Evolving practice of nursing

[jloyloe]

How do you feel about accountable care organizations (ACO), medical homes, and nurse-managed health clinics? I'm working on gathering opinions of how nurses feel about the future of nursing in regards to these patient care models. Any thoughts would be greatly appreciated! Here is a little background in case you are not familiar:

Accountable Care Organizations

"Accountable Care Organizations (ACOs) are groups of health care providers that work as a team to coordinate care for a group of patients, with the goals of providing high-quality, patient-centered care and reducing costs" (National Alliance for Quality Care, 2013). ACO's focus on better healthcare via efforts to improve quality and reduce costs across the care continuum. They are designed to encourage the cultural change necessary to achieve the 'Triple Aim' which includes better health for the population, higher quality care, and lower costs of care. Additionally, they strive to provide smooth, continuous, high-quality care instead of the fragmented care in Medicare's current fee-for-service model. Nurses have an integral role to play "acting as care coordinators, communicators, quality improvement managers and providers of advanced levels of care" (National Alliance for Quality Care, 2013).

Medical Homes

Patient-centered medical homes (PCMHs) are primary care practices in which patients receive coordinated, interdisciplinary and interprofessional care. A personal health care provider maintains a continuous patient relationship and manages a team that takes responsibility for the continuum of care. The team often consists of physicians, APRNs and other nurses who all strive to provide integrated patient-centered care. PCMH utilizes strategies such as team approach, collaboration with other providers, care coordination, self-management and health information technology. Care is arranged to meet the patient's short and long-term healthcare goals, throughout every stage of life, settings, and care levels. An APRN may lead PCMH in certain states that authorize nurse-led practices. Nurses are pivotal in coordinating care and especially during transitions in care. Nurses bring the concept of holistic patient care to PCMHs that physicians often lack. This type of care delivery model allows patients to be at the center of their health care coordination with accessible primary care (Case Di Leonardi, 2015).

Nurse-Managed Health Clinics

Nurse-managed health clinics (NMHCs) are accessible service sites that deliver community-based primary and/or wellness care regardless of a patient's ability to pay. They provide primary health care experience with underserved populations. Nurses provide the majority of care; a team of advanced practice nurses, RNs and other health care professionals in collaboration with physicians in jurisdictions where required. The dominant theme for NMHCs is that nurses control their own practice and provide the care. "NMHCs serve as critical access points to keep patients out of the emergency room, saving the healthcare system millions of dollars annually" (American Association of Colleges of Nursing, 2013). NMHCs provide clinical placements for undergraduate and graduate nursing students necessary to increase the enrollment in nursing education programs, helping to eliminate shortages in the supply of nurses (Sutter-Barrett, Sutter-Dalrymple, & Dickman, 2015). This exposure enhances the chance that the students will select to practice in underserved areas. NMHCs give students the unique opportunity to integrate classroom learning with community-based care.

American Association of Colleges of Nursing. (2013, May 16). Nurse‐managed health clinics: Increasing access to primary care and educating the healthcare workforce. Retrieved from American Association of Colleges of Nursing: http://www.aacn.nche.edu/government-affairs/FY13NMHCs.pdf

Case Di Leonardi, B. (2015, January 16). The role of the nurse in transforming healthcare. Retrieved from RN.com: The Future of Nursing Report: The Role of the Nurse in Transforming Healthcare

National Alliance for Quality Care. (2013, May 1). The role of nurses in accountable care organizaitons. Retrieved from National Alliance for Quality Care: http://www.naqc.org/main/resources/nursesrole-accountablecareorg.pdf

Sutter-Barrett, R., Sutter-Dalrymple, C., & Dickman, K. (2015). Bridge care nurse-managed clincis fill the gap in health care. Journal for Nurse Practitioners, 11(2), 262-265. doi:10.1016/j.nurpra.2014.11.012

[JustBeachyNurse, LPN]

Homework?

