Career Profile: Renal Nurse (or Dialysis Nurse)

Renal disease is one of the biggest diseases on the rise in America today. End stage kidney disease is expected to quadruple from affecting 500,000 people today to at least 2,000,000 by 2030. Effective kidney-knowledgeable nursing can help to counteract this statistic. Kidney nurses, who specialize in renal conditions, are one of the best guards against increasing numbers of patients in renal failure.

Kidney nurses are known by several titles. Referred to as urology nurses, nephrology nurses, renal nurses and dialysis nurses, these nurse cover any number of conditions, but typically work with dialysis. Dialysis nurses undergo certification in order to use dialysis equipment, which filters urine for patients who's kidneys have stopped functioning correctly.

Salaries average at about $60,000 a year, but can vary depending on a number of factors. Some districts pay as low as the mid $50,000s, and some pay more than $70,000 a year. Certification, Bachelors degrees and experience can lead to even higher salaries. Dialysis nursing is not a common certification, which means that there are many positions open. With low supply and high demand, dialysis nurses have more opportunities for positions than do other nurses.

Regarding education, renal nurses require advanced degrees and training to gain certification. You can start with a online nursing degree from any program, from an Associate degree to a Bachelor of Science in Nursing. Nurses with higher education are generally paid more than those with the minimum amount and are more likely to be hired. Once you complete your schooling, you can study advanced diseases of the kidneys. There are plenty of programs that you could attend in order to get the information you need. Then, take your state's Certified Dialysis Nurse Examination. After you pass, you'll have the certification you need to operate a dialysis machine.

Nurses that have patients that have undergone renal transplant surgery have more responsibilities beyond standard care for post-surgery recovery. Renal nurses working with postoperative patients are chiefly responsible for timely healing. Because steroids slow down the healing process, and sutures need to be left in for three weeks, infection can be a big problem. In order to ensure that no permanent damage has occurred during the healing process, nurses need to be constantly aware of their patient's condition.

Maintaining hydration and electrolyte balance is more important for kidney transplant patients than it is for others, due to the impaired function of the kidneys during this stage. As always, nurses need to tend to the wound and the patient's pain. Many of the medications that the patient will be prescribed following surgery will act as a constipator, so it's important to administer laxatives, stool softeners and enemas to clear the bowels.

The Jonas Center for Nursing Excellence

One of the biggest problems facing healthcare today is the nursing shortage. There are at least 100,000 nursing vacancies across the country, but 500,000 registered nurses aren't working in their field due to dissatisfaction and a number of other causes. Combined with aging baby boomers who will need assistance in the coming years, America simply doesn't have the healthcare infrastructure to support the demand.

The Jonas Center for Nursing Excellence
The Jonas Center for Nursing Excellence is doing their part to help right the shortage. The primary goal of the Jonas Center is to increase nursing recruitment and retention in New York City hospitals, but they hope to expand the limits of their philanthropy. The Center is funded in part by the Barbara and Donald Jonas Family Fund.

The Jonas Center aspires to reward and promote effective nursing programs and leadership. By signing grants to and acknowledging hospitals that meet and exceed the expectations of the center, the group hopes to decrease nursing vacancies and improve the diversity among nurses. Though the Jonas Center focuses on New York City, they recognize hospitals elsewhere as well.

One of the most important aspects of the Jonas Center for Nursing Excellence's nursing recruitment and retention programs is their intermediary function. Representatives of the Jonas Center help to facilitate discussion between nurses, healthcare workers, lobbyists and business owners. These discussions can greatly improve nursing conditions by raising awareness of problems in the workplace and drawing attention to funding concerns. Furthermore, by involving lobbyists and policy makers, the Jonas Center helps to bring small scale changes to the national level.

Another impact of the Jonas Center is their work with grant-makers. Many fully-deserving hospitals and nursing programs miss out on excellent opportunities for funding because of simple ignorance. The Jonas Center fosters relationships between hospitals and the academic world, which helps to bring changes where they need to be brought. This connects the hospital directly with grant benefactors, greatly increasing their chances of getting the funds they need.

Furthermore, the Jonas Center brings even more grants to the market by encouraging donors to create grants for hospitals. By interacting with numerous philanthropic groups and donors, the Jonas Center is making it easier than ever for hospitals to find the funding they've lacked over the years.

