Sustaining nurse-managed practice

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A multiple case study of CBNMPs in prevalent practice contexts revealed factors that facilitated or hindered the innovation development process of CBNMPs. Critical facilitating factors included a supportive infrastructure, full-time delivery of needs-driven primary health care by advanced practice nurses, and growth from a steady stream of diverse users and a mix of payers. Noteworthy hindering factors included insufficiently planned transition from initial grant funding, invisibility of the CBNMP within the community, lack of referral sources, and inadequate reimbursements. To promote sustainable practice, CBNMPs should articulate a practice mission, identify the practice as nursing, create a team approach, balance mission with margin, and promote attractive practice sites. Other recommendations include planning for growth and evolution of health care and applying for awards to increase the visibility and political clout of CBNMPs. © 2005 Elsevier Inc. All rights reserved.

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