Health Care System

The term “health care system” refers to the organization, financing, payment, and delivery of health care. As described in greater detail in the IOM report Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), the U.S. health care system is a complex, adaptive system (as opposed to a simple mechanical system). As a result, its many parts (including human beings and organizations) have the “freedom and ability to respond to stimuli in many different and fundamentally unpredictable ways.” In addition, the system has many linkages so that changes in one part of the system often change the context for other parts (IOM, 2001). Throughout this report, the committee highlights what it believes to be one of the strongest linkages that has emerged within the U.S. health care system: that between health reform and the future of nursing. As the report emphasizes, the future of nursing—how it is shaped and the directions it takes—will have a major impact on the future of health care reform in the United States.


The range of nursing care providers described below work in a variety of settings including ambulatory care, hospitals, community health centers, public health agencies, long-term care facilities, mental health facilities, war zones, prisons, and schools of nursing, as well as patients’ homes, schools, places of worship, and workplaces. Basically anywhere there are health care needs, nurses can usually be found. Types of nursing care providers include

Nursing Assistants/Certified Nursing Assistants (NA/CNAs) provide basic patient care under the direction of licensed nurses: they feed, bathe, dress, groom, and move patients, change linens and may assume other delegated responsibilities. The greatest prevalence of these providers is in home care and in long-term care facilities. Training time varies from on-the-job training to 75 hours of state approved training for certification (CNA).

Licensed Practical/Licensed Vocational Nurses (LPN/LVNs) provide basic nursing care including monitoring vital signs, performing dressing changes and other ordered treatments, and dispense medications in most states. LPNs work under the supervision of a physician or registered nurse. While there is declining demand for LPNs in hospitals, demand is high in


This section is reprinted from AARP, 2010b. Courtesy of AARP. All rights reserved. Original data provided by the American Academy of Nurse Practitioners, the American Association of Colleges of Nursing, the American Nurses Credentialing Center, the Bureau of Labor Statistics, the Health Resource and Service Administration, and the National League for Nursing.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement