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The nation’s economy is closely aligned
with the health of the nation’s population.
The United States, in 1999, spent 13 percent
of its gross domestic product on activities
promoting good health and providing care
to ensure the continuance of a healthy
population. Changes in health care financing
have led to radical changes in the way
the system is constructed and the sites
in which care is delivered. These activities
take place within the context of an expanding
and more diverse population characterized
by an increase in the proportion of older
adults with chronic conditions.
In this first report on its activities
to the Secretary of Health and Human Services
and Congress, called for under the Nurse
Education and Practice Improvement Act
of 1998 (P.L. 105-392), the National Advisory
Council on Nurse Education and Practice
(NACNEP) provides an overview of its activities
and its perspectives on the nursing workforce,
education and practice improvement.
Registered nurses (RNs) are essential
to the many dimensions of health care,
well beyond direct patient care. Contrary
to popular perceptions, nurses practice
in a variety of settings and capacities,
both within and outside hospitals. They
fulfill multiple roles in the broad health
care enterprise. In addition to functioning
in the hospital inpatient arena, RNs practice
in outpatient and ambulatory care clinics,
day surgeries, health departments and
school systems, long term care facilities,
home health care services, primary care
centers and clinics, telephone counseling
services, prison systems, the Department
of Veterans Affairs, the military and
managed care organizations. In addition
to providing direct patient care, RNs
are in administrative and supervisory
roles, and are also in demand to manage
quality assurance programs, conduct utilization
review, coordinate clinical trials, design
and deploy information systems and provide
case management services.
RNs with advanced preparation provide
specialized patient care as clinical nurse
specialists, nurse practitioners, nurse
anesthetists, and nurse midwives. Many
with advanced preparation are employed
as faculty in schools of nursing, as scientists
in universities and biomedical research
organizations and as administrators of
health care organizations.
RNs are the most widely dispersed professionals
in health care settings as well as the
most flexibly deployed because of their
broad knowledge and experience base. Access
to health care services is dependent on
having an adequate supply of registered
nurses who are the core staff for these
services both in and out of hospital settings.
While nursing remains primarily a female-dominated
profession, increased opportunities for
women in other professions threaten the
availability of RNs to staff health care
services. An aging nurse workforce and
a decreasing nursing student body contribute
to the RN shortage of today and in the
future.
As the health care delivery system has
changed and evolved, the delivery of nursing
and health care have become increasingly
complex. This is due in part to a shift
from hospital-based to community-based
care. The increased acuity of patients
in all settings and shorter lengths of
stay in hospitals coupled with the expanding
use of technologies in diagnosis and management
have created a need for well-prepared
RNs who can provide and manage complex
clinical care in varied settings.
Quality and safety of care are growing
concerns nationally. Spearheaded by the
Institute of Medicine’s release of a report
on the prevalence of preventable medical
errors, considerable efforts on the part
of both public and private agencies and
institutions are going into studying,
developing and initiating monitoring systems
to enhance the care being provided.
RNs often are the monitors for systems’
gaps. RNs represent the primary surveillance
system for patients in hospitals 24 hours
a day. RNs make a positive difference
in the outcomes of a stay in the hospital.
A recently completed study showed that
higher RN staffing was associated with
a 3 to 12 percent reduction in certain
adverse outcomes such as urinary tract
infection, pneumonia, shock and upper
gastrointestinal bleeding. The study,
carried out by the Harvard School of Public
Health under a contract with the Health
Resources and Services Administration
Division of Nursing and co-sponsored by
the Health Care Financing Administration,
the Agency for Healthcare Research and
Quality and the National Institute of
Nursing Research, was developed in response
to Congressional and Departmental concerns
about nurse staffing and the outcomes
of care. Reductions in complications arising
in a hospital stay reduce risk to the
patients and the use of costly resources.
Since undertaking its responsibilities
under P.L.105-352, NACNEP focused its
attention on a number of issues including
patient safety; the composition and quality
of the nursing workforce, including its
continuing concerns about inadequate diversity
in the workforce, and the financing of
nursing education. In carrying out these
latest activities, NACNEP built on its
previous studies of the roles of nurse
practitioners and clinical nurse specialists
and their importance to the provision
and enhancement of the health care of
the population as well as its study of
the initiatives necessary to more adequately
prepare nurses to use technology in their
education and practice.
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