So for this week you will have 2  parts.  The 1st part is a formal presentation.  You can do a  Power Point Presentation with Speaker Notes, or you can write a paper  with objectives and goals and such, or an other way you want to  document your paper.  This part is a Formal Presentation that  should be in APA Format with References.  Then after you present  your Presentation to 3 Colleagues you will write an informal summation  of their responses.  This should clearly define that their are 3  Colleagues and they have 3 responces. 



As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals.

  1. Write      an informal presentation (500-700 words) to educate nurses about how the      practice of nursing is expected to grow and change. Include the concepts      of continuity or continuum of care, accountable care organizations (ACO),      medical homes, and nurse-managed health clinics.
  2. Share      your presentation with nurse colleagues on your unit or department and ask      them to offer their impressions of the anticipated changes to health care      delivery and the new role of nurses in hospital settings, communities,      clinics, and medical homes.
  3. In      800-1,000 words summarize the feedback shared by three nurse colleagues      and discuss whether their impressions are consistent with what you have      researched about health reform.
  4. A      minimum of three scholarly references are required for this assignment.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.


[email protected] AJN ▼ February 2012 ▼ Vol. 112, No. 2 23

Despite continued efforts by congressional Republicans to repeal—or undermine funding for aspects of—the Patient Protection and
Affordable Care Act (ACA), policymakers are forg­
ing ahead to improve the quality of health care and
contain its costs through reform of how health care
is both paid for and delivered. While the emphasis
of the ACA is to expand access to health insurance
coverage for 35 million uninsured Americans, the
new law also encourages the adoption of innova­
tive models of care and payment, such as account­
able care organizations (ACOs).

The ACA describes an ACO as an arrangement
between providers and suppliers of health care ser­
vices that “promotes accountability for a patient pop­
ulation and coordinates items and services under
Medicare parts A and B, and encourages investment
in infrastructure and redesigned care processes for
high quality and efficient care delivery.”1 While the
ACA directs the development of ACOs for Medicare
beneficiaries, ACOs are also being launched in many
areas of the country as a way to deliver care to Amer­
icans of all ages who have private health insurance.

Because nurses are on the front lines of patient care,
they are key stakeholders in any redesign of the pay­
ment and delivery systems and should be knowledge­
able about and involved in the development of ACOs.
Nurses are likely to have key roles in ACOs as leaders,
managers, clinicians, and care coordinators.

The current U.S. health care system is fragmented
and duplicative. Because no sole entity—providers,
payers, or employers—takes full responsibility for
managing patient care, the costs are high and quality
is uneven.2 While there is no rigidly defined ACO
model of care, an ACO generally consists of an in­
terrelated system of providers that may comprise
hospitals, home care and long­term care agencies,
physician group practices, and other health care en­
tities, such as medical homes, whose focus is primary
care. The ACO assumes responsibility for managing
the care of the patient and the delivery of services
across the continuum of care, with a strong empha­
sis on primary care and prevention. Performance

measurement is critical as well. The goal of the ACO
is to provide high­quality, cost­effective health care,
with providers rewarded for delivering excellent care.
ACO types include3

• a “virtual” ACO, which may consist of different
types of providers, such as physician practices and
hospitals that may get extra payments for deliver­
ing quality, cost­effective care.

• an “integrated” ACO, which may encompass in­
surance and delivery roles, as in the ACOs run
by the Geisinger Health System in

Academy of Medical-Surgical Nurses














In March 2010, health care reform legislation titled The Patient
Protection and Affordable Care Act (PPACA) was signed into law
(HR 3590, 2010). This act has been lauded as empowering the aver-
age citizen, reviled as socialized medicine, predicted to change the
way health insurance companies operate and to drive the United
States into deeper debt, and resulted in some positive changes while
enduring lawsuits by multiple states’ attorneys-general. Regardless
of one’s political stance on the topic, the PPACA is certain to impact
the medical-surgical nurse personally and professionally.

The words nurse, nursing, and nurse practitioner (NP) are used
liberally throughout the 2,300 page PPACA document. Although
not all of the implications for nurses and nursing practice are
spelled out in the legislation, it is a certainty that 32 million
newly insured people will affect the health care system and
nurses at the core of this system. As such, the full impact may
not be known for quite some time. Judicial rulings stating aspects
of the law are unconstitutional and a movement by conservative
members of the House and Senate may again change the face of
the law.

