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Showing papers on "Workforce published in 1994"


Journal ArticleDOI
TL;DR: In this paper, the authors argue that the notion of national systems of innovation is a useful one, since it treats explicitly what was ignored in earlier models of technical change: namely, deliberate "intangible" investment in technological learning activities that involve a variety of institutions (principally business firms, universities, other education and training institutions, and governments), links amongst them and associated incentive structures and competencies.
Abstract: We shall argue that the notion of ‘national systems of innovation’ is a useful one, since it treats explicitly what was ignored in earlier models of technical change: namely, deliberate ‘intangible’ investment in technological learning activities that involve a variety of institutions (principally business firms, universities, other education and training institutions, and governments), links amongst them and associated incentive structures and competencies. Considerable diversity–indeed divergence–exists amongst OECD countries in the level and sectoral pattern of business investments in technological learning, and in the quality of support structures in basic research and workforce skills. Some of this international ‘diversity’ is not economically and socially desirable: in particular, persistently low investment in business R & D and related technological activitics, and in associated workforce skills, which help determine both long-term economic growth rates, and the level of national demand for basic ...

491 citations


Journal ArticleDOI
20 Jul 1994-JAMA
TL;DR: It appears that national health reform--based largely on an expansion of managed care networks--will have significant impact on the US physician workforce, and the issue is not so much a primary care provider shortage as a specialty care surplus.
Abstract: This article provides an estimate of the effects of health reform on the US physician workforce requirement. Its basic methodology is to extrapolate current patterns of staffing within managed care plans to the reshaped health care system of the year 2000. In this analysis it is assumed that 40% to 65% of Americans will be receiving care from integrated managed care networks in the near future, and that all citizens will be covered by some type of health insurance. On the basis of these assumptions, this article forecasts that in the year 2000, (1) there will be an overall surplus of about 165000 patient care physicians; (2) the requirement and supply of primary care physicians will be in relative balance; and (3) the supply of specialists will outstrip the requirement by more than 60%. In summation, it appears that national health reform—based largely on an expansion of managed care networks—will have significant impact on the US physician workforce. Concerns have been raised by others that health system reform's shift toward more primary and preventive care will be stymied by workforce availability. This study underscores this concern to some degree. However, the evidence presented herein suggests that the issue is not so much a primary care provider shortage as a specialty care surplus. (JAMA. 1994;272:222-230)

402 citations



Journal ArticleDOI
TL;DR: In this article, the results of a national postal survey of employers' attitudes and policies towards older workers supported by the ESRC were reported, and the survey's key findings are discussed in the context of older workers.
Abstract: This article reports the results of a national postal survey of employers' attitudes and policies towards older workers supported by the ESRC. The survey's key findings are discussed in the context...

267 citations


Journal ArticleDOI
TL;DR: This article analyzed a sample of 688 establishments to estimate multivariate models of the relationship between employer-provided job training and organizational size, unionization, and workforce composition in most multivariate equations.
Abstract: We draw hypotheses about the factors related to company provision offormal job training programs from diverse theoretical perspectives and research findings. Using data from the 1991 National Organizations Survey, we analyze a sample of 688 establishments to estimate multivariate models. The relationships between employer-provided job training and organizational size, unionization, and workforce composition are reduced or eliminated in most multivariate equations. Employer-provided training is most extensive in establishments with elaborate internal structures that operate in complex market environments. The job-training practices of U.S. employers affect employees from the executive suite to the loading dock, enhancing skills from basic literacy to interpersonal sensitivity. A new training ideology is rapidly eclipsing the traditional segmented pattern-a pattern in which universities educate the professionals and technicians, companies prime the executives, unions apprentice workers in the skilled trades, and government prepares the disadvantaged. Facing competitive world economic pressures that have eroded America's market positions, employers are now using job training as one means of coping with changes fostered by technological innovation, market competition, organizational restructuring, and demographic shifts. Although training is an integral part of the employer-employee relationship, direct evidence about company training practices based on representative samples of diverse employing organizations is almost nonexistent. Most previous research has drawn on either self-reported labor force surveys or highly restricted samples of organizations (typically skewed to very large firms). We examine hypotheses about employer-provided job-training practices in the early 1990s, using a national survey of U.S. work organizations.

