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EXECUTIVE SUMMARY
* As health care delivery organizations react to the changes brought about by public and private sector reform initiatives, RNs can anticipate that, in addition to intended outcomes, there will be unpredictable pressures and unintended consequences arising from reform.
* Biennial national surveys of RNs conducted over the past decade have explored various changes in the nursing workforce, quality of the workplace environment, staffing and payment policies, and RNs' views of health policy, including their expectations of health reform.
* The latest survey results offer a picture of RNs' capacity to practice successfully in a care delivery environment that, over the current decade, is expected to emphasize teams, care coordination, and become driven increasingly by payment incentives that reward quality, safety, and efficiency.
* If RNs are provided with strong clinical leadership, participate in developing an achievable vision of the future, and if supported to take risks and innovate to improve the quality and efficiency of care delivery, then the profession is likely to thrive rather than struggle during the health reform years that lie ahead.
* Increasing the education and preparation of nursing leaders, and particularly unit-level managers, will be increasingly vital for nursing to prosper in the future.
THE HEALTH CARE SYSTEM HAS begun a decade of transitions that, for the nursing pro - fession, promise to change the practice of nurses, expand current nursing roles and create new ones, and provide many opportunities for nurses to participate in shaping the future delivery system. With the passage of the Affordable Care Act (ACA) in 2010, care delivery and financing systems are undergoing significant transformations that will accelerate in 2014, when major provisions of the legislation are implemented. Under the ACA, Accoun - table Care Organizations will be developed to align the goals of health care delivery reorganizations, enhance care coordination, and improve patient transitions across the care delivery continuum. Expansion of medical care homes, community health care centers, and enhanced coverage for preventative care services will help to shiftthe delivery system's current focus on acute care to a greater emphasis on prevention and treatment of chronic care conditions using health care teams and information technology. And, over the decade, changes that capitate provider payments and bundle payments for episodes of...