In conducting its work and evaluating the challenges that face the nursing profession, the committee took into account a number of considerations that informed its recommendations and the content of this report. The committee carefully considered the scope and focus of the report in light of its charge (see Box P-1 in the preface to the report), the evidence that was available, costs associated with its recommendations, and implementation issues. Overall, the committee’s recommendations are geared toward advancing the nursing profession as a whole, and are focused on actions required to best meet long-term future needs rather than needs in the short term. farmacias que venden tadalafil en el salvador whenever cialis en farmacia con receta or cenforce 200 quick delivery completely combien coute une boite de tadalafil 20mg.
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. At the same time, the nursing profession has its challenges. While there are concerns regarding the number of nurses available to meet the demands of the health care system and the needs of patients, and there is reason to view as a priority replacing at least 900,000 nurses over the age of 50 (BLS, 2009), the composition of the workforce is turning out to be an even greater challenge for the future of the profession. The workforce is generally not as diverse as it needs to be—with respect to race and ethnicity (just 16.8 percent of the workforce is non-white), gender (approximately 7 percent of employed nurses are male), or age (the median age of nurses is 46, compared to 38 in 1988)—to provide culturally relevant care to all populations (HRSA, 2010). Many members of the profession lack the education and preparation necessary to adapt to new roles quickly in response to rapidly changing health care settings and an evolving health care. tadalafil se requiere receta medica essentially cialis forum iskustva or cheap cialis online pharmacy once tadalafil coupons free trial. 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.
Although it is difficult to prove causation, an emerging body of literature suggests that quality of care depends to a large degree on nurses (Kane et al., 2007; Lacey and Cox, 2009; Landon et al., 2006; Sales et al., 2008). The Joint Commission, the leading independent accrediting body for health care organizations, believes that “the future state of nursing is inextricably linked to the strides in patient care quality and safety that are critical to the success of America’s health care system, today and tomorrow” (Joint Commission, 2010). While quality measures have historically focused on conditions or diseases, many of the quality measures used over the past few years address how well nurses are able to do their jobs (Kurtzman and Buerhaus, 2008). easy to get sildenafil really is it ok to take cialis and viagra together also canadian online pharmacy no prescription literally the inventor of sildenafil.