213 citations


Journal ArticleDOI
TL;DR: In fact, temporary employment is now a $20 billion a year business as mentioned in this paper, and more than 20 percent of all the new positions created in the U.S. economy were temporary jobs.

212 citations


MonographDOI
TL;DR: In this paper, the authors compare evidence on the returns from worker training in the United States, Germany, France, Britain, Japan, Norway and the Netherlands and conclude that training in a workplace is more effective than training in schools.
Abstract: How can today's workforce keep pace with an increasingly competitive global economy? As new technologies rapidly transform the workplace, employee requirements are changing and workers must adapt to different working conditions. This volume compares evidence on the returns from worker training in the United States, Germany, France, Britain, Japan, Norway and the Netherlands. The authors focus on Germany's widespread, formal apprenticeship programmes; the US system of learning-by-doing; Japan's low employee turnover and extensive company training; and Britain's government-led and school-based training schemes. The evidence shows that training in the workplace is more effective than training in schools. Moreover, even when US firms spend as much on training as other countries do, their employees may still be less skilled than workers in Europe or Japan. This text points to training programmes in Germany, Japan, and other developed countries as models for creating a workforce in the United States that can compete more successfully in the economy of the 20th century.

178 citations


Posted Content
TL;DR: In this article, the authors compare worker training in the United States, Germany, France, Britain, Japan, Norway, and the Netherlands and show that training in a workplace is more effective than training in schools.
Abstract: How can today's workforce keep pace with an increasingly competitive global economy? As new technologies rapidly transform the workplace, employee requirements are changing and workers must adapt to different working conditions. This volume compares new evidence on the returns from worker training in the United States, Germany, France, Britain, Japan, Norway, and the Netherlands. The authors focus on Germany's widespread, formal apprenticeship programs; the U.S. system of learning-by-doing; Japan's low employee turnover and extensive company training; and Britain's government-led and school-based training schemes. The evidence shows that, overall, training in the workplace is more effective than training in schools. Moreover, even when U.S. firms spend as much on training as other countries do, their employees may still be less skilled than workers in Europe or Japan. Training and the Private Sector points to training programs in Germany, Japan, and other developed countries as models for creating a workforce in the United States that can compete more successfully in today's economy.

134 citations


Book ChapterDOI
TL;DR: In this article, the authors argue that in countries where a large proportion of the workforce is unskilled, firms have little incentive to provide good jobs (requiring high skills and providing high wages), and if few good jobs are available, workers have little incentives to acquire skills.
Abstract: The paper explains how a country can fall into a "low-skill, bad-job trap," in which workers acquire insufficient training and firms provide insufficient skilled vacancies. In particular, the paper argues that in countries where a large proportion of the workforce is unskilled, firms have little incentive to provide good jobs (requiring high skills and providing high wages), and if few good jobs are available, workers have little incentive to acquire skills. In this context, the paper examines the need and effectiveness of training policy, and provides a possible explanation for why western countries have responded so differently to the broad-based shift in labor demand from unskilled to skilled labor.

131 citations


Posted Content
TL;DR: In this paper, the authors compare evidence on the returns from worker training in the United States, Germany, France, Britain, Japan, Norway and the Netherlands and conclude that training in a workplace is more effective than training in schools.
Abstract: How can today's workforce keep pace with an increasingly competitive global economy? As new technologies rapidly transform the workplace, employee requirements are changing and workers must adapt to different working conditions. This volume compares evidence on the returns from worker training in the United States, Germany, France, Britain, Japan, Norway and the Netherlands. The authors focus on Germany's widespread, formal apprenticeship programmes; the US system of learning-by-doing; Japan's low employee turnover and extensive company training; and Britain's government-led and school-based training schemes. The evidence shows that training in the workplace is more effective than training in schools. Moreover, even when US firms spend as much on training as other countries do, their employees may still be less skilled than workers in Europe or Japan. This text points to training programmes in Germany, Japan, and other developed countries as models for creating a workforce in the United States that can compete more successfully in the economy of the 20th century.

