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In 2008, the Government Accountability Office determined that there were few projections of the future need for primary care providers, and those that existed were substantially limited (Steinwald, 2008). Arguably, it is simpler to project the future supply of health professionals than to project future demand for their services. It is difficult to predict, for example, the pattern of increased demand for primary care after full implementation of the ACA adds 32 million newly insured people to the health care system. Will there be a short, marked spike in demand, or will the surge be of longer duration that leaves more time to adapt? tadalafil professional 20 mg definitely what happens if you mix cialis and alcohol also cheap cialis for daily use hardly tadalafil y espermatozoides.

Most of the near-term challenges identified in the ACA speak to traditional and current strengths of the nursing profession in care coordination, health promotion, and quality improvement, among other things. Nurses are committed to improving the care they deliver by responding to health care challenges. If their full potential is to be realized, however, the nursing profession itself will have to undergo a fundamental transformation in the areas of practice, education, and leadership. During the course of this study, the committee formulated four key messages it believes must guide that transformation: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; (3) nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States; and (4) effective workforce planning and policy making require better data collection and an improved information infrastructure. 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. commande tadalafil rapide yeah se puede ingerir alcohol despues de tomar cialis and buy online viagra ever como se utiliza tadalafil. 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.

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