Nursing Practice Expected to Grow and Change Ageing of population and healthcare providers, coupled with reforms to healthcare, will raise demands for professionals in the field, also expanding existing professionals' required skill sets and roles. Physicians, physician assistants, nurse practitioners, nurses, and medical assistants are included in this growth area. Fortunately, healthcare is characterized by a swiftly expanding and large workforce (with 23000 new entrants every month, nationally); this sector progressed even in recent economic recessions (Survey, 2013). Registered Nursing (RN) is one of the leading U.S. occupations which is projected to grow 26% and add the highest number of jobs by 2020 (an estimated 1.2 million RNs overall), as per U.S. Bureau of Labor Statistics (Survey, 2013). This stems from a projected rise in demand, as well as a need for replacing the current ageing RNs. Nursing careers are being pursued in America increasingly; the number of students enrolled in Bachelor of Science in Nursing (BSN) increased by about 20,000 (5.1%) in 2011 from 2010 figures. Concurrently, there are indications that competent applicants are turned away from training due to limited financial resources and faculty shortages (Survey, 2013). An American Association of Colleges of Nursing survey conducted in 2011 revealed the number of BSN graduates to be over 80,000 students, including around 28,000 (or 35%) from BSN completion courses and 52,922 from entry-level courses. BSN completion-course enrolments have risen annually for the past 9 years, with the 2011 increase being 15.8% (Survey, 2013).

Concepts helping in the changes for Nursing Practices

Institute of Medicine's (IOM's) report, which determines hurdles, explains new opportunities and systems, and offers a special visions about advanced practice nurses' (APNs) crucial contribution to healthcare, addresses all nursing levels, emphasizing most on APNs. It details three Accountable Care Organizations examples, together with how nurses' complete potential can be tapped to deliver high-value, high-quality healthcare (Ridge, 2011). Restructuring and expanding nurses' roles can help achieve positive value, quality, and access outcomes, by maximizing nursing's scope relative to education and training. Kaiser Permanente's Vice President of Patient Services Program Office, Marilyn Chow states that our future is not just anywhere; it is here. Kaiser Permanente, Veteran's Affairs (VA) department, and Geisinger Health system are three healthcare delivery organizations maximizing nursing's scope. They adopted programs, which provided real-world proof of how nursing practice at its best can impact patient health outcomes and the healthcare system positively (Ridge, 2011). VA's shift to a care-focused system bases itself on nurse practitioners' (NPs) maximization as primary healthcare providers. VA's NPs conduct their practice in the field within an environment of professional teamwork. Thus, VA patients, by 2007, could obtain more reasonable, higher-quality healthcare than similar Medicare recipients could. The report includes Geisinger, a private non-profit, for its transformation from a specialty-focused, pricey healthcare facility to a high-value organization (Ridge, 2011).

Nurse-managed health clinics (NMHCs) are also an example of expected positive healthcare sector changes. NMHCs refer to accessible service facilities, which deliver community and family oriented healthcare. APNs provide majority of healthcare, by collaborating with physicians, dentists, social workers, and other healthcare providers and nursing professionals (Pohl, et al., 2010). NMHCs could be standalone organizations, or affiliated to some service institution (hospitals, home health organizations, etc.) or university. Most (74%) of NMHCs are affiliated to university nursing schools, while the rest (26%) are hospital outpatient facilities or standalone nonprofits (Institute for Nursing Centers Survey, 2008). Though they offer facilities over a continuum of healthcare, NMHCs are typically differentiated as wellness clinics or primary care facilities. Roughly 160 out of 250 NMHCs call themselves "wellness clinics," whereas the remaining deliver inclusive primary healthcare (NNCC Survey, 2008). NMHCs do not perceive potential and existing health issues in isolation; rather they view health issues within contributory cultural, societal, and environmental contexts (NURSE-MANAGED HEALTH CENTERS, 2011).

The need to include nurses as leaders in Patient-Centered Medical Homes (PCMHs) has long been noted by nursing groups. Efforts for including NPs moved to states; thereafter, Washington, Iowa and Minnesota initiated programs to include them. The Affordable...

