Alleviate this physician shortage and expand the scope of practice for advanced practice registered nurses (APRNs). The Institute of Medicine (IOM) of the National Academy of Sciences has weighed in on this idea of allowing APRNs to do more, in a landmark 2010 report "The Future of Nursing." The IOM conducted an exhaustive review of care provided by APRNs and concluded that properly trained APRNs can independently provide core primary care services as effectively as physicians. In its report, the National Academy of Sciences recommended that "[a]dvanced practice registered nurses should be able to practice to the full extent of their education and training."
Whether nurses should be allowed to administer anesthesia without doctor supervision has been playing out here and around the country in recent months. In Colorado the issue has prompted a legal battle. Since Colorado’s rural hospitals were exempted from the supervision regulation in 2010, some medical facilities that may not have employed anesthesiologists have been able to attract specialists because there is no longer a concern about who would administer anesthesia or supervise, said Scott K. Shaffer, president of the nurse anesthetists association in Colorado. In 2010, anesthesiologist and medical societies filed a lawsuit in state court asserting that allowing nurse anesthetists to deliver anesthesia without supervision was not consistent with state law, a requirement for opting out of the federal rule.
Thousands of registered nurses from eight Bay Area Sutter Health-managed hospitals are striking Tuesday and are planning to participate in rallies to protest a proposed decrease in their employer-covered health care expenses. It is the third strike in seven months by members of the California Nurses Association over contracts that have been under negotiation for nearly a year. Some 4,500 nurses went on strike 7 a.m. today, and plan to strike a full 24 hours, according to the nurses association. Discussions have reached an impasse because nurses say Sutter is demanding that they forgo paid sick days and pay more toward their healthcare, among other requested concessions.
After a patient died last year at a Veterans Affairs hospital in Manhattan, federal inspectors discovered nurses in his unit had a startling gap in their skills: They didn't understand how the monitors tracking vital signs worked. The incident followed two deaths in the cardiac monitoring unit at a VA hospital in Denver that raised similar questions about nurse competency. Earlier this month, a broader review by the VA inspector general of 29 VA facilities found only half had adequately documented that their nurses had the needed skills. Some nurses "did not demonstrate competency in one or more required skills," but there was no evidence of retraining, the report said.
There's a fight over fashion within the Allina Health System. In May, the Minneapolis-based hospital group will start requiring workers in a dozen different job classifications to begin wearing matching uniforms with distinguishing colors. But the change has drawn protest from unionized nurses who say the switch should have been negotiated and stomps on autonomy.
As new care models emerge, new types of leader are taking the helm: physician and nurse executives. There has been a major uptick in the number of requests for physicians and nurses who are prepared to lead health systems, academic medical centers, community hospitals, and managed care organizations. They are exchanging their lab coats for a seat in the C-suite, taking advantage of opportunities to lead during the post-reform era.