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Introduction

Recent modifications and reorganizations of the healthcare system used in the United States have

been prompted by problems with access, fluctuating costs, fragmentation, inequities, and

unsatisfactory results. There were also worries regarding demography, changes in the kind of

condition, and the cost and quality of healthcare services (Salmond, 2017). It has always been

crucial and required to modify the way doctors deliver care because of the importance of vital

care and the high expense of clinical care for patients with chronic diseases.

As a result, it has become easier for nurses to take the initiative and influence comparable trends

due to the prominence of these transformational developments. However, in order to be

significant players and stakeholders in influencing these changes, nursing professionals must be

aware of the numerous elements impacting the transformation as well as the important skills and

knowledge base necessary for success. In order to reform and rebuild the consideration model

and activities carried out by experts, this study aims to examine the steps that have been taken

and the modifications that have been made.

Federation regulation and nursing roles and responsibilities

The "Sustaining Excellence in Medicaid Act," enacted by the federal government in 2019,

intends to reform the American healthcare system (H.R. 3253). This legislation was introduced

to Congress on June 13, 2020, and it was enacted into law on August 6, 2020. A Michigan-based

consultant called Debbie Dingell proposed and backed this piece of legislation. The measure

seeks to redesign the Medicaid program by extending some of its provisions (Congress.gov,

2019). One of the changes allowed Medicaid investment to continue into fiscal year 2024.Also
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included in this law is the power to assess and look into court cases involving patients who have

not been institutionalized by Medicaid fraud devices. This adjustment is essential because it

avoids some of the contradictions that result from ignoring these patients' legal battles despite the

fact that they are legitimately eligible for Medicaid protection.

This act also expands Medicaid eligibility to protect individuals from their spouses' poverty or

destitution. Spouses from lower socioeconomic backgrounds may occasionally be refused

coverage because they do not have access to Medicaid (Policy Source, 2019). For instance, the

population that receives entirely scientific services through a network and at home is covered by

the law's expanded coverage provisions. Along with these changes, this law also repeals the

requirement that drug companies incorporate the cost of ordinary medications in their rate

computations.

This act has an impact on nursing practice by increasing nurses' duties and tasks. The patient's

partner's inability to pay for high-quality medical care may also be a barrier. The nurse should be

able to relate to these patients and inform them of the new developments so that they may

receive quality hospital care more easily. This law affects the function and duty of the nurse by

extending the role of the advocate in nursing. The nurse is required to represent non-

institutionalized patients in litigation and help them with Medicaid appeals if their requests for

care are turned down.

Effects of quality measures and pay for performance on patient outcomes and nursing

practice

Practitioners are paid using a system termed "pay for performance" that bases payments only on

how well they do overall in scientific practice. It's a compensation structure based on

performance with the goal of improving and expanding patient access to healthcare services

(Mathes, 2019). As a result, in this version, practitioners who do poorly are likewise punished. A

doctor, for instance, is not often compensated for contributions if a patient refuse to quit smoking

during their period. This concept motivates physicians and nurses to deliver outstanding care for

their patients in exchange for monetary rewards linked to their responsibilities and performance

evaluation criteria, which benefits patients in various ways. However, this reward system runs

the danger of having negative consequences since it promotes "person dumping." This activity

has negative patient outcomes because the patients no longer receive timely or appropriate

medical treatment.

In these circumstances, a nurse should keep in mind upholding moral standards like "no malice"

in order to do as little harm as possible. This idea would be used by the nurse to persuade doctors

to accept and treat patients with complicated medical issues. The nurse should also remind the

other doctors that they have an obligation to preserve lives under the Hippocratic Oath. It is the

duty of nurses to inform their coworkers about these moral issues since patient dumping is a

serious violation of this oath (HG.org, 2022).

Professional leadership and management functions in nursing

Knowing about nursing informatics and nursing generation may be required for a new

management role in nursing that deals with new advances. A developing trend in healthcare is

the use of technology in medical settings, which is driving up the demand for nurses with

technological abilities. As a result, management and management jobs in various settings have

emerged. More precisely, the Health for All Act addressed the problems with the healthcare

reforms implemented by the Obama administration. However, due to the rising demand for

healthcare services, the majority of nursing practitioners have felt forced to take on roles that are

intended for doctors. Furthermore, the inclusion of illegal immigrants has resulted in an increase

in management and control positions, such as nurse managers, patient and family advocates, and

leader nursing officers, to name a few (Manchikanti, 2010).

The importance of these management and management roles in addressing changing trends and

promoting patient safety necessitates the availability of advanced skills in addressing the needs

of the populace and ensuring wellbeing based on the prioritization of care that specializes in

patients, coordinated operations, the evaluation of facts, and the enhancement of quality (Kidwai,

2019). Most significantly, because of changing roles and dynamics in the healthcare system,

emerging leadership and management positions will play a critical role in the transformation of

fitness services by leveraging the contributions of care providers who operate throughout the full

exercise spectrum. Similar to that, they will considerably help to produce patient-focused,

coordinated treatment, which necessitates professional cooperation. Nurses will also have the

chance to advance since these elements will be included in the decision-making and problem-

solving approaches.
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Emerging Trends

The duties and responsibilities of healthcare professionals and nurses are expected to change

significantly as a result of the health care system transition in the United States. Among the

recent trends aimed at forcing those adjustments are more prescription medicine usage, higher

charges for fitness services, and more sophisticated clinical generation (Banthin, 2006).

Inadequate best-practice development infrastructures, uneven usage of tools and pointers, and

carriers' failure to support decisions are further issues. Peer responsibility measures are also

lacking. The lack of medical data structures that can access and use digitalized data in the care

delivery process, for example, will raise questions about the quality of the care services offered.

The problematic way of life that inhibits development will thus persist in organizations that fail

to adopt and incorporate strict procedures that have an influence on fines throughout the course

of the following five years. In order to address the social and environmental elements that

contribute to preventable circumstances, programs and activities will be implemented that

promote prevention and well-being in nursing practices and roles (Symons, 2021). These might

complement approaches that treat patients as members of their families, communities, and

friends by educating them on self-care and illness management.

References

Banthin, J. S. (2006). Trends in prescription drug expenditures by Medicaid enrollees. Medical

care(I27–I35), 44(5 Suppl). https://doi.org/10.1097/01.mlr.0000208132.36055.84

Congress.gov. (2019). PUBLIC LAW 116–39. From the U.S. Government Publishing Office.

Retrieved from https://www.congress.gov/bill/116th-congress/house-bill/3253/text

HG.org. (2022). Standard Nursing Obligations for Care. HG.org. Retrieved from

https://www.hg.org/legal-articles/standard-nursing-obligations-for-care-45620

Kidwai, M. (2019). Importance of Healthcare Management. bizfluent. Retrieved from

https://bizfluent.com/13365444/importance-of-healthcare-management

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Policy Source. (2019). H.R.3253: Sustaining Excellence in Medicaid Act of 2019.

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