Policy, Politics, and Nursing Practice最新文献

The Nurse Training Act (NTA) was passed by the United States Congress in 1964 in response to growing national concerns about a shortage of nurses. The legislation provided substantial funding for nursing education to increase the supply of nurses and improve the quality of nursing services. However, contemporary investigations into the causes of the shortage focused on the professional lives and experiences of white women, who were the main target of nurse recruitment and retention efforts. This research shifts the focus to Black women nurses, examining both the causes of the shortage and the impact of the NTA on the nursing workforce from their perspective. It argues that a key achievement of the NTA-alongside the Civil Rights Act of 1964-was the dismantling of legalized racial segregation in professional nursing schools, a major barrier to the development of the Black professional nursing class. Yet, this federal intervention was not simply bestowed; it was the result of decades of sustained advocacy by Black nurses from the 1890s to the 1960s to secure equal educational opportunity and federal support for their civil liberties. Viewing this landmark legislation through the eyes of Black nurses underscores the federal government's pivotal role in both promoting and obstructing racial and healthcare equality. As the nation faces yet another nursing shortage, coupled with the eradication of affirmative action and diversity, equity, and inclusion initiatives, this perspective is especially timely and important for informing current and future issues pertaining to health equity.

Since the 1960s, nurses have worked to improve access to health care services among underserved communities through the establishment of community-based nurse-led clinics (NLCs). Evidence demonstrates NLCs' effectiveness in delivering high quality and cost-effective primary care services to underserved communities. However, few studies have analyzed the role and meaning of community within NLCs. This article uses historical research to analyze and evaluate the roles played by communities in three community-based NLCs established between the 1960s and 1990s. This research shows that how nurses entered the communities they intended to provide care, the degree to which they collaborated with community members to conceptualize, operationalize, and maintain NLCs, and how they balanced community needs with academic imperatives are critical to understanding and addressing the difficulties NLCs have encountered delivering sustained, community-centered care. This research also addresses the impact on communities when NLCs fail, making clear the need for policy interventions that address the financial and political factors undermining NLCs' sustainability, particularly limitations on nurse practitioners' practice authority and credentialing as Medicaid providers, and reduced reimbursement rates for nurse practitioners. Ultimately, it argues that NLCs' engagement with underserved communities should be historically informed and integrate community expertise, robust community engagement, and community-centered definitions of quality care.

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.

This article examines the trends and trajectories of the nursing profession and healthcare practices in Israel from a historical perspective, following the enactment of the 1995 National Insurance Health (NHI) Law, which entitled every Israeli resident to healthcare services. Since then, Israel's health funds have become more competitive and services to patients have improved. Nurses in Israel have taken on new roles in the healthcare system, including working with professional colleagues to develop efficient teamwork that serves patients' needs. Nursing in Israel has also become increasingly academized, with all nursing training taking place in universities or academic colleges as of 2024. These changes mirror global trends in nursing and demand new thinking about the role of nurses, including how nursing can best serve patients and the wider healthcare system.

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.

This article presents a historical analysis of the Sentosa nurses, a group of nurses recruited from the Philippines in 2005 and 2006 to work in a health-care facility on Long Island, New York. The international nurse recruitment company that hired them underpaid them, assigned them to work in unsafe conditions with low nurse-to-patient ratios, and breached other parts of their contracts with the nurses. When the nurses decided to resign and break from their contracts early, the recruitment company retaliated, initiating civil, administrative, and criminal charges against the nurses. The Sentosa nurses' story reflects that by the end of the first decade of the 2000s, the international nurse recruitment industry grew not only in size, but also in power, leaving internationally-educated nurses vulnerable to exploitation. More recent reports from 2019 of the labor trafficking of internationally-educated nurses are not new. Instead, a historical perspective reveals an ongoing pattern of deceptive practices and informs recommendations for stricter policies that ban recruiters from using liquidated damages provisions or breach-of-contract fees to trap nurses in exploitative work environments.

Since the "Black Lives Matter" reckoning of 2020, professional health organizations have made public statements and apologized for not recognizing the role of racism in the creation of health disparities. For the American Nurses Association, this has taken the form of the National Commission to Address Racism in Nursing. One result of that work has been the Report on the History of Racism in Nursing, which details the constant maligning of the competence of Black nurses and their systematic exclusion from institutions within the profession. In this article, we want to take these ideas further and argue that the issue for nursing is not so much a generic kind of racism that a professional reorganization can address, but rather a deep and abiding "anti-blackness" that is intrinsic to the heart and soul of medical and health knowledge itself. Anti-blackness as an idea comes from a collection of theoretical interventions developed by Black philosophers, literary theorists, sociologists, and historians who continue to grapple with the question posed by W.E.B. DuBois: "How does it feel to be a problem?" Anti-blackness is the "relegation of Black people to inhumanity and non-being" and "is a global phenomenon that takes on distinct forms of expression in each sociocultural context." Given the call to understand the role of historical, social, political, environmental, and economic factors via the social determinants of health, a more expansive approach is needed to articulate the Black lived experience. Anti-blackness is one tool available to nurses interested in a deeper level of analysis.

Nurses have a critical role to play in creating, implementing, critiquing, and advancing health policy within diverse contexts to ensure people living with life-limiting illness receive equitable and ethical access to palliative care services and programs. This article describes a critical analysis of the British Columbia's Palliative Care Benefits (BCPCB). The BCPCB is a provincial government program in British Columbia (B.C.), Canada, that provides eligible residents with palliative care services at home. Utilizing Fairclough's Dialectical-Relational Critical Discourse Analysis, the study investigates the process by which BCPCB determines B.C. residents' eligibility and access to resources proportionate to their need, function, illness burden, and urgency. This article reviews the construction of palliative care in Canada and how current biomedical perspectives construct palliative care policy and services in B.C. The findings indicate that the BCPCB program produces vague, discriminatory, and ableist prognostication practices through the implementation of its eligibility policy. This article also suggests that palliative care nurses are optimally positioned for policy influence: to critique, disrupt, and transform the BCPCB Program and palliative care practices.

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.