Registered nurses' perspectives on health care and the 2008 presidential election

As this historic presidential election draws near, what do RNs think of our nation's priorities? Which candidates do they think will be most effective in shaping our health care system and addressing the most pressing issues of our time? The results of this survey show that RNs do not identify overwhelmingly with one political ideology or party and, in fact, they closely resemble the public on these political dimensions. The data also show that RNs identify health care issues as the most important problem facing the nation. RNs who believe that it is the responsibility of the government to provide health insurance to those without it, have more confidence in the government to achieve this outcome, and are more likely to be Democrats than Republicans. The presidential election is expected to be highly contested and could be determined by a relatively small margin of votes and, thus, nurses should recognize their chances of influencing the outcome of the election. The data from this survey provide baseline information potentially useful to increasing the political influence of the nursing profession, informing other organizations about where they might align with nurses, and helping candidates and the political parties compete more effectively in seeking the support of roughly 3 million RN voters.     

Effects of a short-term linguistic class on communication competence of international nurses: implications for practice, policy, and research

International nurses face a host of challenges in their transition and adaptation to the U.S. health care environment. Language and communication barriers have been ranked consistently as a top concern by employers, regulatory agencies, and international nurses themselves. Researchers in this study examined the effects of a 10-week linguistic class on the reduction of phonologic errors affecting foreign accent in a sample of international nurses. The linguistic course appeared to be effective in improving the international nurses' linguistic competence by reducing their phonologic errors significantly. Moreover, the intervention narrowed the linguistic gap between international nurses from non-English and English-speaking countries. Findings from this study have important implications for practice, policy, and research regarding quality of care, as well as for the transition, job satisfaction, and retention of international nurses.     

Evolution of the chronic care role of the registered nurse in primary care

High-quality, accessible, and efficient primary care is needed as the U.S. health care system undergoes significant change. Advancing the role of registered nurses in the primary care setting is important to the solution. A large academic health center implemented five initiatives to improve the care of chronically ill patients through the expanded role of RNs in the context of the health care team. Role evolution of nurses in the pilots required some continuing education and some additional nursing support to release the pilot nurses from their usual duties. These strategies allowed the nurses to apply interventions that enhanced the coordination of care and promoted patient self-management skills. Some short-term improvements in health status were realized and barriers to self-care were identified and resolved.     

Pieces of the shortage puzzle: aging and shift work

Addressing issues important to the aging nurse and night-shift worker is imperative for retention success. It is important for nurse leaders to create an environment that will keep older nurses and night-shift workers working. The good news is that health care leaders are talking. Research is being done and will hopefully continue. Now it is time for health care leaders to welcome nurses, educators, and policymakers into their circle of discussion to preserve quality health care and retain our nurses at the bedside.     

The political economy of public health expenditure and wait times in a public‐private mixed health care system

Abstract This paper investigates the determinants of public health expenditure in a public‐private mixed health care system, where a longer wait time for public care is the major difference between public and private sectors. Voter preferences for health care vary according to their age and by income, and public policy choices are part of a multi‐dimensional, competitive political equilibrium. We show how equilibrium public health expenditure and wait times depend on demographics and explain why they are independent of the distributions of income and political influence. We also show that population aging may not always lead to more public health expenditure.     

Nurses leading the response to the crisis of palliative care for vulnerable populations

All nurses are prepared to be generalists in palliative care. Within the discipline there are nurses who seek advanced educational preparation and develop clinical expertise in palliative care nursing. These are our leaders in palliative care nursing who can exert influence in all health care settings to support nurses providing palliative care. It is nurses and advanced practice nurses in partnership who are capable of developing and advocating for palliative care across settings. The focus of care is the person, not the diagnosis or the setting. The viewpoint that "all nursing care is palliative care" can transform health care with nurses taking the lead.     

Registered nurses: the impact of wages on labour force participation and hours worked – are wages an effective mechanism for addressing RN shortages with evidence from 1960 to 2008?

Registered nurses (RNs) are critical producers and coordinators of patient care in acute and non-acute settings (Needleman et al. 2011). The Affordable Care Act coupled with an ageing population, are increasing demand for health care and, in turn, RNs. Numbering 3 million, RNs comprise the largest professional occupation in health care. Therefore, the labour force participation and hours worked are of keen interest to stakeholders and policymakers. Rising demand may exacerbate nursing shortages and have important effects on costs. We estimate the impact of wages on participation and hours worked as a possible policy tool to increase nursing supply. In 2008, the RN wage had a positive and significant effect on participation and a small positive but only marginally significant effect on hours worked given participation. The latter elasticity for married females (single females) was 0.11 (0.33). Therefore, the elasticity of hours worked with respect to the nurse wage is and unlikely to have an important effect on the participation rates or hours worked of currently trained female RNs. Consequently, wage increases are unlikely to be an effective policy to increase the labour supply among the currently licensed RNs and will not relieve any short-term nursing shortage.     

Foreign-educated nurses: an overview of migration and credentialing issues

It is important for nursing administrators to understand the migration and credentialing process as they integrate foreign-educated nurses into United States health care systems. Issues and considerations related to migration and credentialing of foreign-educated nurses are summarized.     

A transparency and accountability framework for high-value inpatient nursing care

Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value.     

Do Competing Health Insurance Licensors Provide Pro-patient Effects?

This paper shows that competition among health insurance licensors has strong pro-patient effects, if inter-regulatory competition is allowed. The pro-patient effects of the competition among health insurance licensors do not depend on the need for the patients to form or exercise their political influence, such as, forming cooperatives or voting, as suggested by Backer's pressure group theory. When inter-jurisdictional transactions are allowed, endogenous policy making ensures that the health care licensors pursue public interests at no costs to patients.     

