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The nursing shortage has been labeled a significant crisis in the health sector. This shortfall could severely threaten both the nursing profession and the entire American health care system. Numerous studies have focused on nurses' satisfaction with their work and the factors leading to positive and negative evaluations. A major deficiency of these endeavors, however, is that none have examined the attitudes of the nurses toward the shortage nor the activities which might be undertaken to rectify it. Moreover, political competence and the nurses' perceptions of the political arena have not been addressed and related to the shortage. The purpose of this paper is to help fill these gaps in the literature.

This paper deals with the system of emergency medical services in Italy. More specifically, it is a case study of the organization and operation of this system in the region of Tuscany. Recent decentralization decrees have established regional governments with major responsibilities for health care, including emergency medical services. The effects of a long history of social and political cleavages on provision of these services at the regional level are presented and discussed. The paper concludes that prospects for rational reform of emergency care service are dim.