and indirect care experiences either in hospital settings or in their local communities, hence enhancing their skills, expertise, research, and data collection capabilities (Hader, 2012). The ongoing health care reform has also propagated a situation in which nurse practitioners (NPs) are now enjoying more leeway to run “nurse-managed health centers” with the view to availing quality health care services to Medicaid beneficiaries and uninsured individuals in areas considered to be medically underserved (Wilson et al., 2012). It is also becoming increasingly clear that the role of advanced nursing professionals in medical homes continues to expand, particularly after the realization by relevant stakeholders in the health sector that, when exposed to the right skills and expertise mix, NPs can act as agents of change not only in the provision of patient-centered, accessible, comprehensive, and coordinated care across all the elements of the medical homes, but also in partnering with other professionals in the provision of consultation and education aimed at developing capacity and optimizing care practices in the homes (Kaasalainen et al., 2013).

As the practice of nursing continues to grow and shift, it is expected that nurses will increasingly play a fundamental function throughout the continuum of care, with the view to not only serving and facilitating primary care requirements of their respective communities, but also ensuring optimal patient treatment and care outcomes in hospital settings, as well as engaging in specialized consultative health care delivery (Wilson et al., 2012). In the context of “Accountable Care Organizations” (ACOs), it is now evident that the practice of nursing is becoming increasingly obliged to work in the spirit of teamwork particularly when coordinating high-quality, patient-oriented care at greatly discounted costs; however, although NPs have been permitted to provide primary care in ACOs, it is evident that discriminatory regulations only allow for the reimbursement of Medicare to patients treated by primary care physicians, implying that patient’s who wish to prefer a NP as their principal care provider do not qualify for reimbursement (Hart, 2012).

The responses of the three nurses demonstrate an increased awareness of the expanded role that nurses are supposed to play not only in the delivery of quality health care services to patients across the country, but also in collaborating with other health providers and public policy makers in the provision of patient-centered services throughout the continuum of care. The ongoing efforts aimed at reforming health care, according to the nurses, have gone a long way in expanding the role of nursing professionals in hospital settings, communities, ACOs, “nurse-managed health care centers”, and medical homes. As indicated by the nurses, there has been an ongoing paradigm shift in the way nurses are perceived in the American society, with indications suggesting that nurses are now increasingly viewed as primary care givers rather than mere support providers in health care settings. Health care consumers, in recognition of the shifting trends in the continuum of care, are now visiting “nurse-managed health centers” in large numbers to benefit from high quality, low cost health care services that were beyond their reach a decade ago. The nurses are also in agreement that, owing to sustained shifts in the education and training of nurses, professionals in the field are now benefiting from non-traditional learning approaches provided within the confines of their workplaces and local communities to enhance their clinical skills and competencies.

The nurses’ impressions of the changing health care system, in my view, are consistent with what has been researched in this paper with regards to the ongoing health care reform. Available literature demonstrates that the increased involvement of NPs in the provision of comprehensive patient-centered care in medical homes, ACOs, and “nurse-managed health centers” across the country has been “shown to reduce hospital admissions, visits to the emergency department, and costs while improving access to primary care” (Kaasalainen et al., 2013 p. 478). Exposure to non-traditional techniques to learning and inter-professional collaboration among the relevant stakeholders in the health sector, according to Hader (2012), has been illuminated as a reservoir for skills and knowledge expansion among nurses, which in turn leads to the provision of quality care to diverse populations across the country. More and more nurses are being absorbed into leadership positions in community health networks and hospital boards, implying that their roles are becoming increasingly visible in influencing policies aimed at optimizing health care delivery and ensuring health care institutions are efficiently run (Wilson et al., 2013).

It can be argued that the ongoing health care reform is on course in terms of providing a level playing ground for nurse professionals to practice to the optimal extent of their skills, competencies and training as witnessed by expanded role advanced-level nurses has taken in the provision of primary care to patients visiting ACOs and “nurse-managed health centers” (Devi, 2011). Nurses are increasingly becoming consultants for a whole range of medical issues affecting populations within the community level as well as in hospital settings. Owing to sustained shortage of physicians in medical homes and other care environments across the United States, advanced nursing professionals have stepped in to provide the much needed health care services to patients as well as assist in the development of an evidence base for optimal health care delivery through education and research (Hader, 2012). Qualified nurses are now acting as counselors to patients and family members, not mentioning that they are actively engaged in driving the health agenda in communities through networks and coalitions. It is important to note that the expanded role of nurse professionals in the United States, as demonstrated in this discussion, has been necessitated by the ongoing health care reform.

Overall, it is evident that the role of nurse professionals in the delivery of health care will continue to expand with the ongoing reform in the health care system. However, nurses need to be given more responsibilities and be allowed to practice without being supervised by physicians provided they demonstrate the required skills and competencies. Medicare reimbursement issues also need to be sorted out to allow NPs practicing in ACOs a wider leverage over patients who may wish to rely on them for primary care.

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Devi, S. (2011). US nurse practitioners push for more responsibilities. Lancet, 377(9766), 625-626.

Hader, R. (2012). Healthcare delivery: Which way do we go? Nursing Management, 43(9), 32-37

Hart, M.A. (2012). Policy & politics. Accountable care organizations: The future of care delivery? American Journal of Nursing, 112(2), 23-26.

Kaasalainen, S., Ploeg, J., McAiney, C., Martin, L.S., Donald, F., Martin-Misener, R., Brazil, K…Sangster-Gormley, E. (2013). Role of nurse practitioner in providing palliative care in long-term care homes. International Journal of Palliative Nursing, 19(10), 477-485.

Wilson, A., Whitaker, N., & Whitford, D. (2012). Rising to the challenge of healthcare reform with entrepreneurial and intrapreneurial nursing initiatives. Web.

Wilson, K., Orff, S., Gerry, T., Shirley, B.R., Tabor, D., Caiazzo, K., & Rouleau, D. (2013). Evolution of an innovative role: The clinical nurse leader. Journal of Nursing Management, 21(1), 175-181.

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