Nurses are the pillars of the healthcare system in the U.S. because they work at a ground level and bring into life policies that were adopted at other levels. They are the indicator of problems and successes of the system. The better nurses perform, the more coordinated the system is. In any sphere, there are always multiple ideas on how to increase the productivity, transparency, service, and many other items. Changes in nursing are also envisioned through several different models and concepts such as continuity of care, accountable care organizations (ACO), medical homes, and nurse-managed clinics. For the purpose of broadening the horizons and readiness to evolve, nurses in the field should be aware of such models.
Continuity of Care
Continuity of care represents a model of healthcare provision that encompasses a broad range of techniques and practices aimed at providing all-round care for the population of all ages (HIMSS, n.d.). This paradigm ensures that the quality of care is maintained at all levels from administrative to clinical and home ones. Continuity of care provides guidance and treatment not only when the help is needed but also works on prevention and early identification of various conditions in people on a completely new systemic level. To ensure that all the above set goals are met, this model emphasizes and implements collaboration between different service providers and policymakers. This holistic framework is already implemented in some institutions across the U.S. and began shaping the future of nursing.
Accountable care organizations are seen as a solution that will allow saving plenty of resources across all levels of healthcare without having to sacrifice quality of service. The main idea of this model is in a voluntary unity of healthcare professionals that focus on error elimination at their workplaces and seek ways to optimize the system while continuing to provide excellent care for patients (Nyweide et al., 2015). The key measures that make such actions possible are the reduction of excessive administrative forces that draw too much a share of the budget. Another idea here is the increase of payment schemes’ flexibility to ensure healthcare is affordable.
The medical home model is a framework, under which a patient receives the full attention of a single most experienced and well-rounded healthcare professional who focuses all their efforts on delivering the best service possible. Such collaboration of patient and nurse is viewed to be happening in a unified healthcare institution setting. It is also paramount that this model includes family members as important mediators of pre-and-post treatment. Therefore, a nurse, patient, and those closest to the patient are encouraged to collaborate under the guidance of the former to ensure that each party’s goals and expectations are met. This prominent model is seen as perspective provided that certain adjustments are made in future (Peikes et al., 2012).
The idea of nurse-managed clinics presupposes to entrust caregiving fully to those who provide it daily and have the most knowledge of it (Esperat, Hanson‐Turton, Richardson, Debisette, & Rupinta, 2012). Under this newly-emerged model, nurses are placed in charge of a healthcare institution with minimal administrative superstructures that are often deemed burdening at a ground level. Such framework allows concentrating efforts of professionals on providing top-quality care at a reduced price. Importantly, nurse-managed clinics empower nurses to take and manage responsibility for a client learning to organize and conduct treatment as they see fit for a patient.
Overall, my colleagues evaluated the idea of raising awareness among nurses as positive. One of them mentioned that since present nursing education appears somewhat incomplete and does not cover the full scope of the profession, additional knowledge is always welcome. Others agreed that under current conditions in the field and with the number of errors made every day, further education and knowledge-building is an absolute necessity. However, the colleagues also noted that current practice often leaves no room for that process and changes are to be made in order for nurses to have time for advancing their skills and knowledge. Regarding the material I presented, the nurses formed different opinions. They all had various ideas and visions about the future of their profession.
Continuity of care as a model did not arise much interest or gain approval amongst my colleagues except for one who is the youngest. Older nurses noted that increasing collaboration between levels of healthcare had been a goal as far as they can remember, and so far, legislators achieved little result. The younger colleague mentioned that the mere goal-setting is helpful and placing collaboration at the top of the list is making it audible to healthcare professionals. They all agreed, however, that the idea of collaboration at different levels could be achieved in future, but it will take a huge amount of resources, administrative, and legislative work.
The concept of ACO yielded a great deal of support. All of the nurses mentioned that less administrative staff could help resolve systemic issues in clinics. However, they see this solution as an item of a distant future because, again, loads of work should be done in order for this model to work properly. One of the colleagues noted that restructuring always takes time and new human resources policy should be introduced as many of the tasks will befall former doctors, forcing them into managerial roles. When asked about the timeframe for such a change, the colleagues agreed on 10 to 20 years for the ACO to be fully operational. It was also proposed that this solution is not universal and what might work in our state will not always perform as good in others.
Medical homes were taken with a large portion of skepticism. It was not clear for my colleagues what should be done in cases when identification and treatment of a disease in a patient exceeds knowledge and skill of a nurse, and whether the referrals are possible under this model. In addition, the schedules were named as a weak spot for such a framework. If a patient assigned to a certain specialist requires urgent medical attention, how this model will provide it.
Nurse-managed healthcare concept was a topic that aroused the greatest discussion. One of the colleagues admired the idea and said that it would be an improvement as compared to the present situation in the sphere. It will allow a certain freedom and, as a result, will increase the speed and quality of decision making. Others noted that as much as they want to be in control, they do not want to carry additional obligations. Since administrative function will not cease to exist despite the absence of administrative staff, someone will have to carry their duties and perform as a nurse at the same time. Consequently, some of the colleagues wondered whether such innovations could negatively affect the quality of care. It was then argued that if modern technologies such as electronic document flow, automatic drug admission system will are used then managing a nurse clinic should not significantly burden a nurse. Above that it was noted that there are plenty of nurses with managerial skills and the personnel gap is not a problem even now, so the implementation of such a model of nursing in the foreseeable future is possible. The arguing parties did not seem to reach an agreement on all points of the discussion. However, the colleagues all agreed that in special conditions and under close monitoring such a system might be introduced in a test mode. Its potential with proper organization and acquisition of a legal basis is immense in terms of empowering nursing personnel to perform at the top of their capacity.
The future of nursing is a subject for a long debate, which this presentation has managed to initiate. The discussed future models of nursing did find an emotional response in my colleagues. Not every framework was critically acclaimed, which reflects the difference in a vision that every nurse has. Most notably, nurse-managed hospitals were of interest to my fellow nurses. Through engagement in discussion, they managed to form a better understanding of a subject and review their own ideas about reforming health care. Therefore, I consider such an educational experience positive and will later repeat it with a new topic. The colleagues seemed pleased and supportive of the idea, which inspired me even more.
Esperat, M. C. R., Hanson‐Turton, T., Richardson, M., Debisette, A., & Rupinta, C. (2012). Nurse‐managed health centers: Safety‐net care through advanced nursing practice. Journal of the American Association of Nurse Practitioners, 24(1), 24-31.
Healthcare Information and Management Systems Society (HIMSS). (n.d.). Definition: Continuum of care. Web.
Nyweide, D. J., Lee, W., Cuerdon, T. T., Pham, H. H., Cox, M., Rajkumar, R., & Conway, P. H. (2015). Association of pioneer accountable care organizations vs traditional Medicare fee for service with spending, utilization, and patient experience. JAMA, 313(21), 2152-2161.
Peikes, D., Zutshi, A., Genevro, J. L., Parchman, M. L., & Meyers, D. S. (2012). Early evaluations of the medical home: Building on a promising start. American Journal of Managed Care, 18(2), 105-116.