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  1. The U.S. health care delivery system


    Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.     


Subject Nursing Pages 5 Style APA


The U.S. Healthcare System Reforms and the Role of Nursing in Healthcare Delivery

Governments worldwide should safeguard, secure, and provide measures that help their citizens thrive. Part of these important measures provided by the governments of the world is healthcare. The United States is no different from other governments in ensuring that Americans have proper access to healthcare and can thrive. Therefore, with the provision of healthcare by the government, various changes have occurred in the U.S. healthcare system to help it provide full access to healthcare to all Americans. None of these reforms has been as effective as the Affordable Care Act passed into law. Therefore, as the Affordable Care Act (ACA) ensures that all Americans have access to healthcare through payable healthcare insurance, there has been an approach to use the pay for performance initiative as a value-based incentive program that has been proven ineffective towards patient outcomes; hence,  as ACA has led to the need for more nursing professionals in healthcare facilities, there is a need to look into future nursing trends that will optimize patient outcomes as more ACA goals are fulfilled.

The Affordable Care Act

During the Obama administration, the Affordable Care Act (ACA), commonly known as Obamacare, was passed into law in 2010. The act looked into making reforms in the U.S. healthcare system. ACA’s primary goal was to reduce insurance costs while maintaining a firm understanding that any American citizen in need of healthcare services had to have health insurance with them (NurseJournal Staff, 2020). During its institution as law, the reforms in ACA stated that each family was supposed to have a healthcare plan or face the consequences of paying the penalty. During its five-year implementation plan, ACA also permitted that individuals under the age of 26 were eligible to stay under their parents’ healthcare plans and qualify for Medicare soon after while low-income houses could reduce their medical costs through partial funding from ACA (NurseJournal Staff, 2020). The passing of ACA into law permitted employees and other Americans who did not receive health insurance from their employers or have pre-existing conditions o be liable to healthcare insurance like any other American.

Since its legislation into law in 2010, ACA has revolutionized the U.S. healthcare system by achieving some of its goals.  The collaboration of the state and federal government has propelled the government into providing funding of the Medicare healthcare initiative in over 37 states in the U.S. In addition, reforms in the Affordable Care Act have helped employees who did have insurance from their employers could access and gain insurance from private entities without the risk of getting high insurance premiums. At the same time, individuals with pre-existing conditions are no longer marginalized against healthcare insurance (NurseJournal Staff, 2020).  However, issues have risen in Americans who incur penalties for not having healthcare plans. Americans have raised this as an issue of concern, looking into how these penalties may be higher in older citizens and citizens with pre-existing conditions, especially since they would be at a higher risk of needing medical aid. Since ACA’s reform implementations, the quality of healthcare in the U.S. has also risen.

Reforms in the Affordable Care Act have increased the access to healthcare to Americans, which has consequently improved people’s healthcare outcomes, especially amongst older people and those with pre-existing and chronic conditions. There has also been a rise in the interest amongst Americans to venture into preventative care that helps Americans take care of themselves before getting sick (NurseJournal Staff, 2020). The Affordable Care Act has been significant in improving healthcare around the U.S. that has led to value-based incentivization amongst healthcare professionals through the pay-for-performance initiative because of improved healthcare services in the U.S.

Pay for Performance Payment Initiative

Pay for performance (P4P) payment initiative in healthcare works on the principle that nurses and other healthcare professionals are extended certain financial stimulus packages for fulfilling certain performance programs set by healthcare institutions. The main purpose of the pay for performance initiative in healthcare facilities is to work hand in hand with the implemented policies from the Affordable Care Act to ameliorate the caliber of healthcare and enhance the patient experience (NEJM Catalyst, 2018). While this is the overall goal for the healthcare payment initiative by reducing patient readmissions, the initiative is proving to be a challenge for patient healthcare outcomes.

 This comes as a problem with evidence that supports where there is a high quality of healthcare; healthcare costs will rise proportionally (Mendelson et al., 2017). With national programs like Medicare being rolled out, payments have been adjusted based on the value of healthcare given to patients as insurance companies incur the costs. With additional care being targeted with such measures as preventative care, there will be a rise in healthcare services. Therefore, the pay-for-performance payment initiative that acts as an incentive program will not effectively ensure a rise in patient health outcomes. Since different healthcare facilities have different organizational goals, finding a common factor that helps align organizational goals to the P4P initiative will be hard. Ultimately, each healthcare facility will seek to find their method of incentives over a unified one across the U.S. Therefore; it is important to understand the importance of nursing leadership and management to help promote patient safety with the emerging trends in healthcare.



