Policy, Politics, and Nursing Practice最新文献

The healthcare sector is ubiquitously plagued by workforce shortages in economies around the globe. The fragility of this structural shortage becomes apparent when external shocks, such as the COVID-19 pandemic, exacerbate the lack of workers in clinical practice. In this article, we summarize current trends in healthcare workforce development across the globe, review theoretical concepts of workforce shortages, and discuss policies to address them. In practice, developed countries often address workforce shortages with targeted migration policies. However, targeted workforce migration policies only intensify workforce shortages in low-and middle-income countries. Theoretical macroeconomic models suggest that supply shortages may result from too low wages, supply lagging behind demand, and social perception. Changes in the wage rate cannot sufficiently increase the supply of health professionals as scholars find inelastic wages for physicians and nurses. Nonpecuniary factors such as working conditions, job satisfaction, and intrinsic motivation are at least equally important as financial incentives. In conclusion, increased wages can only be part of a heterogeneous policy plan to address shortages. Migration and retirement levels of health professionals can temporarily mitigate workforce shortages but rarely change the underlying systemic issues. Increasing the number of places available in medical and nursing schools while also improving, both, financial and nonfinancial incentives for employees are long-term structural policy options.

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.

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.

Effective health workforce analysis requires robust data and information. Quality data facilitate monitoring workforce trends, identifying shortages, forecasting employment needs, and planning educational programs. A wide range of federal agencies collect various forms of data, including administrative data, surveys, and censuses, which can be used for health workforce analysis. However, identifying the most appropriate data sources to address a specific nursing workforce issue can be challenging, particularly for newcomers to the field or those researching unfamiliar topics. In this article, we introduce and review 18 federal data sources pertinent to nursing workforce analysis. We categorize the datasets by their associated federal agency, describe each source, discuss their applicability to nursing workforce studies, present examples of past studies that employed these datasets, and highlight their limitations. Our aim is to help researchers, policymakers, and healthcare administrators efficiently locate and leverage relevant data for their analysis.

Introduction: Nurse-led primary care is a relatively rare model for primary care, but given nurses more holistic approach to medicine, can prove effective in both reducing costs and disparities in access and outcomes. The present study compares cost adjusted quality of care between a nurse-led primary care facility and the standard primary care.

Design: To compare the cost adjusted quality of care between the standard primary care model and a nurse led primary care model the outcomes from a population of patients that visited each (control and experimental, respectively) are compared with respect to three complications of hypertension (stroke, heart attack, and coronary heart disease).

Method: The number of three complications (stroke, heart attack, and coronary artery disease) from hypertension for the experimental population is estimated using time-to-event distributions estimated from the control population. Costs are estimated using the control population data.

Results: It is found that the population that visited the nurse-led primary care facility had better cost adjusted outcomes than the population that visited the physician led facilities. We can attribute, at least, $3.7 million in costs not realized due to the quality of care provided by the nursing center.

Conclusion: Nurse-led primary care is one way that the U.S. healthcare system could reduce costs while providing consistent quality of care.

With the recent enactment of the National Nursing and Midwifery Commission (NNMC) Act, 2023, significant changes are anticipated in the scope of practice and autonomy for registered nurses and midwives in India. However, alongside these anticipated advancements, concerns have emerged regarding various aspects of the Act, necessitating critical examination. In this article, we aim to explore expected changes in nursing education and service and concerns about the NNMC Act, providing insights into the implications of the NNMC Act on the regulation and advancement of the nursing and midwifery profession in India. The Act is anticipated to introduce uniform standards, implement entry and exit examinations, recognize midwifery as a distinct discipline, and determine the scope of practice for nurses and midwives. Moreover, the implementation of the Nurse Practitioner Program and guidelines for its limited prescribing authority is anticipated. Concerns exist regarding the composition of the commission and board members, adequate stakeholder representation, lacking provisions for ensuring continued competence, working conditions of nurses and midwives, nomenclature, integrating new terms, and clearly defining roles. These concerns emphasize the need for viable career pathways, uniform cadres, and a streamlined registration system, crucial for advancing nursing and midwifery profession in India. The coexistence of concerns and anticipation highlights the complexity of enacting regulatory reforms in nursing and midwifery. Policymakers can lay the foundation for a comprehensive, inclusive regulatory system that promotes excellence in nursing and midwifery practice, ultimately benefiting both healthcare providers and patients.

The nursing profession in Greenland, particularly in rural and remote areas, faces challenges due to geographical limitation and a lack of interdisciplinary collaboration. The registration process and status of internationally educated nurses (IENs) in Greenland are unclear. This article aimed to analyze existing policies and propose recommendations for an independent registration process for IENs in Greenland. A qualitative discourse analysis was used to critically discuss existing policies and regulations governing nursing registration in Greenland. Relevant legislation, government reports, and official documents were reviewed. Legislative regulations protect the title of registered nurse in both Greenland and Denmark. To work in Greenland, an IEN must have a residence permit. With recent health agreements between Greenland and Denmark, both countries have streamlined the permit acquisition process for foreign healthcare professionals, making it more accessible. However, the process of acquiring a license to work as a registered nurse for IENs lacks clarity. Policy reform is needed to establish a group of diverse nurse experts under the National Board of Health responsible for the assessment and registration of IEN qualifications. There is also a need for a bridging education program or national licensure examination which could facilitate faster IEN recognition. Mutual recognition of nurse licenses between Greenland and Denmark should be established to ensure efficient healthcare delivery and maintain professional standards. Embracing IENs can address nursing shortages and improve healthcare services in Greenland.

Gun violence is a leading public health concern in the US; subsequently, firearm-related violence prevention is a top priority for policymakers. Extreme risk protection order (ERPO) laws are a state-level attempt to reduce gun-related injuries and deaths. These court-issued orders prohibit people found to be dangerous to themselves or others from temporarily purchasing or possessing a firearm. Six states (Colorado, Connecticut, Hawaii, Maryland, Michigan, New York) and the District of Columbia have passed or amended their laws to include nurses as ERPO petitioners. The study's purpose was to conduct a review of state ERPO laws that included nurses as petitioners. Using a legal mapping approach, information on nurse ERPO petitioning was extracted from the seven jurisdictions. ERPO laws with nurse petitioners were passed between 1999 and 2023. Nurse petitioners included advanced practice registered nurse (n = 3), clinical nurse specialists (n = 3), nurse practitioner (n = 3), professional nurse (n = 2), and register nurse (n = 1). Psychiatric/mental health (n = 2) and school nurses (n = 2) were specified. Statutes differed in the handling of disclosed health information as part of the ERPO petition, as well as how health information would be handled by the court (e.g. sealed by the court, confidential by the court, returned to provider/disposed of post-hearing/order.) Three statutes exempted petitioners from civil and/or criminal liability, if petitions were submitted in good faith. Two of these states extended protection from liability to all petitioners, while one only referenced petitioners who were healthcare providers. The study findings have important policy, clinical, and research implications.

The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses' increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.