118 citations


BookDOI
01 Jan 1994
TL;DR: Gender differences in stress symptoms, stress producing contexts and coping strategies Desiring Careers but Loving Families - Period, Cohort and Gender Effects in Career and Family Orientations Gender, Work and Mental Distress in an Institutional Labour Force - An Expansion of Karasek's Job Strain Model Measurement of Sexual Harassment in Organizations - An Integrated Model Unemployment, Social Resources and Mental and Physical Health - A Threeway Study on Men and Women in a Stressful Life Transition Organizational Stress and Coping in Seven National Contexts - A Cross-Cultural Investigation Job Stress and Health Out
Abstract: Gender Differences in Stress Symptoms, Stress Producing Contexts and Coping Strategies Desiring Careers but Loving Families - Period, Cohort and Gender Effects in Career and Family Orientations Gender, Work and Mental Distress in an Institutional Labour Force - An Expansion of Karasek's Job Strain Model Measurement of Sexual Harassment in Organizations - An Integrated Model Unemployment, Social Resources and Mental and Physical Health - A Three-way Study on Men and Women in a Stressful Life Transition Organizational Stress and Coping in Seven National Contexts - A Cross-Cultural Investigation Job Stress and Health Outcomes Among Anglo and Hispanic Employees - A Test of the Person-Environment Fit Model Social Identity, Work Stress and Minority Workers' Health Work and Wellbeing in an Ethnoculturally Pluralistic Society - Conceptual and Methodological Issues The Effects of Age, Financial Strain and Vocational Expectancies Upon the Stress-Related Affect of Adult Job Losers Older Working Widows - Present and Expected Experiences of Stress and Quality of Life in Comparison to Married Workers Improving Older Workers' Working Conditions by Analyzing Attitudes Towards Early Retirement Child Care Difficulties and Impact on Concentration, Stress and Productivity Among Single and Non-Single Fathers and Mothers Subjective Work Stress and Family Violence Stress, Control, Wellbeing and Marital Functioning - A Causal Correlational Analysis Family-Friendly Workplaces, Work-Family Interface and Worker Health Marriage and Children for Professional Women - Asset and Liability? Balancing the Multiple Roles of Work and Caregiving for Children, Adults and Elders Work and Life Experiences - Career Patterns Among Managerial and Professional Women Linking Unemployment Experiences, Depressive Symptoms and Marital Functioning - A Mediational Model.

Journal ArticleDOI
14 May 1994-BMJ
TL;DR: Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems, and dealing with such problems requires experience, objectivity, and a willingness to tolerate unpleasantness and criticism.
Abstract: Objectives: To describe the incidence, nature, and implications of serious disciplinary problems among the medical staff of a large NHS hospital workforce. Design - Descriptive study with analysis of case records. Setting: Northern Health Region, an administrative area within the NHS covering a population of three million. Subjects: Forty nine hospital doctors: 46 consultants and three associate specialists. Main outcome measures: The nature of the problems encountered within the doctors9 practice, and the types of action taken by the employing authority. Results: Over a five year period concerns serious enough to warrant the consideration of disciplinary action were raised about 6% of all senior medical staff (49/850). Ninety six types of problem were encountered, and were categorised as poor attitude and disruptive or irresponsible behaviour (32), lack of commitment to duties (21), poor skills and inadequate knowledge (19), dishonesty (11), sexual matters (seven), disorganised practice and poor communication with colleagues (five), and other problems (one). Twenty five of the 49 doctors retired or left the employer9s service, whereas 21 remained in employment after counselling or under upervision Conclusions: Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems. Dealing with such problems requires experience, objectivity, anda willingness to tolerate unpleasantness and criticism. Because most consultants9 contracts are now held by NHS trust hospitals, however, those who had developed skill over the years in handling these complex issues are now no longer involved.

Journal ArticleDOI
TL;DR: Proactive recruitment from selected target groups, the use of role models, and the exploitation of appropriate media sources are but three feasible strategies identified from the literature review that might be considered if nurses really would value changing the sex imbalance in the nursing workforce.

Book
01 Jan 1994
TL;DR: In this article, the authors examine why women work, what satisfaction they find in remaining in the workforce, and how they meet the demands of work and household, caught in a contradiction between traditional socio-cultural ideology and modern economic reality.
Abstract: This is a persuasive, multilayered analysis of a vital but little-examined sector of the Japanese workforce--the female permanent blue-collar worker. Through personal accounts of factory life, the author examines why these women work, what satisfaction they find in remaining in the workforce, and how they meet the demands of work and household, caught in a contradiction between traditional socio-cultural ideology and modern economic reality.

