American Healthcare Structure and Nursing Challenges

The American Health Care Structure

The healthcare structures in various countries differ by their basic characteristics, the service systems, insurance schemes, payment methods, and the extent of the government’s involvement in the system. In the USA, the state offers a few publicly funded health care programs – Medicare and Medicaid. However, “the majority of the population is covered by employment-based private insurance” (Cacace & Schmid, 2008, p. 398). Although the absence of tax for private insurance helps the employers to save some amount, the rapid increases in prices for medicaments, drugs, and medical services make the healthcare insurances expensive. As the result, the employers may refuse to provide insurances for the personnel, and a lot of low-income families cannot afford the medical treatment.

“US healthcare spending was about $7,439 per person and accounted for 16.3 percent of the nation’s gross domestic product (GDP) in 2007 and will trend upward reaching 19.5 percent of GDP in 2017” (Kumar, Ghildayal, & Shah, 2009, p. 367). Despite the high costs and the increasing level of healthcare spending, the efficiency of the provided medical services is disputed by many researchers and specialists. “Studies have shown the inconsistency of the medical liability system in determining negligence and compensating patients, and doctors struggle to pay soaring medical liability premiums” (Kumar, Ghildayal, & Shah, 2009, p. 382).

In several European countries, the public investments are focused on the provision of effective training and medical education, and, as the result, a high level of competence and professionalism refines the quality of the services, and the positive health outcomes become more frequent. The high performance is also guaranteed by a larger involvement of the government in the system and by the universal insurance coverage for the citizens – it supports transparency and accountability.

The current situation in the healthcare system affects nursing as well. Nowadays, “nursing is challenged to create work environments that enhance productivity, professionalism and quality outcomes in patient care” (Kotzer & Arellana, 2007, p. 1658). The causes are multilateral: financial organizational issues, lack of budgets for the adoption of the necessary technologies, high expectations, medical errors, etc. The poor organizational structure and working culture in many US medical settings induce qualified nurses to leave the profession. Insufficiency of the recruited nursing staff, in its turn, negatively influences the system’s performance and the quality of care.

Although it is said that healthcare is a basic human right, and everyone within the boundaries of the country must have access to medical care, the facts are against it. The insurance coverage doesn’t guarantee a high-quality service, and it proves that the state needs to take some measures to improve the medical staff training, working conditions, and organizational environment in the medical settings.

Challenges in Nursing

The most challenging issues in the nursing profession include the care of self and the care of the profession. The idea of care of profession includes the concept of professionalism: high quality of service and performance, competence, experience, collaboration with the colleges, self-discipline, etc. The self can be regarded as “professionhood” – the ability of the individual to meet the high standards of the profession (Chiovitti, 2015, p. 51). The care of self and the care of profession are interrelated phenomena, and by developing one of them a nurse contributes to the development of another.

The performance of an individual nurse “reflects on nursing profession as a whole and contributes to the public image of a profession” (Lemire, 2006, p. 134). Therefore, the nurse must constantly be focused on professional development and skills improvement. The high level of participation and accountability are considered the principle aspects of professional good. In nursing, accountability is related to communication, decision-making, and reliability. A nurse needs to assess his or her actions according to the standards and guidelines. The development of self and care of self in nursing depends on the self-motivation to a large extent.

When a nurse continues to ask him/herself about the purpose of the profession and tries to determine a personal perception of nursing, then his/her contribution to the personal development in the profession is more successful.

Contrary to the personal character of professionhood, professionalism is collective (Chiovitti, 2015, p. 54). The professional environment in medicine and nursing, in particular, is prone to constant changes – the medical and technological innovations emerge, the researchers continue to make discoveries in pharmacology, and the practice guidelines are shifting according to the changes. Professionalism characterized by diversity, and the collaboration within the frames of profession supports the profession’s evolvement.

The nurses need to start their professional development from the care of self. Since the process is comprised of self-regulation and training, it can be easily addressed by each individual. Through the evaluation of the personal experience and the refinement of skills, the nurse supports the collective professionalism in the organization. And professionalism in nursing provokes a favorable environment for learning and provision of high-quality services and treatment of patients.


Cacace, M., & Schmid, A. (2008). The Healthcare Systems of the USA and Canada: Forever on Divergent Paths? Social Policy & Administration, 42(4), 396-417.

Chiovitti, R. (2015). Professionhood and professionalism as an educational aid for facilitating nursing students’ development and renewal of self and profession. Journal of Nursing Education and Practice, 5(11), 51-64.

Kotzer, A. M., & Arellana, K. (2006). Defining an evidence-based work environment for nursing in the USA. Journal of Clinical Nursing, 17, 1652-1659.

​Kumar, S., Ghildayal, N., & Shah, R. (2009). Examining the quality and efficiency of the US healthcare system. International Journal of Health Care Quality Assurance, 24(5), 366-388.

Lemire, R. (2006). Canadian Nurses Association. M. McIntyre, E. Thomlinson & C. McDonald (Eds.), Realities of Canadian Nursing: Professional, Practice, and Power Issues (pp. 133-151). Philadelphia, US: Lippincott Williams & Wilkins.

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