Recruiting Nurses in Rural Communities

Recruiting Nurses in Rural Communities B. Trimble Perceptions of nurse practitioner students on clinical rotations in rural health care areas, and the likelihood of practicing in a rural area. With the current primary care provider shortages in rural areas, could the key be the use of nurse practitioners, to ultimately, fill the gap in medical services? How satisfied are patients with a nurse practitioner’s services? How do communities recruit and keep nurse practitioners? What role do rural clinical rotations play in the recruitment of nurse practitioner graduates for practice in rural areas? Rural communities have difficulty recruiting and retaining primary care providers. With the number of aging providers looking at retirement and the lack of medical school graduates interested in primary care, the need will be further increased. The national shortage of primary care providers has many communities searching for help. Meeting the current needs is difficult and the need for services is expected to increase as the rural population ages and the enactment of the patient protection and affordable care act. Advanced practice registered nurses, whom studies show can provide care that is safe and as effective as a physician, are a powerful solution to the problem of the shortage in primary care providers and rising health care costs. There are currently 189,000 nurse practitioners, 35,000 nurse anesthetist, and 18,500 certified nurse-midwives in the United States according to the American Association of Nurse Practitioners (American Association of Nurse Practitioners, 2014). Nurse practitioners play a pivotal role in providing necessary medical care to the underserved of rural communities. A need for studies that examine the experiences of rural health care providers, to assess the barriers and the facilitators for nurse practitioner practice are needed. Offering mentorships, in the rural areas, may be another way to increase interest of the nurse practitioners in rural areas. As the new health care laws become effective, the need will increase. The purpose of this study is to examine how incorporating rural health rotations, in training of nurse practitioner students, may improve on the recruitment of nurse practitioner graduates into the rural healthcare sector. In rural health centers, nurse practitioners fill key leadership positions. In a study on rural health clinic efficiency and the impacts made by nurse practitioners and physician assistants, indicated that rural health centers that used nurse practitioners had a high rate for expertise in quality care and cost effectiveness (Ortiz, Wan, Meemon, Paeth, Agiro, 2010). The purpose of the study was to investigate the impact of nurse practitioners to rural health clinics yield, determine the association of proficiency indicators, and understand specific and organizational factors that affect productivity. The questions posed were as follows: Does rural health clinic’s performance vary contingent on nurse practitioner staffing? To what extent do nurse practitioners influence productivity? What are characteristics of highly productive rural health clinics? (Ortiz, Wan, Meemon, Paeth, Agiro, 2010). . The study suggests that, employments of higher portions of nurse practitioners has a definite stance on productivity, and are able to handle a larger number of patients without adding professional staff. Process efficiency in clinics with a large percent of licensed staff tends to use larger numbers of nurse practitioners. Clinic size is definitely associated with industrial efficiency. The larger the clinic’s professional percentage, the higher the efficiency or production observed. The clinics able to maximize the value of nurse practitioners are the most cost effective in providing health care amenities. The conclusion of the study was that the use of nurse practitioners and physician assistants increased productivity and cost effectiveness in clinics that maximized the use of these medical professionals. There is a need for further studies to determine the contribution of nurse practitioners. Future research would involve risk adjustment factors to assess the effects of patient demographics and socioeconomic aspects. In addition, the evaluation of observational information would provide a better understanding of the nurse practitioner involvments. (Ortiz, Wan, Meemon, Paeth, Agiro, 2010). In a study conducted by Ryan and Rahman in urgent care centers, to determine what factors influence the satisfaction of care provided by nurse practitioners, it was determined that the care provided was scored positive. The scores were higher for those noted to be uninsured as compared to those with insurance. A descriptive study including four urgent care centers using two to four nurse practitioners was used for the study. Two of the four urgent care centers were excluded from the study, due to weather conditions. Patients were asked to complete a post visit review and sealed in an envelope after completion. Participant inclusion was they had to be 18 years of age, be able to