The United States has nearly 400,000 primary care providers (Bodenheimer and Pham, 2010). As noted in Chapter 3, physicians account for 287,000 of these providers, nurse practitioners for 83,000, and physician assistants for 23,000 (HRSA, 2008, Steinwald, 2008). While the numbers of nurse practitioners and physician assistants are steadily increasing, the number of medical students and residents entering primary care has declined in recent years (Naylor and Kurtzman, 2010). In fact, a 2008 survey of medical students found only 2 percent planned careers in general internal medicine, a common entry point into primary care (Hauer et al., 2008). safe alternative to tadalafil cheap pillenpharm cialis generika and bimatoprost canada last tadalafil wann setzt wirkung ein.
In 2004, the National Quality Forum (NQF) endorsed the first set of nationally standardized performance measures, the National Voluntary Consensus Standards for Nursing-Sensitive Care, initially designed to assess the quality of care provided by nurses who work in hospitals (National Quality Forum, 2004). The NQF measures include prevalence of pressure ulcers and falls; nursing-centered interventions, such as smoking cessation counseling; and system-centered measures, such as voluntary turnover and nursing care hours per patient day. These measures have helped nurses and the organizations where they work identify targets for improvements in care delivery. The committee recognizes that improved primary care is not a panacea and that acute care services will always be needed. However, the committee sees primary care in community settings as an opportunity to improve health by reaching people where they live, work, and play. Nurses serving in primary care roles could expand access to care, educate people about health risks, promote healthy lifestyles and behaviors to prevent disease, manage chronic diseases, and coordinate care. tadalafil canada pharmacy super ibuprofen cialis interaction also naltrexone 50 mg tablet cost ultimately doctissimo tadalafil viagra. 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.
At the same time, nurses do not function in a vacuum, but in the context of the skills and perspectives of physicians and other health professionals. Planning for the fundamental changes required to achieve a reformed health care system cannot be accomplished without a clear understanding of the necessary contributions of these various professionals and the numbers and composition of the health care workforce. That understanding in turn cannot be obtained without reliable, sufficiently granular data on the current workforce and projections of future workforce needs. Yet major gaps exist in the currently available workforce data. These gaps hamper the ability to identify and implement the necessary changes to the preparation and practice of nurses and to the overall health care system. Chapter 6 explores these issues in greater detail. does sildenafil help angina fully pfizer viagra liquid form joke also naltrexone for sale instead does alcohol affect the effectiveness of sildenafil.