Shaping nursing profession regulation through history - a systematic review.

AIM: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. BACKGROUND: An in-depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. INTRODUCTION: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio-contextual circumstances upon which governments made regulatory changes. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and an inductive thematic approach for synthesis. RESULTS: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. DISCUSSION: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. CONCLUSION: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. IMPLICATION FOR NURSING AND HEALTH POLICY: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally.

Multistate licensure: opportunities for nurses to practice in new ways.

The first state board of nursing came into being in 1903. It was not until about 1980, however, that the last state passed legislation mandating licensure for all RNs. Traditionally, RNs had been licensed to practice only within their state licensure and were required to be re-licensed for every other state in which they wished to practice. This article examines multistate licensure and how this practice will open up wider opportunities for today's registered nurses.

Outsourcing: a managerial competency for the 21st century.

The widespread application of outsourcing has been fueled by the changing nature of the work contract between employers and employees. The large-scale corporate downsizing that began in the late 1980s inspired a trend away from employer loyalty. This fact, coupled with today's tight labor market, has created a "guerrilla" work force comprised of deal-hungry professionals conditioned to signing bonuses, stock options, and higher-than-scale salaries.

Quality wound care equals cost-effective wound care: a clinical model.

The cost of wound care frequently is defined as the cost of materials and labor, ignoring the effect of both variables on outcome. As a result, money-saving measures actually may increase cost while reducing the quality of care. Definitions and tools to enable professionals to understand, evaluate, and compare the cost-effectiveness of wound care practices and treatment modalities are given.

Quality wound care equals cost-effective wound care: a clinical model.

The cost of wound care is often defined as the cost of materials and labor, ignoring the effect of both variables on outcome. As a result, money-saving measures may actually increase cost while reducing the quality of care. Definitions and tools to enable professionals to understand, evaluate and compare the cost-effectiveness of wound care practices and treatment modalities are given.

Nursing: the hospital's competitive edge.

The health care marketplace is becoming increasingly competitive. The hospital has a built-in marketing force with the nursing department, because nurses are in constant, direct contact with the customer. Nursing must identify the case mix profile of the community and focus the hospital product lines to meet community needs. The nursing department should decentralize, change, measure, and innovate the staff mix needed to operationalize these product lines. The development of nursing practice standards for the case mix will help to identify the staff mix needed and create systems to efficiently manage the product lines. Nursing management must become aware of cross-subsidization and downward skill substitution of nursing personnel. Nursing information systems must generate quality reports that invoke cost consciousness on the part of nursing staff. Quality assurance programs must become unit based and complete with frequent audits to correlate length of stay with nursing quality. Correlations must be determined between nursing productivity and case mix to determine the hospital's niche in the marketplace. The transformation of health care into a competitive business industry has created many opportunities for nursing. The health care industry's incentives for efficiency along with the decreasing demand for inpatient hospital services will be the forces driving health care toward a competitive marketplace. The hospital's nursing department should be strategically positioned to become accountable for increasing market share and enhancing quality patient outcomes. The focus has shifted from the theoretical to the tactical, which is a step in the right direction, particularly for nursing. Nursing, if strategically positioned, will not only thrive but will also excel in this chaotic environment by capturing the opportunities and being innovative.

DRGs: a new era for health care.

The DRG system classifies patients according to their resource consumption, based on their medical diagnosis. It was originally developed at Yale University and later studied in New Jersey. This resulted in its implementation as a pricing system. It incorporates the clinical and financial information, through the use of the patient record, resulting in the generation of information for managers to use in making decisions to run their operations. Although it began as the Medicare prospective pricing system for acute inpatient settings, it has extended to other third party payers and beyond the hospital. The changes and challenges that this new system has brought about has presented numerous opportunities for nursing.