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Current Trends in Nursing Practice

In 2010, the United States took a huge step towards changing its healthcare delivery model by enacting The Patient Protection and Affordable Care Act (ACA). The legislation aimed to enhance the quality of patient care, expand access to healthcare, and make health care affordable. This paper will highlight the current federal regulation or emerging healthcare law and explain its effect on nursing practice and nurses’ roles and responsibilities. It will discuss how pay for performance and quality measures impact patient outcomes. Discuss nursing management roles and leadership and provide two emerging trends to grow nursing practice and roles within the next five years.

Current federal regulation or healthcare law

The enactment of The Patient Protection and Affordable Care Act saw the US take a massive approach towards enhancing access to healthcare, improving the quality of healthcare, and regulating the growing healthcare cost (Salmond & Echiverria, 2017). The legislation focuses on health promotion and prevention. For nurses, it provides insights into the heightening of services offered to patients and their families. Salmond and Echevarria argue that the act envisions nurses to lead and be part of the changes (2017). Since its implementation, many aspects of the US healthcare sector have recorded drastic changes. Specifically, the enactment of the act saw the shift in the healthcare model from provider-based and fee–for–service to patient care cantered system. The new healthcare delivery model is based on a system that rewards healthcare providers depending on patients’ experiences and quality outcomes. Therefore, to deliver the outcomes, nurses have to change their roles as well as nursing practice. Salmond and Echevarria point out that these changes require an enhanced or new skill set to provide patient care and wellness (2017). Nurses should, therefore, renew their focus on patient-centered care, care coordination, data analytics, and quality improvement. In addition, Salmond and Echiveeria argue that to deliver the outcomes of this model, nurses are also required to partner with patients and their families (2017). This enables nurses to understand patients’ social environment and, as a result, achieve defined patient outcomes. This legislation requires nurses to assume roles and responsibilities that enhance healthcare quality and promote health among the US population.

Pay for Performance (P4P) and Quality Measures

Pay for Performance and quality measures are examples of key aspects linked with the reforms in the US healthcare sector. Pay for performance is a policy that was designed to reduce healthcare costs and improve efficiency. Through the program, healthcare providers are given financial incentives. The incentives are determined by the healthcare providers’’ performance on (1) Clinical care, (2) Safety, (3) caregiver and patient-centered experience, (4) efficiency and cost reduction. On the other hand, quality measures are standards used to measure healthcare processes, patient perceptions, patient outcomes, and organizational structure (Centers for Medicare & Medicaid Services n.d.). Quality measures help identify important healthcare aspects such as safety, timeliness, fairness, and effectiveness. Pay for performance and quality measures ensure that healthcare is value-based as they underline the essence of quality care over quantity care.

Pay for performance reduces healthcare costs through the Hospital-Acquired Conditions Reduction Programs (NEJM Catalyst, 2018). The program aims to help adjust high-risk measures in healthcare facilities such as acquired infections, disease prevention and control, and falls. Also, the program has safety steps that enhance patient care and outcomes and reduce the possible health risks. Despite enhancing the quality of health care, pay for performance has some drawbacks. For example, if the performance is not improved, access to healthcare can be reduced (NEJM Catalyst, 2018). For instance, readmission of low-income patients is often unavoidable. Such patients struggle to pay for medical appointments, care, medications and possibly have no support from family. Therefore, offering reimbursement and lowering the pay for performance scores allows equitable access to medical care (NEJM Catalyst, 2018).

Nursing management roles and leadership

When examining the Patient Protection and Affordable Care Act, it is evident that the legislation emphasizes healthcare prevention and promotion, and wellness. Leadership and management are key for maintaining and continuing this healthcare delivery model (The National Academies Press., 2011). The cost control and patient-centered care associated with the model have drastically changed some aspects of nursing practice. The reform requires nurses to provide high-quality patient care to achieve positive outcomes at a lower cost. The institute of medicine points out that nurses play a key role in patient safety. The institute argues that nurses can enhance or change their professional roles through nursing education and research. Apart from professionalism, health promotion also requires leadership. According to The National Academies Press (2011), becoming an effective leader requires acquiring core competencies. Examples of these competencies include the ability to advance quality care and an Evidenced-based practice competency. Nursing leaders can combine these leadership competencies with creative vision and critical thinking to deliver high-quality patient care. With this kind of professional management and leadership, the rate of patient satisfaction can improve and patient health and outcomes (The National Academies Press., 2011).

Emerging trends

Technology has revolutionized health care systems globally. Today, many emerging trends in the healthcare sector are tech-related. Examples of these trends include the use of health information technology (HIT) and Telehealth. Health information technology is used to interchange medical records or information between healthcare providers, quality monitors, payers, and consumers (Shahmoradi et al., 2017. This piece of technology has tremendously improved nursing practice. It allows nurses to gather, collect, and share or obtain patient data electronically. For instance, the technology allows nurses to retrieve lab test results, physician’s notes, and other useful information needed to provide patient care.

Telehealth is also another emerging trend that has improved nursing care. This technology allows nurses to monitor their patients remotely from their homes (Lee et al., 2018). An example of a category of patients that have benefited from telehealth technology is diabetic patients. Telehealth allows diabetic patients to check daily blood pressure, body weight, blood sugar levels, pulse, and body oxygen levels and automatically send the results to the assigned nurses (Lee et al., 2018). In cases of emergencies where patients report symptoms or emergencies, nurses can intervene faster. With telehealth, nursing professionals can evaluate information from patients and report to the specialist physician about the patient’s potential needs. In addition, it allows nurses to order a test on patients and follow up the results with the patients and PCPs. the benefits of telehealth to nursing practice include: (1) it improves access to healthcare as patients and nurses can engage 24/7, (2) it improves patient’s knowledge of their health conditions, (3) it results in reduced hospital visitations for non-critical, or emergency issues, (4) allows patients to self-manage and stay independently, (5) and overall, it improves patient’s quality of life (Lee et al., 20180


The healthcare sector continues to experience changes. Many of these changes are brought about by the enactment of laws and regulations. As a nurse, it is important to stay abreast of new laws, regulations, and practices to improve professional practice. Importantly, every healthcare facility in the country should embrace the changes in healthcare delivery models such as The Patient Protection and Affordable Care Act (ACA) to ensure the realization of accessible, affordable, and quality healthcare.


Centers for Medicare & Medicaid Services. (n.d.). Quality Measure Development and Management Overview. Retrieved from

Lee, P. A., Greenfield, G., Pappas, Y. (2018). Patients’ perception of using telehealth for type 2 diabetes management: A phenomenological study. BMC Health Services Research, (1), 1-9. Retrieved from

NEJM Catalyst. (2018, March 1). What Is Pay for Performance in Healthcare? Retrieved from:

Salmond, S. W. & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic nursing, 36(1), 12–25. doi:10.1097/NOR.0000000000000308

Shahmoradi, Darrudi, Arji, and Nejad, F. (2017). Electronic Health Record Implementation: A SWOT Analysis. 642-649

The National Academies Press. (2011). Read “The Future of Nursing: Leading Change, advancing health Retrieved from


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