医師不足には看護士の活用を/米国医療事情

 米国医学研究所は火曜日、医療改革による医師不足にたいして看護士を活用してより多くの医療行為を行う教育と権限の両方を持たせるべきであるとの報告を公表した。高価な米国の医療制度を改革するための鍵になると言う。
 しかし、約12万人の医師を代表する米国医師会は直ちにこの報告を批判した。看護士は医療に不可欠であり、看護士と医師の両方が不足することになるので、医師不足に対する答えとは言えないという。
 3月に承認された米国医療改革法により、3200万人の米国人が健康保険に加入すると見られている。医学研究所を含むいくつかのグループは、治療にあたる医師の不足を予測している。先月、米国医科大学協会は、2015年にはさらに63,000人の医師が必要であろうということを示した新しい試算を発表した。
 このギャップを埋める看護士の機能について数十年の間に蓄積してきた証拠を評価した」とコロンビア大学公衆衛生のジョン・ロウ博士(リポートの著書の1人)は言う。米国には300万人を超える看護士がいる。州、連邦機関、および医療組織が、看護士がすることができることを制限するいわゆる「実行の範囲」の関門を取り除くべきであるという。
 2020年までに、看護婦の80%が少なくとも学士号を持つべきであり、10%が博士号学位を続けて取るべきであるとリポートは勧めている。

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Doctor shortage looming? Use nurses, report says
http://www.reuters.com/article/idUSTRE69445L20101005

By Maggie Fox, Health and Science Editor
WASHINGTON | Tue Oct 5, 2010 2:35pm EDT

画像Nurses can handle much of the strain that healthcare reform will place on doctors and should be given both the education and the authority to take on more medical duties, the U.S. Institute of Medicine said on Tuesday.

A report from the institute calls for an overhaul in the responsibility and training of nurses and says doing so is key to improving the fragmented and expensive U.S. healthcare system -- President Barack Obama's signature political initiative.

"We are re-creating nursing in America," Dr. Risa Lavizzo-Mourey, president and CEO of the nonprofit Robert Wood Johnson Foundation, said at a news conference.

"We believe that this report and the implementation of its findings is vital to the strength of healthcare in this nation," she said.

But the American Medical Association, which represents about 120,000 practicing physicians as well as students and resident doctors, quickly criticized the report.

"Nurses are critical to the health care team, but there is no substitute for education and training," the group said in a statement. "With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage."

Nurses already often deliver babies, counsel patients with heart disease or diabetes and care for dying cancer patients -- and these roles should be expanded nationally and paid for by both public and private insurers, the report says.

"Nurses have to be full partners with doctors," said Donna Shalala, a former Health and Human Services secretary who helped write the report. She said it should "usher in golden age of nursing" by allowing nurses to practice "to the full extent of their education and training."

DOCTOR SHORTAGE ANTICIPATED

The U.S. healthcare reform law passed in March is expected to add 32 million Americans to health insurance company rolls. Several groups, including the Institute of Medicine, have forecast shortages of doctors to provide care.

Last month, the Association of American Medical Colleges released new estimates that showed 63,000 more doctors would be needed in 2015 than would be available.

"We evaluated the evidence which has been accumulating now for decades as to the capability of nurses to bridge that gap," said Dr. John Rowe of the Columbia University Mailman School of Public Health, one of the report's authors.

"There have been concerns in the past that nurses could provide the quality and safety for some areas of primary care. The committee concluded that it was very clear from the evidence that nurses can very effectively and safely ... deliver those primary care services."

The United States has more than 3 million nurses, making them the single-largest segment of the healthcare workforce, said the nonpartisan institute, which advises the federal government on medical matters.

It said states, federal agencies and healthcare organizations should remove so-called "scope of practice" barriers that limit what nurses may do.

The U.S. government and non-profit organizations should fund grants and scholarships to allow nurses to further their educations so they can take on bigger responsibilities.

"We really need to use nurses to their full potential," Shalala said.

By 2020, 80 percent of nurses should have a bachelor's degree at least and 10 percent of them should go on to get a doctorate degree, the report recommends. Many nurses now practice with a two-year certificate.

(Editing by Bill Trott and Xavier Briand)
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The Future of Nursing: Leading Change, Advancing Health
http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Released:
October 5, 2010
Type:
Consensus Report
Topics:
Health Care Workforce, Quality and Patient Safety, Health Services, Coverage, and Access
Activity:
Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine
Board:
Studies under the IOM Executive Office

With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well- positioned to lead change and advance health.

In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing. Through its deliberations, the committee developed four key messages:

* Nurses should practice to the full extent of their education and training.
* Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
* Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
* Effective workforce planning and policy making require better data collection and information infrastructure.

The United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation. However, the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; government, businesses, health care organizations, professional associations, and the insurance industry all must play a role. Working together, these many diverse parties can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes.

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