Book
01 Feb 1994
TL;DR: In this article, the authors discuss the role of the small business in the labour market, and present an analysis of the relationship between small businesses and the supply of labour in the UK labour market.
Abstract: 1. Small Firms and Employment J.Atkinson and D.J. Storey 2. Running to Stand Still: the Small Business in the Labour Market J. Atkinson and N.Meager 3.Employers' Workforce Construction Policies in the Small Service J.Kitching 4. Labour Market Support and Guidance for the Small Business J. Atkinson 5. Labour Intensive Practices in the Ethnic Minority Firm T. Jones, D. McEvoy and G. Barrett 6. Employment and Labour Process Changes in Manufacturing SMEs During the 1980s D. North, D. Smallbone and R. Leigh 7. Employment in Small Firms: Are Cooperatives Different? Evidence from Southern Europe W. Bartlett 8. Generating Enterprise and Employment in Disadvantaged Urban Areas A. McGregor and R. Fletcher 9. The Characteristics of the Self-Employed: The Supply of Labour H. Rees and A. Shah.

Posted Content
TL;DR: In this paper, leading sociologists, economists, and social psychologists present their highly original research into changes in jobs in Britain in the 1980s, combining large-scale sample surveys, personal life-histories, and case studies of towns, employers, and worker groups.
Abstract: In this major new book leading sociologists, economists, and social psychologists present their highly original research into changes in jobs in Britain in the 1980s. Combining large-scale sample surveys, personal life-histories, and case studies of towns, employers, and worker groups, their findings give clear and often surprising answers to questions debated by social and economic observers in all advanced countries. Does technolgoy destroy skills or rebuild them? how does skill affect the attitudes of employees and their managers towards their jobs? Are women gaining greater skill equality with men, or are they still stuck on the lower rungs of the skill and occupational ladders? The book also takes up neglected issues (what do employees really mean by a skilled job? how does skill-change link with changes in social values?) and challenges and discredits the widely held view that new technology has de-skilled the workforce. Skill and Occupational Change exploits the richest single data-set available in contemporary Europe and the authors exemplify many new techniques for researching skills at work: as an economic resource, as a motor of occupational change, and as a basis for personal careers and identity. It provides the most comprehensive, authoritative, and carefully researched set of conclusions to date on skill trends and their implications and draws the authoritative new map of skill-change in British society.

Journal ArticleDOI
TL;DR: The United States Labor Secretary's Commission on Achieving Necessary Skills (SCANS) has identified many leadership skills and qualities among groupings of basic skills, thinking skills, personal qualities, resource allocation skills, interpersonal skills and organizational skills that will be needed by workers for productive and meaningful employment in today's workforce.
Abstract: The Labor Secretary’s Commission on Achieving Necessary Skills (SCANS) has identified many leadership skills and qualities among groupings of basic skills, thinking skills, personal qualities, resource allocation skills, interpersonal skills and organizational skills that will be needed by workers for “productive and meaningful employment in today’s workforce.” (Brock, 1992, p. 22). By focusing on developing agricultural leadership, cooperation, and citizenship, the National FFA Organization also focuses on skills for today’s workforce. It is almost taken for granted by agricultural and other educators that youth who participate in youth organization leadership activities such as public speaking, holding an office, or attending meetings are developing leadership skills. How true is this perception?

Journal ArticleDOI
TL;DR: The role of education in preparing the workforce is affected by the changing nature of work as discussed by the authors, which is typically described by a concept of skill requirements that is used to analyze jobs and wo...
Abstract: The role of education in preparing the workforce is affected by the changing nature of work. The latter is typically described by a concept of skill requirements that is used to analyze jobs and wo...

Journal ArticleDOI
TL;DR: A Competive Workforce: The Issues and the Study (P. Mirvis) Strategic Human Resource Management (E. Useem) Workplace Flexibility: Faddish or Fundamental? (V. Parker & D. Hall) Corporations and the Aging Workforce (M. Barth, et al.) The Changing Nature of Employee Health Benefits (K. Davis) The Findings and Their Implications (P as mentioned in this paper Index).
Abstract: A Competive Workforce: The Issues and the Study (P. Mirvis) Strategic Human Resource Management (E. Lawler, et al.) Restructuring and Downsizing (M. Marks) Company Policies on Education and Training (M. Useem) Workplace Flexibility: Faddish or Fundamental? (V. Parker & D. Hall) Corporations and the Aging Workforce (M. Barth, et al.) The Changing Nature of Employee Health Benefits (K. Davis) The Findings and Their Implications (P. Mirvis) Index.


