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To A Lesser Extent Tv Sir Thomas More Action Extra Old Age Free People Of Fondle

Trend data consistently point to a substantial shortfall in the numbers of nurses in the near future. HRSA has calculated a shortfall of as many as 1 million FTEs by 2020 (HRSA, 2004). However, that projection is almost certainly too high because it depends on extrapolating today’s unsustainable growth rates for health care to the future. A more conservative estimate from 2009 suggests a shortage of 260,000 registered nurses (RNs) by 2025, by comparison, the last nursing shortage peaked in 2001 with a vacancy rate of 126,000 FTEs (Buerhaus et al., 2009). Yet this more conservative projection is almost certainly too low because the new law is highly likely to increase demand for health care services and hence for nurses” (RWJF, 2010). Figure 6-1 shows a forecast of supply and demand for FTE RNs, 2009–2030. tadalafil soft tabs how to take effectively cialis belgique forum and http://genericalis.com deliberately quel est la différence entre le tadalafil et le viagra.

Compared with support for the role of nurses in improving quality and access, there is somewhat less evidence that expanding the care provided by nurses will result in cost savings to society at large while also improving outcomes and ensuring quality. However, the evidence base in favor of such a conclusion is growing. Compared with other models of prenatal care, for example, pregnant women who receive care led by certified nurse midwives are less likely to experience antenatal hospitalization, and their babies are more likely to have a shorter hospital stay (Hatem et al., 2008) (see Chapter 2 for a case study of care provided by certified nurse midwives at the Family Health and Birth Center in Washington, DC). Another study examining the impact of nurse staffing on value suggests that increasing the proportion of nursing hours provided by RNs without increasing total nursing hours was associated with 1.5 million fewer hospital days, nearly 60,000 fewer inpatient complications, and a 0.5 percent net reduction in costs (Needleman et al., 2006). Chapter 2 includes a case study of the Nurse–Family Partnership Program, in which front-line RNs make home visits to high-risk young mothers over a 2.5-year period. This program has demonstrated significant value, resulting in a net savings of $34,148 per family served. The program has also reduced pregnancy-induced hypertension by 32 percent, child abuse and neglect by 50 percent, emergency room visits by 35 percent, and language-related delays by 50 percent. The United States has nearly 400,000 primary care providers (Bodenheimer and Pham, 2010). As noted in Chapter 3, physicians account for 287,000 of these providers, nurse practitioners for 83,000, and physician assistants for 23,000 (HRSA, 2008, Steinwald, 2008). While the numbers of nurse practitioners and physician assistants are steadily increasing, the number of medical students and residents entering primary care has declined in recent years (Naylor and Kurtzman, 2010). In fact, a 2008 survey of medical students found only 2 percent planned careers in general internal medicine, a common entry point into primary care (Hauer et al., 2008). Compared with support for the role of nurses in improving quality and access, there is somewhat less evidence that expanding the care provided by nurses will result in cost savings to society at large while also improving outcomes and ensuring quality. However, the evidence base in favor of such a conclusion is growing. Compared with other models of prenatal care, for example, pregnant women who receive care led by certified nurse midwives are less likely to experience antenatal hospitalization, and their babies are more likely to have a shorter hospital stay (Hatem et al., 2008) (see Chapter 2 for a case study of care provided by certified nurse midwives at the Family Health and Birth Center in Washington, DC). Another study examining the impact of nurse staffing on value suggests that increasing the proportion of nursing hours provided by RNs without increasing total nursing hours was associated with 1.5 million fewer hospital days, nearly 60,000 fewer inpatient complications, and a 0.5 percent net reduction in costs (Needleman et al., 2006). Chapter 2 includes a case study of the Nurse–Family Partnership Program, in which front-line RNs make home visits to high-risk young mothers over a 2.5-year period. This program has demonstrated significant value, resulting in a net savings of $34,148 per family served. The program has also reduced pregnancy-induced hypertension by 32 percent, child abuse and neglect by 50 percent, emergency room visits by 35 percent, and language-related delays by 50 percent. how long before sex should i take tadalafil 20mg suddenly cialis 5 mg monograph also cialis usa smooth viagra levitra tadalafil comparación. Accordingly, the committee limited its recommendations to those it believed had the potential for greatest impact and could be accomplished within the next decade. Taken together, the recommendations are meant to provide a strong foundation for the development of a nursing workforce whose members are well educated and well prepared to practice to the full extent of their education, to meet the current and future health needs of patients, and to act as full partners in leading change and advancing health. Implementation of these recommendations will take time, resources, and a significant commitment from nurses and other health professionals, nurse educators, researchers, policy makers and government leaders at the federal, state, and local levels, foundations, and other key stakeholders.

At the same time, new systems and technologies appear to be pushing nurses ever farther away from patients. This appears to be especially true in the acute care setting. Studies show that nurses on medical–surgical units spend only 31 to 44 percent of their time in direct patient activities (Tucker and Spear, 2006). A separate study of medical–surgical nurses found they walked nearly a mile longer while on than off duty in obtaining the supplies and equipment needed to perform their tasks. In general, less than 20 percent of nursing practice time was devoted specifically to patient care activities, the majority being consumed by documentation, medication administration, and communication regarding the patient (Hendrich et al., 2008). Several health care organizations, professional organizations, and consumer groups have endorsed a Proclamation for Change aimed at redressing inefficiencies in hospital design, organization, and technology infrastructure through a focus on patient-centered design; the implementation of systemwide, integrated technology; the creation of seamless workplace environments; and the promotion of vendor partnerships (Hendrich et al., 2009). Realizing the vision presented earlier in this chapter will require a practice environment that is fundamentally transformed so that nurses are efficiently employed—whether in the hospital or in the community—to the full extent of their education, skills, and competencies. bupropion and sildenafil basically is it safe to take viagra after heart attack or www.viagrapid.com together stacking cialis and sildenafil.

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