ABSTRACT
The poor, elderly, single parents and other vulnerable groups have had limited options in receiving affordable, comprehensive and culturally sensitive care. Today, this gap is being filled by nurse-managed centres in accessible areas offering primary care to communities, particularly the underserved. Below, the planning, development and implementation of one such nursing centre.
Subject(s)
Community Health Centers/organization & administration , Community Health Nursing/organization & administration , Health Facility Planning , Primary Health Care/organization & administration , Program Development , Humans , Planning Techniques , Program EvaluationABSTRACT
During the past 20 years, models of autonomous nursing practice, referred to as nursing centers or nurse-managed centers (NMC), have been reported with increasing frequency in the literature. This review of the NMC literature focused on five factors influencing the scope of practice in these settings. Scope of practice was influenced by the purpose of the NMC, whether for faculty practice, community service, or as a setting for specialty nursing practice. A majority of NMCs appear to include nurses in advanced practice, although registered nurses do fulfill a variety of roles. Although the relationship an NMC maintains with the medical community is ideally characterized by collaboration and mutual acceptance, issues of competition arise. NMCs typically target underserved populations or candidates for specialty nursing care such as geriatric or cardiac rehabilitation patients. Finally, the scope of practice defined by an NMC is affected by the center's need to generate income. A survival strategy for NMCs would appear to require (1) provision of high-quality nursing services; (2) public and community support; (3) healthy, collaborative relationships with other health care providers; and (4) documentation of patient outcomes through NMC-based nursing research.
Subject(s)
Community Health Centers/organization & administration , Models, Nursing , Nurse Clinicians/organization & administration , Primary Health Care/organization & administration , Clinical Nursing Research , Income , Interprofessional Relations , Marketing of Health Services , Nursing Faculty Practice/organization & administration , Organizational Objectives , Outcome Assessment, Health Care , United StatesABSTRACT
The focus on advanced practice is now critical, as the nation begins to reform our health care system. President Clinton has called for a plan that incorporates "security, simplicity, savings, choice, quality, and responsibility". These are major efforts for health care providers, including nurses who deliver direct care and designers of these health care systems. The future work of the advanced nurse practitioner evolves from today's practitioners and their vision. Now, nurses in advanced practice can help design and implement systems of the future. The author highlights some of the issues involved in advanced practice, remarking on how advanced practice might be implemented in the critical care setting. The specifics of implementation is the responsibility of specialists in acute care. As a primary care nurse practitioner, the author provides ideas of application and examines some of the barriers to the continuing growth of nursing practice.
Subject(s)
Critical Care , Job Description , Nurse Clinicians , Nurse Practitioners , Certification , Forecasting , Humans , Nurse Clinicians/education , Nurse Clinicians/standards , Nurse Practitioners/education , Nurse Practitioners/standards , Professional AutonomySubject(s)
Education, Nursing, Graduate , Primary Health Care , Rural Health , Humans , PreceptorshipABSTRACT
As we look to the new century and are engaged in designing the future of professional nursing, it seems that exploring new services and settings, human resource development, entrepreneurial opportunities, and most importantly, establishing the economic viability of nursing are logical beginnings. Nursing's ability to move onward will be determined by today's advances in nursing practice. With our growing knowledge, our vision, and our search for expansion and excellence in professional practice, we have changed our lives and those of others. We are captains of our destiny. Today's search for understanding is unbounded. Ours is the age of knowledge, choice, and opportunity. As tomorrow's world approaches, we must question, discover, and understand. But our central challenge remains to respond to social need with professional intelligence.