Impact of ACA on Nursing and Nurse Roles

As healthcare facilities find a common way to incentivize their healthcare professionals, it is important to understand that the enactment of ACA into law is solely focused on ensuring that improving patient outcomes. Therefore, there will be an emphasis on the importance of nursing professions to effectively administer care to patients (NurseJournal Staff, 2020). With this in mind, the demand for nursing professionals in the U.S. healthcare system will increase correspondingly. Nurses will need to improve their educational levels by advancing their current educational levels to understand better, and procedures of care that assure more set goals as per the ACA are reached. The preference of care nurses to physicians in healthcare facilities stems from the knowledge that advanced practice nurses (APN) and nursing practitioners (NP) are trained for holistic treatment of the patient (Dyess et al., 2016). Therefore, APNs and NPs will take care of patients solely based on better health outcomes rather than diagnosis and treatment bases like physicians do. The increased knowledge from higher educational institutions will also help nurses have better workplace performances that increased their interactive and engaging side with patients. Through the ACA, reforms have been that nurses gain more education that will help them be more empathetic, which resultantly improves patient outcome through improved healthcare procedures administered.

The increase in the number of insured people accessing healthcare services has increased in the number of nurses needed in healthcare facilities. Dyess et al. (2016) explain that ACA has opened up nurses to more patients than they can handle per day while administering care. Nurse roles have also increased with the increase of patients in healthcare facilities. The result of understaffed healthcare facilities in the nursing department will lead to nurses experiencing burnout because of long shifts that may lead to patient errors (NEJM Catalyst, 2018). Therefore, as the reforms in the Affordable Care Act continue to improve, more Americans are getting access to healthcare insurance; and in turn, there is a need for increased nurses in the healthcare facilities. With such impacts on nurses and nurse roles in hospitals, increasing there is a need to look into future trends that will help with an effective reform to the Affordable Care Act that increases patient outcomes and improves healthcare across the U.S.

Future Trends in Nursing that Transform Healthcare in the U.S.

According to the Online Carson-Newman University 2020 research, there is an urgency to place online classes to help increase Americans’ access to healthcare insurance. Obamacare has led to the increased access of healthcare insurance to all Americans with no rise in patients; therefore, many Americans who did not have access to healthcare service now do have them. With the emergence of the Covid-19 pandemic, healthcare facilities need healthcare professionals with no universities and healthcare institutions opened (Carson-Newman University Online, 2020). Therefore, online classes will help nursing students access certification that helps with the increased number of nursing practitioners in hospitals to counter the increasing number of healthcare needs. This will lead to increased patient outcomes with fewer nurse burnouts and patient errors.

Secondly, nurses need to be certified to practice fully as healthcare practitioners who can diagnose, treat, and offer medication to patients in need. This helps ensure that the goal of ACA is achieved through Americans having access to professionals who offer holistic care to them, increasing patient outcomes (Carson-Newman University Online, 2020). The Covid-19 pandemic has placed an importance on the need for more medical professionals who can practice fully. Therefore, the need for nurses to be granted practice authority is needed. The authorizing of nurses to practice will increase the healthcare outcomes and propel the Affordable Care Act into achieving its goals.


Healthcare reforms help in increasing health outcomes amongst patients in the U.S. The Affordable Care Act enrolled into law in 2010 in the Obama administration has propelled Americans into getting proper care while accessing healthcare insurance. As this happens, there has been a need for more nurses to help with the growing population of Americans with healthcare insurance. As this happens, graduate nurses need to be granted access to practice while going through online classes. Ultimately such trends and reforms in the Affordable Care Act will propel healthcare into a better path of proper healthcare access to all Americans.


Carson-Newman University Online. (2020, January 6). 25 Nursing Trends We Expect to See in 2020. Cn.edu. https://onlinenursing.cn.edu/news/nursing-trends

Dyess, S. M., Sherman, R. O., Pratt, B. A., & Chiang-Hanisko, L. (2016). Growing Nurse Leaders: Their Perspectives on Nursing Leadership and Today’s Practice Environment. ANA Periodicals, 21(1). https://doi.org/10.3912/OJIN.Vol21No01PPT04

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. https://doi.org/10.7326/m16-1881

NEJM Catalyst. (2018). What Is Pay for Performance in Healthcare? https://doi.org/10.1056/CAT.18.0245

NurseJournal Staff. (2020, September 21). The Affordable Care Act and Nursing | NurseJournal.org. NurseJournal. https://nursejournal.org/resources/affordable-care-act-nursing-guide/














Appendix A:

Communication Plan for an Inpatient Unit to Evaluate the Impact of Transformational Leadership Style Compared to Other Leader Styles such as Bureaucratic and Laissez-Faire Leadership in Nurse Engagement, Retention, and Team Member Satisfaction Over the Course of One Year

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