Healthcare Transformation and Changing Roles of Nursing

What is healthcare transformation? The healthcare system is presently undergoing significant transformation with a crucial emphasis on the value of services delivered and the quality of care.

The factors that drive the changes in the health care system include inequalities, suboptimal outcomes, untenable costs, access problems, and disintegration.

Quality and cost concerns, as well as disease-type and social demographics, have established the most significant urgency and essence of change.

Nurses, due to their education and experience, are at the front line of leading change within the healthcare system.

The new regulations that increase access to quality care and enhance health outcomes without compromising quality have increased the nursing role.

Presently, nurses are no longer only performing the role of providing care for patients as they have assumed vital roles in managing and leading change in healthcare.

This article explores the concepts of healthcare transformation and changing nursing roles.

Healthcare Transformation

In recent years, quality and costs concerns, as well as the changing demographics, have influenced the changes in the health care sector.

The untenable increase in the costs of healthcare without complementary excellence in health outcomes and quality for the American population has been on a significant increase.

The increase has become unaffordable for patients, employers, and budgets at the state and federal levels.

The healthcare expenditure in the United States is the highest in the entire world. Compared to other advanced nations, its expenditure is about 2.5 times more.

Current Trends on Healthcare Transformation

The U.S. health care expenditure was at $3.0 trillion, $3.0 trillion in 2014, which is approximately $9,523 for each individual and about 30 percent of the GDP.

With the changing demographics, including an increase in older adults with chronic illnesses, the healthcare expenditure is projected to reach $4.3 trillion.

Factors such as higher healthcare costs increased the consumption of prescription medication, and increased use of sophisticated technology has contributed to the high costs.

However, approximately $750 billion spent on healthcare are wasted through fraud, prevention failure, inflated prices, and high administrative costs, and poor delivery.

Furthermore, even with the high cost of care, the United States is still underperforming regarding access, quality, and cost.

America reports high mortality rates for deaths caused by inadequate healthcare, higher infant mortality, higher disease burden, and higher laboratory, medication, and medical error.

Poor healthcare quality is mostly caused by intolerable levels of errors and recurrent communication failures.

The reduced care coordination within the system makes it quite challenging for patients and caregivers to navigate the healthcare system.

Ethnic and racial minorities, as well as people with low socioeconomic status, are disproportionately by the critical barriers to healthcare access.

Lack of clinical information systems, incoherent use of provider decision-support tools and plans, and underdeveloped quality improvement infrastructures affect health care quality.

The aging population in the United States is also causing significant changes in the U.S. healthcare sector.

It is estimated that by 2060, the number of older adults aged 65 years and above will be more than 98 million.

These demographic changes present critical economic implications for Medicare and Social Security.

Furthermore, the changing disease-type demographics resulting from the aging population presents challenges to the healthcare system.

More people are grappling with chronic diseases such as arthritis, obesity, Type 2 diabetes, cancer, stroke, and heart disease.

Chronic diseases not only threaten people’s productivity, but it is also among the most costly health issues.

Healthcare Reform

Factors like rising healthcare costs, quality and healthcare issues, and poor health status of people in the United States necessitated healthcare transformation and reforms.

The Patient Protection and Affordable Care Act (ACA) of 2010 relied on the fact that there were about 40 million underinsured and 50 million uninsured Americans.


The ACA is meant to help expand insurance coverage among Americans, also control costs, and improve health care quality.

The healthcare system is presently focused on value-based patient care; hence, the introduction of new payment and care models.

The new healthcare model care premised on rewarding healthcare providers for intervening to prevent disease progression and illness and quality outcomes.

The new health care system is also keen on using specialists appropriately, avoiding duplicative care, and minimizing waste.

The ACA has also availed funds to ensure that healthcare organizations are investing in electronic health records (EHR) and health information technology (HIT) to help track outcomes.

Quality improvement measures have also been prioritized to help establish the safety of culture and minimize the ‘near adverse events.’

The ACA also formalized the Hospital-Acquired Conditions (HACs) Reduction Program, which helps reduce the rates of HACs, which are regarded as preventable.

More attention is placed on chronic and preventative care across the whole population. Emphasis is placed on delaying disease progression and presenting acute illnesses.

The focus is on Patient-Centered Medical Homes and Accountable Care Organizations (ACOs) to adopt cost-sharing approaches.

ACA emphasizes on community participation, collaboration, team approaches, continuous comprehensive care, health promotion, and prevention.

Nursing Role in the Changing Healthcare Sector

Nursing has a central role to play in leading and managing change in the healthcare sectors and with the present shift towards affordability accessibility and patient-centeredness.

Nurses have to take proactive positions in the healthcare sector and champion change towards a value-based health care system.

With the changing payment models, healthcare providers, including nurses, are focused on redesigning care delivery.

Nurses need to learn about quality improvement, data analytics, care coordination, patient-centered care, and wellness and population care.

The modern-day nurse ought to examine his or her attitudes, skills, and knowledge to establish whether they resist or contribute to change.

As seen from their personal statements, nurses are assuming expanded roles in the redesigned healthcare system, and new job titles are emerging.

Some of the emerging nursing roles and titles include managing patient care transitions, geriatric care, informatics design and analytics, and population health management.

Nurses are increasingly connecting patients with healthcare services, especially in community settings.

With the emerging new roles, the nurse also needs to employ their knowledge and skills in new ways and develop new skills.

They need knowledge of preventive- and wellness-focused evaluations as well as health education and wellness programs.

Patient- and family-centered care is currently promoted, and nurses should embrace holistic care that involves patients, their families as well as communities.

Nurses need to learn how to function effectively in interprofessional teams as healthcare providers are increasingly working together within the care continuum to deliver quality care.

The focus is also shifting on quality and outcomes improvement, and data helps in understanding the required transformations.

Therefore, nursing professionals need data analytics skills to help collect and analyze clinical and financial data in the healthcare system.

Data collected at the population and individual level include details on patients’ quality of life, functionality, health status, and treatment.

This data is analyzed and elicits meaningful conversations as well as recommendations regarding quality improvement in healthcare

What Next

Overall, the health care system in the United States has undergone significant changes that have affected how nurses work.

In the transformed healthcare system, nurses are assuming a new role to increase value, advance health, and improve care.

With the use of nursing cover letters, they need to acquire new skills, knowledge, and attitudes to help them function in interprofessional teams and use technology and data to improve patient care.

They also need to have an understanding of geriatric needs as well as how the community characteristics affect populations and patients.

The present-day nursing programs should be focused on ensuring that future nurses acquire the competencies and skills needed to work in the modern healthcare setting. Check this sample essay on why people choose the nursing profession.

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