Advanced practice nurses in integrated health care systems.

Changes in the health care delivery system are discussed with a view to those affecting the role and use of advanced practice nurses and particularly nurse practitioners who provide primary and reproductive care to women. Nurse practitioners are particularly well suited to function within integrated systems. They accomplish cost-containment strategies because of lower salaries or fees, fewer invasive procedures, greater compliance by patients, and increased nonpharmacologic treatments. They collaborate with all providers of primary care and enhance communication with patients. They develop clinical pathways for professionals and for patients and their families and support the use of guidelines and protocols to enhance standards of practice. It is suggested that women will become powerful consumers and that nurse practitioners are especially versed, not only in providing routine screening and episodic care, but also in teaching self-care, providing developmental and emotional support, and increasing compliance for health promotion and disease prevention. A high demand exists for education as an advanced practice nurse. Although many educational programs are moving to the master's degree, standardized educational levels are urged as a means for professionals and consumers to better understand advanced practice nursing roles. The need for nurse practitioners in the primary care market-place is demonstrated, but the system is in a state of flux, and the roles may not be used appropriately. Nurse practitioners should help to define new jobs and be assertive in negotiating for positions.