Even if there have been serious attempts to reform the system and introduce a universal means of publicly financing medical care for all people, "Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average." (Gladwell, 2005) Indeed, given the fact that the U.S. is considered to be the most advanced country in the world it is rather peculiar the lack of a reasonable medical care system, one that would provide assistance also for those with medium to low incomes in order to help them access more freely the hospital and clinical systems. Attempts to reform the medical system have been made but rarely has the real issue been addressed. More often the legislature, no matter their political orientation, tried to resolve the under funding of the medical units by cutting the spending the state has with insuring staff in major hospitals or even by reducing the number of hospitals. Such initiatives have led to the current situation in which there are fewer hospitals operating with a more limited staff. This in turn forced the patient to either seek solutions for their treatment in the private sector or, more worryingly, to adopt a self-made home remedy. Eventually, there is no easy way out or a reasonable one. The reality today is that there is a reduction in hospital units and a shortage of nurse staff because of the policies undergone by all administrations from the late 60's on. (Reid, 2004)

From my point-of-view, I consider this situation rather unacceptable. I do feel that there should be a system set in place that would offer a minimum of medical assistance irrespective of the family or personal outcome. Indeed, it may encourage certain abuses, as the notion of "moral hazard" suggests insurance can change the behavior of the person being insured (Gladwell, 2005); at the same time, however, it may help some of those who cannot afford private medical insurance to get treatment because, according to different interviews taken, "almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow the immediate answer was 'my teeth.'"(Gladwell, 2005) therefore there is an acute need for public funding in this respect.

At the same time however, a satisfying solution could also be one that advocates a more intense public involvement in financing the medical system. More precisely, in order to have more funds to the budget, additional contributions by employees and employers should be made common and regular practice. In this way, there would be more significant financial resources to provide the medical care needed and one that would enable every person the access to a basic package of medical care.

The particular situation of the medical care system is just one of the issues a nurse must confront when entering the practice. Up to the point of graduation, there are more theoretical aspects rather than practical ones that are given increased attention. However, when dealing with real life and common situations, even if there had been discussed in class, they become important and in the beginning they represent a certain amount of difficulty. Dependent of such cases, there can be a smooth or less smooth transition from the state of graduate student to that of fulltime nurse. As Janice Ellis and Celia Hartley consider, "like most new nursing graduates, when you complete your studies, you will probably seek employment in an organization- a health care organization. This may be in an acute care hospital, a long-term care facility, an intermediate care facility, a clinic, an outpatient unit or a variety of other organizations that offer challenging opportunities. Accepting employment in a health care organization requires that you are knowledgeable about and become accustomed to the policies and procedures established by that organization. You will go through what we refer to as 'role transition', the process of assuming and developing a new role." (Ellis and Hartley, 455) The idea,...

At the same time however, there are certain aspects that can be applied to all situations in which a graduate student passes through the so called role transition period. For instance, as students, we only learn about the need to respect ethical percepts in our work; it is only when a difficult case appears that we fully grasp its importance. Similarly, the idea of impartial treatment of patient is yet another change we must adapt to. Even if in theory, it is rather easy to declare the fact that one would always treat patients equally and unbiased, it is hard to manage to make on the spot decisions over the priority of certain cases dependent of their seriousness. However, nursing is not fully engaged in on the spot decisions; still, the theoretical idea of impartiality cannot be fully respected because there are other issues such as personal preferences and sympathies that can intervene and thus interfere with the impartiality criteria.
Moreover, there are also issues of practical nature that focus on the financing of the medical care system. Once we enter the public sector, we come in contact with certain aspects of the budgetary life that we were either unaware of or we were not directly affected by it. Once we become to a certain extent dependent of them, budgetary allocation, the lack of financial sources or the exceeding funds begin to draw our attention and become an important part of our current reality. Therefore, we experience also a shift in interests and in matters affecting our everyday life. From this perspective, we can find ourselves engaged in serious discussions over the reform of the medical care system or the right of patients to be granted a minimal of medical insurance, issues that did not affect us to such a large extent before.

Another major issue that can change the focus of our attention once we become full time nurses will be, in my view, the moral and ethical debates surrounding different aspect of today's medical practices. One of these subjects has stirred a rather heated debate in recent years because it places in contrast several distinct moral and even legal issues. The right of a patient who is fighting a terminal illness to choose the way he wants to end or prolong his life has been the subject of debate and controversy.

On the one hand there are those who believe that the patient, existing in a serious state of pain and suffering, has the right to end his life, or more precisely to choose the way he wants to spend the remaining moments of it. The claim to such a right however must be seen through the perspective of the psychology a terminal patient begins to develop. Thus, according to Martin Lipp, the patient is in fact choosing how to die, being constantly aware of the imminent fact. He decides however the means because, unlike the rest of the health people, he does not have the time to experience the slow death which, again according to the author starts from the moment we are born. Thus, he justifies the behavior of terminal patients by arguing that "there are as many ways to die as there are to live. Sudden death is the exception rather than the rule; more often life continues as one is dying; thus, the issue is not how to die, but rather how to live with the knowledge that death is imminent." (Lipp, 94) Choosing to way in which to die is therefore spearing the person of time spent in suffering and pain.

On the other hand however, there are those arguing against such practices and refuse the patients the right to decide on their treatment. Ending a life at the choosing of the patient is seen as means to relieving pain which involves more often a lethal dosage of one specific medicine which induces immediate death. The argument against this practice lies especially in the moral and legal aspects it arises. On the one hand, there is the idea that doctors, and the entire medical staff, are designed to offer support in favor of life and not to curve it. No matter the consent of the patient, the doctors have not been invested with such a high authority to put an end to a life. The legal aspect of the matter lies in the fact that, even if there is the consent of the…