Journal ArticleDOI
TL;DR: The evidence collected suggests that the NHS employs a significantly younger workforce than is found in the economy as a whole, and the age profile of nurses is even more skewed towards younger age groups than that of non-nursing staff working in the NHS.
Abstract: Using information collected from more than 100 district health authorities in England for the year 1989-1990, this paper examines turnover rates amongst a range of nursing and other staff groups in the National Health Service (NHS), and their relationship to the age and length of service characteristics of the labour force. The evidence collected suggests that the NHS employs a significantly younger workforce than is found in the economy as a whole. The age profile of nurses is even more skewed towards younger age groups than that of non-nursing staff working in the NHS. Nurses tend on average to have longer lengths of service than non-nursing staff groups, and it would seem that the average length of service has increased over the last 20 years, certainly amongst registered nurses. Overall, the study found an annual turnover rate amongst all NHS staff of 13.6%. Turnover rates were significantly higher among full-time staff than part-time, and amongst non-nursing staff groups compared with nurses. Broadly, turnover rates decline with age then rise close to retirement. However, there is a more complex relationship between length of service and turnover: turnover rates tend to be high in the first year of service, and to remain high or even rise during the second year of service, before declining. Turnover remains a poorly understood issue in the NHS. The evidence presented here should move some aspects of debate onto a more solid empirical foundation.

Journal ArticleDOI
TL;DR: In this paper, the authors developed formal models and optimal solution approaches for various worker training scenarios to assist managers in deciding optimum tactical plans for training/retraining a workforce according to the skills required by a forecasted production schedule for a definite planning horizon in a manufacturing plant.

Journal ArticleDOI
TL;DR: In this paper, the authors discuss progress and future possibilities for additional useful research on gender equity in education and conclude that there are many continuing inequities that merit exploration and resolution by educational researchers and practitioners.
Abstract: Many contributors to this article started their journey to increase gender equity in education around 1972, when federal Title IX legislation was passed. Title IX prohibits discrimination on the basis of sex in educational programs or activities receiving federal financial assistance. This article discusses progress and future possibilities for additional useful research. After reviewing relevant goals, we address equity issues in the areas of the education workforce; student educational attainment and career achievement; formal curricula (including content and testing); and informal curricula (including classroom interaction, single-sex environments, sexuality, and family and child care issues). Although there has been progress in attaining equity goals in some of these areas, we conclude that there are many continuing inequities that merit exploration and resolution by educational researchers and practitioners. Additionally, there is a need for more systematic development of a comprehensive research and...

Journal ArticleDOI
TL;DR: A hierarchical workforce in which a higher qualified worker can substitute for a lower qualified one, but not vice versa is considered, and a simple one-pass method is presented that frequently gives the least cost labor mix.

Journal ArticleDOI
TL;DR: Investigation of the importance of various job characteristics for retaining and recruiting employees and the results from a survey among employees of a Dutch hospital experiencing a tight labour market find job characteristics other than wages were found to play a major role in individuals' choices to resign or stay.
Abstract: Scarcities of qualified personnel are becoming a common phenomenon in The Netherlands. At the same time, increasing wages to secure an adequate workforce is not always possible or sufficiently effective, and other ways of retaining and recruiting personnel have to be found. Investigates the importance of various job characteristics for retaining and recruiting employees and presents the results from a survey among employees of a Dutch hospital experiencing a tight labour market. Job characteristics other than wages, such as labour relations and work content, were found to play a major role in individuals' choices to resign or stay. Discusses consequences for employment strategies in other organizations.

Book
01 Oct 1994
TL;DR: The authors examines the potential of such projects in Morocco and observes that although the recent educational reforms and other education projects have desired impacts, the government of Morocco may accelerate educational achievements by furthering investments, especially in rural areas, in complementary inputs such as roads, irrigation and electrification that raise the rate of return to education.
Abstract: Although education plays an important role in economic development, many low income countries are failing to develop their education systems fast enough to reap the benefits of an educated workforce. In many countries, two-thirds of school-aged children are not being educated at all or are receiving a poor quality education. As part of its commitment to improve education, the World Bank is supporting various education projects in many developing countries. This paper examines the potential of such projects in Morocco. Focusing primarily on basic education, this study observes that although the recent educational reforms and other education projects have desired impacts, the government of Morocco may accelerate educational achievements by furthering investments, especially in rural areas, in complementary inputs such as roads, irrigation and electrification that raise the rate of return to education.

