The reluctance to refer patients to specialists may also mean that nurses must practice more holistic, rather than specialized forms, of nursing. The desire for cost containment has resulted in many nurses assuming physician's duties, such as those duties confined in previous eras to the patient's primary care physician. In states with high HMO (Health Maintenance Organization) enrollment, more nurses were shifted to lower-paying nonhospital settings, such as in home health care settings, to defray costs (Buerhaus & Staiger 1996).

What affect has manage care had on nursing education?

Surprisingly, the majority of nursing schools still do not work with a managed care organization or with physician training programs to facilitate educating student nurses in managed care competencies. However, 57% of hospitals do offer continuing education to staff members though educational seminars, staff meetings, and other programs (Copeland 2003, p.2-3). Although the managed care system is likely to change in...
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