The Jonas Center works personally with nursing leaders to improve conditions both in the workplace and in the entire hospital as well. The Center supports and provides leadership that works toward the betterment of everyone involved in New York City healthcare. By presenting the findings from these changes to medical journals and practices, the Jonas Center is creating a working healthcare model, an example to hospitals across the country.

This year, the Jonas Center for Nursing Excellence gave four grants to institutions that met the standards for their Jonas Nursing Scholars program. The entire program is awarding $2.5 million to deserving nursing schools. The Columbia University School of Nursing was one of the beneficiaries.

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Nursing Quality and Patient Recovery

America's health care shortage extends into every level of its hospitals, from nurses to gift shop volunteers. This shortage can cause huge problems in effective coverage for United States citizens. However, statisticians believe that increasing the number of nurses per hospital will improve health care quality for everyone.

The highest level of the health care shortage is in primary care doctors. Though the federal government has been pushing for increased primary care physician presence, their efforts have failed. Primary care physicians have been decreasing faster and faster every year since the 1970s.

Many hospitals have found the solution for the lack of primary care physicians: nurses. Nurses, and especially those with advanced training like nurse practitioners and clinical nurse specialists, provide much of the same care as doctors, at lower price and with less education, as reported by the Yale Journal on Regulation.

Both the lay community and members of the health care sector are attributing major hospital mortality problems to the nursing shortage. In a 2005 edition of Nursing Economic$, researchers found that more than half of registered nurses and CNOs (Chief Nursing Officers) think that reduced staffing is causing a decrease in the quality of care in hospitals and other health care centers. Over 90% of registered nurses complained about overstaffing causing poor patient care. On the other hand, 40% of American citizens have criticized the health care sector, claiming that between 1999 and 2004, quality of hospital care has sunk, citing stress, understaffing and lessened individual care as major factors in the condition of health care.

A study by The New England Journal of Medicine in 2002 tested the hypothesis that low nurse staffing levels will increase the number of deaths and complications in patients. After examining almost 800 hospitals in eleven states, the research team concluded that higher numbers of nursing care hours shortened the day, reduced risk of infection, pneumonia, heart attack and 'failure to rescue.' Additionally, surgical patients who saw their nurses more regularly had decreased urinary tract infections and increased rates of success after surgery. Overall, the study proved that increasing coverage of patients by upping the number of nurses on staff will lead to better health care in hospital patients.

A further study in Health Services Research and the Journal of Nursing Administration went on to study the effects of education on mortality rates. The research teams found that hospitals that staff nurses who graduated from baccalaureate programs had lower rates of mortality and 'failure to rescue' than did hospitals who staffed nurses with a lower level of education.

The study of mortalities as a consequence of the nursing shortage has been the most frightening of all. In 2002, the Journal of the American Medical Association came forward with research on the benefits of increasing nursing staff. Thousands of lives would be saved a year by simple changes in hiring. At the University of Pennsylvania, where the research was conducted, the team found that a hospital with a low ratio of nurses to patients, patients are almost a third more likely to die than in hospitals that are adequately staffed. Every patient added to a nurse's daily workload in the surgery ward increases the chance of death by 7%.

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Jump-start your career: Testing the waters with a learning internship in nursing

If you asked a nurse what they duties they performed for their job, they would probably stare blankly at you and state, "What jobs don't I do?" A nurse is a jack-of-all-trades, someone who manages the patient care and makes the call when the doctor isn't there. The need for nurses has literally never been higher, and although students are entering nursing programs at a record rate, the supply doesn't meet the demand. Once a nurse graduates, she or he has many choices to make, including where to do an internship.

Nurse internships are a way to gain practical knowledge on the job. During an internship, new nurses are able to diagnose patients, assist doctors, get acquainted with medical equipment, and become familiar with drugs used to treat patients. Although going to school for nursing will give you the practical knowledge you need to perform your job, an internship will give you the hands on experience that is necessary to accurately care for patients.

Typically, a nurse internship lasts 14-16 weeks, and during that time the nurse will have hands on experience with patients. Supervised by a senior nurse or mentor, nurse interns will gradually work their way through a set program. Throughout the process, the nursing intern is guided through the many different aspects of the job. Internships are available in many departments of the hospital, including labor and delivery, emergency or acute care, pediatrics, and surgery.

