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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. compra tadalafil online senza ricetta tomorrow cialis hamilelik and buy viagra online cheapest aside tadalafil 5 mg mal di testa.
Restrictions on scope of practice and professional tensions have undermined the nursing profession’s ability to provide and improve both general and advanced care. Producing a health care system that delivers the right care—quality care that is patient centered, accessible, evidence based, and sustainable—at the right time will require transforming the work environment, scope of practice, education, and numbers and composition of America’s nurses. The remainder of this section examines the role of the nursing profession in health care reform according to the same three parameters by which all other health care reform initiatives are evaluated—quality, access, and value. Awareness of impending shortages of nurses, primary care physicians, geriatricians, and dentists and in many of the allied health professions has led to a growing consensus among policy makers that strengthening the health care workforce in the United States is an urgent need. This consensus is reflected in the creation of a National Health Workforce Commission (NHWC) under the Affordable Care Act (ACA) whose mission is, among other things, to [develop] and [commission] evaluations of education and training activities to determine whether the demand for health care workers is being met,” and to [identify] barriers to improved coordination at the Federal, State, and local levels and recommend ways to address such barriers.”1 The ACA also authorizes a National Center for Workforce Analysis, as well as state and regional workforce centers, and provides funding for workforce data collection and studies. The committee believes these initiatives will prove most successful if they analyze workforce needs across the professions—as the Department of Veterans Affairs did in the 1990s (see Chapter 3)—rather than focusing on one profession at a time. Furthermore, national trend data are not granular enough by themselves to permit accurate projections of regional needs. Finally, the health care system is widely understood to be a complex system, one in which responses to internal and external actions are sometimes predictable and sometimes not. Health care experts repeatedly encourage health professionals to understand the system’s dynamics so they can be more effective in their individual jobs and help shape the larger system’s ability to adapt successfully to changes and improve outcomes. In a field as intensively knowledge driven as health care, however, no one individual, group, or discipline can have all the answers. A growing body of research has begun to highlight the potential for collaboration among teams of diverse individuals to generate successful solutions in complex, knowledge-driven systems (Paulus and Nijstad, 2003; Pisano and Verganti, 2008; Singh and Fleming, 2010; Wuchty et al., 2007). Nurses must cultivate new allies in health care, government, and business and develop new partnerships with other clinicians, business owners, and philanthropists to help realize the vision of a transformed health care system. Many nurses have heard this call to develop new partnerships in a culture of collaboration and cooperation. However, the committee found no evidence that these initiatives have achieved the scale necessary to have an impact throughout the health care system. More intentional, large-scale initiatives of this sort are needed. These efforts must be supported by research that addresses such questions as what new models of leadership are needed for the increasingly knowledge-intensive health care environment and when collaboration is most appropriate (Singh and Fleming, 2010). tadalafil and pycnogenol originally what is the right dose of cialis and buy viagra online cheapest pretty tadalafil celexa. 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, nurses do not function in a vacuum, but in the context of the skills and perspectives of physicians and other health professionals. Planning for the fundamental changes required to achieve a reformed health care system cannot be accomplished without a clear understanding of the necessary contributions of these various professionals and the numbers and composition of the health care workforce. That understanding in turn cannot be obtained without reliable, sufficiently granular data on the current workforce and projections of future workforce needs. Yet major gaps exist in the currently available workforce data. These gaps hamper the ability to identify and implement the necessary changes to the preparation and practice of nurses and to the overall health care system. Chapter 6 explores these issues in greater detail. sildenafil pricing cvs widely can you take viagra through airport security and buy viagra online cheapest rarely what are the long term effects of taking sildenafil.