Health care delivery models and nursing practice guide

Four questions and roughly 1,100 words means about 275 words each, and the paper only works if each question is answered as a distinct thing rather than as four angles on "health care is changing". The structure the brief supplies is actually a chain, and seeing it saves you most of the work. A law changes what gets paid for. Payment changes what gets measured. Measurement creates roles whose job is managing the measures. And those roles are the leading edge of what the profession is turning into. Writing it as a chain rather than as four separate essays is what makes the last section — the prediction — defensible rather than speculative, because your two predictions can then follow from the mechanism you have already described instead of arriving from nowhere. Decide the chain before you write a word, and the transitions between sections stop being a problem.

The first question is more constrained than it looks. It asks for a current or emerging law or federal regulation introduced to reform or restructure some aspect of the delivery system, and then for its effect on nursing practice and the nurse's role and responsibility. Two things go wrong here, and both are avoidable at the planning stage. One is choosing something too big to trace: the Affordable Care Act as a whole cannot be connected to a nurse's daily work in 275 words, whereas a single provision within it can. The other is stopping at description. The requirement is the effect on practice, so the paragraph has to travel from a statutory or regulatory text to something a nurse now does, documents or is accountable for that they were not before. Pick the smallest instrument that reaches that far, and name it with its date so a reader can check it.

The second question pairs quality measures with pay for performance, and the pairing carries the argument. A quality measure on its own is information; attaching payment to it converts it into a behavioural incentive, and incentives have effects the designers did not intend as well as the ones they did. Documentation burden, the temptation to avoid complex patients who might worsen a score, and improvement in the measured thing at the expense of the unmeasured thing beside it are all well documented and all land directly on nursing work. A paper that reports only the intended effects has answered half the question and will read as promotional. The strongest submissions state an intended effect, a measured result, and one documented unintended consequence, and then say what that combination means for the expectations now placed on the nursing role. That three-part move is worth building the section around.