Nurses have great potential for developing innovative strategies to improve the healthcare system. However, many historical, regulatory and political barriers limit the ability of nurses to generate large-scale transformation. Other barriers include the fragmentation of the health system, high turnover rates among nurses, the difficulties of nurses transitioning from school to practice and the aging of the workforce and other demographic problems. Many of these barriers have resulted from structural deficiencies in the US health system; others reflect the limitations in the current working environment, as well as the potential and demographic composition of the nursing workforce itself. Regulatory barriers are particularly problematic.
The provisions defining the limitations in the field of practice vary widely by state. Some of them are very detailed, while others contain uncertain provisions that are open to interpretation. Some states are not lagging behind the evolution of the health care system by changing their practice rules to allow nursing practitioners to see patients and prescribe medications without seeing or collaborating with the doctor. However, most state laws are lagging behind in this respect. As a result, what practicing nurses can do when they finish their studies vary widely for reasons not related to their ability, education or training, or to security problems, but to the political decisions of the state in which they work. Depending on the state of the restriction on the practices of a nurse practitioner who has passed best practice, they can limit or completely deny the authority to prescribe medication, take patients to the hospital, assess the condition of patients, and evaluate and evaluate tests.
Since many problems associated with a variety of practice areas are the result of the patchwork effect of government regulatory regimes, the federal government is particularly well suited to facilitating effective reforms by collecting and disseminating best practices from across the country and encouraging their adoption. In particular, the Federal Trade Commission has a long history of targeting anticompetitive behavior in the health care market, including restrictions on the business practices of health care providers, and policies that can impede the entry of new competitors to the market. As a payer and health insurance administrator for federal employees , The Office of Human Resources Management and the Health Benefits Program for Federal Employees are responsible for promoting and securing Stupa employees / subscribers to the widest selection of qualified and cost-effective medical care providers. Equity principles suggest that this choice of subscriber should be encouraged by politicians providing full and demonstrative practice for all providers regardless of geographic location. Finally, the Medicare and Medicaid Services Centers are responsible for enacting policies and policies that provide Medicare and Medicaid beneficiaries with access to adequate health care, and can therefore ensure that their rules and policies reflect the developing abilities of licensed providers.
In addition to the barriers associated with the scale of the practice, high rates of turnover among newly-registered nurses underscore the need for greater emphasis on managing the transition from school to practice. In 2002, the Joint Commission recommended the development of nursing residency programs - planned, comprehensive periods of time during which graduates of nurses can acquire knowledge and skills for
provide a safe, quality care that meets certain standards (organization or professional society). Resident programs are supported mainly in hospitals and larger health systems, with a focus on emergency care. This was the greatest need, since most new graduates get jobs in emergency care, and the proportion of new employees (and nurses) who are new graduates is growing rapidly. However, it is important that residency programs that do not relate to emergency care be developed and evaluated. Much of the evidence supporting the success of the residences was obtained through self-evaluation by the residency programs themselves. For example, one organization, Versant, 2 demonstrated a profound decrease in turnover rates for new graduates of registered nurses-from 35 to 6 percent at 12 months and from 55 to 11 percent at 24 months-compared to new graduates of registered nursing control groups hired at the facility before implementation of the residency program.
Patient Care Improves Quality
Health research demonstrates the benefits of reorganizing the provision of health services around what is most important for patients. As indicated in the section "Crossing the Qualitative Gap", patient-centered care is based on the principle that people should be the ultimate referees in choosing the type of treatment and care that they receive. Nevertheless, practice is still usually organized around what is most convenient for the provider, payer or health organization, and not for the patient. Patients were repeatedly asked, for example, to change their expectations and schedules so that they correspond to the needs of the system. They must provide the same information to several trustees or when they visit one and the same provider sequentially. Primary care appointments are usually not available outside of working hours. Consultations, education and coaching, necessary to help patients make informed decisions, have historically been neglected. In addition, patient insurance policies often limit the choice of provider, especially if the provider is not a doctor. Box 2-1 presents an example of how one health care system, the University of Pittsburgh Medical Center, has implemented a truly patient-centered program.
A number of studies are related to patient orientation and quality. For example, studies comparing operations with the vigilant expectation of patients with benign prostatic hyperplasia showed how strongly the preferences of patients played a role in determining the quality of life. It has also been found that the involvement of patients more directly in the management of their own condition leads to significant improvements in health for people with insulin-dependent diabetes mellitus. By 2001, so many different studies have found similar results that the "Crossing of the Qualitative Gap" has identified patient orientation as one of the six pillars on which the health system of the 21st century should be built (others - safety, effectiveness, timeliness, and justice).
One of the hallmarks of patient-centered care is improved access to care, the key component of which is access to information. For example, an increasing number of patients have greater access to their laboratory results and diagnostic reports of their procedures through electronic forums such as personal medical records and patient portals.
In 2001, an 18-month-old Josie King was hospitalized at the John Hopkins Children's Center with burns that she sustained as a result of a bathroom accident. First, Josie responded well to treatment, but her condition quickly deteriorated. When her mother, Sorrel King, expressed concern, state nurses and doctors repeatedly fired them, and two days before her scheduled release, Josie died. The cause was dehydration and mistakenly injected opioid - the result of a series of errors recognized by the hospital.
Ms. King has since dedicated herself to the elimination of medical errors, the creation of the Josie King Foundation and the appeal to clinicians, politicians and consumers about the importance of creating a "safety culture". And the need for this. According to the 2000 report of the Institute, up to 98,000 people die every year from medical errors (IOM, 2000); almost 10 years after the publication of this report, in spite of the improved patient safety systems, the C + + report was given in the 2009 report for efforts to expand patient capabilities to prevent errors (Wachter, 2009).