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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. buying tadalafil vietnam lower where to order cialis online safe also generic ed pills from canada above potenzmittel tadalafil preise.

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. One currently available resource for examining the role of providers in primary care is the National Provider Indicator (NPI). While the NPI is a mechanism for tracking billing services, this data source at the Centers for Medicare and Medicaid Services (CMS) could be thought of as an opportunity to collect workforce data and conduct research on those nurses who bill for services, primarily nurse practitioners. The committee believes the NPI presents a unique opportunity to track and measure nurse practitioners with regard to their practice, such as where they are located, how many are billing patients, what kinds of patients they are seeing, and what services they are providing. These data would be a significant contribution to the supply data currently being collected, adding to the knowledge base about practice partnerships, utilization of services, and primary care shortages. The committee encourages CMS to make these data available in a useful way to workforce researchers and others who might contribute to this knowledge base. Nurses should move seamlessly through the education system to higher levels of education, including graduate degrees. Nurses with graduate degrees will be able to replenish the nurse faculty pool; advance nursing science and contribute to the knowledge base on how nurses can provide up-to-date, safe patient care; participate in health care decisions; and provide the leadership needed to establish nurses as full partners in health care redesign efforts (see the section on leadership below). benicar tadalafil short generic cialis tadalafil reviews also http://www.viagrapid.com/ once tadalafil siparişi ver. The committee also focused on advanced practice registered nurses in its discussion of some topics, most notably scope of practice. Recognizing the importance of primary care as discussed above, the committee viewed the potential contributions of these nurses to meeting the great need for primary care services if they could practice uniformly to the full extent of their education and training.

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