read, write and comprehend English. The survey contained five questions on demographics and thirteen items where ten assessed the clarity of the nurse practitioner role. Approval was granted from Shenandoah University IRB and the four participating urgent care centers. No enhancements were offered to participants for participation in the study. Examining factors that affect patient satisfaction, with nurse practitioners in rural urgent care centers studies showed that there was a high rate of patient satisfaction regardless of age, insurance, race, or gender. The clarity of the nurse practitioner role was significantly different between participants that were uninsured as compared to those with insurance. The uninsured rated the experience higher than those with insurance. The overall scores for satisfaction with care were positive. Several of the patients were unaware they were being treated by nurse practitioners until the after treatment survey. This implies that the care was comparable to what had been provided by physicians in the past. The American healthcare system has not been able to meet the demands for accessible, low-cost medical care. Rural areas face a shortage of healthcare providers as family physicians retire and current graduate physicians decide to enter into specialties rather than general practice. Nurs e practitioners can fill the gap in medical providers. The role of the nurse practitioner is on the increase in rural areas that are underserved and are well accepted by colleagues and patients. Nurse practitioners provide competent care; this and previous studies have confirmed that patients are highly satisfied with primary care provided by nurse practitioners (Ryan, 2012). In a qualitative study by Boynton Sharp, to explore the factors related to the recruitment and retaining of nurse practitioners in rural areas, it was determined that nurse practitioners are more likely to accept a position in rural healthcare after having completed at least one clinical practicum in a rural setting (Boynton Sharp, 2010). In this study, the sample size was 29 nurse practitioners from across the United States. The data collection method was semi-structured interviews. Analysis of categories and themes determined that three of the concepts of rural nursing theory were applicable. It was anticipated that the knowledge gained would contribute to understanding nurse practitioner choices to practice in rural areas, to determine the developing rural nurse practitioner educational programs and existing federal agencies involved in recruiting and retainment nurse practitioners, in rural areas. A qualitative study using a focused ethnographic approach was used to explore the cultural construction of rural nurse practitioner roles. A conceptual model analysis from the theory of cultural marginality was developed. The marginality framework was developed to provide a basis for data collection and analysis. Data set used interviews conducted using audio/video tapes of electronic media interviews through web conferencing, except two interviews were conducted by telephone. Data analysis was through transcription of interviews; at the end of the analysis three concepts from the rural nursing theory were identified. Lack of anonymity was subdivided into respect and annoyance. Outsider versus insider status was defined, not as being an insider in the community, but as an outsider in the medical community. Permission to conduct the study was granted by the University of Texas at El Paso’s IRB. Names of participants did not appear anywhere in the report or research. This study identified the three concepts of the rural nursing theory. In the study, the nurse practitioners did not find the lack of anonymity to be an annoyance, but viewed it as a part of being an effective medical care provider. The study indicated that nurse practitioners are well accepted by the community members. However, nurse practitioners are not always accepted by the existing medical community. Self-reliance was indicated by the nurse practitioner’s ability to function alone and make independent decisions related to their clinical practice. Due to differences between urban and rural care needs, it is important that nurse practitioner students be given an appreciation for the uniqueness and benefits of rural practice including a) limited access to healthcare, b) limited resources, and c) distance to specialists. This can be accomplished through changes in didactic and clinical components of nurse practitioner educational programs. Nurse practitioners who accept positions in rural areas most often have a background in rural areas, have participated in a rural training program, or have a desire to serve in a rural community. Completion of a rural program is associated with accepting a position in a rural practice. In this study, 72% of the nurse practitioners completed at least one rural clinical practicum. This supports the importance of rural training as an effective strategy in recruitment of nurse practitioners for rural areas (Boynton Sharp, 2010). In another study published by Purdue