The nursing profession has experienced numerous changes. In 1980s, there was a shift to all registered nursing staffing that led to nursing care being solely delivered by highly skilled nurses. Additionally, at the moment, health care institutions are restructuring their workforce in a bid to cut costs. Hospitals are reducing the number of registered nurses, but increasing the number of unlicensed assistive personnel (UAP). Health care institutions are establishing nursing care delivery models, which include nursing teams consisting of a registered nurse leader and assistive personnel such as the UAP. Currently, there is a focus on a nurse as a supervisor of a team of care givers with a spectrum of cognitive skills and knowledge. Due to the fact that a registered nurse if held responsible for the outcome of nursing care delivered by a team, registered nurses should be skilled in capacities, such as delegation, and so forth.
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It is imperative for present-day nurses to have delegation skills as much as the critical thinking and traditional assessment nursing skills. The solution to performing in the function of a care leader is an understanding of the principles and role of delegation. Nurses are advocates of patients, and the objective of delegation is to guarantee that patient safety and quality care reach the bedside.
However, delegation is a challenging skill to obtain. It is simply a leadership and management skill. Nursing students in their early education experience should be introduced to the concept of a nurse as a care giver or a leader of a care delivery team. Nursing students need to be provided with ample opportunities to practice such skills in the clinical setting. They should know which kind of nursing skills should be delegated, and those that cannot. More significantly, they should be aware of basic delegation skills which be expected in their first nursing experience or job where they will have to supervise and lead care delivery.
A popular model for delivering enhanced nursing primary care, which has gathered momentum and is now being tested globally, is the medical home. This model is likely to get more prominence in the coming years when accountable care organizations (ACOs) start operation, because many caregivers suppose that primary care practices that belong to an ACO will want to adopt some elements of the medical home model to manage the care of their ACO patient panel efficiently enough so as to generate shared savings (Haas, 2011).
So how do nurses contribute to cost effective patient care in ACOs? A notable focus in the Patient Protection and Affordable Care Act (PPACA) is cost effective care of patients with serious diseases, particularly those with numerous co-morbidities. Undoubtedly, advanced practice nurses will be a part of the health care team in these environment providing, based on their certification and education, specialty or primary care to patients with numerous serious diseases.
In general, there is a scarcity of research to allow a satisfactory evaluation of what the model of medical homes can accomplish. At least, there is some supportive evidence for some elements of medical homes. According to Haas (2011), improvements are required in quality of preventive care, patient access, care processes, and general cost savings resulting from inpatient utilization and reductions in emergency department.
Research, which documents remarkable success stories show the efficiency of the medical home care model in controlled settings, although the efficiency of this model when adopted generally remains an open question. Like other good ideas, it might prove challenging to spread an initiative, which works tremendously well in some environments to the broader health care arrangement. Furthermore, health care organizations, which already meet most of the requirements linked with being a medical home, can actually improve more through incremental improvements, while nursing practices in need of change might be stuck if they cannot muster the human and financial capital needed to fix their practices.
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In short, the medical home model has the potential to transform the manner in which health care is delivered. The risk posed by the present enthusiasm for the theory is that is can lead to the adoption of unproven models on a broad scale nationwide before assessments of existing pilots can reveal what works best in what environments, and what points of reimbursements are required to get providers to engage in all the new activities covered in the medical home model. This could potentially lead to a failure to save costs or improve quality and could result in a good idea being termed ineffective before it has been given a chance to do well.
When patients receive care from various sources, connecting that care into an effective trajectory becomes challenging. Policy reports globally urge a combined effort to enhance continuity of care and avoid fragmentation. However, efforts to explain the problem or offer solutions are weighed down because continuity has been described and measure in countless ways. Continuity of care is conceived in a different way in nursing. The experience of care by a one patient with a provider is the first core factor of continuity; the second factor is that care continues over time, at times this is referred to as chronological or longitudinal continuity (Dickerson, 2012). Both factors should be present in order for continuity to exist, however their presence does not amount to continuity. For providers, continuity is the experience of having sufficient knowledge and information about a patient to best apply their professional aptitude and the assurance that their care is pursued and recognized by other providers.
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