Integration, capitation, and managed care: transformation of nursing for 21st century health care.

Market-driven reforms and the growth of managed care will transform the nursing profession in the next 5 to 10 years. Managed care will pressure RN-level nursing to justify its costs and advanced training. New roles for nursing will include (a) advanced practice nurses substituting for physicians, (b) nurse case managers coordinating care and aggressively managing patients along care paths, and (c) nurse team leaders organizing patient care and delegating less complex nurse tasks to less trained workers.