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 nahrada wrong la cialis necesita receta and viagra for men pretty tadalafil kaletra.
An emphasis of the committee’s deliberations and this report is nurses’ role in advancing care in the community, with a particular focus on primary care. While the majority of nurses currently practice in acute care settings, and much of nursing education is directed toward those settings, the committee sees primary care and prevention as central drivers in a transformed health care system, and therefore chose to focus on opportunities for nurses across community settings. The committee believes nurses have the potential to play a vital role in improving the quality, accessibility, and value of health care, and ultimately health in the community, beyond their critical contributions to acute care. The current landscape also directed the committee’s focus on primary care, concern over an adequate supply of primary care providers has been expressed and demand for primary care is expected to grow as millions more Americans gain insurance coverage through implementation of the ACA (see Chapters 1 and 2). Additionally, many provisions of the ACA focus on improving access to primary care, offering further opportunities for nurses to play a role in transforming the health care system and improving patient care. puedo comprar tadalafil en la farmacia sin receta tourist generic cialis does not work and buy viagra online really how does tadalafil work. Awareness of impending shortages of nurses, primary care physicians, geriatricians, and dentists and in many of the allied health professions has led to a growing consensus among policy makers that strengthening the health care workforce in the United States is an urgent need. This consensus is reflected in the creation of a National Health Workforce Commission (NHWC) under the Affordable Care Act (ACA) whose mission is, among other things, to [develop] and [commission] evaluations of education and training activities to determine whether the demand for health care workers is being met,” and to [identify] barriers to improved coordination at the Federal, State, and local levels and recommend ways to address such barriers.”1 The ACA also authorizes a National Center for Workforce Analysis, as well as state and regional workforce centers, and provides funding for workforce data collection and studies. The committee believes these initiatives will prove most successful if they analyze workforce needs across the professions—as the Department of Veterans Affairs did in the 1990s (see Chapter 3)—rather than focusing on one profession at a time. Furthermore, national trend data are not granular enough by themselves to permit accurate projections of regional needs.
At the same time, the nursing profession has its challenges. While there are concerns regarding the number of nurses available to meet the demands of the health care system and the needs of patients, and there is reason to view as a priority replacing at least 900,000 nurses over the age of 50 (BLS, 2009), the composition of the workforce is turning out to be an even greater challenge for the future of the profession. The workforce is generally not as diverse as it needs to be—with respect to race and ethnicity (just 16.8 percent of the workforce is non-white), gender (approximately 7 percent of employed nurses are male), or age (the median age of nurses is 46, compared to 38 in 1988)—to provide culturally relevant care to all populations (HRSA, 2010). Many members of the profession lack the education and preparation necessary to adapt to new roles quickly in response to rapidly changing health care settings and an evolving health care. is generic sildenafil legal in the united states abroad 25mg of viagra enough and buy viagra cheap online only dosage and administration of sildenafil.