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The role of the Occupational Health and Safety Administration (OSHA) is to promote the safety and health of working people by setting and enforcing standards, providing training, outreach, and education, establishing partnerships, and encouraging continual process improvement in workplace safety and health.
The Department of Public Health (DPH) is generally charged with the protection of the health and well-being of the state's population and environment. The Joint Commission is a nonprofit organization whose mission is to "continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations." The role of the Occupational Health and Safety Administration (OSHA) is to provide a safe and healthy workplace for their employees. The Centers of Medicare and Medicaid Services (CMS) is the federal agency that manages Medicare, which is the health insurance program for people over 65 years of age, people with certain disabilities under age 65, and those with end-stage renal disease (ESRD).
Hospitals receive the same payment for every patient with a given diagnosis, or who falls within a given DRG. If the cost of the patient's care is lower than the payment, the hospital makes a profit; if the cost is higher, the hospital incurs a loss. As a result, hospitals are placing greater emphasis on reducing costs, monitoring utilization of services, and limiting length of patient stay.
The role of nurses is specified by individual state boards of nursing and is termed scope of practice. Scope of practice is used to delineate actions that are legally permitted for a particular profession, based on specific educational qualifications. It behooves nurses to know and understand their scope of practice, as well as those of other professions with which they interact during patient care. Some actions are described as dependent, meaning that a specific action depends upon an order from a medical doctor (MD) or licensed independent practitioner (LIP). An example of a dependent action is a task such as administering medications that have been ordered. Other actions are interdependent and are done in a collaborative manner with others. These might include medication titration or participation in interdisciplinary rounds. Independent actions can be performed by the nurse without input from others. This type of action includes performing nursing assessments. Nurses may also delegate tasks to other colleagues, such as the taking of vital signs to nursing assistants. When a nurse delegates a task to another, the delegating nurse remains ultimately responsible for both the action and its outcome (Box 1-2).
Advances in technology have occurred with greater frequency during the past several decades than in all other periods of civilization. Sophisticated devices have revolutionized how disease is prevented, how patients are diagnosed and treated, and even how communication to and about patients is conducted. Advanced technology has provided access to faster, less invasive, and less painful testing and procedures. In fact, many tests and procedures that once required a hospital stay are performed routinely on an outpatient basis. A disorder that once may have required an operation for diagnosis many times can be diagnosed via computed tomography (CT) or magnetic resonance imaging (MRI). Computers are also significantly changing workflow, as medical records become completely electronic, resulting in improved communication among caregivers, efficient documentation, and ease of medical investigation and research.
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