Informal presentation
Hello colleagues. I am privileged to have worked with most of you in various forums. The healthcare setting is our second home and it is the point where we not only give back to the community but also work to fulfill the calling that is care giving. We are part of the healthcare system that is changing fast and moving closer and closer to meeting the needs of a community whose needs are increasing in equal measure with time. The adoption of the Affordable Care Act 2010 is one of the milestones that significantly changed the role and scope of nursing as well as expanded our responsibilities to the community. The ACA is one of the instances where we were empowered at the resource and regulation levels so that we could drive the sector to a new dawn characterized by an ever increasing population with ever-increasing health needs (Cherry & Jacob, 2014).
This was further backed up by the IMO Future of Nursing report which sought to empower nurses who could work within the new healthcare environment which had specific focus on patient-centered care and a sharp focus on accountability. We have to understand our roles in this new dispensation especially in regard to what we need to do for those groups that have significantly remained sidelined even within the adoption of the ACA. I therefore seek to focus on expounding on some issues that come up with the adoption of the ACA namely the continuum of care, the Accountable Care Organizations (ACO’s) medical homes as well as the concept of nurse-managed health care clinics (NMHCs).
The emergence of ACOs and the NMHCs has been influenced by the need to have a system that meets the needs of all subgroups of people within the community and within the population that we serve. Under the ACA, the focus was to afford the patient population an better platform to interact with the healthcare provider and therefore meet the health needs that have in the past derailed them from achieving a high quality of life. The ACOs are designed to provide highly coordinated care to Medicare patients and they include the health facilities, physicians, private practices, nurses, assistant physicians and additional caregivers who have voluntarily come together to ensure that these patients and particularly those with chronic illnesses can receive quality and effective care (Cherry & Jacob, 2014). While the Affordable care act provided the platform no which persons can access care irrespective of their financial status, for instance through the Medicare plans, the ACOs are part of the entities that have sprouted from the ACA to help fill the technical gaps that the ACA had identified and provided legal and logistical frameworks for solving (Fitzpatrick, 2010).
The role of the ACA is specifically defined within the concept of continuity of care, which is a concept that appreciates the need to sustain and maintain the quality of care over time irrespective of the financial, physical and infrastructural impediments that may be in existence. The focus of the healthcare systems over the past few years has been on enhancing the relationship between the healthcare provider and the patient and this is essentially the basis on which the medical homes have arisen. Within the medical homes the idea is to provide care tailored care as well as develop patient provider relationship in a bid to facilitate self-care and self-management techniques in patients even when they are ailing from very serious chronic illnesses (Fitzpatrick, 2010).
The medical homes are community owned and their focus is the patient and their family. There is appreciation of the role of the nurse, physician, technicians and aides who take part in the care process such that they are not only in a working professional relationship with the patient but a humanly social and spiritual relationship that can enhance holistic healing. These entities have filled a very big gap in healthcare and there are many others that we need to become more innovative and inventive in order to fill. We are yet to reach the epitome of the healthcare system and with the integration of technology; we are even faced with a new need where we have to phase out the obsolete system and replace with new systems that are compatible with these technologies and the needs within the healthcare sector. Even as we seek to face these challenges and those that may present in the near future as the dynamics of technology and the changing needs of the population continue to manifest, nurses and healthcare providers have to be well prepared for the task ahead.
We have had the foundation set out and we can say that it is stable but still in need of restructuring and modification. However the goal and objectives of the healthcare system remain as steadfast as ever. We have to ensure that the populations we serve are at a position where they can attest to the continuum of care irrespective of the physical, social, economic, environmental or political climate around them (American Nurses Association, 2010). This however has to be based on the ability of the nurses and the healthcare providers to understand the needs of the sector in a more detailed way and that includes dwelling on research and evidence-based methods.
In this case, as we move forward, continued education for nurses as set out in the IMO Future of Nursing report is a necessity and each of us needs to take it as a personal challenge. We need to expand out skills and our knowledge, we need to reorganize the system and that implies utilizing valuable evidence and data to implement change. This will be the foundation of the future healthcare system that we aspire to have and as key stakeholders we cannot just sit back and watch as events unfold. We need to take the mantle and go out there and influence this change (Fitzpatrick, 2010).
