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Additionally, a 2008 review by Aiken and Cheung (2008) explains in detail why international migration will no longer be as effective in plugging gaps in the nursing workforce of the United States as it has in the past. Since 1990, recurring shortages have been addressed by a marked increase in the recruitment of nurses from other countries, and the United States is now the major importer of RNs in the world. Figure 6-2 compares trends in new licenses between U.S.- and foreign-educated RNs from 2002 to 2008. Although exact figures are difficult to come by, foreign recruitment has resulted in the addition of tens of thousands of RNs each year. However, the numbers are insufficient to meet the projected demand for hundreds of thousands of nurses in the coming years. U.S. tadalafil pewny sprzedawca item cialis scored tablet or canadian online pharmacies extra tadalafil davkovanie.

As discussed in the preface, this study was undertaken to explore how the nursing profession can be transformed to help exploit these opportunities and contribute to building a health care system that will meet the demand for safe, quality, patient-centered, accessible, and affordable care. This chapter presents the key messages that emerged from the study committee’s deliberations. It begins by describing a vision for a transformed system that can meet the health needs of the U.S. population in the 21st century. The chapter then delineates the roles of nurses in realizing this vision. The third section explains why a fundamental transformation of the nursing profession will be required if nurses are to assume these roles. The final section presents conclusions. The nursing workforce may never have the optimum numbers to meet the needs of patients, nursing students, and the health care system. To maximize the available resources in care environments, providers need to work effectively and efficiently with a team approach. Teams need to include patients and their families, as well as a variety of health professionals, including nurses, physicians, pharmacists, physical and occupational therapists, medical assistants. Nurses practice in many settings, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers. They have varying levels of education and competencies—from licensed practical nurses, who greatly contribute to direct patient care in nursing homes, to nurse scientists, who research and evaluate more effective ways of caring for patients and promoting health. As described in Annex 1-1 at the end of this chapter, most nurses are registered nurses (RNs), who “complete a program of study at a community college, diploma school of nursing, or a four-year college or university and are required to pass a nationally standardized licensing exam in the state in which they begin practice” (AARP, 2010). Figure 1-1 shows that of the many settings where RNs practice, the majority practice in hospitals; Figure 1-2 shows the employment settings of nurses by highest nursing or nursing-related education. More than a quarter of a million nurses are APRNs (HRSA, 2010), who hold master’s or doctoral degrees and pass national certification exams. APRNs deliver primary and other types of health care services. For example, they teach and counsel patients to understand their health problems and what they can do to get better, they coordinate care and advocate for patients in the complex health care system, and they refer patients to physicians and other health care providers. APRNs include nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives (see Table 1-1). Annex 1-1 provides more detailed descriptions of the preparation and roles of nurses, pathways in nursing education, and numbers of nurses. stendra vs viagra vs tadalafil first il cialis ha effetti collaterali also cenforce 50 often family guy tadalafil. Planning for fundamental, wide-ranging changes in the preparation and deployment of the nursing workforce will require comprehensive data on the numbers and types of professionals currently available and required to meet future needs. Such data are needed across the health professions if a fundamental transformation of the health care system is to be achieved. Major gaps exist in currently available workforce data. Filling these gaps should be a priority for the National Health Workforce Commission and other structures and resources authorized under the Affordable Care Act.

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