Health Care Delivery
The United States health agencies create and update policies through oversight from Congress. The U.S Department of Health and Human Services (HSS) is mandated to oversee all health issues in the country and create a road map for health improvements. Among the controversial issues that the HSS faces are the increased cost of care and lack of transparency (Major, 2019). In most cases, the public is in the dark over the actual cost that individuals are expected to pay. The issue has attracted the attention of the White House, and in 2019, President Trump, in consultation with Centers for Medicare and Medicaid Services, issued the Price Transparency Ruling. It is a healthcare reform that legally compels healthcare providers to declare the cost of standards care. The providers, payers, and self-insured groups are expected to inform patients about the cost of their services. Patients are offered opportunities for identifying and estimating the cost of care before treatment. This reform has been introduced in response to the secretive pricing, some of which have been exploitative.
Nurses comprise the highest percentage of healthcare workers in most facilities and, therefore, are in a unique position for influencing the cost of care (Margaret et al., 2017). In the new reform, nurses have the role of helping patients receive the best quality care at the most effective cost. Their responsibilities will include sharing information related to the cost of the available care plans and allowing patients to choose the most preferred care based on the aspect of cost. The objective of this responsibility of nurses is to allow patients to pay fair prices for quality care.
Quality Measures
Pay for performance (P4P) attaches payment to measures like patients’ satisfaction, best practices, and outcomes. This program has been found to have a direct relationship with cost and quality of care. In most cases, the care providers receive 30-40% of the income from incentive payments (Kyeremanteng et al., 2019). It increases the patients’ access to high-quality information concerning the performance of a provider and the cost of treatment. P4P combines cost, access, and quality to the advantage of patients in assessing metrics of the outcome, process, and structure. Since the emphasis of P4P is quality care, the overall patients’ outcomes are reduced rates of hospital admission and recurring visits. The providers are motivated and incentivized to concentrate on quality care for the benefit of patients.
The payment model imparts a higher level of transparency through the process of public reporting. The approach can hold nurses accountable for the significant payment they receive in offering patient care. The model allows patients to make informed choices when they need medical services. This limits the influence that policymakers or health insurers have on healthcare services since it is a process of supporting quality improvement.
The P4P model shifts the focus of nurses to specific priorities of patients. It assumes a patient-centered approach to care in maximizing the potential of positive patients’ outcomes. Although illness and injuries are the common symptoms for majority of patients, each has different reactions to treatment (Kyeremanteng et al., 2019). This approach results in patients’ satisfaction. It has financial incentives that facilitate nurses in building relationships rather than focusing on a specific form of care that is potentially chargeable. The model is complementary to the base payment method that exists without altering the basic format.
The model affects nurses’ roles by shifting attention to quantity rather than volume of services offered. It nullifies the volume service pricing where a nurse has an incentive for providing as many medical services as possible that open doors for patients to pay for services they do not really need in maintaining their wellness. P4P model increases nurses’ satisfaction since they develop meaning for their work. This is a significant reason for nurses to hold on to their jobs despite complexities. Employees are motivated to work harder and improve their skills if they know that meeting their objective performance results in an increase in compensation.
Nursing Leadership and Role
Studies suggest that nurses are continuously being engaging in emerging leadership and management roles. More than 60% of nurses in leadership positions enroll in training programs in preparation for these new roles (Kyeremanteng et al., 2019). Among them is the role of transformation. Most care settings are moving at the same pace with scientific and technological advancement, which needs constant change in the workflow and even the hospitals’ structure. Nurse leaders and managers play this role by advocating for change and leading their facility towards the desired change. For example, evidence-based care has been gaining popularity and value in most care settings. It is the responsibility of the leaders and managers to move the entire workforce towards this direction. These responsibilities mean serving as role models, creating and nurturing innovation and creativity in the workforce, and addressing other nurses’ needs.
Nursing leaders and managers are faced with the role of creating and nurturing diverse workplace culture. People have become highly mobile and move from one place to another to pursue better employment conditions (Major, 2019). The care system does not only have a diverse workforce but also patients. Nursing leaders and managers are tasked with creating homogeneity by promoting respect, cultural sensitivity, and tolerance. This role requires accommodating the cultural beliefs and values of all people and learning about the changing demographics.
Emerging Trends
Quality assurance is a significant trend impacting healthcare. Nurses play a primary role in steering forward quality assurance since they are the most visible staff members in a care setting (Figueroa et al., 2017). They have a role in protecting patients by following safety and health standards that are set by the state and federal governments. The improvement in health care management introduces the need for nurses to adhere to the standards of the Joint Commission by reviewing incident reports and ensuring patients’ safety.
The retention of nurses is a significant trend affecting most care systems. The cost and time for replacing a nurse are high because of the acute shortage of staff. It is estimated that a reduction of 1% in nursing turnover is worth $337,000 a year (Dyess et al., 2016). It is further estimated that 50% of nurses are millennials, although a typical care setting has several generations in the workforce. An average hospital loses $5.2-$8.1 million in turnover of a registered nurse. A third of hospitals in the U.S. experiences a vacancy rate of 10% (Dyess et al., 2016). In 2016, the rate was 8.5%, representing a representation 1.3% increase from the previous year. Hospitals are faced with the challenge of improving these conditions.
Within the next five years, nursing roles will shift towards offering culturally competent care. The world is continuously moving towards becoming an integrated community through rapid technological advancement (Margaret et al., 2017). The continuous improvement in communication and the high mobility of people is resulting in a culturally diverse society. For example, American society is made up of people from almost all cultural backgrounds. The responsibility of nurses in offering culturally competent care will become more pronounced than ever. Nursing roles will focus more on overcoming barriers such as racism, prejudice, and stereotyping through widespread training and education.
In the next half-decade, Telehealth and Chatbot’s use will become more prominent in healthcare and increase patients’ access to care. Technology is rapidly finding ways into healthcare, and these two aspects may fully automate many nursing roles a few years from today. Patients will be in positions for managing some aspects of health on their own through online portals. For example, they may access some of their test results, plan for appointments with nurses, and manage their refills of prescriptions.