The revised inpatient payment rule from the Centers for Medicare and Medicaid Services has the potential to significantly affect the delivery of nursing care in hospitals. Scheduled to take effect October 1, the new rule disallows additional payments for eight conditions, such as infection, that were not present on admission and could presumably have been prevented. According to a report released by the George Washington University Department of Nursing, because these conditions are associated with nursing care, it's hoped that the rule change will be a catalyst for "investing in nursing, including staffing resources, to mitigate and prevent these complications." The report was funded by the Robert Wood Johnson Foundation and is available at http://www.rwjf.org/files/research/ippswhitepaper2007.pdf.

Retail health clinics may be the next battleground for turf wars, as physician groups urge states to impose tougher restrictions on these mostly nurse-managed centers for minor acute care problems (see AJN Reports, July 2007). The Wall Street Journal reported in August that California requires the clinics to be owned by physicians, and Massachusetts proposed regulations limiting the number of visits a patient could make to a clinic and forcing clinics to refer patients to primary care physicians. But groups are pushing back-and not just nurses. In November the National Business Group on Health-a nonprofit organization that seeks to find "innovative and forward-thinking solutions" for health care and comprises 288 companies-issued a position statement supporting retail clinics.

"Pandemic fatigue" is the term used to describe the malaise that appears to have dampened efforts to prepare for an influenza pandemic. Most experts say that a pandemic is inevitable, but after a flurry of media reports, attention and planning on the local and household levels have abated. The American Academy of Pediatrics raised concerns last October because of the lack of preparation for treating and caring for children during a pandemic. For example, the national stockpile contains only 100,000 doses of antiviral medications for children, and there are no child-size N95 respirators.

Sobering Statistics

$1 trillion: The estimated annual cost burden of chronic disease in the United States

45.3 million: The number of adult smokers in the United States, representing 20% of the adult population

33 million: The number of people infected with HIV globally

1 to 2 million: The estimated number of people over 65 years of age who have been abused or mistreated

1 million: The number of cases of chlamydia reported in the United States (2006 data), the most ever

535,900: The estimated number of maternal deaths worldwide in 2005 (the most recent data available), half in sub-Saharan Africa

340,000: The number of unfilled nursing positions in the United States in 2020 if current trends continue

154,000: The number of people in the United States under the age of 20 diagnosed with diabetes

Maureen Shawn Kennedy, MA, RN, news director