Sustaining nurse-managed practice.

Community-based nurse-managed practice (CBNMP) brings primary health care to local, typically vulnerable, populations. Despite cost-effective, high quality care, a 21% decline in academic CBNMPs was documented in the 1990s. A multiple case study addressed factors that hindered or facilitated diffusion and sustainability of CBNMPs in prevalent practice settings. To promote sustainable practice, CBNMPs should articulate a practice mission, identify the practice as nursing, create a team approach, balance mission with margin, and promote attractive sites. Other recommendations include planning for growth and evolution of health care and applying for awards to increase the visibility and political clout of CBNMPs.