Internships take place both inside and outside the classroom and as a supplement to online nursing degree programs. Instruction is provided in a classroom setting along the way, and at the same time the nurse is given hands on experience in the hospital. The goal is to ease the transition between being a student nurse to gainful employment. As there is such a shortage of nurses in the US right now, stress and fatigue are a large part of the job. It is more important than ever to make graduates entry into the workforce as simple as possible.

Landing an internship requires excellent academic grades and a keen desire to succeed in nursing. A student candidate seeking an internship should begin by researching hospitals of interest and comparing the intern programs. Often the co-op department of the University the student attends provides detailed information on specific nursing internships. Co-op departments can also assist in placement of the student nurse in an internship that would best suit them.

Finding the best internship for you are based on two vital issues: curriculum and support. The internship should cover in detail as many areas of the actual department as possible. Becoming familiar with your area of specialization is vital to your success on the job, and an internship should make you feel comfortable in your choice of department. Support on the job is extremely important. Often new graduates feel as though they are being thrown to the lions when first starting out. The reality of starting the job can come as a huge shock when you pair the learning curve with fatigue and demanding hours. Internships should offer on the job support in the form of a mentor, and encourage feedback and discussion from the new nurse.

If you are interested in obtaining a nursing internship, begin by asking questions of your instructors. Often they will have information on specific internships. Choose a few hospitals that you'd be interested in working in and inquire about their programs. Spend as much time as possible researching various intern opportunities. Your choice can affect your entire future.

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The Nursing Crisis: Overwhelmed and Underpaid

When you enter the hospital to have a baby, who greets you? Although we associate our doctors with delivering our babies, often it's a nurse who walks us through labor and is with us from the first cramp until we wave goodbye with our newborn in our arms. Not every hospital stay is as happy as delivering a child, but the one constant throughout each and every visit we have to a hospital is the presence of nurses. Who then, can the general public rely on during a nursing shortage crisis? Although new graduates are entering the hospital workforce daily, they are struggling with the demand and overload of nursing shortage. The United States is in a clear nursing shortage crisis for many reasons.

Nursing Shortage results in Stress for Nurses
Working nurses in the midst of this crisis deal with increased stress, fatigue, and an overwhelming sense of helplessness at never quite being enough for their patients.
Although there are many qualified students entering traditional campus and online nursing degree programs, there simply isn't enough instructors nor are there enough spaces to fulfill the current nursing shortage. This is due to the current economic crisis and lack of funding in schools, as well as fewer students willing to take on the financial burden of student loans and the credit card debt that they would incur to further their education. Even if there were enough spaces for interested nursing applicants, instructors are not as readily available as they have been in years past. Nursing instructors need to have a Bachelors degree at a minimum, with a Masters degree being preferable, in order to instruct. There are not enough nurses pursuing their higher degrees to overcome the demand.

New nursing grads are almost guaranteed to go through long periods of exhaustion and burn out. They work tremendous hours, and have the added stress of being the full support team for their patients. Whereas doctors simply examine and move on, nurses are required to be dedicated to the care of their patients. New nurses find that they have a very high patient to nurse ratio, and it would almost seem impossible to keep up with the demands of each patient over your shift if you have 5 people ailing to 1 nurse. Not only do they juggle many patients, they provide more over all care to their patients than physicians. The job is all encompassing, and put together with long hours and 2 week long stints without a day off, our new nurses are experiencing tremendous stress and pressure from the nursing shortage.

Extra burden is placed on nursing graduates, as their aging supervisors get ready for retirement. It's no secret in the US that the retirement of the large majority of baby boomers will put a huge strain on health care. Nurses getting ready to retire don’t have ready replacements in new graduates.

How do we lessen the burden on our new fleet of nurses? The only solution is to educate more nurses. In order to do so, we need to free up more spots in educational institutions. Our aging nurse population needs to focus on fulfilling educational supervisory roles as opposed to maintaining employment in the hospitals. Hospitals themselves need to put a heavy focus on restructuring within the hospital to diminish the impact of the shortage on individual nurses.

The nursing shortage is a vicious circle of stress, fatigue, and an overwhelming sense of helplessness at never quite being enough for their patients. Although many will say they are fulfilled by their careers, the sense that the job is never quite complete may never leave them. Perhaps with the new Government health care initiatives, the solution to the crisis is right around the corner.

