Meeting new health care challenges with a proven innovation: nurse-managed health care clinics.

Beginning in January 2014, millions of Americans will enroll in health insurance plans under the Affordable Care Act. Some of these individuals were obtaining health care in safety net health clinics, emergency departments, or urgent care centers; many were going without needed care and will be new to the health care system. In addition to these newly insured, the ranks of older Americans and persons in need of chronic disease management will be on the rise. The way in which health care is delivered will have to change in order for the health care workforce to meet the demand for their services without sacrificing quality or access. Nurse practitioners and registered nurses have the education and skills to provide health promotion, disease prevention, and chronic disease management services that will make up a sizable portion of the demand. Amending state practice acts so that the authority to practice matches the ability to practice and opening provider panels to advanced practice nurses will provide opportunities to establish or expand sustainable nurse-led primary care practices in health care shortage areas. Along with these changes, models of health care delivery that incorporate differentiated practice roles and shared interprofessional responsibility for providing care will maximize the capacity of the system to provide the health care that people need.

Enhancing diagnostic reasoning skills in nurse practitioner students: a teaching tool.

The Advanced Health Assessment course provides an opportunity to focus on critical thinking and diagnostic reasoning skills as students transition to the nurse practitioner role. The authors describe a structured teaching tool designed for faculty to use in facilitating diagnostic reasoning and clinical judgment. This tool gives faculty a format to use in the classroom or online for helping students decide which data to collect and which data are important in developing hypothesis driven differential diagnoses.