Factors influencing scope of practice in nursing centers.

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.