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Nursing Students Save Their Own Lives

Two UCF nursing students have learned what it really means to save a life - their own. Kerrie Lynch and Gaby Chaparro, who never met until a week before graduation, both entered the nursing program at the University of Central Florida hoping to make a difference in the health of others, but neither of them ever expected to save their own lives.


Two nursing students at the University of Central Florida saved their own lives with information they gained in class.
The two women graduated from the University of Central Florida in early August after undergoing the test of a lifetime: cancer. Both Lynch and Chaparro owe their lives today to their education, which provided them with the tools for early detection. After diagnosis in fall of 2008, the women have remained in class, and have graduated this summer.

Lynch, 43, who took classes at the University of Central Florida's main campus, learned what a breast tumor felt like in a Health Assessment Lab class. The school provided false models and fabricated body parts in order to demonstrate patient evaluation. One of the models had a breast tumor, the feeling of which Lynch noted.

A few months later, while performing her routine self breast exam, Lynch recognized the feel of a "little Jelly Belly underneath the skin." After visiting the University of Central Florida's Health Services Center, meeting with doctors and undergoing tests, Lynch's hunch was found to be correct: she was diagnosed with breast cancer. Because the tumor was found so early, she went through three months of chemotherapy and a month and a half of radiation treatment.

Similarly, Chaparro, 27, realized that she had cancer during one of her classes at the University of Central California's Cocoa campus. After learning about chronic diseases in one of her courses, she recognized the symptoms of colon cancer. However, many gastrointestinal disorders and diseases, like Crohn's disease and Celiac, present with the same symptoms, so it was difficult to pinpoint what was affecting her. Chaparro had dealt with increasingly painful stomach problems as of summer of 2008, but doctors had ignored her suspicions, as a result of her youth.

As her condition worsened, she visited the UCF Health Services Center, where she was examined by a Nurse Practitioner named Kristina Grabnickas. Noticing Chaparro's weight loss, Grabnickas referred her to a gastroenterologist, who confirmed Chaparro's diagnosis of colon cancer. Unlike Lynch, Chapparo's cancer was not found early, and had already metastasized at this point, making treatment more difficult for her than it had been for Lynch. Chaparro underwent six months of chemotherapy.

Fortunately for both Chaparro and Lynch, their professors, counselors, and nursing peers were understanding of the stress both students were under, and allowed the two to adapt their schedule in order to fit their chemotherapy regimens while remaining on track for graduation. Additionally, the professors arranged for labs and community outreach programs that would not interfere with the women's suppressed immune systems.

Both Chaparro and Lynch finished treatments for their cancers before graduation. The two now hope to work in hospitals, applying what they've experienced in the pursuit of their degrees to their patient care.

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New Bill that would allow 20,000 foreign nurses annually to enter the US

Despite concerns about employment as a consequence of the recession, nursing vacancies grow steadily everyday. Over the course of the last ten years, Americans have experienced a nursing shortage the likes of which had not been seen since the 1960s. Despite attempts at righting the shortage, America is still looking at a gap of over 100,000 nursing positions nationwide.

It is almost impossible for the need for nurses created by aging baby boomers to be satisfied with current resources. Without major changes made soon by legislators, the vacancy rate could as much as quadruple. Obama's healthcare reforms could only exacerbate the problem by increasing the number of insured Americans by millions, without a healthcare infrastructure in place to take on the burden. There simply aren't enough nurses who to fill the demands.

Floridian Representative Robert Wexler has proposed a bill to help fill in the short term nursing crisis. The Democrat announced in May of 2009 that his bill would allow for the extension of 20,000 visas to foreign nurses every year for the next three years, bringing in 60,000 nurses total, and providing for 60% of today's shortage. Should the bill in its current form not pass through the Senate, legislators plan to add an immigration reform package to the bill. Obama spoke to the legislators about the bill this summer in order to discuss even further immigration reform.

Many proponents of the bill to allow immigrants to fill positions in American hospitals are looking for temporary relief. Unpopular areas have a difficult time attracting qualified nurses, and the bill would help to assuage this problem. Dozens of nurses from Canada, the Philippines and Mexico would be eager to take any position, regardless of the area. Though these visas would eventually expire, sending the nurses back to their nations of origin, hospitals currently undergoing shortages of registered nurses would be helped quickly.

