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Health Care Delivery Models and Nursing Practice

In the recent past, the United States healthcare system has undergone sporadic changes aimed at reforming and restructuring it. These changes have been majorly driven by the Affordable Care Act (ACA) OF 2010. Various regulations have been introduced in this law, and several standards aim to improve access to healthcare, reduce healthcare costs, and improve the quality of care. Nurses have therefore been tasked or presented with new roles and responsibilities, which are vital in prompt response to the changes that the act has brought about. This paper seeks to examine the various changes that have been introduced to reform and restructure healthcare in the U.S healthcare delivery system, discuss the impacts of these changes on nursing practice and the role of nurses in implementing these changes, discuss nursing professional leadership and management roles and also give a prediction of two ways in which nursing practice and nursing roles will grow and transform within the next five years in response to upcoming trends and predicted issues in healthcare.

Current or Emerging Health Care Law or Federal Regulation

One of the most significant reforms and changes in the U.S. healthcare system in the past years is the introduction of the Affordable Care Act (ACA) of 2010. This law was formed with the central aim of reforming and restructuring the healthcare system through expanding the number of people covered by insurance, healthcare quality improvement, and healthcare cost reduction. Specifically, the introduction of ACA has led to the adoption of various rules, regulations, and standards for quality healthcare delivery. This has also included establishing changes in health insurance, Medicaid eligibility expansion, reintroduction of quality measures, and pay-for-performance initiatives. This act has also enabled the establishment of various health insurance marketplaces. It established a federal and state health insurance marketplace known as exchanges that would make it easier for families and individuals to be in a better position to compare and purchase health insurance plans with an informed decision. Moreover, the act has helped in the prohibition of discriminatory acts based on some preexisting conditions; this means that ACA has illegalized denial of coverage by health insurance companies or the insurance companies charging higher payments in the form of premiums as a result of existing medical conditions.

Effect of the Affordable Care Act on Nursing Practice and the Nurse’s Role

The adoption and implementation of the ACA have significantly impacted the nursing practice and nurses’ roles. A good example is the increment t of affordable healthcare access through expanding Medicaid eligibility. This has also been achieved by establishing various health insurance exchanges (Cleveland & Smith, 2019). The significant result of this has been increased demand for nursing services. Therefore, most nurses are expected to continuously provide proper comprehensive care to many patients who need it (Cleveland & Smith, 2019).

Moreover, ACA has also introduced various measures to ensure quality care and reward by paying for incentives due to good performance. This has had a ripple effect in the form of increasing care attention to the patients and ensuring that the outcomes of service provision of the patients are exemplary (Cleveland & Smith, 2019). Finally, nurses are also required by ACA to take up new responsibilities and roles that would make them continuously provide the best services to the patients. These roles and responsibilities include preventing diseases, educating patients, and promoting healthcare.

Quality Measures and Pay for Performance

ACA has introduced quality measures and payment for performance incentives to help in improving patient quality care. Quality measures have been known as the metrics used to evaluate the quality of care patients provide (James, 2018). These include readmission rates, satisfaction scores of the patients, and mortality rates. Pay for performance incentives, on the other hand, are the financial rewards that healthcare providers receive as a result of attaining or meeting the measures of quality (James, 2018). Patient outcomes have significantly been impacted by the quality measures and pay for performance since these measures lead to a proliferation of focus on evidence-based and the best patient–centered care.

Professional Nursing Leadership and Management Roles

As a result of ACA, various nursing roles have also emerged, such as management and leadership roles. For a proper response to the ever-dynamic healthcare environment, nurses must be aggressive in taking continuous learning of management and leadership courses to ensure patients are provided with the best quality care (Joseph & Huber, 2017). Some of these roles include managing financial resources and leading interdisciplinary teams (Joseph & Huber, 2017). Moreover, some of these roles also require nurses to understand healthcare laws and structured regulations that fully advocate for the patient’s interests and rights.

ACA has also ensured that nurse managers and leaders take different career roles. This, however, depends on the qualifications and specialties of the nurses (Joseph & Huber, 2017). Nurse leaders must consistently perform the functions of a leader in the entire medical organization, including faculty transformation, developing better innovative methods, and acting as the leaders of various departments (Joseph & Huber, 2017). On the other hand, nurse leaders are required to act as the directors of patient care. They should also be the pioneers of objectives accomplishment in the organization.

Emerging Trends and Predicted Changes

In the current world, where there is a continuous evolution of healthcare, there is a high expectation that there will be a transformation and growth in nursing and nursing roles. This is a dynamic that will come in handy in response to current trends and most of the issues that are in the healthcare sector.

Implementing new technologies is one of the trends expected to shape the future of nursing. Such technologies include; artificial intelligence, telehealth, and electronic health records. Such technologies will help nurses continuously provide quality and effective patient care (Salmond & Echevarria,2017). Moreover, new disease emergence, such as antibiotic-resistant infections, will require nurses to take on new responsibilities to prevent, diagnose, and treat various conditions.

The increment in nurses’ demands is expected to increase nurses’ retention (Salmond & Echevarria,2017). This aspect will require the nurses to focus on new roles and responsibilities to promote professional development and job satisfaction.


There has been an immense and significant impact on the U.S. healthcare systems as a result of the implementation of the Affordable Care Act of 2010. This regulation has ended up introducing various regulations and standards that would help in healthcare delivery and improve access to care, cost reductions, and improvement in the quality of care that is given. Therefore, nurses have been tasked with various roles and responsibilities that did not exist before. These roles are indispensable in responding better to the dynamic healthcare field. Moreover, adopting pay-for-performance incentives and quality measures has significantly impacted patient service delivery outcomes. This is because these measures lead to an increment of focus to the of patient–centered care that is evidence-based. Additionally, professional nursing leadership and management roles have emerged, which aim to provide a conclusive response to the dynamic healthcare environment. There is also still an expectation that nursing practice and roles will continuously be growing and transforming to effectively respond to the current trends, coming trends, and the healthcare issues that have been predicted.


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

Joseph, M. L., & Huber, D. L. (2017). Clinical leadership development and education for nurses: prospects and opportunities. Journal of healthcare leadership, pp. 7, 55. Retrieved from;

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing36(1), 12. Retrieved from;

James, J. (2018). Pay-for-performance. Health Affairs34(8), 1–6. Retrieved from;


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