University (Richards, 2011) stated that as practitioner students are subjected to underserved populations, they are able to better understand the complicated clinical situation, which also confronts nurse practitioners to provide valuable and professional, high quality safe and cost efficient patient care. The practitioner students rotated through the clinics; this was found to improve the staff role in clinical knowledge, strengthen the evidence of clinically relevant research, and enhance the classroom instructions and assignments. The rotations made class instruction and assignments more meaningful when the students observed the instruction being used in a clinical setting. The experience integrated previous subject matter and allowed practitioner students to develop skills in a supportive and strengthened environment. Allowing students to perform alongside nurse practitioners, help to develop mentoring and educational relationships, regard for others capability, and improves comprehension of the nurse practitioner role. The staff roles shifted from the expert to a mutually supportive learning association (Richards, 2011). The advanced practice nurse can serve to fill the gap in primary health care. Nurse practitioners can provide quality, cost effective care to these communities, offsetting the limited access and rising health care costs. Access to primary health care is essential in maintaining and improving health. Those who have regular primary health care receive more preventative services, are more likely to comply with prescribed treatments, and have lower rates of illness and preventive deaths. To ensure recruitment and retainment of nurse practitioners in these areas, it is important to increase the nurse practitioner student experience with clinical rotations in rural or underserved areas. References American Association of Nurse Practitioners. (2014). NP Fact Sheet. Retrieved from AANP.org: http://www.aanp.org/all-about-nps/np-fact-sheet Boynton Sharp, D. M. (2010). Factors related to the recruitment and retention of nurse practitioners in rural areas. (3409167), 110. Ann Arbor, Mi, United States: ProQuest, LLC. Retrieved March 29, 2014, from http://search.proquest.com.southuniversity.libproxy.edmc.edu/docview/613695577?accountid=87314 Ortiz, J., Wan, T., Meemon, N., Paeth, S., Agiro, A. (2010, July/August). Contextual Correlates of Rural Health Clinics Efficiency: Analysis of Nurse Practitioners Contributions. Journal for Health Care Leaders, 28(4), 237-44. Retrieved March 20, 2014, from http://www.medscape.com/viewarticle/729490_1 Richards, E. (2011). The role of nursing students at two rural nurse managed health clinics. School of Nursing Faculty Publications (paper 4). Purdue University. Doi:10.1080/07370016.2011.539086 Ryan, K. D.-C. (2012, February 1). Examining Factors Influencing Patient Satisfaction With Nurse Practitioners in Rural Urgent Care Centers. Journal of American Academy of Nurse Practitioners, 24(2), 77-81. Doi:10.1111/j.1745.7599.2011.00688.x

Iran Nuclear Program

I) Introduction Iran started their nuclear program since 1979 and claimed that the purpose is â€Å"for peaceful† but the West believes that Iran is developing weapons. The UN’s International Atomic Energy Agency published a report which complained that it had been unable to â€Å"provide credible assurance about the absence of undeclared material and activities in Iran† and that it continued to have â€Å"serious concerns regarding military dimensions to Iran’s nuclear program†. II) Content 1) The military force Iran wants to build deliverable nuclear weapons quickly and it may well want, at some points, to develop the bombs themselves. This is deeply worrying to Israel ( tai vi sao). _ It also alarms nearby states, which fear Iranian power and could lead some of them – Saudi Arabia, Egypt, perhaps Turkey – to seek nuclear weapons of their own. Many fear that this would make the region which is not stable much more terrible. _ The pos sibility of an Iranian bomb comes closer with every revolutions of the centrifuges in its underground enrichment plants.Israel’s director of military intelligence, General Kochavi, says that Iran has obtained 4 tones of uranium enriched to 3. 5% and another 100kg enriched to 20%. It could possibly enrich from 20% to 90% and thus, the uranium would be enough for up to four nuclear weapons. General Kochavi says that it would only take the Iranians a year to make a crude device and another one or two years to put together a nuclear warhead that would fit on a ballistic missile. _ For Israel, there is no more opportunity to effectively deal with the Iranian.Although Iran has shown some intent to return to the bargaining table with the West, little progress made in the past and Iran continues expand its uranium-enrichment capabilities with the ongoing installation of centrifuges at Natanz and Fordow, which is known as its two enrichment plant. _ Although Israel likes the use of sa nctions to make Iran stop its nuclear activities, there appears to be an implicit assumption within Irael that the military force would be required to prevent