Impact on Nursing of Health Care Changes

The rise in health care costs and changes in the organization of health care result in modifications in the care delivery system as well as changes in the role of nursing.

These shifts are reflected in nursing education, and role restructuring with new definitions of nursing (Betz, 1995; & Girard, 1993).

Changes Occurring in Health Care Delivery System

Nursing care delivery models demonstrate how care is given in a specific setting, with a focus such as patient, institution, or nurse/worker. A common model is an organizational flow chart. Three levels of development in organizational models include: the theoretical or conceptual level with a framework; the way care will be delivered (professional model, functional model, primary care model, and nurse extenders); and financial aspects. Analysis of a nursing care delivery model demonstrates how nursing works within a specific context. Change is found to be a major characteristic of today's health care delivery (Girard, 1993).

Major changes are found in financial and organizational aspects of health care. Costs are escalating; "annual health care spending in the United States has increased from $280 billion in 1980 to an estimated $620 billion in 1989" (p. 482). Hospital care uses up to 40 percent of this estimate, physician costs (20 percent), medications, appliances, and dental care (20 percent), construction and research (5 percent), and nursing home care

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education. Nurses of the future will be working in community and health care organizations. Community-based nurses may find themselves shifting from care givers to preventative roles, educating families, professionals and community workers. A new role for the nurse may include case manager; the nurse may need to distinguish nursing practice from social work. Nurse education must include the learning of critical thinking skills, written and verbal communication skills, and managerial skills. Competencies to function independently and autonomously in long-term care settings will be necessary as will the ability to be part of a professional and paraprofessional interdisciplinary team. Cultural influences will need to be understood. Community settings will require the ability to deal with ambiguities of community practice, creative approaches to care, functioning as a community member, and abilities to deal with families in these new environments (Betz, 1995). The roles of first-line nurse managers have been defined and classified into technical, human and conceptual skills. Technical skills include an understanding and proficiency in specific activities (budgeting, decision-making, planning). Human skills include activiti
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Approximate Word count = 1733
Approximate Pages = 7 (250 words per page)

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