Shalala Donna E
Front Health Serv Manage. 2014 Winter;31(2):3-16.
Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to advance healthcare through nursing, and it explores the progress being made to remove unnecessary restrictions on nursing practice.
数以百万计的美国人获得了医保。老年患者数量不断增加。慢性病发病率上升。医疗服务提供者减少。我们的医疗体系如何才能不仅应对这些挑战，还能在控制成本的同时提高医疗绩效并改善医疗服务可及性呢？答案在于我们的护士。在美国的一些地区，护士提供全方位的初级和预防性护理。他们已成功改善了农村地区的医疗服务可及性和质量。在其他地区，护士的手脚却被过时的法律法规束缚，这些法规限制了她们扩大医疗服务可及范围的能力。当我们的医疗服务提供者无法按照其教育、培训水平及能力上限来提供服务时，我们的体系就无法增加医疗服务可及性。是时候重新思考我们提供初级和预防性护理的方式，并重新定义医生和护士的角色了。本文审视了美国国家医学院（IOM）《护理的未来》报告（由作者担任主席）的历史以及由此产生的《护理的未来行动倡议》，该倡议正致力于在全美50个州推行该报告的建议。IOM报告的建议很简单：1. 消除对护理实践的过时限制。2. 促进护士在医院董事会及所有医疗领域发挥领导作用。3. 加强护士教育与培训，增加拥有高级学位的护士数量。4. 增加护理人员队伍的多样性，以更好地反映患者群体特征。5. 改进数据报告与汇编，以预测劳动力需求。纽约州、肯塔基州和明尼苏达州是最近消除阻碍高级实践注册护士充分执业障碍的三个州。加利福尼亚州、佛罗里达州和印第安纳州的类似努力最初遭遇失败，但预计在不久的将来会取得进展。本文阐明了美国护理倡导中心（美国退休人员协会、美国退休人员协会基金会和罗伯特·伍德·约翰逊基金会的一项倡议）如何以及为何致力于通过护理推动医疗发展，并探讨了在消除对护理实践的不必要限制方面所取得的进展。