Iran from developing nuclear weapons.Even the attack would be costly; Israel considers it to be a â€Å"price worth paying to remove what it considers to be an existential threat to the country†. ( Nuclear Fallout) 2) The Sanction It is true to say that If Iran were to gain a weapon only for its own protection, others in the region might then feel they need weapons too. â€Å"Saudi Arabia has said it will arm- and Pakistan is thought ready to supply a bomb in exchange for earlier Saudi backing of its own program. Turkey and Egypt, the regional powers, might conclude they have to join the nuclear club. † A Middle East with five nuclear powers riven by rivalry and sectarian feuds, each would have its fingers permanently twitching over the button, in the belief that the one that pressed first would be left standingà ¢â‚¬ . There’s no wonder that some people want a pre-emptive strike. However, military action is not the best solution for stopping the nuclear program in Iran. There are 3 reason why military force is not an option: First, even Israel was successful in solo missions against the weapons program of Iraq, in 1981, and Syria, in 2007; striking Iran would be much harder.Iran’s sites are spread out and some of them demand repeated hits. Iran has a number of nuclear and related missile facilities – some with hardened features- that are widely dispersed across the country, with the most well protected facilities in Iran. If an attack were designed to damage Iran’s ability to construct a nuclear weapon, it would be necessary to destroy four main targets : the uranium-enrichment halls at Natanz and Fordow; the Arak reactor and Iran’s existing stockpile of enriched uranium. All of them located in hardened area which make them difficult to be destroyed in an air launched attack.The Natanz underground plant is constructed of two-meter thick concrete walls and buried beneath estimated 10 meters soils, making it challenging target. The Fordow uranium-enrichment facility located in Tehran would be even be more difficult site for Israel to destroy since it is deeply buried in rugged mountain terrain. A successful air-launched attack on this facility would need to penetrate through a considerable volume of the mountain to collapse the facility’s interior space, which Israel munitions would struggle to achieve, and although any centrifuges operating during an attack would probably be destroyed from the ground shock, they ould be replaced relatively quickly if the facility survived and the required equipment were available. The biggest question is whether an Israel strike would have any impact on the centrifuge chamber at Fordow, said to be buried 80 meters deep. The answer is: Yes, there could be a 35% ~ 90% chance of the Israel weapon s arriving at just the right place and at least one bomb would penetrate the facility if the Israel military use the F-15Is aimed the GBU-28 and GBU-27 and repeat hit several times. But even if things went off, Iran would retain the capacity to repair and reconstitute its program.Even a successful Israel strike might thus delay Iran’s progress by only three or four years. An American attack might gain five years or even ten; it could drop more bombs on more of the sites, and much bigger bombs – its B-2s carry GBU-57, weighing almost 14 tones. An American attack thus remains a possibility, and will continue to be one up to the day Iran fields weapons. But America is unlikely to rush into a strike following an Israel mission. American has its own reason not to attack Iran now. Iran is a vast populous and sophisticated country, thus, it may have secret sites to escape.Even if all its sites are hit, Iran’s nuclear know-how cannot be bombed out of existence. Nor can its network of suppliers at home and abroad. Perhaps America could bomb Iran every few years. But how would it know when and where to strike? The fail of American strike in Iraq and Afghanistan has demonstrated that a war could raise the threat of retaliation. The idea that a bomb is the only defense against an American enemy might become stronger than ever. There’s no doubt that America prefer to wait and that is one reason why it is seeking to hold Israel back.Second, the West is implementing the sanction which is designed to get Iran stop enrichment and the nations concerned about centered on sanctions as their favored policy tool. It is true that sanctions have not achieved their strategic goal of changing Iran’s nuclear policy. Nor have they met tactical success in bringing Iran return to the negotiations nuclear program. But sanctions are helping to limit Iran’s ability to quickly assemble a nuclear weapon. Sanctions have helped to restrict Iran’s a bility to employ its advanced centrifuges in larger numbers. The UN Panel of Experts Established Pursuant to Resolution 1929 concluded in May 2011 report that Iran has difficulty producing some of the critical â€Å"choke points† items that are necessary to sustain and advance its centrifuge enrichment program. † The Panel of Experts’ also concluded that sanctions are blocking the trade of items related to nuclear and missile