Reflections
For a majority of nurses, there is so much hope and expectation in regard to the healthcare systems of the future. Nurses are not only excited about the integration of technology and the new roles that they have found; they are not just excited about the improved working conditions and the ability to further their education and build a career path; they are more optimistic that the patient outcomes are due to improve and the healthcare system will indeed be appreciated for what it is in terms of saving lives. Apparently, as one of my colleague, TW, who has worked in the healthcare system as a nurse for the last 13 years says, the challenge is not for the new nurses but more so for those nurses who still hold the bureaucratic definition of the traditional nurse and who are not ready to evolve.
TW notes that this is a transition period and we are due to lose many experienced nurses even as the young vibrant generation takes over the sector. However, TW indicates that there should be a balance; much as we anticipate for change and call for change, we have to appreciate the experience is difficult to purchase and thus there is need to protect the experienced nurses through this transition and allow them to grow into the new roles that have emerged. Like any other transition, there are due to be challenges and all nurse scan attest to this. However, in as much as challenges exist, the healthcare sector is unique in that it calls for accuracy and less errors and misses. Therefore, the quality of care and the safety of the patients cannot be compromised by any measure even as we pursue new methods of care delivery. The balance is necessary for s sustainable future (American Nurses Association, 2010).
Another colleague, Kelly, who has been in the nursing profession for 17 years now indicates that nurses, cannot shy away from furthering their education now as the opportunities are expanded. In Kelly’s view, there is a likelihood that nurses how stick to their past academic credentials and certifications will in a few years feel out of place and the workplace will begin to haunt them. According to Kelly, nurses have to take up leadership roles especially at unit and departmental levels and initiate change from the bedside. The utilization of evidence-based techniques for instance outwits any other form of investment that the healthcare system can imagine and in Kelly’s view there is no need to look for change that will impact the entire systems at once. Each nurse has to work their way at their local facility, utilize the knowledge available in books and research archives while the nurse managers and the administrations have to enhance the modes and channels of communication so that nurses can share widely the information that they have and utilize it to improve care outcomes at their respective places of work (Melnyk & Fineout-Overholt, (Eds.), 2011).
George, a colleague who has been in the profession for seven years, insists that the Affordable Care Act gives us the platform to determine what the population will receive. According to George, it is apparent that the nurses are the determinants as to how the continuum of care will be accomplished (Fitzpatrick, 2010). In essence, there are those populations that are at risk such as the elderly, those with chronic illnesses and those from low income areas who have limited access to care. These populations need to be assured of their health now and into the future. One of the key strategies to a healthy population is in ensuring that all individuals and groups are afforded individualized care and that which meets their holistic health needs (American Nurses Association, 2010).
There is an agreement across the board that the nurses of the present and the future have to focus on continuum of care not only within the need for primary outcomes such as physical healing but also the relationship between the nurse and the patient such that it goes beyond the disease episodes. The society out there has taken the lead role in driving the reforms in the healthcare sector and since they have a sense of what they want, it is up to us the nurses to develop means and methods to meet those wants by aligning them to patient outcomes. On the other hand, as the society expectations on nurses and the healthcare system expand, there is a need to recognize that working closely with the society is the more realistic approach. In essence, we need to appreciate the role of community health as the new dimension through which we can impact the society (Fitzpatrick, 2010).
Community health is the platform that will allow the nurses and the healthcare providers to identify with the actual needs of the community and the socioeconomic determinants that impact the health of this population. In this case therefore, identification of these needs will imply working with communities beyond the episodes of illnesses. At a time when the evidence-based nursing is taking shape, data and information are vital elements that will determine how effective the EBP can be implemented (Melnyk & Fineout-Overholt, (Eds.), 2011). This data and information is readily available at the community level and nurses can act as the agents who collect and utilize this data for purposes of family, individual and community health. The need to develop tailored solutions to health issues within the community can be accomplished when data is available and this data can be more useful when it is utilized alongside the experience of the nurses (Cherry & Jacob, 2014).
References
American Nurses Association. (2010). New care delivery models in health system reform: Opportunities for nurses and their patients. Retrieved from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf
Cherry, B., & Jacob, S. R. (2014). Contemporary nursing: Issues, trends & management (6th ed.). St. Louis, MO: Mosby/Elsevier.
Fitzpatrick, J. J. (2010). The future of nursing: Leading change, advancing health. Nursing Education Perspectives, 31(6), 347-348.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
