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首页> 外文期刊>Journal of professional nursing: official journal of the American Association of Colleges of Nursing >Is health care payment reform impacting nurses' work settings, roles, and education preparation?
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Is health care payment reform impacting nurses' work settings, roles, and education preparation?

机译：保健支付改革是否影响护士的工作环境，角色和教育准备？

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Abstract This study explores nurses' work settings and educational preparation in the five years before passage of the Affordable Care Act (ACA) and five years after ACA passage, with the aim of identifying areas for nurse educators' attention. The study setting was one small state undergoing rapid transition away from fee-for-service service and thus provided the ideal laboratory to assess the impact of health reform on the nursing workforce. A secondary analysis of data gathered during relicensure compared the nursing workforce at an interval of one decade, with surveys in 2005 ( n =4075; 65% response rate) and in 2015 ( n =6723; 97% response rate). Findings demonstrated an increase in the proportion of nurses who reported working in ambulatory care and community settings ( p =0.001). However, there was no associated decrease in the proportion of nurses who reported working in hospitals. Among respondents who reported employment in the ambulatory care/community settings in 2005, 34.3% had a BSN or higher, a proportion that increased to 41.2% in 2015 ( p =0.010); nevertheless, the greatest proportional increase was among AD prepared nurses (34% to 48%). Although new nursing roles emerging as a result of health reform offer baccalaureate nurses the opportunity use the full complement of their knowledge and skills, these data suggest that BS prepared nurses are not fully accessing these opportunities. Implications for nursing education and further research are detailed. Highlights ? Nurses who reported working in ambulatory care and community settings have increased. ? In the study state, the greatest proportional increase was among AD prepared nurses. ? BSNs have not yet been seen as value-added in these settings or aren't available. ? As health care financing changes, new nursing roles will need to emerge.
机译：摘要本研究探讨了在经济实惠的护理法案（ACA）和ACA通道后五年内的五年内的护士工作和教育准备，目的是确定护士教育者注意的领域。研究环境是一个小型国家，正在远离服务费用服务，因此提供了评估卫生改革对护理劳动力的影响的理想实验室。在减重期间收集的数据分析比较了一十年的间隔，2005年的调查（n = 4075;响应率为65％），2015年（n = 6723; 97％的响应率）进行调查。调查结果表明，报告在动态护理和社区环境中工作的护士比例（P = 0.001）。但是，报告在医院工作的护士比例没有相关的减少。在2005年报告在205年的动态护理/社区环境中雇用就业的受访者之间，34.3％的BSN或更高，2015年增加到41.2％的比例（P = 0.010）;尽管如此，最大的比例增加是广告准备的护士（34％至48％）。虽然由于卫生改革提供的新出现的新护理角色，但是机会使用他们的知识和技能的全部补充，这些数据表明BS准备的护士无法充分访问这些机会。详细说明了护理教育和进一步研究的影响。强调 ？据报道，在守护护理和社区设置工作的护士增加了。还在研究状态下，最大的比例增加是广告准备的护士。还BSN尚未被视为在这些设置中添加的增值或不可用。还随着医疗保健融资的变化，新的护理角色将需要出现。

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