[Rose_Queen, BSN, MSN, RN]

While I agree with JustBeachy that this sounds suspiciously like homework, I would like to know your opinion first. After all, you did start the thread, and you will find posters much more ready to respond if you show you've put your own effort into starting.

[jloyloe]

Hello! Yes homework. I'm suppose to see how my colleagues feel about the patient care models i wrote about above. However, I'm not working so don't have any "colleagues" in a work sense. This is my first post. I had no idea this forum existed! I have a feeling I will be up all night checking out all the posts ~ great information!

[JustBeachyNurse, LPN]

So what are your thoughts?

[jloyloe]

AH I see, not supposed to have homework questions? I was not aware. I wrote all of the information I posted, just looking for impressions from other nurses to write a section on how colleagues feel about this "new" avenue of nursing.

I became an RN in November 2013 and found out I was pregnant with our 4th child so I decided to work on my BSN instead. With that being said, I sometimes feel like perhaps I'm a bit naive in how I see the world of nursing being I have never officially practiced with my license.

As far as the future of nursing and what the IOM and ACA are working on to evolve nursing I think it is all amazing and am hopeful the recommendations will come through on all levels. Specifically in regards to the 3 I wrote about above, I feel these types of care models help push nurses to the forefront and encourage the "respect" they deserve. Unfortunately, I feel there are still many people in healthcare as well as patients, family members etc. who view nurses as the doctors "assistant" and really have no idea the extent of what and RN license entails. These models create roles for of leadership for nurses and allow us to have a voice in critical decision making when it comes to healthcare. And why shouldn't we ~ we are the ones on the front lines with, in my opinion, the best for pushing through with researching and implementing evidence based practice. My favorite of the three is the concept nurse-managed health clinics, I feel that would be amazing for collaboration and patient care.

[mmc51264, BSN, MSN, RN]

I had that same question when I was getting my BSN. I have no idea where any of those places exist. I think just in textbooks. Sorry I can't help as I have never personally known of an actual place where those exist.

[Altra, BSN, RN]

Aaarrgh! Nursing faculty who give assignments to gather opinions on social media for academic credit: for the love ... PLEASE STOP!

[SmilingBluEyes]

It's not that we are so angered or annoyed by homework questions. But you would do well to present your opinion, based on YOUR OWN research, then ask us for ours. It's better-received that way. GOOD LUCK TO YOU!

[jloyloe]

I appreciate everyones suggestions as this is my first post. I should have clarified it is all my own research and can see how posting my own opinion first would have helped. Thanks.

[CamillusRN, BSN]

AH I see, not supposed to have homework questions?

By no means - we welcome the opportunity to help out. It's a good idea to provide your own work to this point to show an effort is being made (which I note you have provided).

I will be starting a new position at an ACO shortly, so I can't say much from personal experience yet. From my research into the company and the care delivery model in preparation for the interview, I can say that it impressed me almost as much as the "universal bed" model I had the privilege of participating in with my previous job. I do believe that the universal bed model will continue to lead to comparatively better patient outcomes, but I understand the financial advantage of the ACO. Only time will tell. Looking forward to following this thread!

[HouTx, BSN, MSN, EdD]

OK - what the heck. I'll contribute a thought or two for OP.

Nursing "evolution" is pretty much theoretical right now - mostly espoused by nursing leaders & optimistic "futurists" that ignore the golden rule.... e.g., He who has the gold makes the rules.

Until healthcare reimbursement changes so that nurses can receive direct payment for the services they provide..... it just isn't going to happen. I can't speak for all states, but in mine, the physician lobby has a stranglehold on healthcare legislation. If they don't like it, it's dead in the water. Just recently, they managed to put a stop to any expansion of telemedicine. Unless a miracle occurs, they will continue to react quickly and effectively to squash anything that creates a 'disturbance in the force' and undermines physician control (AKA impact on their income).

Hope springs eternal . . .