Models of nursing care in a changing environment: current challenges and future directions.

The last decade of health care in America has been characterized by elements that converged to mandate the need for restructuring health care delivery, which included rising costs, the prospective payment system, consumer expectations, patient care monitoring, the quality movement, and the nursing shortage. This changing environment has resulted in an array of nursing care delivery models to restructure care to assure quality of care, patient satisfaction, and cost containment. Some of the models include paired practice, case management, patient-focused care, cross-training, and product line management. To meet the challenges of future health care delivery, nurses need to be aware of predicted future trends: decreasing specialization of health care personnel, flexibility of the traditional nursing role, increased community-based care, and expanded roles for nurses.