This article will highlight several aspects of the PPACA that
will affect medical-surgical nursing. Funding for the programs dis-
cussed here is not guaranteed; budgetary discussions have
stalled the implementation of all the changes and it is almost cer-
tain that any funds received will be at markedly reduced levels
from fiscal year 2011 funding. Five articles of the act will be dis-
cussed to inform the medical-surgical nurse and to serve as a
call to action.
1. Reauthorization of Title VIII Workforce

Development Programs
There are grants for workforce diversity providing stipends

for racial and ethnic minorities with diplomas or associate
degrees in nursing to enter bridge or degree completion pro-
grams. Provisions for grants to train family nurse practitioners in
primary care to work in federally-qualified health centers or
nurse-managed health clinics and grants for state partnerships
to address health care workforce issues were also included in
the act. Current discussions will decrease Title VIII funding to
2004 or 2008 levels, resulting in a significant cut in funds for
these grants.
2. Increased Funding for Nurse-Managed Clinics

Much of the new law revolves around community care that
is external to the acute care setting. Programs for school-based
and nurse-managed clinics, transitional care, and services for

The PPACA and its Impact on
Medical-Surgical Nursing

Robin Hertel

rural areas are outlined. There is a clear focus on prevention and
chronic d

August, September, October 2010 Nevada RNformation • Page 7

Healthcare Reform and Nurses: Challenges and Opportunities
By Laura Stokowski, RN, MS

Medscape Ask the Experts Advanced Practice Nurses
Reviewed by Denise S. Rowe, MSN, APRN, BC, FNP

Federal healthcare reform, specifically, The Patient
Protection and Affordable Care Act (PPACA) was
passed into law by Congress in March, 2010. The
legislation was passed after a year of intense debate
on the pros and cons of the federal government’s role
and responsibilities in providing or increasing access
to healthcare for its citizens. In this article, Stokowski
does not rehash the debate, but offers insights on
the implications of PPACA from two nationally known
nurse leaders. The article also summarizes key
provisions of PPACA that affect nursing.

Stokowski states that the expectation of 32 million
people becoming newly insured will significantly
affect our healthcare system and that nurses will
continue to play a central role in healthcare delivery.
To discuss the likely challenges and opportunities,
Stokowski interviewed Maureen “Shawn” Kennedy,
MA, RN, Editorial Director and Interim Editor in Chief
of the American Journal of Nursing, and Susan
Hassmiller, PhD, RN, FAAN, senior nursing advisor at
the Robert Wood Johnson Foundation.

Both leaders suggested that the new law will
be good for nurses. To start, PPACA provides
additional funding for baccalaureate and advanced
practice nursing education. One exciting area
that the law creates is a grant program for health
clinics to be managed by nurse practitioners (NP).
Kennedy stated this will lead to more NPs going into
independent practice. She also pointed out that even
though physicians raise the issue of safety when they
perceive NPs are treading into their turf and affecting
their financial bottom-line, NP delivered care has
been shown to be as safe as physician delivered

Another question asked was whether there
would be enough nurse practitioners to meet
the demands of millions more people with health
insurance. Hasmiller commented that when the
2006 Massachusetts law offered health insurance to
virtually all its residents, there was initially a shortage
of primary care providers and emergency room visits
went up sharply, initially causing a spike in healthcare
costs. Subsequently Massachusetts passed a law
requiring recognition and reimbursement for NPs as
primary care providers by health insurance plans.
Under PPACA, Certified Midwives will receive the
same pay as physicians for Medicare Part B, which
covers physician fees. The Joint Commission is
also working on a medical home designation which
expands leadership roles in primary care beyond
just physicians to include independent practitioners
including NPs.

What about the paradigm shift from a sick care
model to a prevention based model whi


The Evolving Practice of Nursing

Pamela S. Dickerson, PhD, RN-BC

January, 2012

Purpose: The purpose of this session is to enable the nurse to be proactive in advocating

for the future of nursing.


Describe changes impacting the current and future practice of nursing.


A number of factors have converged in the first decade of the 21
century to radically

alter the environment in which health care is provided and change the nature of the role

and responsibilities of the nurse. This study will explore these changes, with a focus on

the current and potential impacts on the profession of nursing.

Setting the Stage

Changes in the environment in which health care is practiced have occurred more rapidly

in the first decade of the 21
century than in the past. Hospital care, which used to be the

“normal” and most common venue for the practice of nursing, is now only one of a

myriad of opportunities for the nurse. Patients are in the hospital for shorter periods of

time, and only the sickest patients are hospitalized. Consequently, hospitals are

employing nurses who are experts in the type of care needed by hospital patients. Units

which typically provided care for “medical-surgical” patients are often incorporating

telemetry and other services that used to be reserved for critical care units. Many of the

patients who used to be cared for on traditional medical-surgical units are now cared for

either in rehabilitation centers or in their homes. Long-term acute care hospitals and/or

units have been developed for those patients who need care for longer periods of time

than the typical acute care facility can now handle. Reimbursement issues have driven

many of these changes.

The health care reform provisions based on federal law passed in 2010 have yet to be

fully determined. Some elements of the anticipated changes include more focus on

preventive care, more persons having insurance to pay for primary care, and more focus

on community-based care. The nurse is well positioned to be a provider for preventive

care and services in the community. It is anticipated that resources for care in clinics,

offices, and other community-based settings will need to increase to meet demand in the

coming years.

Technological advances are impacting the types of services patients receive, where those

services are provided, and the competencies of the personnel required to manage the

technology. New equipment, telemedicine, use of electronic health records, and the