NRS-440VN: Health Care Delivery Models and Nursing Practice Paper

NRS-440VN: Health Care Delivery Models and Nursing Practice Paper

NRS-440VN: Health Care Delivery Models and Nursing Practice Paper

The healthcare system in the United States has been characterized by several changes meant to improve the quality and safety of health services.Health policies or programs are aimed at improving access to affordable and quality health care services. These policies are decisions, plans, and actions placed in a society or community to help its people attain health objectives. Additionally, health care policies directly affect the costs that citizens must pay to access quality services (Cleveland et al., 2019). Therefore, a health policy determines people’s health in a given locality. Health acre reforms come in handy to improve existing policies, making care more affordable, safe, and accessible to more citizens.The purpose of this paper is to explore a recent health care reform, its effects on the responsibilities and roles of nurses, and how the reform impacts nursing practice. Additionally, the paper analyzes how paying for quality measures and performance affect patient outcomes, emerging leadership and management roles of the professional nurses, and a forecast of how nursing roles are likely to transform in the emerging trends.


Health Care Law Reforms

A recent federal law is the Sustaining Excellence in Medicaid Act of 2019 (HR 3253). On June 13, 2019, the bill was introduced to the 116th Congress by Michigan Representative Debbie Dingell. Dingell (2019) notes that the bill was presented to provide some extensions in some provisions to restructure the Medicaid program. The bill allowed Medicaid appropriations through to the 2024 fiscal year. The bill also authorizes the state to enablefraud units to consider and examine complaints launched by non-institutionalized patients. The reform is of great essence as it eliminates disparities that arise when complaints from patients are ignored, yet they are in full qualification for cover under the Medicaid program.

The second section of the bill discusses community health services demonstration programs extension. The third section discusses extendingthe protection ofMedicaid recipients of community-based and home services against spousal impoverishment. At times, spouses from low socioeconomic backgrounds are denied coverage by Medicaid. The reform extends the cover to such individuals, including home-based and community-based medical services recipients. Besides the earlier mentioned reforms, the bill requires that companies manufacturing drugs include the prices of generic products when determining the prices of their products (Cleveland et al., 2019). In extension, the requirement reduces the cost at which wholesalers acquire new biologicals and drugs. Therefore, consumers do not end up being overcharged. Furthermore, the bill allows rebate calculations by excluding drug manufacturers from the definition of wholesalers dealing with drugs.

The bill affects the responsibilities and roles of nurses and the general nursing practice. The discussed bill protects spouses from impoverishment and extends cover to such individuals, extending nurses’ roles and responsibilities. The nurse has a mandate of identifying individuals affected by spousal poverty and is limited to accessing quality care and educating them on the changes. By doing so, the nurse would help the disadvantaged group get access to quality and safe health care services. The reforms of the discussed bill also supplement the role of nursing advocacy. Through nursing advocacy, nurses contribute to building stronger health care delivery systems (Cleveland et al., 2019). The nurse should help non-institutionalized patients to lodge formal complaints and aid them in appealing when denied the required services. By doing so, nurses would be assisting many patients in getting social justice.

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Quality Measures and Pay for Performance and the Effects on Patient Outcomes

Several healthcare systems have introduced and adopted the pay for performance (P4P) model. Kyeremanteng et al. (2019) describe the P4P model as offering financial incentives to medical groups and health professionals to attain specificperformance measures. The compensating approach is performance-based,aiming to improve the quality and delivery of health services to patients. When one does not achieve a particular set performance standard, the health provider loses the incentive of not hitting the set targets. There is penalty-based pay for performance incentives which penalize hospitals financially for failing to institute the appropriate and necessary preventative measures, leading to medical complications (Kyeremanteng et al., 2019). The P4P model motivates physicians, nurses, and other health care professionals to offer services of the utmost quality to their clients to hit the set targets to attain the incentives. However, Kyeremanteng et al. (2019) observe a risk for poor patient outcomes as the model could encourage patient dumping. This implies a tendency by the health providers to concentrate more on clients with lesser complex health issues and a higher likelihood of faster recovery while neglecting those with complex health issues, placing them at the periphery. The latter would experience poor health outcomes owing to a lack of sufficient and timely services and medical attention.

When confronted with such situations, the nurse should apply ethical principles to guide the decision-making and practice. These include the principles of respect for autonomy, justice, non-maleficence (not to harm), and beneficence (to do good). The nurse should also motivate other practitioners and health professionals to adhere to the Hippocratic Oath binding them to the duty of saving their patients’ lives (Kyeremanteng et al., 2019). Guided by the ethical principles, nurses would provide the best services to all the clients irrespective of the complexity and nature of the clients’ situations and conditions, and not based solely on the motivation to attain the financial incentives of achieving set performance targets.

Professional Nursing Leadership and Management Roles

With the diverse health care needs and emerging trends, nursing roles have evolved to respond to these situations. An emerging role is the use of technology and nurse informatics in nursing, following the ubiquitous technology use in health care settings. Nurses have been necessitated to equip themselves with skills and knowledge of handling technological advancements. For instance, surgical robots are being used in various settings. For nurses to fulfill their roles satisfactorily, they must know how the robots work. Another emerging trend is bedside alert systems when patients leave their beds unattended. Patients also use them to inform nurses of the requirement of urgent care. The systems reduce the incidence of falls and improve timely interventions (Okumoto, 2020). Nurse leaders and managers ensure nurses are technologically informed as part of their roles. Additionally, nurses must also be aware of using electrical medical records, which have revolutionized clinical documentation. They must use the EMRs appropriately and comply with the provisions and regulations of the HIPAA.

Emerging Trends

An emerging trend is the use of robots in surgeries. Robot-assisted surgeries have been driven by 5G connectivity rollout, AI and machine learning growth, and robotic proliferation. Health practitioners must be aware of how the robots work, set them up, and recognize instances of malfunctioning. Nurses are also required to learn how the robots work, nurses’ duties and responsibilities in operating rooms, and how to respond in cases of emergencies, which can be life-saving. Increased use of telemedicine is another trend observed in health care settings. Telemedicine refers to the use of telecommunications and information technology to provide health services where there is a considerable physical distance between health providers and patients (Hyder & Razzak, 2020). This will continue to enhance the role of nurses as communicators. Nurses should communicate in the simplest and within the shortest time possible. Nurses will be required to enhance their skills and knowledge o technology and use various platforms to communicate with patients. Nurses must use technological equipment in telemedicine appropriately to avoid errors that could be catastrophic.


Reforms in health care have led to changes that have improved systems, leading to the provision of safer, higher-quality, and more affordable health services. With the emerging trends in various health care settings, health professionals and nurses have been necessitated to continually update their skills and knowledge to keep abreast with the trends. Nurses should continue embracing technological advancements in their places of work. Training institutions should also prepare students technologically to ensure competence in providing quality and safe services in the increasingly technologically complex health settings.


Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable Care: Harnessing the Power of Nurses.

Dingell, D. (2019, August 6). Text – H.R.3253 – 116th Congress (2019-2020): Sustaining Excellence in Medicaid Act of 2019.

Hyder, M. A., & Razzak, J. (2020). Telemedicine in the United States: An Introduction for Students and Residents. Journal of Medical Internet Research, 22(11).

Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., &Neilipovitz, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients. Critical Care Research and Practice, 2019, 1–7.

Okumoto, A., Miyata, C., Yoneyama, S., & Kinoshita, A. (2020). Nurses’ Perception of the Bed Alarm System in Acute-Care Hospitals. SAGE Open Nursing6, 237796082091625.

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28.


Assessment Description
Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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