Clinical practice: new challenges for the advanced practice nurse.

This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?

Revised orientation program for ambulatory care.

This article describes the revisions made to an orientation program based on the introduction of a new organizational culture, expanded classes and a customized focus by means of a preceptor program.

Interventions to improve patient appointments in an ambulatory care facility.

Failed patient appointments in ambulatory care may result in decreased revenues. The purpose of this study was to determine if patient reminders would affect the "no-show" rate of a medical ambulatory care setting. Patients of 10 physicians participated in a 6-week study. Patients were randomly assigned to one of three groups: 2 weeks of appointment reminder postcards, 2 weeks of appointment reminder phone calls, and 2 weeks of no intervention. Chi-square analysis revealed significant differences between the control group and the two groups receiving interventions. Patient reminders may be a mechanism to decrease the no-show rate in ambulatory care.