Academic progression models in nursing: design decisions faced by administrators in four case studies.

Although nursing education pathways have expanded access to the profession, fragmentation accompanying these entry points has created uncertainty among students about the desired end point, questionable efficiency and effectiveness of reaching career goals, and unclear merging mechanisms to enable seamless, linear progression. In response to these challenges and in anticipation of greater demands on nurses due to health reform, the Institute of Medicine (IOM) examined the capacity of the nursing workforce and proposed a transformative blueprint for change that relies on an education system to promote seamless academic progression. Despite support for this recommendation, little research exists regarding the best way to achieve the IOM's vision. This study examined the most promising practices in design and implementation of alternative pathways for academic progression in nursing. Four case studies are presented that explore the challenges of designing alternative pathways and identify performance measures to assist with developing such programs.

U.S.-based recruitment of foreign-educated nurses: implications of an emerging industry.

OBJECTIVES: Despite an increase in the number of foreign-educated nurses (FENs) working in U.S. hospitals and nursing homes, very little is known about the industry that brought them here. Our objectives were to learn more about the size and scope of the international nurse recruitment industry, its business models, and the range of countries where companies actively recruit. Based on reports from focus groups of FENs in New York City, we also sought to identify some of the problems that have occurred in the areas of contracting and clinical orientation. METHODS: We used a combination of qualitative methods and secondary data sources, which included U.S.-based international nurse recruitment company Web sites, interviews with 20 executives from international nurse recruitment companies, two focus groups with FENs in New York City, and letters sent to the Philippine Nurses Association of America by FENs seeking legal advice. RESULTS: Through a July 2007 Internet search, we found that at least 273 U.S. companies were actively recruiting FENs. While most such companies focused on the Philippines and India, about 20 companies were active in Africa. (A second search revealed that, as of January, at least 211 U.S. companies were actively recruiting FENs abroad.) Within the industry there is growing use of the staffing-agency model, which typically requires nurses to sign 18-to-36-month contracts and imposes high breach-of-contract fees. The focus group discussions with FENs in New York City revealed inadequate orientation programs and several types of labor abuses. CONCLUSIONS: Concerns about recruitment practices, which were expressed by many industry executives and FENs, reveal the need for accountability within the industry.

Health insurance coverage in Central and Eastern Europe: trends and challenges.

Health insurance systems in Central and Eastern Europe have evolved in different ways from the centralized health systems inherited from the Soviet era, but there remain common trends and challenges in the region. Health spending is low in comparison to the spending of pre-2004 European Union members, but population aging, medical technology, economic growth, and heightened expectations will generate major spending pressures. Social health insurance is the dominant model in the region, but coverage is uneven. Key3reform issues include identifying ways to encourage additional investment in the health sector; and defining formal benefit packages, copayments, and the role of private insurance.

Beyond the sound of one hand clapping: experiences in six countries using health equity research in policy.

In an attempt to better understand the complex and sometimes tenuous relationship between health equity research and health policy, we undertook a collaborative comparison of six case studies with researchers from the United States, the United Kingdom, the Netherlands, China, South Africa, and Chile. Patterns in factors contributing to governments' interest in research included the role of domestic advocacy, interest in their international standing, and the existence of internal government champions. Strategies used by researchers to promote their findings included carefully crafting messages and selecting messengers in accordance with their audience's concerns, delaying publication until interactions with policy makers had occurred, monitoring public opinion, and a host of ideas relating to the style and content of government-sponsored commission reports. Most of the similarities crossed the developing/developed country divide, although it did appear that in the three case studies from the north, greater attention was paid to the professional legitimacy of institutions, individuals, and journals, while in the three developing countries the existence of trusted personal messengers appeared essential. While there are no prescriptions for ensuring the use of health equity research in policy, the comparison across such different international settings stimulated participants to question their assumptions about what works, when, and why.

Care management in Germany and the U.S.: an expanded laboratory.

Germany and the U.S. share a keen interest in exploring the potential of care management programs for the chronically ill. Despite obvious health system differences, in both countries there has been a proliferation of disease management models, initiated by a variety of actors, paid for in different ways, targeting different types of population groups, and encompassing a broad menu of interventions and services. Comparison of three case studies from the U.S. and four from Germany reveals greater differences among models within countries than between them.

The medicine cabinet: what's in it, why, and can we change the contents?

The failure of the pharmaceutical industry to produce drugs for common chronic diseases, emerging diseases, and the potential threats of bioterrorism or the spread of tropical diseases contrasts sharply with the industry's output of lifestyle and "me-too" drugs. In this paper we review the decision-making process that resulted in our current portfolio of medicines and offer several alternatives to better align business incentives with medical need.