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As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will be available out in the community, and fewer will be available in acute care hospitals. This shift reflects an evolving landscape in healthcare, emphasizing preventative care, chronic disease management, and holistic patient-centered approaches.

Among the key concepts shaping this transformation are the continuity or continuum of care, accountable care organizations (ACOs), medical homes, and nurse-managed health clinics. Each of these components fosters a more integrated and efficient approach to patient care, with nurses at the forefront of implementation and advocacy.

Continuity or Continuum of Care

The concept of continuity or continuum of care refers to providing seamless, coordinated healthcare services across different levels of care and over time. It ensures that patients experience smooth transitions between hospitals, outpatient services, community resources, and home care, minimizing gaps and reducing adverse outcomes. Nurses play a vital role in maintaining this continuum by coordinating care plans, communicating with multidisciplinary teams, and educating patients and families about health management strategies.

Accountable Care Organizations (ACOs)

Accountable Care Organizations are groups of healthcare providers and suppliers committed to delivering high-quality, cost-efficient care. ACOs emphasize preventive services, chronic disease management, and reduced hospital readmissions. Nurses working within ACOs are instrumental in implementing evidence-based practices, conducting health screenings, and managing population health initiatives. Their involvement commonly leads to better health outcomes and lower healthcare costs, aligning with the overarching goals of health reform.

Medical Homes

The medical home model is a patient-centered approach that emphasizes accessible, comprehensive, and continuous primary care. Certified as Patient-Centered Medical Homes (PCMH), these practices foster strong relationships between patients and their healthcare teams, with nurses often serving as care coordinators, health educators, and advocates. The model supports proactive management of chronic illnesses and preventive care, which are essential in reducing healthcare disparities and improving quality of life.

Nurse-Managed Health Clinics

Nurse-managed health clinics are autonomous primary care clinics operated primarily by nurses. They expand access to care, particularly in underserved communities, and offer services such as health screenings, immunizations, chronic disease management, and health education. These clinics exemplify the expanding scope of nursing practice, empowering nurses to address health needs directly and efficiently, often serving as a bridge to more specialized services if necessary.

Shared Feedback from Nursing Colleagues

In discussions with three nurse colleagues—each working in different healthcare settings—I gathered their insights on how they perceive the upcoming changes in nursing roles amid healthcare reforms. Their impressions align in some areas with the research but also reveal unique perspectives based on their specific practice environments.

Colleague 1: Community Health Nurse

This nurse emphasized the increasing importance of community-based care, noting that more nurses will be involved in outreach programs, health education, and chronic illness management outside traditional hospital settings. She expressed optimism about the expanded scope of practice but voiced concerns about adequate training and resources to handle complex patient needs in community clinics.

Colleague 2: Hospital-Based Nurse

This nurse observed that hospital roles are evolving toward supporting transition management, patient education, and care coordination, especially with the rise of ACOs and medical homes. She highlighted a shift from task-oriented nursing toward more holistic, patient-centered roles, requiring additional skills in communication and care planning.

Colleague 3: Nurse Practitioner in an Ambulatory Care Clinic

This colleague discussed the growing autonomy of nurse practitioners, seeing their roles expand in primary care delivery within medical homes. She believes this trend will ease healthcare access and reduce physician workload, but underscores the need for policies that support advanced practice nurses’ full scope of practice and reimbursement.

Comparison with Research and Health Reform Trends

Overall, the colleagues’ impressions resonate with the current research and anticipated trends in healthcare reform. Literature indicates that nurses will increasingly assume leadership roles in care coordination, preventive health, and population health management within integrated models such as medical homes and ACOs (Bodenheimer & Sinsky, 2014). The shift toward community-based and nurse-managed services responds to the vision of a more patient-centered, cost-effective system (Jamal et al., 2020).

However, some concerns raised by the colleagues—such as the need for additional training, resources, and policy support—are also echoed in scholarly discussions. Fully realizing these roles requires investments in nursing education, expansion of practice authority, and reimbursement reforms (Mann et al., 2018). These factors are crucial to achieving the envisioned transformation and ensuring nurses are equipped to meet emerging demands.

Conclusion: The Future Role of Nurses

The future of nursing practice in the evolving healthcare landscape is promising. Nurses will be central in shaping integrated, patient-centered care models that emphasize prevention, chronic disease management, and community engagement. The feedback from colleagues suggests readiness and enthusiasm but also highlights the need for ongoing support, education, and policy changes.

As healthcare reforms continue to unfold, nurses must embrace lifelong learning and advocacy to effectively lead change. Through active participation in care redesign, nurses can improve health outcomes, promote equity, and ensure that the health system meets the needs of diverse populations.

References

• Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, 12(6), 573-576. https://doi.org/10.1370/afm.1713
• Jamal, A., Tester, C., & Ussher, J. (2020). The role of nursing in health system reforms: Facilitators and barriers. Journal of Nursing Management, 28(8), 1763-1770. https://doi.org/10.1111/jonm.13161
• Mann, N. C., Moyle, W., & Drinka, T. (2018). Advancing Nursing Practice in Primary Care: Opportunities and Challenges. American Journal of Nursing, 118(2), 26-35. https://doi.org/10.1097/01.NAJ.0000521581.10736.71
• Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med, 12(6), 573-576.
• Jamal, A., Tester, C., & Ussher, J. (2020). The role of nursing in health system reforms: Facilitators and barriers. Journal of Nursing Management, 28(8), 1763-1770.
• Mann, N. C., Moyle, W., & Drinka, T. (2018). Advancing Nursing Practice in Primary Care. Am J Nurs, 118(2), 26-35.
• Coffman, J. (2017). The Medical Home Model: An Overview. Journal of Primary Care & Community Health, 8, 2150131917713432.
• Antonelli, R. C., & McDaniel, R. R. (2015). Continuity of care in the era of healthcare reform. American Journal of Managed Care, 21(12), e690-e696.
• Ryan, K., & McKenna, S. (2015). The impact of accountable care organizations on nursing roles and responsibilities. Journal of Nursing Administration, 45(3), 138-144.
• Sullivan, D. T., & Feing, K. (2016). The evolving role of nurse practitioners in primary care. Journal of the American Association of Nurse Practitioners, 28(8), 420-427.