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. più efficace tadalafil o viagra cheap cialis tadalafil 100mg also viagra generic online cool tadalafil generico online italia.
The education system should provide nurses with the tools needed to evaluate and improve standards of patient care and the quality and safety of care while preserving fundamental elements of nursing education, such as ethics and integrity and holistic, compassionate approaches to care. The system should ensure nurses’ ability to adapt and be flexible in response to changes in science, technology, and population demographics that shape the delivery of care. Nursing education at all levels needs to impart a better understanding of ways to work in the context of and lead change within health care delivery systems, methods for quality improvement and system redesign, methods for designing effective care delivery models and reducing patient risk, and care management and other roles involving expanded authority and responsibility. The nursing profession must adopt a framework of continuous, lifelong learning that includes basic education, residency programs, and continuing competence. More nurses must receive a solid education in how to manage complex conditions and coordinate care with multiple health professionals. They must demonstrate new competencies in systems thinking, quality improvement, and care management and a basic understanding of health policy and research. Graduate-level nurses must develop even greater competencies and deeper understanding in all of these areas. Innovative new programs to attract nurse faculty and provide a wider range of clinical education placements must clear long-standing bottlenecks in nursing education. Accrediting and certifying organizations must mandate demonstrated mastery of clinical skills, managerial competencies, and professional development at all levels to complement the completion of degree programs and written board examinations. Milestones for mandated skills, competencies, and professional development must be updated more frequently to keep pace with the rapidly changing demands of health care. And all health professionals should receive more of their education in concert with students from other disciplines. Interprofessional team training of nurses, physicians, and other health care providers should begin when they are students and proceed throughout their careers. Successful interprofessional education can be achieved only through committed partnerships across professions. Taking into account the need to transform the way health care is delivered in the United States and the observations and goals outlined in Chapters 3 through 5, policy makers must have reliable, sufficiently granular data on workforce supply and demand, both present and future, across the health professions. In the context of this report, such data are essential for determining what changes are needed in nursing practice and education to advance the vision for health care set forth in Chapter 1. Major gaps exist in currently available data on the health care workforce. A priority for the NHWC and other structures and resources authorized under the ACA should be systematic monitoring of the supply of health care workers, review of the data and methods needed to develop accurate predictions of future workforce needs, and coordination of the collection of data on the health. tadalafil è detraibile mostly cialis 5 mg generico preço also cheep viagra ill vente de tadalafil 5mg. Solutions to some of these challenges are well within the purview of the nursing profession, while solutions to others are not. A number of constraints affect the profession and the health care system more broadly. While legal and regulatory constraints affect scopes of practice for advanced practice registered nurses, the major cross-cutting constraints originate in limitations of available resources—both financial and human. These constraints are not new, nor are they unique to the nursing profession. The current economic landscape has magnified some of the challenges associated with these constraints while also reinforcing the need for change. To overcome these challenges, the nursing workforce needs to be well educated, team oriented, adaptable, and able to apply competencies such as those highlighted throughout this report, especially those relevant to leadership.
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