CHANGES IN HEALTH CARE-IMPACT ON NURSING
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 (8 percent) comprise the remainder. Organizational changes are found regarding multi-institutional provider networks and/or development and expansion of ambulatory care services. In an effort to control costs, many organizations (over half of all hospitals in 1986 survey) are involved in health maintenance organizations (HMOs) or preferred provider arrangements (PPAs) or preferred provider organizations (PPOs). This change toward managed care, results in a tie betwee...