DQ 1 :Discuss The Shift To Value-Based Health Care And Its Impact On The Roles And Responsibilities Of Advanced Registered Nurses.
Describing value-based purchasing is the first half. The second asks what will hit your own practice in three to five years, which needs a named setting and a named trend.
Editorial process
Last reviewed · August 18, 2026
Value-based care, and what it does to the ARN role
Be precise about what the shift actually is, because vagueness here makes the second half impossible. Fee-for-service pays for volume: more visits, more procedures, more revenue. Value-based arrangements tie payment to outcomes and cost together — the Hospital Readmissions Reduction Program penalises excess readmissions, the Value-Based Purchasing programme adjusts payment on quality measures, bundled payments hand a single sum for an episode of care, and accountable care organisations share savings against a spending benchmark. The consequence for advanced registered nurses is structural rather than rhetorical. Under volume payment, a discharge phone call is unbilled work; under a readmissions penalty it protects revenue. Care coordination, transitional care and chronic disease management move from things a good nurse does anyway to things an organisation has a financial reason to fund, and that is what changes roles. That is a structural claim about incentives, and it is more persuasive than any statement about nursing's value.
Then forecast, and do it for your own practice. Name the setting — a primary care clinic, a cardiology service, a skilled nursing facility — because the trends land differently in each. Candidates worth developing: the continued expansion of risk-bearing contracts, which increases demand for nurses who can manage a panel rather than a visit; telehealth reimbursement, which is still unsettled and determines whether a virtual follow-up is viable; workforce shortage, which pushes scope-of-practice change and makes full practice authority a live question in many states; and quality measures moving toward patient-reported outcomes, which changes what gets measured about your work. Pick two, say what each would require you to do differently, and answer the influence question with mechanisms — sitting on the committee that selects measures, leading the transitional care protocol, giving evidence on a scope bill — rather than with a claim that nurses will be essential.
Likely learning objectives
- Define value-based payment against fee-for-service precisely.
- Explain how payment structure changes which nursing work gets funded.
- Forecast trends for a specific practice setting.
- Name mechanisms of influence rather than asserting importance.
Assignment instructions
Read the full question
Review every instruction before using the planning guidance that follows.
NUR 514 Topic 1 DQ 1 DQ 1 :Discuss The Shift To Value-Based Health Care And Its Impact On The Roles And Responsibilities Of Advanced Registered Nurses. Discuss The Shift To Value-Based Health Care And Its Impact On The Roles And Responsibilities Of Advanced Registered Nurses. What major evolving trends in the health care delivery system will affect your practice in the next 3-5 years, and how do you think advanced registered nurses will continue to influence the direction of health care?
Turn the brief into deliverables
- 01A definition of the shift with at least two named programmes.
- 02A concrete example of work that changes value under the new model.
- 03A named practice setting.
- 04Two trends with a stated consequence for that setting.
- 05Specific mechanisms by which ARNs influence direction.
The shift, the role change, then the three-to-five-year trends
What the shift is, structurally
Contrast volume payment with outcome-linked payment using named programmes.
What the assessor is likely looking for
Programmes named, not just the concept.
Work that changes value
Show a nursing activity moving from cost to investment.
What the assessor is likely looking for
A specific activity with a payment consequence.
Your setting
Name the practice environment the forecast applies to.
What the assessor is likely looking for
A setting concrete enough to have distinct pressures.
Two trends and their consequences
Develop two trends with what each would require of you.
What the assessor is likely looking for
A change in practice, not a change in the environment.
Mechanisms of influence
Name committee, protocol and policy routes for ARN influence.
What the assessor is likely looking for
A named forum where a decision is actually made.
Where the payment models are actually defined
Recommended databases
- Centers for Medicare & Medicaid Services
- NCBI Bookshelf
- PubMed Central
- American Association of Nurse Practitioners
Search sequence
- 1.Read the CMS description of the value-based programmes rather than a summary of them.
- 2.Find a reference on pay-for-performance and its measured effects.
- 3.Check your state's practice environment for the scope trend.
- 4.Choose the practice setting before drafting the forecast.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Value-Based Programs
Centers for Medicare & Medicaid Services · 2025
The value-based programmes themselves, named and defined by the payer.
Pay-for-Performance and Value-Based Care
StatPearls, NCBI Bookshelf · 2024
Pay-for-performance and value-based care, including evidence on what these programmes achieve.
State Practice Environment
American Association of Nurse Practitioners · 2024
State practice environments, for the scope-of-practice trend.
Nurse practitioners' perception of temporary full practice authority during a COVID-19 surge: A qualitative study
International Journal of Nursing Studies · 2022
Nurse practitioners under temporary full practice authority — a trend already tested.
Closing the "Techquity" Gap: Ensuring Equitable Access to Patient Portals
PubMed Central · 2024
Equitable access to patient portals, relevant to the telehealth and digital access trend.
Review before submission
Common mistakes
- Describing value-based care without naming a single programme.
- Forecasting for health care in general rather than for your practice.
- Claiming nurses will influence direction without naming a mechanism.
- Treating the shift as a philosophy rather than as a payment structure.
Submission checklist
- Have you named at least two real payment programmes?
- Is there an example of unfunded work becoming funded?
- Is your practice setting specified?
- Does each trend come with a consequence for that setting?
- Are your influence mechanisms things a person actually does?
Use this guide to plan and review your own work. Follow your institution's rules and read Brinevia's academic-integrity policy.
Written by
Maren Caldwell
MSN, RN, CNE
Medical-surgical nursing, pharmacology and NCLEX preparation
Maren is a registered nurse with over 15 years of clinical and educational experience in medical-surgical nursing. She writes on NCLEX preparation, patient care fundamentals, pharmacology and evidence-based practice.
Reviewed by
Dr. Tessa Redmond
DNP, RN, CNE
Evidence-based practice and clinical education
Tessa is a doctorally-prepared nurse educator. She reviews Brinevia content for clinical accuracy and alignment with current evidence-based guidelines.