Significant changes in the health-care delivery system during the past Few years has resulted in shirts in managed care. Under this system, the fundamental assumptions or health-care delivery have been challenged and are beginning to change: emphasis on health, not illness, primary versus specially care, hospital-based care to care networks, and revision of medical education patterns, The resulting opportunity for nursing has assisted in the expansion of Its care to a practitioner model within the acute-care setting. Through case management and direct acute-care patient management, acute-care nurse practitioners (ACNPs) may ultimately contribute to reductions in hospitalization costs. Literature suggesting actual coats of ACNPs to be high must be measured against their invaluable contributions to increased quality of cars. Detailed evaluation programs are needed far more complete analysis. An example of ACNP practice at a large teaching hospital shows varied interpretations of the role

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