Journal ArticleDOI
TL;DR: A survey of 16 large retailers, using a postal questionnaire and personal interviews, revealed that non-food retailers are likely to have more senior women than food retailers as mentioned in this paper, and the isolation of lone senior women was confirmed by personal interviews and in company mentors were identified as a possible help in that regard.
Abstract: Reports the findings of a combined survey of 16 large retailers, using a postal questionnaire and personal interviews. Researchers sought information regarding the proportion of women holding senior management positions and the approach and attitude of retail companies to the advancement of women. Results reveal no shortage of goodwill towards the provision of equal opportunities for women, with many responding companies actively pursuing policies aimed at improving the gender balance of their workforce. Findings suggest that non‐food retailers are likely to have more senior women than food retailers. Senior women interviewees confirmed that working conditions in retailing were a factor in the statistics, but they suggested that negative attitudes from staff and customers also play a part. The isolation of lone senior women was confirmed by personal interviews, and in‐company mentors were identified as a possible help in that regard. The problem of balancing a family and career remains while store manager...

Book
07 Dec 1994
TL;DR: An economic approach to human resource management has been proposed in this article, where the authors present an economic approach for human resources management in the US workforce, including the compensation decision, making general pay adjustment, and the collective bargaining relationship.
Abstract: 1 An Economic Approach to Human Resource Management 2 The US Workforce 3 Productivity 4 Employee Appraisal and Reward 5 Alternative Pay Systems 6 Analysis of Pay Setting 7 The Compensation Decision 8 Making General Pay Adjustments 9 Making General Pay Adjustments 10 The Collective-Bargaining Relationship 11 Conflicts Between Employer and Employee Goals 12 The Employment Market 13 Training, Human Capital and Employment Stabilization 14 Economic Regulation, Social Insurance and Minimum Standards 15 Restricting Opportunity and Enhancing Opportunity: Immigration Control and EEO 16 International Side of Human Resource Management.

Journal ArticleDOI
TL;DR: To identify requirements for vocational training and continuing education programs in rural general practice, Vocational Training and Continuing Education programs in Rural general practice are identified.
Abstract: Objective: To identify requirements for vocational training and continuing education programs in rural general practice. Design: A questionnaire was sent to all 487 rural doctors and 140 metropolitan and 140 provincial city general practitioners (GPs) in Queensland. A sample of medical educators, health professional and consumer representatives and rural doctors was also interviewed. Responses were compared by geographical area, practice characteristics and level of postgraduate training. Results: There are significant differences between rural and urban practice profiles. Rural doctors have to practise a range of clinical skills in an environment with restricted access to health professional support, although the need for advanced training in procedural or other skills depends on the type of rural practice. Rural and urban doctors want more influence in determining continuing medical education (CME) programs. Interactive learning methods were rated as the most effective education methods by both rural and urban GPs. Rural doctors were less likely to consider that they spent enough time on CME. Conclusion: Vocational training programs should accommodate various rural career objectives, including those requiring advanced levels of procedural work. There is a significant unmet demand for CME tailored to the needs of individual doctors, both rural and urban, but distance and isolation may make this more critical in rural practice. These issues need to be addressed as training opportunities can contribute to improved retention of the rural medical workforce.

Journal Article
TL;DR: The supply of nurses is viewed as adequate, but the educational mix is seen as deficient with regard to nurses with baccalaureate and higher degrees who will be in greatest demand in new and expanding roles.
Abstract: We provide an appraisal of the adequacy of the aggregate supply of nurses and the appropriateness of their educational mix in view of anticipated changes in health care. We view the supply as adequate, but the educational mix as deficient with regard to nurses with baccalaureate and higher degrees who will be in greatest demand in new and expanding roles. Five priority areas are identified in which nursing can make particularly important contributions to improving health and health care: restructuring hospitals, improving primary care availability, contributing to the viability of academic health centers, improving care of the underserved, and redesigning the role of public health in a reformed health care system.