ulcers; fractures, dislocations, intercranial injury, crushing injury, and burns; catheter‐associated urinary tract infections; vascular catheter‐associated infections, object left in patient during surgery, air embolism, blood incompatibility, and mediastinitis after coronary artery bypass graft). Medicare no longer pays hospitals for these conditions (Waxman, 2008). Clearly the nurse of the future must be educated about never events. The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to gross medical errors like wrong‐site surgery that should never occur. Over time, the term's use has expanded to signify adverse events that are clearly identifiable and measurable, resulting in death or significant disability, and usually preventable. Since the initial never event list was developed in 2002, it has been revised multiple times, and now consists of 29 “serious reportable events” grouped into seven categories (Abimanyi‐Ochom, Jones, & Cheng, 2019). The latest list from 2016 includes:
1 Surgical or invasive procedure events
2 Product or device events
3 Patient protection events
4 Care management events
5 Environmental events
6 Radiological events
7 Potential criminal events
A complete listing, including the subcategories, is available at www.qualityforum.org
Nurse Shortages
Until recently, shortages of nurses have been cyclical. These nurse shortages are associated with increased demand for patient care services at a time of falling nursing school enrollment, salary compression, and nominal increases in wages. The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age. According to a 2018 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 50.9% of the RN workforce is age 50 or older. The HRSA projects that more than 1 million registered nurses will reach retirement age within the next 10–15 years. The RN workforce was expected to grow from 2.9 million in 2016 to 3.4 million in 2026, an increase of 438,100 or 15% (ANA, 2019). According to the Bureau of Labor Statistics' Employment Projections 2016–2026, it projects the need for an additional 203,700 new RNs each year through 2026 to fill newly created positions and to replace retiring nurses. The current nursing workforce has 56% of RNs prepared at the baccalaureate or graduate degree level. The AACN reported a 3.7% enrollment increase in baccalaureate programs in nursing in 2018. According to AACN's report on 2018–2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away more than 75,000 qualified applicants from baccalaureate and graduate and nursing programs in 2018. Changing demographics signal a need for more nurses to care for our aging population. Issued in May 2014, the U.S. Census Bureau report on An Aging Nation: The Older Population in the United States, found that by 2050 the number of U.S. residents aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.13 million in 2012. With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases and comorbidities. With an aging nursing workforce (Norman et al., 2005), more nursing faculty is needed to train larger numbers of students.
Case Study 2.2
Review the ratings of hospitals in your area of the country at www.healthgrades.com, www.hospitalcompare.hhs.gov, www.100tophospitals.com/top-national-hospitals, and the U.S. News & World Report Best Hospitals, annual ranking, available at http://health.usnews.com/best-hospitals
What kinds of ratings are given to hospitals in your area?
Review the criteria and evaluation system used to rate the hospitals. Is it valid and reliable?
Will you choose a hospital for your own family's care using a rating system like this?
American Nurses Association
The ANA is a full service, professional organization representing the nation's entire RN population. The ANA represents the 4 million RNs in the United States through its 54 constituent state and territorial associations. The ANA's mission is to work for the improvement of health standards and availability of health care services for all people, foster high standards for nursing, stimulate and promote the professional development of nurses, and advance their economic and general welfare (ANA, 2019).
The National Labor Relations Board (NLRB) recognizes the ANA as a collective bargaining agent. The fact that the ANA has a dual role of being a professional organization and a collective bargaining agent causes controversy. Some nurses believe that unionization is not professional and that the ANA cannot truly support nursing as a profession if it is also a collective bargaining agent. Nurse managers are excluded from union membership. The ANA lobbies Congress and regulatory agencies on health care issues affecting nurses and the general public. The ANA initiates many policies involving health care reform. It also publishes its position on issues, ranging from whistle blowing to patients' rights. The American Nurses Credentialing Center (ANCC), a subsidiary of the ANA, created the Magnet Recognition Program to recognize health care organizations that provide the very best in nursing care. Since 1994, many institutions have received this award.
In this chapter, we have explored how health care is organized and financed in the United State, compared U.S. Health care with that of other industrialized countries, identified major issues facing health care, and related efforts for improving the quality, safety, and access to health care. Staying abreast of U.S. health care and health care in other countries is part of being a registered nurse and understanding the environment in which we work.
KEY CONCEPTS
Health care reports provide invaluable information that emphasizes the successes and failures of health care throughout our nation.
Evidence of significant disparities and low quality continue to demonstrate the need for significant health care improvement.
Today, leaders, managers, and staff need to be aware of and involved in the ongoing processes of the making of health policy.
Health care systems have three simple components: structure, process, and outcome.
The United States is one of only a few advanced countries in the world without a universal system of health care.
In the United States, the emphasis on acute care health care services has successfully driven health care costs higher, but has not necessarily improved the quality of care or patient outcomes.
Primary care provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
Patients and clinicians need to work together to appropriately utilize services based on the following four foundations of primary care: First Contact, Longitudinality, Comprehensiveness, and Coordination.
The federal government is a major driver of health care organization and delivery.
Today, almost as many persons receive health care in the home as receive health care in acute‐care
