Abstract
In the midst of chaos and disillusionment in health care, nurse anesthetists, midwives, clinical specialists, and nurse practitioners advance the practice of nursing. They are identified in state practice acts. Many have prescriptive privileges and are recognized as health care providers by Medicare, Medicaid, private insurance carriers, and managed care organizations. Whereas their professional and legal relationships with physicians differ from state to state, advanced practice nurses exist as legal, economic, and professional agents of change. In this post-health care reform period many physicians, discouraged by their loss of autonomy and income, are leaving the field. The author urges advanced practice nurses to lay a new agenda on policy tables to balance the focus on cost containment and profit margins. Borrowing the idea of Virginia Henderson that nurses and physicians need good heads, hands, and hearts, she emphasizes evidence-based practice, the value of the laying on of hands, and the importance of respect for the dignity of the person and compassion for his distress.
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