Policy, Politics, and Nursing Practice最新文献

Background: Healthcare worker migration, influenced by push and pull factors, is accentuated by active recruitment strategies of developed nations. This scoping review explores experiences of internationally educated nurses, midwives, and healthcare professionals in the UK since 2010, acknowledging the historical context of UK recruitment policy and the implementation of codes of practice by the World Health Organisation and the UK government.

Methods: Using the Population, Concept, and Context framework, systematic literature searches were conducted in various databases, including CINAHL, Science Direct, Scopus, PubMed/Medline, and Google Scholar. Covidence software facilitated screening, with data systematically extracted and analyzed.

Results: The scoping review included 24 papers focusing on nurses (n = 19), midwives (n = 1), and various allied health professions (n = 4), spanning from 2010 to 2023. Findings revealed diverse challenges and facilitators, from professional recognition and career opportunities to discrimination, language barriers, and socioeconomic factors influencing integration and retention.

Conclusion: The review highlights the multifaceted experiences of internationally educated healthcare professionals (IEHPs) in the UK workforce. Despite their significant contributions, IEHPs face challenges such as unrecognized skills, third-party recruitment issues, and cultural adjustment difficulties. Addressing registration processes, recruitment practices, and cultural competence training is crucial to creating an inclusive environment that maximizes IEHPs' contributions and ensures their professional growth and well-being, ultimately benefiting the healthcare sector.

This study provides baseline data for voting patterns and the political affiliation of licensed nurses (licensed practical nurses [LPNs], registered nurses [RNs], and advanced practice registered nurses [APRNs]) in Ohio for the November 2020, 2022, and 2023 general elections. Using two public databases (licensed nurses and registered voters), the findings for 73.7% of all licensed nurses registered to vote are reported, including 18,894 APRNs, 30,731 LPNs, and 137,353 RNs. Compared to the Ohio population eligible to vote, one in 32 persons of the voting-eligible population is a licensed nurse, and one in 51 registered voters in Ohio is an RN. The data show that 11% of the nurses never voted in any of the three general elections, and 47.7% voted in all three. LPNs had the lowest voting (34%) record, while about 48% of RNs and 52% of APRNs voted in all three. Like Ohio's public, nurses' party affiliation (Democrat, Republican, unaffiliated) varied, and most were unaffiliated with any party. Party affiliation was significantly associated with nurse licensure type (e.g., LPNs are less likely to be unaffiliated). Controlling for age and party affiliation, APRNs were more likely than LPNs to vote, and RNs were more likely than LPNs to vote in each election. Unaffiliated voters were less likely than Democrats to vote in all three elections. Across all elections, older voters were more likely to vote. These baseline findings on nurses' actual voting behavior provide the impetus for engaging nurses individually and collectively in voting and policies that increase voter participation of nurses and the public.

The nursing profession is currently grappling with an ongoing nursing shortage illuminated during the COVID-19 pandemic. While this burgeoning health and environmental crisis exacerbated this workforce issue, it did not create it. This study seeks to expand the idea of "who is a nurse" by arguing for the use of Licensed Practical Nurses (LPNs) as safe, credentialed persons in the nursing workforce. Archival research using primary and secondary sources highlights the history of the LPN movement. Historical case studies of LPN schools show how LPNs enhanced not only the quantity but also the quality of nursing practice. Case studies also reveal successful collaborations between nurses, communities, and hospitals to enhance the nursing workforce and community well-being. Aspects of this study were either approved by or deemed not human subjects research by institutional review boards. The increased emphasis on the registered nurse in the mid-20th century led to the marginalization of LPNs. Yet, history has revealed that collaborations that enhance diversity in the workforce and improve health-care access for patients, without compromising quality of care, can be formed by engaging LPNs. LPNs must be respected as consistent contributors to the country's health-care workforce. As the AACN commits to diversifying nursing, it is significant that LPNs have added to a more diverse, inclusive nursing labor force. For LPNs who wish to advance their nursing education, pathway programs must be supported-thus increasing diversity in the professional and advanced practice workforce.

