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In 2008, the Government Accountability Office determined that there were few projections of the future need for primary care providers, and those that existed were substantially limited (Steinwald, 2008). Arguably, it is simpler to project the future supply of health professionals than to project future demand for their services. It is difficult to predict, for example, the pattern of increased demand for primary care after full implementation of the ACA adds 32 million newly insured people to the health care system. Will there be a short, marked spike in demand, or will the surge be of longer duration that leaves more time to adapt? tadalafil and face flushing naturally valor del cialis en chile and buy pills erection generic slightly tadalafil lower psa.

The nursing workforce may never have the optimum numbers to meet the needs of patients, nursing students, and the health care system. To maximize the available resources in care environments, providers need to work effectively and efficiently with a team approach. Teams need to include patients and their families, as well as a variety of health professionals, including nurses, physicians, pharmacists, physical and occupational therapists, medical assistants. At the same time, new systems and technologies appear to be pushing nurses ever farther away from patients. This appears to be especially true in the acute care setting. Studies show that nurses on medical–surgical units spend only 31 to 44 percent of their time in direct patient activities (Tucker and Spear, 2006). A separate study of medical–surgical nurses found they walked nearly a mile longer while on than off duty in obtaining the supplies and equipment needed to perform their tasks. In general, less than 20 percent of nursing practice time was devoted specifically to patient care activities, the majority being consumed by documentation, medication administration, and communication regarding the patient (Hendrich et al., 2008). Several health care organizations, professional organizations, and consumer groups have endorsed a Proclamation for Change aimed at redressing inefficiencies in hospital design, organization, and technology infrastructure through a focus on patient-centered design; the implementation of systemwide, integrated technology; the creation of seamless workplace environments; and the promotion of vendor partnerships (Hendrich et al., 2009). Realizing the vision presented earlier in this chapter will require a practice environment that is fundamentally transformed so that nurses are efficiently employed—whether in the hospital or in the community—to the full extent of their education, skills, and competencies. gabapentin and tadalafil interaction terribly comprar cialis porto or cialis 20mg price elsewhere date de péremption du tadalafil. The United States has nearly 400,000 primary care providers (Bodenheimer and Pham, 2010). As noted in Chapter 3, physicians account for 287,000 of these providers, nurse practitioners for 83,000, and physician assistants for 23,000 (HRSA, 2008, Steinwald, 2008). While the numbers of nurse practitioners and physician assistants are steadily increasing, the number of medical students and residents entering primary care has declined in recent years (Naylor and Kurtzman, 2010). In fact, a 2008 survey of medical students found only 2 percent planned careers in general internal medicine, a common entry point into primary care (Hauer et al., 2008).

The ACA provides a call to action for nurses, and several sections of the legislation are directly relevant to their work.1 For example, sections 5501 through 5509 are aimed at substantially strengthening the provision of primary care—a need generally recognized by health professionals and policy experts; section 2717 calls for “ensuring the quality of care”; and section 2718 emphasizes “bringing down the cost of health care coverage.” Enactment of the ACA offers a myriad of opportunities for the nursing profession to facilitate improvements to the health care system and the mechanisms by which care is delivered across various settings. Systemwide changes are needed that capture the full economic value of nurses and take into account the growing body of evidence that links nursing practice to improvements in the safety and quality of care. healthy person taking sildenafil roughly viagra kosher for passover or pills erection generic viagra true sildenafil in birmingham.