In a career as varied and full of opportunities as nursing, it’s essential to understand the system you’re working in. This is especially true if you are considering a role as a nurse leader.

To be effective as a leader inspiring the next generation of nurses, you’ll need to not just understand but have an in-depth knowledge of these systems in order to identify weak spots, innovate to make them stronger, and ultimately transform patient care for the better.

Healthcare systems in the United States comprise a number of components that should work seamlessly to provide the best and most equitable patient care. However, as we’ll see in our article, they present a number of challenges to the healthcare professional as well. 

We’re going to take a look at the healthcare systems in use in the U.S. and their various components, how they work together, and also how the role of nurses – specifically nurses in leadership roles – can effect changes for the better.

We hope that if you’re in the nursing profession, this article will inspire you to consider a leadership role that involves deep understanding of healthcare systems and what’s required to effect change for the better.

Healthcare systems in the United States: what nurses leaders need to know

Nurses in practice at any level need to understand how healthcare works in order to serve their patients well. In this section, we’re going to examine healthcare systems and their components and identify some of the challenges that you will likely come across in the nursing profession.

Is there a single healthcare system in the United States?

The first thing to understand about healthcare systems in the United States is that there is no single, overarching system that pulls together the various components that make it.

Healthcare is delivered through a complex, multi-faceted process that involves relationships between healthcare providers (such as hospitals and health centers), those who pay for healthcare (government schemes and private health insurance), and those in receipt of healthcare (patients).

While some patients benefit from private health insurance through their employer or by self-funding, others receive public forms of insurance such as Medicaid and Medicare. 

However, this does not necessarily represent a “catch all” system that ensures adequate insurance for all.  According to The Commonwealth Fund, 43% of working-age adults were underinsured in 2022. This could mean that they had insurance but that it still didn’t provide them with a way to access affordable healthcare or that they had had a gap in coverage during the year or, in the case of 9% of survey respondents, that they were uninsured altogether.

This is one of the challenges that nurses will come across in their career – being able to reach all patients at their time of need. The lack of a single, common way to ensure healthcare for all can translate into lack of equity in care, an issue that nurses need to be acutely aware of in any leadership role.

The role of individual healthcare service delivery systems

So far, we’ve understood that there is no single system that brings together all the healthcare providers and other components of healthcare delivery in one place. 

This means that many individual systems exist to deliver treatment and care to the patients. 

These healthcare systems – sometimes known as “integrated delivery networks” (IDNs) – pull together networks of sites of care, like hospitals or clinics, and healthcare professionals, like doctors and nurses.

Their role is to deliver patient care, strive to continuously improve this care and outcomes for patients, and act as innovators and leaders in the delivery of treatments and care.

Within these networks, you may find individual community hospitals, acute hospitals, specialty hospitals such as those providing psychiatric care or rehabilitation, and federal hospitals that provide care exclusively to Native Americans, military personnel, and veterans.

You’ll also find individual doctor’s offices, private practices, health centers, clinics, and hospices, as well as care provided in colleges, schools, and residential and correctional facilities.

While many patients receive their healthcare within a single network, there may be occasions when this isn’t possible – for example, if a patient has to seek specialized care for a rare condition outside their network.

This can mean a lack of coordination or joined-up care, which can be frustrating for both healthcare professionals and patients alike. This can even be true within networks, which are often vast and comprise many facilities and healthcare professionals.

Any nurse wishing to progress their career will have a grasp of this issue and, in a leadership role, will be in a position to effect change toward more coordinated and seamless care.

Understanding the challenges of healthcare systems 

Despite the variety of healthcare systems and components available in the United States and high expenditure compared to other countries around the world, we’ve seen already that there are challenges to be overcome – lack of access for all and fragmentation being the two highlighted in the previous section.

Any nurse intent on progressing their career needs to understand the full spectrum of challenges that are present in healthcare systems every day. 

In addition to the issues we’ve already identified, it’s worth knowing that healthcare outcomes do not always match the expenditure invested in the systems. And for minority groups, outcomes are worse compared to the U.S. average, adding a layer of inequity. 

Add into the mix an ageing population as the “Baby Boomers” born between the mid-1940s and mid-1960s enter their elderly years.