A grant scheme was established for setting up community-centered interdisciplinary units to aid primary healthcare. PCMHs were defined as having a primary care focus, while sharing common features like a primary healthcare clinician (physician, physician assistant or NP) to supervise and manage patient care. Thus, the National Committee for Quality Assurance (NCQA) re-evaluated applications of eight Pennsylvanian NP-directed primary healthcare facilities, which were reviewed previously under the Chronic Care Initiative of Pennsylvania's Governor, in 2009, in southeastern Pennsylvania, awarding recognition to them all (Scudder, 2011).
Feedback by Nurses

Brenda Cassidy, upon completing her master's pediatric NP degree in 1997, was not entitled to write prescriptions in Pennsylvania State despite being adequately educated and trained. Fourteen years since, NPs are entitled to prescribe in every U.S. state. However, this change was achieved after years of battling regulatory obstacles, and Cassidy actively agreed to participate in this struggle; finally, reforms in healthcare can be said to be speeding up. Cassidy is of the view that balancing clinical and political duties is a challenge. At the same time, she also holds that this is a very crucial time for nursing professionals to take part in the process of policy-making (Dunbar-Jacob, 2011). Furthermore, Cassidy states that diving into politics is especially challenging for practicing clinicians. According to her, the hard part is navigating through to grasp and understand how it is applicable to everyday nursing practice. For those who aren't specialized in the field of political science, the concept appears foreign; getting to the meat is also very taxing. She believes it to be her duty to make these transformations more significant and valuable to other NPs. Cassidy claims that doing this has proven exciting for her because reforms in healthcare will cause an increase in inspired individuals, in line with the decrease in numbers of primary healthcare providers. This change has opened up opportunities to enable NPs to take on a more prominent role in primary healthcare (Dunbar-Jacob, 2011). Remarking on the Institute of Medicine (IOM) report, she asserts that this can be considered a big deal, as one particular action required by the IOM for achieving this cooperative response: removal of the barriers, to nursing practice's scope, that prevent APNs from practicing in primary health care. Finally, Cassidy states that realizing these recommendations in an age of healthcare reorganization will help restructure nursing's image to prove and improve the significance of the profession.

Corina Barrow, a U.S. Army lieutenant colonel, working for the Army's Nurse Corps, recently finished tenure as army nurse fellow to Hawaii's U.S. Representative, Daniel Inouye. As Inouye's chief legislative counselor on issues pertaining to healthcare, Barrow offered recommendations on funding requests, floor proceedings, legislation's co-sponsorship, and report language. She affirms that changes in healthcare will undoubtedly redesign the profession of nursing. The Affordable Care Act's implementation and persistent discussions on reforms to healthcare will underline the important contributions of nurses to healthcare units, as members and leaders (Dunbar-Jacob, 2011). Barrow makes a reference to a recent IOM report, The Future of Nursing: Leading Change, Advancing Health: she maintains that it will prove to be an incentive for promotion of nursing's role in implementation of healthcare reforms. This report makes demands with regards to permitting nursing professionals to carry out practice to their utmost potential, as befits their qualifications; this statement implicates state and national regulatory barriers, which restrict NPs from doing even what is permissible by state laws. In contrast, IOM desires that nurses assume the role of absolute partners in healthcare reformation (Dunbar-Jacob, 2011).

Heidi Donovan, who works for the School of Nursing, University of Pittsburgh, was delighted to find a real-time laboratory at the threshold of the institute, for her students to gain a firsthand understanding of the potential importance of nurse's role in transforming community health. She believes strongly in the notion that that health can and must be promoted at all levels of the nation's healthcare system. According to her, the solutions to health promotion offered by her students are plain but tough: supporting people to become successful in their efforts to change behavior, proposing policy reforms, urging local food stores to stock healthy foods, and training unprofessional staff of community establishments to elicit healthy behaviors in clients (Dunbar-Jacob, 2011).

An era of reform has come upon the nation's healthcare system that promises to alter nursing practice, expand existing nursing roles, develop new roles, and provide nurses with numerous opportunities to play a role in development of the future care delivery system. By means of the 2010 Affordable Care Act, healthcare financing and delivery systems are going through momentous transformations, which have accelerated further in the year 2014, with implementation of the Act's key provisions. Several private entities and foundations have offered considerable backing to strengthen the profession of nursing. With time, we will be able to ascertain whether the above investments provide the anticipated progress and advantages. If firm clinical leadership is provided to…