Introduction
Nursing undergoes continuous evolution, and its education system is likewise adjusting. The existing nursing practices must accommodate disruptions caused by external elements such as the pandemic, technological progress, and sociocultural challenges. These, among other factors, contribute to the ongoing trends observed in nursing education. The U.S. healthcare system has undergone significant reforms to enhance efficiency, accessibility, and quality of care. Fundamental changes include the Affordable Care Act, a shift to value-based care, the adoption of electronic health records, telehealth growth, a focus on population health, interprofessional collaboration, alternative payment models, social determinants of health emphasis, and mental health integration (McNiff, 2018). These reforms aim to improve overall healthcare outcomes and address emerging challenges. This paper explores the recent healthcare reforms that restructure the U.S. healthcare system, the roles of nurses in adapting to the changes, the effects of quality measures and pay performance on patient outcomes, and nursing leadership and management roles.
Current Federal Healthcare law and regulation
The Sustaining Excellence in Medicaid Act of 2019 (HR 3253) is a recent federal legislation aiming to reform the U.S. healthcare system. Introduced by Michigan representative Debbie Dingell, the bill, signed into law on August 6, 2020, focuses on restructuring Medicaid. One significant change involves extending specific provisions until the fiscal year 2024. Additionally, the bill empowers state fraud units within Medicaid to address complaints from non-institutionalized patients, rectifying disparities that may arise when such complaints are overlooked despite the patients being legally eligible for Medicaid coverage (Reinhard et al., 2019).
This law extends Medicaid eligibility, protecting individuals from spousal impoverishment, especially those from lower socioeconomic backgrounds previously denied coverage. It also covers those receiving home-based and community-based medical services. Additionally, the legislation removes the requirement for drug manufacturers to consistently include generic drug prices in determining prices, and it excludes drug manufacturers from being categorized as drug wholesalers, simplifying rebate calculations (McNiff, 2018).
Impact of Sustaining Excellence in Medicaid Act on Nursing
This bill’s effect on nursing practice and roles includes the adjustment of the roles and responsibilities of nurses. Nurses are now required to educate patients on the new changes; for example, the change extended Medicaid to cover spouses and protect them from impoverishment, nurses were required to identify patients suffering from spousal poverty and educate them so that they know their rights and be able to access quality medical care. Nurses also took the role of patient advocacy by advocating for non-institutionalized patients, listening to their complaints, and helping patients appeal in cases where they are denied healthcare services (McNiff, 2018).
Effect of Quality Measure and Pay Performance on Patient Outcome
Quality measures and pay-for-performance initiatives are designed to improve patient outcomes by motivating healthcare providers to deliver top-tier, evidence-based care. Adherence to predefined benchmarks and the introduction of financial incentives establish a framework to enhance safety, efficacy, and overall patient contentment. In nursing practice, adherence to stringent standards is paramount (Liao et al., 2022). Nurses are pivotal in upholding quality measures and evidence-based methodologies, involving scrupulous record-keeping, verifying that care aligns with established protocols, and active participation in initiatives to enhance quality.
Patient-centered care is another focal point influenced by quality measures. Nurses at the forefront of patient care serve as instrumental advocates for communication, education, and collaborative decision-making. Their responsibility lies in ensuring that care is not only clinically effective but also tailored to each individual’s unique needs and preferences. Furthermore, nurses are entrusted with meticulous data collection related to patient care, a crucial component for reporting quality metrics. Proficiency in electronic health record utilization and other data collection tools is essential for nurses to contribute effectively to the overall evaluation of healthcare quality. The commitment to continuous improvement is ingrained in nursing practice, with nurses actively identifying areas for enhancement, participating in performance improvement initiatives, and fostering a culture of learning and adaptability (Shurson & Gregg, 2021).
The expectations and responsibilities of nurses extend to adherence to established protocols, patient advocacy, interdisciplinary collaboration, and an educational role. Nurses are charged with staying updated on best practices, incorporating evidence-based interventions into daily practice, and advocating for patients by ensuring their needs and preferences are prioritized. Collaboration with other healthcare professionals, including physicians and therapists, is crucial for achieving quality outcomes. Additionally, nurses serve as educators, imparting information to patients about their conditions, treatment plans, and preventive measures, contributing significantly to patient empowerment and positively impacting long-term outcomes. In conclusion, quality measures and pay-for-performance programs directly shape nursing practice, with nurses acting as crucial conduits for translating these initiatives into tangible improvements in patient outcomes. Their diverse responsibilities encompass adherence to standards, patient advocacy, data collection, continuous improvement, and collaborative efforts to ensure that the quality of care aligns with the evolving landscape of healthcare quality initiatives (McNiff, 2018).