Female political representation and substantive effects on policies: A literature review

The share of women in political offices has increased considerably over the past few decades in almost every country in the world. Does this matter for policy outcomes? This is the first paper to provide a literature review on the substantive effects of female representation on policies. In developing countries, the increase in female political representation has caused a better provision of public goods, especially with regard to education and health. In developed countries, higher female representation has not affected public policies as measured by spending patterns. However, more recent evidence shows that female representation has induced changes in parliamentary deliberations and specific policy choices (e.g. more public child care) that may not be reflected in the observable composition of public spending. Finally, higher female representation has improved institutional quality by reducing corruption and rent-extraction by those in power.     

The impact of decentralization and inter-territorial interactions on Spanish health expenditure

This paper examines the determinants of regional public health expenditure in a decentralised health system. Unlike previous studies we take into account possible policy and political interactions among authorities, as well as unobserved heterogeneity. Our emprirical contribution lies in running a spatial panel specification using a dataset of all Spanish region states on aggregated and disaggregated health expenditures (pharmaceuticals, inpatient and primary care). Results are consistent with some degree of interdependence between neighboring regions in spending decisions. Empirical evidence of long term efficiency effects of health care decentralisation, suggests that a specific spatial-institutional design might improve the health system efficiency as well as regional cohesion. Political and scale effects are consistent with theoretical predictions.     

Development Economics from a Chicago Perspective

The interlocking board directorships among corporations. as well as between corporations and social organizations, is important for defining the modern political economy. This article finds the networks of those interlocks for Koch Industries Inc. and TD Ameritrade Holding Corporation. Moreover, the article extends the networks to describe and analyze the accompanying political network of contributions to Nebraska political campaigns. For corporate and social networks, we utilize conventional theoretical structures to find the new database of those networks for Koch Industries and TD Ameritrade. The new theoretical structure and database concern the campaign contributions of the board of directors in the corporate and social networks, as we trace them to campaigns for federal offices. The new political campaign finance structure we uncover here includes thousands of interconnected campaign finance conduits, through which money flows to political campaigns.     

Measuring teamwork and patient safety attitudes of high-risk areas

Patient care leaders recognize that substantial reductions in health care errors will not come until more attention is given to human solutions, such as improving teamwork in health care teams. The authors introduce a short, valid, and reliable instrument to measure teamwork and patient safety attitudes in hospital high-risk areas, namely the emergency department, the operating room, and the intensive care unit. The instrument was tested among nurses in four hospitals and the results showed that the nurses favored the team approach, while recognizing that teamwork in their departments is not very advanced and that communication with some key team members is problematic. This situation seems ideal for the design of a team training intervention in these settings.     

An empirical analysis of habit and addiction to antibiotics

Because of bacterial resistance, current antibiotic consumption is reinforced by past use, and future utility is lower. The purpose of this article is to provide evidence on habit and addictive behavior toward antibiotics by exploring variations in the average consumption of antibiotics across 20 Italian regions. Using a balanced panel data set (2000–2009), we estimate myopic and rational addiction models, in which antibiotic consumption depends upon demographic and socioeconomic characteristics of the population, the supply of health care in the community, antibiotic price, and the “capital stock” of endogenous bacterial resistance measured by past and future consumption. Our empirical evidence shows that past antibiotic consumption stimulates current consumption and is also consistent with the rational addiction hypothesis. The low price elasticity of antibiotic demand suggests that policy measures targeted at antibiotic co-payments may not be effective in controlling antibiotic consumption. There is scope for other policy interventions, such as incentives and information campaigns targeted at doctors.     

The role of e-Health in the changng health care environment

In 2005 health care organizations spent 2.3% of total operating expenses on information technology and are slowly developing the infrastructure necessary to expand e-Health capabilities. E-Health is being recognized as a method to improve the overall health status of the population. It is important to build partnerships among health care providers, local community organizations, and national health care associations to ensure the continued development of e-Health initiatives. This study has managerial implications associated with the strategic application of e-Health systems and policy implications on future resource allocation.     

Dangerous diagnosis

Most policy experts assume that the public will have to make sacrifices if the health care system is overhauled. The public assumes nothing of the kind. The upshot could be a major political backlash against Bill Clinton and Congress.     

Government response to increased demand for public services: The cyclicality of government health expenditures in the OECD

The more that health care expenditures are financed by general taxation, the greater the discretion governments are likely to exercise when timing increases in health care expenditures. Vote-maximising governments time increases in health care expenditures to occur in economic upturns, when voters are not as aware of the required increase in taxation. In recessions, they have an incentive to sustain expenditures on health care by diverting expenditures from other public expenditure programmes that voters perceive as low priority. In this way, government pursuit of a political agenda is likely to exert a systematic influence on the cyclicality of government expenditure. Predictions are tested with reference to the cyclicality of government health expenditures, for a sample of OECD countries from 2000 to 2012.     

Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market

Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.     

“社会”是一个关键词：“五四解释学”反思

“五四”曾经作为一个政治事件进入了政治史关注的视野,也曾作为新文化运动的起源,扮演着代言自由主义个性解放的角色。但以往的“五四”研究越来越趋向于把政治和社会运动与“个性解放”的话语对立起来加以论证,以突出“五四”作为中国革命悲剧性命运开端的地位。这种“思想史分析”框架一度广为流行,成为对抗正统意识形态的重要依据。问题在于,过度强调“五四”个人启蒙遭遇挫折的一面,有可能遮蔽将“社会改造”的探索作为“五四”另一个内涵所具有的重要价值,从而不自觉地以西方的历史视角衡量“五四”的意义,最终忽略了中国现代历史转型更重要的一些面相。