The American economy exploited the Appalachian people more on their mountain farms than it did later when it had to pay them fully family-supported wages (welfare). Both the Appalachian regional economy and America’s national economy benefited more from these people when they were subsistence farmers and supplied subsidized workers to industry than it has benefited from them since they have joined more fully in the money economy and are no longer self-sufficient . The same can certainly be said of nurses prior to the country’s shift from community-based to the institutionalised provision of health care. While nurses continue to call for increased salaries, reduced nurse-patient ratios, greater professional autonomy and safer working conditions they are simultaneously continuing to leave the profession in droves citing their frustration with a system that continually curtails their ability to provide the type of humane, meaningful, quality care they feel obligated to provide to the people they serve . For both Appalachia and the nursing profession it was not the ‘enterprise’ system itself that weakened the culture; it was the form that it took. For Appalachia, it was working for currency instead of people and for the FNS and in a larger sense for the profession of nursing as well, it was working for institutions instead of patients.
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