activity and thus slowing development of the programs. Iran’s missile program is dependent on foreign supply of items such as aluminum powder for production of fuel.Previously, Iran has been purchased the powder item from China but in recent months, Chinese have tightened controls on such exports. As a result, the sanction made Iran to change suppliers, which in turn is considered as difficulties to missile engineers. Additionally, the sanctions are restricting Iran’s ability to use the international financial system in support of illicit trade. â€Å"Following the EU decision, there is only one Europe-based financial institution – the Paris branch of Bank Tejarat – is available for use of Iran today. More importantly, Iran is unable to conduct business in either dollars or Euros. It therefore cannot repatriate payment except through barter. â€Å"As of August in 2011, Iran had over $20 billion locked up in escrow accounts in China, $3. 4 billion in India and almost $4 billion in South Korea. â€Å" Even though it is not a purpose of the sanctions to restrict Iranian trade overall, they are contributing to unemployment and inflation which are reported to be 15% in Iran. There also are reports of food shortages, hoarding and a drying up of investments.Foreign reserves are running low and the economy is becoming distorted as legitimate trade shifts to the informal sector. Iran is facing a higher cost of doing business. However, America still wants to put stricter sanction which target Iranà ¢â‚¬â„¢s central bank by penalizing any foreign financial institutions doing business with it. As a result, the European Union has imposed an embargo on Iranian oil. Iran’s economy is mostly reliant on oil and gas exports, which account for 50% ~ 70% of the government’s revenues. Thus, it is estimated that Iran’s oil exports may fall about 60% of their former level. Finally, Conclusion

How the Declaration of Independence and Bill of Rights...

The English Colonies was a hard place to live in with the Sugar Act, the Stamp act, and the monarchy trying to rule our every move . England was trying to pay for all their previous debts in other wars and took it out on the colonist. The English Colonies decided to revolt against England and won their independence, this war was known as the American Revolution. The United States was starting to look like a place where people would want to live, because there was no monarchy and a government that all white men can vote on. After the United States established independence the government ruled under the Articles of Confederation, and this was better than being ruled by England but was not what everyone thought it would be. Then after work and thought by the country leaders we now live under the Declaration of Independence and the Bill of Rights. There have been had rough times for the people of the United States and still is more to come. Right after the American Revolution there was s ome post war debt that effected most of the population in the United States, especially poor artisans and subsistence farmers . It was really rough at first for families to make it and not lose their houses, business, and farms to foreclosure. Financier Robert Morris took global perspective and opened a new trade route to the orient. The Empress of China sailed to Canton, China’s foreign commerce, and made a profit of $20,000 on the items they sold to China. After the return of Empress of ChinaShow MoreRelatedArgumentative Essay On The Declaration Of Independence1624 Words   |  7 PagesThe Declaration of Independence was an important document in American history but it does not mean that it gained us our true freedom. It was a document that was written and signed on July 4th, 1776. 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Starbucks and teavana Free Essay Example, 1000 words

This liquidity is desirable on the part of Teavana, who may in turn do anything it wants with the money. The shareholders are not tied to Starbucks in any way after the deal closes, because of the cash nature of the transaction. Given this liquidity, Starbucks has additional leverage in haggling for a lower purchase price, as compared to if the deal was arranged as a stock swap, or as being paid for by a combination of equity as well as debt. The idea is for Starbucks to leverage the liquid, all-cash nature of the intended purchase to sweeten the terms and to make sure that is is able to get the biggest concession/discount possible for any purchase price negotiation (Hedges, 2013; Sherwin, 2013; Weiss and Hughes, 2014; Baertlein and Geller, 2012; Ashworth, 2012). The liquid position of Starbucks is a leverage that can be tapped to negotiate for the best price for the acquisition/merger, and as discussed above, it can certainly be used to lower the price for the deal. At the same time, that Starbucks is also bringing to the table its excellent brand and operations, and its wealth of experience developing a global presence for its products and its stores. We will write a custom essay sample on Starbucks and teavana or any topic specifically for you Only $17.96 $11.86/page