Health Care Delivery Models and Nursing Practice


Over the past two decades, the healthcare system especially in the United States has seen a significant increase in healthcare costs. As a result, the issue has raised an alarm for health care reform before healthcare costs become unsustainable. Building strategies for reform will lower health care costs and improve the quality of health care. Besides, improved quality of care translates to having good working environments for healthcare workers who are responsible for providing safe, sustainable, and efficient care to clients. In this paper, there is a discussion of a current health care law, quality measures, professional nursing leadership, and management roles congruent with health care reform.

The Current Health Care Law

The rendering of health services in most health care systems across the world remains overwhelmed by the increased numbers of patients or clients. In the nursing profession, inadequate staffing remains an issue. Understaffing in nursing units usually leads to overwhelming the nursing staff; inadequate time for quality patient care, delayed care for clients, and nursing staff burnout, and increased stress. Staffing remains one of the most challenging contemporary issues health care organizations strive to settle. A challenge that emerges is creating an equilibrium between adequate staffing for the delivery of quality services and having enough monetary resources to afford enough staff.

Among the current laws established, this paper focuses on the “Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019” (Schakowsky, 2019). The law drums up support for standard staffing ratios and to ensure the quality of care. In essence, the law seeks to ensure proper staffing for nurses and enhance the quality of health care (Schakowsky, 2019). A section of the law indicates that poor and substandard monitoring of registered nurse staffing practices leads to few registered nurses rendering health care services thus impacting the delivery of health care (Schakowsky, 2019). Adequate staffing leads to the delivery of quality healthcare at the same time acquiring optimal value from registered nurses (Park, 2017). The law stipulates that staffing should have one nurse to one patient in accidents and emergency units (1:1), one patient to one nurse in theatre units (1:1), two patients to one nurse in critical care units (2:1), and one nurse to three patients in emergency rooms, antepartum, labor, and telemetry (1:3), four patients to one nurse in medical-surgical units (4:1), a nurse to carter for five patients in the rehabilitation unit (1:5), and six patients in postpartum units (6:1) (Schakowsky, 2019). Therefore, the law advocates for nurses to deliver quality patient care and at the same time ensure the betterment of the health practice environments and reduce burnout due to workload.

Quality Measures on Performance, Patient Outcomes, and Effect on Nursing

Reforms in healthcare seek not only to promote health care quality but also to make health care costs affordable and sustainable. Pay for performance provides a platform for initiatives meant to ensure improved quality, effectiveness, and overall value of health care (Mendelson et al., 2017). Pay-for-performance provides financial incentives to healthcare organizations, healthcare providers, and physicians to deliver health care improvements and attain desired health outcomes (Mendelson et al., 2017). The health care delivery model was brought about by the Centers for Medicare and Medicaid Services (CMS), which also stresses quality measures in place. Some of the quality measure metrics include the efficiency of care, patient care experiences, the delivery of care, and health care outcomes among patients (Tinker, 2020). Patient-specific outcomes include rates of hospital-acquired infections (HAIs), fall risk management, rates of infections, vaccination status (Tinker, 2020). Offering health care providers and organizations reimbursements do incentivize the players in health care to manage health behaviors to enhance patient outcomes and reduce health care costs (Tinker, 2020). Nurses have a significant role in realizing such quality measures and have to embrace the fact that best evidence-based practices ensure the quality of care. Besides, the nursing workforce advocates for patients thus having the capability of ensuring patients receive culturally competent care and ensuring affordability of health care costs.

Professional Nursing Leadership and Management Roles

Leadership in nursing is instrumental in assisting the reform of health care systems. Nurse leaders, therefore, have an integral responsibility of promoting and facilitating channeling and collaborating at all levels in the nursing discipline. With the expansion of the nursing scope through education and knowledge, nurses assume Advanced Practice Registered Nursing (APRN) roles and become the voice of nurses through leadership. Advocacy in the nursing discipline has led to the surfacing of contemporary nursing roles such as care coordinator, patient navigator, and virtual care nurses, among others (Bauer & Bodenheimer, 2017). The emergence of such new roles is usually critical in assisting expand care to patients outside of the acute care environment. For instance, care coordinators aid in the management of care for clients with chronic ailments such as diabetes to access care after discharge from the hospital. Virtual care nurses help link patients with healthcare providers from their convenience without the need to physically avail themselves of the facilities. Considering the emergence of COVID-19, the role of virtual care is instrumental to enable high-risk patients to receive care without the need to interact with other individuals. Therefore, having nurses assuming leadership and management roles assists in the seamless transition and continuum of care.

Predicting of the Change in Nursing Roles and Nursing Practice

There is a remarkable potential in the nurses’ future particularly in improving the quality of care and reducing costs associated with health care. The commitment of nurses to shift and assume the APRN roles helps in closing the gap in primary care and community health roles. APRNs, therefore, are capable of delivering high-quality and affordable care to clients in any health care setting. Autonomy for nurses increases when they make advances in nursing education. Besides, they are crucial in the continuum of care in a variety of settings including clinics in upcountry and home care settings. Certified nurse anesthesiologists help anesthetize patients at an affordable rate. Entry-level nurses are increasingly shifting to acquire bachelor’s degrees. Consequently, such changes aid to reduce health care costs whilst delivering high-quality care.


In summary, nurses are key players in the reformation of health care systems by influencing the delivery of affordable and high-quality care. Nurses also assist in providing sustainable care for clients. They have increasingly advocated for proper nurse-patient ratios. The fundamental reason behind such an effort is reducing workplace burnout and improving the quality of care for patients. Again, nurses facilitate the meeting of quality measures to improve care and influence maximum reimbursement for health care facilities and care providers. Therefore, the nursing discipline is important in reforming the future of health.


Bauer, L., & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future. Nursing Outlook, 65(5), 624-632.

Mendelson, A., Kondo, K., Damberg, C., Low, A., Motúapuaka, M., Freeman, M., O’Neil, M., Relevo, R., & Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care. Annals of Internal Medicine, 166(5), 341.

Park, C. S. Y. (2017). Optimizing staffing, quality, and cost in-home healthcare nursing: Theory synthesis. Journal of Advanced Nursing, 73(8), 1838-1847.

Schakowsky, J. D. (2019). Text – H.R.2581 – 116th Congress (2019-2020): Nurse staffing standards for Hospital Patient Safety and Quality Care Act of 2019.

Tinker, A. (2020). The top 7 healthcare outcomes measures. Health Catalyst.