Rising Professional Nursing Leadership Roles
The emerging nursing leadership and professional roles that have risen to address the ever-changing healthcare system and provide patient safety and quality care are clinical nurse leaders (CNL); these nurse leaders serve as leaders by coordinating care delivery to ensure quality care is achieved. The CNL leaders enhance patient safety by ensuring evidence-based practices in healthcare facilities and acting as coordinators of healthcare teams. Nurse managers are another emerging role; they ensure all healthcare departments practice efficient care delivery by establishing protocols to be followed and managing healthcare resources. Chief Nursing Officer (CNO): This officer assumes a crucial strategic position, shaping organizational policies and supervising the integration of nursing standards across the entire healthcare system (Yoder-Wise & Sportsman, 2022). CNOs actively contribute to patient safety by championing nursing staff, nurturing a safety-centric culture, and aligning nursing initiatives with broader organizational goals, ensuring an approach centered on the patient.
Quality Improvement Coordinator: The coordinators assess and refine healthcare processes to improve patient outcomes and safety. These roles are pivotal in responding to emerging trends by implementing continuous quality improvement initiatives, scrutinizing data to identify areas for enhancement, and ensuring the adoption of best practices in patient care. Infection Control Nurse: Infection control nurses are dedicated to preventing and managing infections within healthcare settings. Amid emerging trends such as infectious disease outbreaks, these nurses play a crucial role in implementing infection prevention measures, safeguarding patient safety, and ensuring compliance with infection control protocols(Yoder-Wise & Sportsman, 2022).
Informatics Nurses: Nurses leverage technology and data to advance healthcare delivery, patient safety, and overall care quality. In response to the digital transformation in healthcare, informatics nurses ensure the effective implementation of health information systems, contributing to heightened patient safety through precise and accessible information. Transitional Care Nurse: Nurses facilitate smooth transitions between care settings, reduce readmissions, and improve overall care continuity. In the context of emerging trends emphasizing care coordination and patient-centered care, transitional care nurses enhance patient safety by minimizing interruptions in care and ensuring a seamless transition between different healthcare environments (Labrague et al., 2020).
Emerging Trends to Shape To Shape Nursing Practice
The emerging trends likely to shape nursing practice are a shift to prevention and community-based care since the healthcare system now focuses on prevention measures to ensure improved health outcomes and minimize costs. Nursing roles now are shifting toward educating patients and the community on effective preventive measures and how to achieve community-based care. Community health initiatives and education programs require nurses to collaborate with community organizations and local health agencies to address health issues. Another trend is integrating technology and telehealth, requiring nurses to assume new roles. Telehealth platforms enable patients to monitor their health progress, consult with healthcare providers, and manage their chronic conditions virtually; this will require nurses to be more involved in utilizing and managing telehealth technologies, creating an effective platform to communicate with patients, hence involving nurses more in data-driven nursing practices, which will ensure personalized and efficient patient care (Buchanan et al., 2020).
Conclusion
Analyzing the changes to reform and restructure the U.S. healthcare delivery system reveals the dynamic landscape of the evolving healthcare system. The multifaceted nature of the changes underscores the relationship between policy, practice, and the vital role of nurses in this evolving environment. Implementation of current federal laws, such as The Sustaining Excellence in Medicaid Act of 2019, has significantly impacted nursing practice by aiming to improve access to healthcare, enhance care quality, and control costs. Nurses have experienced changes in their roles and responsibilities due to expanded access to care, increased emphasis on preventive services, and a shift toward value-based care. The nurse’s role has expanded beyond traditional care settings, emphasizing care coordination, patient education, and population health management. The reforms and restructuring initiatives in the U.S. healthcare delivery system have created a dynamic environment for nursing. Nurses are not only adapting to these changes but also actively contributing to improving patient outcomes, implementing quality measures, and evolving leadership roles. The future promises further transformations, with nurses at the forefront of leveraging technology, embracing preventive care, and fostering community health initiatives. As the healthcare landscape continues to evolve, nurses will play a central role in shaping the future of patient-centered, high-quality care (Centers for Medicare & Medicaid Services, n.d.).
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