Practice model: development of a nurse-managed unit and the advanced practitioner role.

Health care reform has provided opportunities for the creation of nurse-managed centers and the expansion of an autonomous nursing role. This article describes a program established by Massachusetts General Hospital for cardiac patients that has reduced delays in transfer and improved access to the hospital from referral centers. The program merges a strong primary nursing staff with a new advanced practice nursing role to create an alternative to the traditional model of inpatient care.