US Healthcare Delivery Models and Nursing Practice

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The United States health care delivery system undergoes multiple changes regularly. Nowadays, many researchers and journalists call it sick and unreliable due to high costs and the lack of control (Anderlini, 2018). Recent steps to recover healthcare quality and delivery cannot be neglected. During the last two years, Trumpcare remains one of the most influential attempts to measure the quality of healthcare services, patient safety, and nursing roles. The American Health Care Act (AHCA) of 2017 was the bill of Congress to change the delivery system from being federally-driven to state-driven with attention to regional requirements (Vogenberg & Marcoux, 2018). Although the Affordable Care Act (ACA) is the only legal regulation in US health care, Trumpcare’s impact cannot be ignored. The effects of the AHCA, along with the current ACA regulations in the US health care delivery system, including nursing practice, quality measures, and leadership, will be discussed to predict new paths of nursing care.

Current Health Care Law and Its Effect on Nursing Practice

When the era of Donald Trump Presidency began, a number of changes were observed in the healthcare field. The leaders of the Republican Party set the goal to improve the ACA of 2010 and introduce a new plan, changing tax aspects and the level of care quality offered to patients. Although the ACA remains the only legally approved legislation in the country, many people cannot neglect the fact that the AHCA changes the way of how people receive and deliver care. All the citizens are obliged to apply for insurance coverage, and medical workers have to participate in service improvement. The AHCA expands the boundaries and allows the possibility of not having health insurance.

The American Nurses Association (ANA) is one of the leading organizations, the purpose of which is to recognize the true goals of nursing and health care. When the AHCA was introduced, many American nurses were not satisfied with the offered legislation (American Nurses Association, n.d.). The ACA and AHCA effects on nursing practice, as well as nurses’ roles and responsibilities, include the necessity to demonstrate their voices and intentions to improve the quality of care. The major outcome of the AHCA is the recognition of the four principles of the health care delivery system and nursing care. They include universal access to services, optimization of care, stimulation of the economic use, and supply of skilled workers (American Nurses Association, n.d.). Nursing practice is not only the field where changes occur but a group of people who define the major concepts of care delivery and support for patients.

Quality and Patient Outcomes in Nursing Practice

There are many methods to improve patient outcomes in terms of the ACA and its opponent, the AHCA. Quality measures and pay-for-performance (P4P) are the tools that measure healthcare processes and organizational systems in their abilities to promote high-quality care services. It is not enough to introduce safe and effective health care. People must be confident that they always have a chance to reduce costs, receive some compensation, or ask for additional explanations. Quality measures include patient safety, positive healthcare outcomes, the necessity to follow current regulations, and timeliness of care. P4P programs improve the quality of care, and the ACA is the law that expands the use of such initiatives in the country. The ACA promotes the creation of credible alternative payment models like P4P to establish equal financial measures (Shakir, Armstrong, & Wasfy, 2018). The expectations and responsibilities of nurses in situations when quality measures and P4P programs are initiated vary. Nurses get a chance to understand what they should do and what patients want to get within the chosen healthcare setting. Still, nurses deprive themselves of the possibility to consider personal factors and needs.

Professional Nursing Leadership and Management Roles

The promotion of patient safety and quality care is the responsibility of any nurse in a healthcare setting. The role of a nurse leader is to offer options, develop effective care plans, and support cooperation between the representatives of different departments. At the same time, a leader is responsible for new ideas being generated and legally approved by employers. Management roles vary from those of the leading ones because they usually touch upon some organizational issues and tasks. Management of care includes education, training, communication, and the exchange of information at different levels. If the AHCA replaced the ACA, the management of health care could be changed in several ways: increased competition, improved negotiations, lowered prices and decreased out-of-pocket costs (Vogenberg & Marcoux, 2018). In such a situation, leadership and management roles will not stay the same. Nurses must work hard to understand what patients expect from them and if their knowledge is enough to offer high-quality care services. Some nurses are not read to make serious decisions and share their ideas in a correct form, and additional courses or professional support must be obtained.

There are many reasons to believe that the AHCA can replace the ACA in the US health delivery system. Being the President and the Head of the Government, Trump tries to do everything possible to support his party’s proposition and change the conditions under which American citizens receive help. At the same time, the promotion of the AHCA introduces the strong motivation for modern nurses and other healthcare workers to say about their needs and demands and protect the population. Therefore, there are two possible ways in which the practice of nursing and nursing roles may transform in the promotion of care quality within the next five years. On the one hand, nurses will prove the importance of all the four principles be implemented in a new healthcare act. Leaders, managers, and ordinary nurses will strengthen their positions, obtain voice, and remove disparities and concerns in the care delivery system. On the other hand, the power of the Republicans may prevail and diminish the approaches offered by the ANA. Nurses can lose their right to improve the quality of care and support patients as per their true needs.


Modern health care delivery models continue changing, provoking new situations in nursing practices. It is expected that the laws like the ACA and the AHCA aim to stabilize the existing nursing care system. At this moment, these regulations challenge nursing practice and make nurses think about their roles and possibilities. However, legal changes may serve as a good motivator for employees to consider their knowledge and abilities, a fear of failure and uncertainty play a role in understanding nursing roles and responsibilities. The ACA, as well as the AHCA, has the power on nursing practice and the task of nurses to protect patients.


American Nurses Association. (n.d.). Health system reform. Web.

Anderlini, D. (2018). The United States health care system is sick: From Adam Smith to overspecialization. Cureus, 10(5). doi:10.7759/cureus.2720

Shakir, M., Armstrong, K., & Wasfy, J. H. (2018). Could pay-for-performance worsen health disparities? Journal of General Internal Medicine, 33(4), 567-569.

Vogenberg, F. R., & Marcoux, R. (2018). Challenges to the U.S. health care system from legal and regulatory changes in the Donald Trump era. Health Care & Law, 43(9), 544-547. Web.

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