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NACNEP since the enactment of the 1998
legislation has initiated its examination
of the Title VIII administration and regulations
with respect to the nurse workforce, education
and practice improvement during a time
of continual, evolving, change in the
health care environment. Nursing must
be responsive to these changes to fulfill
its responsibility to provide adequate
and qualified health care to the nation’s
population. NACNEP, therefore, specifically
targeted aspects that affect Federal policy
matters and those for which the Federal
government can be particularly instrumental
in affecting change. At the same time,
NACNEP recognizes that change can come
about only through the concerted activities
of all public and private partners involved;
those in the profession, the health care
industry and consumers, and all levels
of government. However, NACNEP sees a
distinct role of leadership for the Federal
government through Title VIII and other
Federal government vehicles that fund
nursing education and nursing services.
Three distinct projects NACNEP initially
undertook during this period examined
specific issues affecting the development
of the workforce and its education and
practice improvement.
- NACNEP looked at the funds available
to nursing education through Medicare.
It recommended that these be redirected
toward providing support at the baccalaureate
and higher degree level nursing education,
as this would best serve the needs for
qualified registered nurses to provide
the services of today’s health care
delivery system.
- NACNEP, in recognition of the increasing
diversity of the population and the
impact of this change on nursing resources
and services, examined the barriers
to and the requirements for increasing
the diversity of the nurse workforce.
It recognized that the magnitude of
the changes required needed a concerted
national effort involving the public
and private sectors and, to that end,
developed a national agenda. The recommendations
within that agenda focused on the following
four goals:
- Enhance efforts to increase the
recruitment, retention, and graduation
of minority students.
- Promote minority nurse leadership
development.
- Develop practice environments
that promote diversity.
- Promote the preparation of all
nurses to provide culturally competent
care.
- NACNEP, working in partnership with
COGME, considered that the enhancement
of patient safety in today’s health
care delivery system requires increased
interdisciplinary activity. Agreement
was reached at the joint meeting of
the two councils on recommendations
designed to foster interdisciplinary
education and practice that were in
line with these five major findings:
Finding One: Patient safety
cannot be accomplished without interdisciplinary
practice approaches.
Finding Two: Patient safety
gains are unlikely to be achieved
at a satisfactory pace in the absence
of revolutionary change.
Finding Three: Current
system discontinuities need to be
confronted towards the aim of building
a true, safety-oriented sys tem
of care.
Finding Four: A significant
cultural change in medicine and
nursing is required to achieve the
needed gains in patient safety.
Finding Five: Patient safety
requires that patients become acculturated
in the need to participate actively
in their own health care.
At present, the nation is experiencing
a severe nursing shortage. Without immediate
action, it is anticipated that there may
be 20 percent fewer RNs than are required
to meet the nation’s health care needs
by 2020. Factors contributing to this
complex nurse workforce shortage include
an aging nurse workforce, declining enrollments
in nursing education programs, a shortage
of nurse educators, and work environments
that challenge the nurse’s ability to
provide safe, quality nursing care to
patients. NACNEP considered the severity
of the current and impending future nursing
shortage and its implications for the
nation’s ability to provide its residents
with health care from an adequate and
qualified nurse workforce.
NACNEP recommended in its first review
of the current nursing workforce shortage
the following thirteen actions:
- Expand funding and Federal programming
for nursing education to increase the
capacity of programs to adequately prepare
sufficient numbers of registered nurses
to meet the health care needs of the
nation.
- Increase the capacity of nursing
programs to ensure a diverse workforce
that reflects the racial/ethnic composition
of the overall society and provides
culturally competent care to racial/ethnic
minority populations, consistent with
the National Agenda for Nursing Workforce
Racial/Ethnic Diversity.
- Target Federal funds to increase
the overall number of baccalaureate
and higher degree prepared nurses making
up the basic nurse workforce to achieve
2/3 BSN prepared nursing workforce by
2010.
- Provide Federal funds to support
workplace improvement activities to
eliminate barriers (such as increased
workloads, mandatory overtime, low salaries,
limited career advancement and low RN
staff to patient ratios) to the delivery
of quality care in safe, traditional
and nontraditional environments.
- Provide Federal funds to demonstrate
appropriate use of the latest technologies,
including informatics and biotechnology,
by nursing faculty, students and clinicians
to assure both the provision and the
management of safe and quality care
to patients.
- Increase program capacity to expand
clinical practice settings to prepare
basic and advanced practice nurses to
serve as nursing faculty, clinicians
and students in primary and specialty
care settings.
- Establish innovative teaching and
leadership institutes in every State
to assist nurses in clinical practice
to develop essential skills to assume
faculty roles.
- Establish innovative, interdisciplinary
educational and practice programs that
are evidence-based and demonstrate the
relationship between the delivery of
quality nursing care and the improved
safety of patients.
- Support enrichment activities for
K-12 students to increase recruitment
into nursing.
- Support recruitment strategies for
second degree students, men, and college
students with undeclared majors, into
professional nursing.
- Improve Federal Medicare reimbursement
of advanced practice nurses, including
nurse anesthetists, nurse- midwives,
nurse practitioners and clinical nurse
specialists, and nursing faculty, in
practice in medically underserved areas.
- Provide reimbursement for nurse managed
centers consistent with that of Federally
Qualified Health Centers for the same
and/or similar health care services
delivered.
- Reform Graduate Medical Education
(GME) funding formulas to include direct
and indirect Graduate Nursing Education
(GNE) dollars for baccalaureate and
higher degree programs to ensure geographic
distribution of funds to all fifty States.
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