In addition, people from ethnic minorities currently make up most of the population growth in the United States. It’s well documented that this group faces disparities and inequalities when it comes to receiving healthcare. And once they do receive the care they need, it is often of poorer quality.

Not only are there significant changes in population patterns but also in the way diseases are changing and presenting. Chronic disease – obesity, arthritis, type 2 diabetes, cancer, stroke, and heart disease, for example – is becoming increasingly common, especially in older Americans. This puts a huge strain on healthcare systems, their finances, and other resources. 

And, of course, no appraisal of a healthcare system is complete without considering the financial status. Care is becoming more costly thanks to more complex technology and increased use of medication. What’s more, a fragmented system means greater waste of resources and can also mean that the cost of treatment can vary noticeably even within a small geographical area.

This means that there is a vast amount of work to be done to address these challenges and improve healthcare systems and the delivery of patient care; nurses are in a perfect position to drive this change.

Nurses delivering care understand what has brought the patient to need care, what their home and healthcare background look like, and what their ongoing needs will be.

Healthcare system reform must be patient-centered to effect the most transformative change, and because of their hands-on experience, nurses have the knowledge to identify weak spots and suggest changes for the better.

Nurses are already highly trained professionals who command respect thanks to their education and experience. They are the link between management and patients and have both the professional competence and people skills to drive change through all levels of healthcare so that it’s fit for the future.

Any nurse who aspires to help transform healthcare systems for the better will benefit from a deep understanding of how care is organized and delivered, through an additional period of study and a qualification that prepares them for the next challenging but highly rewarding phase of their career.

How do I become a nurse leader to effect change?

Working in nursing at any level offers a rewarding career, with many opportunities to progress into leadership roles. In these positions, you can use your skills and experience to help shape healthcare systems, improving them and ensuring they are responsive to the needs of patients.

If this sounds like a goal you would like to aspire to, then this is what you need to know about getting there.

For professionals who are already registered licensed nurses, a Doctor of Nursing Practice (DNP) program is an excellent way to complement your existing experience and develop the skills required to take healthcare forward.

On a DNP program, you will develop advocacy and leadership skills to give you the confidence to practice at a high level.

You’ll also learn more about health and organizational systems. This in-depth knowledge will form an essential foundation to progressing healthcare for the better for patients everywhere.

You will also get the chance to develop your critical thinking skills, empowering you to drive change and improvement throughout systems and organizations.

While fitting in extra study alongside your working and home commitments can be challenging, it’s certainly possible.

One of the most convenient ways of studying for a DNP is to choose an online program. Check out the Walsh University’s online DNP programs for either BSN or MSN entry, designed to draw out the qualities of a good nurse leader who can effect lasting change.

Online DNP programs offered by Walsh University are designed around students, acknowledging that while they lead busy lives, they also want to achieve the best they can.

Three intakes a year means you have a choice of when to start, and because the programs are online, you can study at your convenience without having to compromise your professional or home life.

You’ll be supported by a placement coordinator who can help identify preceptors and clinical sites, meaning you get the best of both worlds, combining studying at your convenience with practical, hands-on experience.

One-to-one coaching and a supportive community will help keep you motivated along your journey. Then, in as little as five semesters for MSN to DNP students or three years for BSN to DNP students, you’ll be the proud owner of your DNP qualification, enabling you to progress in your career.

If you have a special interest in improving healthcare systems so that they deliver better quality, more accessible, and more equitable care, then a DNP program could provide the stepping stone to this exciting and challenging area of your career.

Making changes for the better

Delivering healthcare is a complex business, involving systems that are not always as joined-up or efficient as they could be.

As a nurse, you are in the privileged position of witnessing first-hand the challenges of healthcare while having the potential to direct your career so that you can make changes for the better. 

To support this worthy aim, consider a DNP program that will give you the firm foundations and confidence you need to take your career to the next level. You’ll consolidate your existing skills and uncover a whole range of other useful competencies that will enhance your practice and enable you to take an active part in effecting change for the better.

Transforming healthcare systems is a rewarding goal for any nurse and one that will give you the satisfaction of seeing lasting change for the good of all patients.