Labor unions disagree. Unions are arguing that providing a foreign labor source would limit the incentive of hospital administrators to create more pleasant working environments because they know that their positions will be filled no matter how they treat their employees. Labor unions are afraid that removing such a significant number of nurses from other countries could cause nursing shortages overseas. Bringing in already registered nurses who have been driven from the field by stagnant pay and poor work conditions is the favored plan, as it brings experience back to the field.

Supporters of Obama's healthcare reforms also reject Representative Wexler's Bill, hoping that Obama's economic stimulus does enough to promote a long term solution to the nursing shortage. Obama included $500 million to benefit healthcare workers, by increasing education and encouraging students to pursue the field either at traditional universities or via distance learning with an online nursing degree. Additionally, Obama hopes to cut down on the effects of the recession by increasing the capacity at nursing schools, allowing workers from other industries to gain the education they need to become nurses. This would cut down on unemployment while closing the nursing gap, simultaneously.

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The Effect of the Recession on the Nursing Shortage

As one of the few remaining United States industries with any growth, the health care sector is becoming an attractive option for American workers. With more gainful employees being fired by the day, these workers are looking to the future for other opportunities.

Hospital Nursing Shortage
The current recession is sending certified nurses back to work, which is having a positive short-term impact on the nursing shortage.
While America has been laying off its workers, hospitals have been hiring them. Today's vacancy rate of 16% reflects the constant shortage of American nurses in hospitals.3% as noted by the American Health Care Association in 2008, is the worst reported since the sixties. This shortage, according to Health Affairs, a policy journal, started about a decade ago in 1998 and peaked in 2001 with an average vacancy rate of 13%. This shortage can only increase in the upcoming years, as older generations require medical care that cannot be provided by current hospitals.

The nursing shortage itself has been driving nurses out of the workforce. Dissatisfaction with long hours and understaffing has caused many nurses to look into alternate employment opportunities. This has exacerbated the problem even further, as the nurses that make it through crowded nursing schools don't necessarily enter hospitals after graduation.

Lay offs and cut backs are sending these nurses back to hospitals. Most nurses think of hospitals as being recession-proof due to the need for the procession, keeping the workers in the industry. Sadly, the recession may be responsible for the filling in of the nursing shortage in the short term, since nurses of retirement age are forced to continue working in order to provide income and health benefits for their families. Long term effects will doubtlessly show a shortage increase again when these nurses are finally able to resign.

Researchers are finding that the nursing shortage has decreased slightly, as nurses reenter the workforce, and current nurses work more hours to increase pay and work for years rather than retiring, due to spouse's lost job and a lack of health insurance. This could actually conclude the nursing shortage in some parts of the United States, as small towns and rural areas are hardest hit by the shortage.

A little less than a quarter of a billion nurses joined the health care workforce in the last year, which represents a greater jump than any other in the last twenty years, says Health Affairs. For example, Truman Medical Centers has seen a 13% drop in vacancy rates from 20% to 7% in the last year alone. Using techniques that maximize recruitment and retention, such as funding for continuing education and online nursing degree programs, can be a deciding factor in the success of a hospital.

The recession favors older nurses over young nurses, which can be disappointing for new graduates. Though positions in hospitals are open, many administrators prefer experienced workers, and will wait to hire a nurse reentering the field, rather than a new nurse on his or her first assignment. These hires will eventually find placements, but the process may take longer than they had originally expected based on the economic climate.

The majority of nurses hired in the last year are already approaching retirement age, with only a third between 21 and 34. Recruitment in other countries will help bridge the nursing gap in the short run. Almost twice as many nurses are foreign born today compared to the numbers from twenty years ago, and 10% of these foreign born nurses moved to the United States in the years since the shortage peaked.

The Career of a Medical Technician

Emergency Medical Technicians are responsible for the preliminary care of patients who are going into labor, suffered a heart attack, or experienced an accident, and represent one of the fastest growing employment opportunities in health care. EMTs and paramedics are expected to provide quality care at all hours of the day.

Emergency Medical Technicians and Paramedics are the first people on the scene for immediate medical attention to events like accidents, gunshot wounds and heart attacks. EMTs begin their work at the scene, and will continue to care for the patient on the ride to the hospital.

Paramedics and Emergency Medical Technicians, like firemen and police officers, are called in through a 911 dispatcher. Emergency Medical Technicians and paramedics need to immediately assess the patient's condition, and need to make quick decisions to help save lives. They do primary diagnostic work, determining the nature of the present condition and checking for any existing medical problems, then transport the injured party to a hospital, where emergency room doctors take over.

