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). tadalafil and difficulty swallowing just pharmacie paris cialis sans ordonnance also buy prednisone online suddenly tadalafil typical dose.
Another important vehicle for tracking and improving quality is the National Database of Nursing Quality Indicators, the nation’s largest nursing registry. This database, which meets the new reporting requirement by the Centers for Medicare and Medicaid Services for nursing-sensitive care, is supported by the American Nurses Association.2 More than 25 percent of hospitals participate in the database, which documents more than 21 measures of hospital performance linked to the availability and quality of nursing services in acute care settings. Participating facilities are able to obtain unit-level comparative data, including patient and staffing outcomes, to use for quality improvement purposes. Comparison data are publicly reported, which provides an incentive to improve the quality of care on a continuous basis. This database is now maintained at the University of Kansas School of Nursing and is available to researchers interested in improving health care quality. In 2008, the Government Accountability Office determined that there were few projections of the future need for primary care providers, and those that existed were substantially limited (Steinwald, 2008). Arguably, it is simpler to project the future supply of health professionals than to project future demand for their services. It is difficult to predict, for example, the pattern of increased demand for primary care after full implementation of the ACA adds 32 million newly insured people to the health care system. Will there be a short, marked spike in demand, or will the surge be of longer duration that leaves more time to adapt? tilskud til tadalafil extra buy generic cialis online australia or hopefully hva koster tadalafil i sverige. As discussed throughout this report, the challenges facing the health care system and the nursing profession are complex and numerous. Challenges to nursing practice include regulatory barriers, professional resistance to expanded scopes of practice, health system fragmentation, insurance company policies, high turnover among nurses, and a lack of diversity in the nursing workforce. With regard to nursing education, there is a need for greater numbers, better preparation, and more diversity in the student body and faculty, the workforce, and the cadre of researchers. Also needed are new and relevant competencies, lifelong learning, and interprofessional education. Challenges with regard to nursing leadership include the need for leadership competencies among nurses, collaborative environments in which nurses can learn and practice, and engagement of nurses at all levels—from students to front-line nurses to nursing executives and researchers—in leadership roles. Finally, comprehensive, sufficiently granular workforce data are needed to ascertain the necessary balance of skills among nurses, physicians, and other health professionals for a transformed health care system and practice environment.
These key messages speak to the need to transform the nursing profession in three crucial areas—practice, education, and leadership—as well as to collect better data on the health care workforce to inform planning for the necessary changes to the nursing profession and the overall health care system. sildenafil and drugs like it forward more than one viagra per day or prednisone 5 mg tonight does insurance cover cost of sildenafil.