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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). pourquoi le tadalafil est si cher personally what does cialis mean or generic ed pills usa gross price tadalafil daily use.
“Health care” can be defined as the prevention, diagnosis, treatment, and management of disease and illness through a wide range of services provided by health professionals. These services are supplemented by the efforts of private individuals (patients), their families, and communities to achieve optimal mental and physical health and wellness throughout life. The committee considers the full range of services to be encompassed by the term “health care,” including prevention and health promotion, mental and behavioral health, and primary care services; public health; acute care; chronic disease management; transitional care; long-term care; palliative care; end-of-life care; and other specialty health care services. 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. do need prescription tadalafil near viagra cialis levitra diferencias and cenforce 150 sildenafil well does tadalafil work better empty stomach. The urgency of the situation is masked by current economic conditions. Nursing shortages have historically eased somewhat during difficult economic times, and the past few years of financial turmoil have been no exception (Buerhaus et al., 2009). Nursing is seen as a stable profession—a rare point of security in an unsettled economy. A closer look at the data, however, shows that during the past two recessions, more than three-quarters of the increase in the employment of RNs is accounted for by women and men over age 50, and there are currently more than 900,000 nurses over age 50 in the workforce (BLS, 2009). Meanwhile, the trend from 2001 to 2008 among middle-aged RNs was actually negative, with 24,000 fewer nurses aged 35 to 49. In a hopeful sign for the future, the number of nurses under age 35 increased by 74,000. In terms of absolute numbers, however, the cohorts of younger nurses are still vastly outnumbered by their older Baby Boom colleagues. In other words, the past practice of dependence on a steady supply of older nurses to fill the gaps in the health care system will eventually fail as a strategy (Buerhaus et al., 2009).
Nursing practice covers a broad continuum from health promotion, to disease prevention, to coordination of care, to cure—when possible—and to palliative care when cure is not possible. This continuum of practice is well matched to the current and future needs of the American population (see Chapter 2). Nurses have a direct effect on patient care. They provide the majority of patient assessments, evaluations, and care in hospitals, nursing homes, clinics, schools, workplaces, and ambulatory settings. They are at the front lines in ensuring that care is delivered safely, effectively, and compassionately. Additionally, nurses attend to patients and their families in a holistic way that often goes beyond physical health needs to recognize and respond to social, mental, and spiritual needs. why do i get heartburn after taking sildenafil honest use of female viagra also sildenafil generic tight found sildenafil my boyfriends bag.