How to write a nursing Health Care Delivery Models and Nursing Practice (Essay)

How to write a nursing Health Care Delivery Models and Nursing Practice (Essay)

Current healthcare law to reform the healthcare delivery system

Adopted in 2010, the Affordable Care Act (ACA) aimed to improve healthcare access through expansion of coverage, improving healthcare costs, quality, efficiency, and consumer protections. Policymakers introduced this act to leverage patient resources and control the upward spending trends noted with Medicare before. The Affordable Care Act obliges nurse practitioners to be innovative, transformational leaders and collaborators as they are significant participants in enhancing patient outcomes, quality care, and cost effectiveness (Cleveland, Motter, & Smith, 2019).

The introduction of the ACA led to the acceleration and development of advanced practice nursing roles to improve the quality of healthcare and influence better organizational reimbursement. Expanding nursing training by enhancing managerial and policy skills in the school core curriculum and managerial practice has led to more nurse leaders in health organizations, community programs and insurance companies (Cleveland et al., 2019). As a result, more nurses have contributed to generating health care solutions in a regulatory environment by forming health policies.

Through the ACA, nurses have taken up additional roles to ensure a reduction in the patient admission rate. The act introduced the Hospitals Readmission Reduction Program (HRRP) in 2012. This program requires healthcare institutions to collect and report data on the rate of readmissions within 30 days of hospital discharge (Cleveland et al., 2019). The ACA attributed high admission rates to poor healthcare quality and uncoordinated transition care after discharge. Nurses’ input in the program through daily rounding during hospital admission and participating in the discharge planning is vital.

Additionally, the nurse practitioners communicate with patients after discharge via phone calls and conduct home visits when needed. Also, they collaborate with primary care physicians to enhance patient compliance with post-discharge treatment plans and medications (Cleveland et al., 2019). These actions have led to reduced rates of hospital readmissions within 30 days of discharge, thus cutting unnecessary healthcare costs. Cleveland et al. (2019) document that the program decreased readmission rates for almost 8000 patients within two years from 21.4% to 13.9% and developed best practices for post-discharge care.

Impact of quality measures and pay for performance on patient outcomes and nursing practice

Healthcare providers use quality measures to quantify healthcare processes, patient outcomes and perceptions, and organizational systems linked to healthcare delivery. Pay-for-performance (P4P) programs issue financial compensations or penalties to health care providers or institutions based on their performance on quality measures.

Theoretically, properly designed P4P programs influence health providers’ behaviour to improve the quality of healthcare services, minimize unnecessary utilization of expensive healthcare services, and improve patient outcomes. In practice, several studies reveal mixed impacts of quality measures and P4P on patient outcomes. For instance, there is evidence of improvement in prescribing long-acting reversible contraceptives with P4P (Green et al., 2020). Also, there is marked improvement in the initiation of diabetes mellitus medications. In another study, there were increased rates of screening and diagnosing depression; however, there was no significant change in antidepressant prescription (Green et al., 2020). Green et al. (2020) report no significant improvements in the care process following the implementation of P4P.

P4P has a significant impact on the nursing practice. While P4P programs are intended to improve health quality ultimately, it has a negative impact on the existing nursing workload through increased documentation (Grabowski et al., 2017). Nurses play a significant role in documentation in hospitals. Based on these documents, payers financially compensate the health institutions for achieving certain quality measures. Yen et al. (2018) estimate nurses’ average time on documentation to be at least 34% of their shift time. There are challenges and pressure to align documentation so that the aspects of care that merit reimbursement are always present, where relevant (Grabowski et al., 2017). Increased pressure on nurses to document these aspects and constant quality monitoring and tracking indicators can divert nurses’ attention and efforts from improving clinical care to collecting accurate data for payers to reimburse that healthcare organization.

The importance of nursing leadership and management roles in responding to emerging trends and promoting patient safety and quality of care

Nurse leaders advocate suitable staffing levels. Trends project a decrease in the nursing workforce as more skilled and experienced nurses age and are almost retiring. The need for more nurses will increase, mainly due to an increase in the geriatric population (Boamah et al., 2018). Adequate evidence suggests poor patient outcomes are associated with short staffing in health care institutions. Nurse leaders can advocate for this situation by hiring more nurses to reduce the length of shifts and nurse-patient ratios. They can also advocate for change using viable data in their leadership positions (Boamah et al., 2018). Strong evidence suggests favourable patient outcomes in well-staffed facilities. For instance, there were lower mortality rates in patients treated in well-staffed health facilities (McHugh et al., 2021).

Also, nurse leaders are responsible for creating a culture of safety to respond to the emerging trends, promote patient safety and improve the quality of care in diverse patient populations. Nurses in leadership and management positions understand that safety is among the guiding principles in nursing leadership (Boamah et al., 2018). As such, they prioritize nursing practice safety and incorporate means to drive the cultural change that contributes o patient and provider safety. To promote safety in diverse patient populations, nurse leaders employ leadership education, staff support, goal setting, and reports to regularly review safety data (Boamah et al., 2018).

Lastly, nurse leaders can bridge the professional gap between different healthcare disciplines through collaboration. Nurse leaders facilitate collaborative care management in various health settings as a core professional standard. Nurse leaders influence their nurses to facilitate continuity of care through processes such as patient and family education upon discharge and proper documentation (Boamah et al., 2018).

Ways in which nursing will transform in the next five years

Trends suggest that there will be a need for more family nurse practitioners in the future. The increasing shortage of physicians creates this demand. By 2032, the physician shortage is estimated to be a deficit of 122000. However, nurse practitioners will alleviate this problem as trends project a 26% job growth in the nurse practitioner sector (U.S. Bureau of Labor Statistics, 2022).

Also, there is an anticipated demand for nurse practitioners with a speciality in geriatrics. This is due to a projection of a 20% increase in the geriatric population by 2025 (U.S. Bureau of Labor Statistics, 2022). Less than 1% of registered nurses are in the geriatrics speciality (U.S. Bureau of Labor Statistics, 2022). Thus, there is a high likelihood of staff shortage in the next five years.


Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing outlook66(2), 180-189.

Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: harnessing the power of nurses. Online Journal of Issues in Nursing24(2).

Grabowski, D. C., Stevenson, D. G., Caudry, D. J., O’Malley, A. J., Green, L. H., Doherty, J. A., & Frank, R. G. (2017). The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration. Health services research52(4), 1387–1408.

Green, E., Peterson, K. S., Markiewicz, K., O’Brien, J., & Arring, N. M. (2020). Cautionary study on the effects of pay for performance on quality of care: a pilot randomized controlled trial using standardized patients. BMJ quality & safety29(8), 664–671.

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet397(10288), 1905-1913.

U.S. Bureau of Labor Statistics. (2022). Occupational Outlook Handbook. Retrieved from

Yen, P. Y., Kellye, M., Lopetegui, M., Saha, A., Loversidge, J., Chipps, E. M., Gallagher-Ford, L., & Buck, J. (2018). Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study. AMIA … Annual Symposium proceedings. AMIA Symposium2018, 1137–1146.

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