Recently, the Georgia state House of Representatives passed House Bill 1013, also called The Mental Health Parity Act. The bill sought to address access to and insurance coverage for mental health services, first identified in a report in 2020. The budget for mental health services was reduced by $8 m in 2020, despite an all-time high demand due to the beginning of the Covid-19 pandemic. There is an increasing inability to secure mental health care in the state. Georgia is ranked 37^th in the country for access to quality mental health care (Reinert, Fritze, and Nguyen, 2022) and half the counties in the state have no psychiatrist; the projected mental health workforce will be able to meet only 12% of consumer demand by 2025. Problems with mental health care in Georgia have a long history which intersects with the history of racism, geographical segregation, and policing. HB1013 does not consider any of this history in its recommendations, which barely include nursing. At the same time, policy and practice in Georgia continues to entangle nurses and other professionals with a carceral and punitive system which not only threatens the safety of patients, but also nurses themselves. Nurses need to understand this history if they hope to develop policy that will intervene in the mental health care crisis.

Poor oral health has been associated with various systemic diseases (e.g., endocarditis, pneumonia, cardiovascular disease, and diabetes) and decreased quality of life. When enacted in 1965, Medicare excluded coverage for comprehensive dental services. As of 2023, Medicare has allowed coverage of limited dental services inextricably linked to specific medical conditions. Many Medicare Advantage plans (Medicare Part C) offer dental coverage. Yet in 2019, approximately 24 million Medicare beneficiaries (47% of all Medicare enrollees), lacked dental coverage. Seventy-one percent of traditional Medicare enrollees (those not enrolled in a Medicare Advantage Plan) reported that high cost was the primary reason that they did not obtain dental care. The importance of oral health for the older adults has been the main reason that a national interprofessional consortium, which includes several national nursing organizations, has been advocating for legislation to expand Medicare to include dental coverage. The consortium's efforts have been thwarted by fierce opposition from the American Dental Association and many Republican legislators. Given the vital role that nurses and advanced practice nurses play in caring for the nation's older adults and disabled, nursing's voice needs to be strengthened as leaders in advocating for inclusion of dental benefits in traditional Medicare.

Xylazine, a veterinary sedative, has emerged as a concerning element in the landscape of substance use in the United States. This integrative review synthesizes evidence from a systematic examination of 14 selected studies conducted between 2008 and 2023. The primary objective is to comprehensively understand the epidemiology and prevalence of xylazine use, particularly its involvement in drug-related deaths, regional variations, national impact, co-occurrence with opioids, and challenges associated with detection and intervention. The results underscore stark regional disparities in xylazine prevalence. West Virginia and Miami-Dade County have experienced alarming surges in xylazine-involved drug-related deaths. Nationally, its influence extends beyond regional boundaries, predominantly affecting white males in the Northeast. The co-occurrence of xylazine with opioids, especially fentanyl and heroin, significantly amplifies the risks of fatal overdoses. Detecting xylazine presents formidable challenges due to its frequent presence alongside other substances, necessitating enhanced surveillance and more effective detection methods. User perspectives emerge as pivotal, emphasizing the importance of user-informed harm reduction strategies. In conclusion, this review has significant policy implications. Tailored, region-specific strategies are imperative to address the diverse prevalence of xylazine use. A nationwide response is indispensable, prioritizing harm reduction initiatives, enhanced detection methods, and active user engagement. The multifaceted nature of the xylazine issue requires comprehensive approaches to mitigate its profound risks effectively. Policymakers are urged to consider regional disparities and the co-occurrence of xylazine with opioids when crafting targeted interventions. Immediate, user-informed harm reduction is vital to address the evolving landscape of xylazine use in the United States.

The aim of this qualitative evidence synthesis (QES) is to critically appraise the contemporary literature to gain a comprehensive understanding of the barriers and enablers of workplace integration needs of internationally educated nurses (IENs). An electronic search was conducted across multiple databases, and eligibility criteria were applied to identify papers published between January 2013 and July 2023. Out of the 830 studies initially retrieved, six met the inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the included studies revealed various barriers and enablers for workplace integration experienced by IENs. Barriers were: (a) IEN-related factors (cultural differences, language barriers, and disparities in the scope of nursing practice), (b) organizational factors (poor leadership), and (c) contextual factors (racism and discrimination). Enablers emerged were: (a) IEN-related factors (commitment to learn and adapt) and (b) organizational factors (structured multifaceted program, supportive workplace environment, and mentorship). Dynamic interaction exists among these factors, therefore interventions should address multiple barriers simultaneously. The QES has illuminated essential factors which impact the integration of IENs, and emphasizes the necessity of a comprehensive approach that considers the diverse challenges and opportunities that arise.

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing-the largest healthcare workforce with diverse roles-operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.