Emergency Medical Technicians and Paramedics begin their education with a high school diploma. Workers must attend a training program, but do not need a college degree to enroll. All states require training and education, but the amount of each varies by region.

Employers are most likely to hire EMTs and Paramedics with higher levels of experience, and advanced certifications that can be obtained via distance learning at online nursing schools. The National Registry of Emergency Medical Technicians is the largest provider of certifications, though some states also offer private programs. The National Registry of Emergency Medical Technicians divide these certificates into five levels: First Responder, EMT-Basic, EMT-Intermediate, which is subdivided into 1985 and 1999, and Paramedic. EMT-Basic is the lowest level, and paramedic is the highest.

Emergency Medical Technicians with Basic certification are allowed to provide transport, care for the patient at the scene of the accident and during transit, and is trained to manage conditions. Basic level EMTs, like the other levels, are allowed to maintain respiratory and cardiac function during an emergency, and are also qualified to deal with trauma, like broken bones. The next level, EMT Intermediate, requires more education and training in order to perform more complicated procedures, as dictated by state law. EMT-Paramedics have more education and responsibilities than their peers. Paramedics are given more responsibilities, like medication administration, procedural duties and equipment usage.

Urgent care medicine is a difficult field. EMTs need to be physically prepared for the position, and should be able to life heavy loads and perform additional demanding tasks as well, in rain or shine. EMTs need to be able to work day or night, and in many different kinds of weather; the work of a paramedic is not easy. Furthermore, paramedics and technicians need to be able to make rational decisions quickly in order to save a life. Anyone interested in the field should be comfortable with the responsibility for a person?s life.

Technicians who work through a 911 dispatcher earn more money and are awarded with better benefits than those that work with a private hospital. The average EMT earns approximately $30,870 a year, as reported in 2007.

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U.S. Stimulus for Healthcare Training

As the health care industry grows, due to the aging of the baby boomers, funding has been proposed in order to decrease the effect of healthcare worker and nursing shortages. The United States Labor Secretary, Hilda Stolis, has declared the government's plans to release 220 million dollars of federal stimulus funds to training programs for workers in the medical industry.

Hilda Solis
Hilda Lucia Solis, 25th United States Secretary of Labor
The Labor Secretary revealed plans to stimulate the economy with the bill's funds while touring the University of Kansas Medical Center in Kansas City, Kansas and the Shawnee County Community Health Care Clinic in Topeka. These medical centers represent one of the areas hardest hit by the nursing and healthcare worker shortage, as rural areas have difficulty recruiting and retaining workers.

Economists often consider the medical industry recession-proof. There will always be a need for nurses, doctors and other healthcare workers; healthcare is not a luxury that can be put aside in hard times. With baby boomers aging and needing further medical care, the need for these workers will only increase and even with the increased acceptance of online nursing degree programs, the industry still needs help. The Labor Department aims to take advantage of this medical necessity by providing unlucky workers with a chance to start over in a field that is both lucrative and necessary.

While viewing the Kansas medical centers that will be among those improved by the funds from the healthcare training stimulus bill, Labor Secretary Hilda Solis routinely referred to President Barack Obama's planned healthcare reform bill, that he hopes to make through Congress this summer. This healthcare training fund is a forerunner to those that will follow the President's bill.

Healthcare reforms bills are particularly important in these difficult to staff rural areas. Training healthcare workers provides an ample job market for the unemployed, and will also help areas like Detroit that have been hard hit due to the changes in the auto industry. More than ten percent of the funds have been earmarked for areas suffering from unemployment as a consequence of auto industry restructuring.

The remainder of the money will to go fund groups that train nurses, workers in medical informatics, allied health careers and hospice care, in both the public and private sectors. More than half of the bill will be used for healthcare projects, with the remainder put towards medical technology and other miscellaneous items. The Labor Department hopes that private donors and foundations will attempt to meet and exceed the funds provided by the stimulus bill, bringing even more money towards health care training programs.

The Labor Department hopes to begin dispersing funds to worthy applicants in the next couple months, with further grants passed out by the end of 2009. Hospitals and departments with training programs already in effect can apply for funds from this stimulus bill through the Labor Department. There is an emphasis on currently effective training programs, so groups that are active now stand a better chance of being selected for stimulus funds than those started after the stimulus was put into effect.
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