Conclusion: Demographic Challenges

The nurse workforce is slowly becoming more diverse, and the proportion of racially and ethnically diverse nursing graduates has increased by 10 percent in the last two decades, growing from 12.3 to 22.5 percent (HRSA, 2010). Nonetheless, additional commitments are needed to further increase the diversity of the nurse workforce. Steps should be taken to recruit, retain, and foster the success of diverse individuals. One way to accomplish this is to increase the diversity of the nursing student body, an issue addressed in Chapter 4. The combination of age, gender, race/ethnicity, and life experiences provides individuals with unique perspectives that can contribute to advancing the nursing profession and providing better care to patients.


The ACA will bring new opportunities to overcome some of the barriers discussed above and use nurses in new and expanded capacities. This section offers a brief look at four of the current initiatives—the accountable care organization (ACO), the medical/health home, the community health center (CHC), and the NMHC—that are designed to implement these changes at an affordable price regardless of whether the providers involved are part of a large, integrated health care organization like the VA, Geisinger, or Kaiser Permanente. All four initiatives have shown enough promise that they were selected to receive additional financial support under the ACA.

Depending on their outcomes, these exemplars may lead the way to broader changes in the health care system. Given this possibility, the creation of the new Center for Medicare and Medicaid Innovation within the Department of Health and Human Services may prove to be one of the most important provisions of the ACA (Whelan and Russell, 2010). The Center is designed “to test innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing the quality of care.”30 CMS can expand the duration and scope of successful programs with priority given to programs that also apply to private payers. They can also terminate or modify programs that are not working well. These types of decisions had previously been allowed only after congressional action.

The committee offers no predictions as to which combination, if any, of these four exemplars—ACOs, medical/health homes, CHCs, and NMHCs—will best succeed at meeting patients’ needs. However, it wishes to emphasize to the Center for Medicare and Medicaid Innovation that each of these four initiatives depends on high-functioning, interprofessional teams in which the competencies and skills of all nurses, including APRNs, can be more fully utilized. New models of care, still to be developed, may deliver care that is better and more efficient than that


Patient Protection and Affordable Care Act, HR 3590 § 3021, 111th Congress.

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