st prominent of the non physician health care professionals involved in the direct delivery of health care services to patients.
Nurse practitioners and clinical nurse specialists engage in the delivery of a wide variety of health care services without the direct supervision of physicians (Thibodeau and Hawkins, 1994, pp. 205-218). The early role of the nurse practitioner was primarily as a member of a primary health care team. This role continues to be important in the 1990s, although the function of the nurse practitioner has expanded far beyond this concept.
In the 1990s, the nurse managed clinic frequently serves as a focal point for primary health care (Reifsteck and D'Angelo, 1990, pp. 12-21). As a focal point, the nurse managed clinic is the hub through which all health care services for patients may be arranged. Within this context, the assumption of additional responsibilities by nurse practitioners and clinical nurse specialists has been found to be effective in the combined context of cost containment and improving care quality (Manion, 1991, pp. 18-21; Behner and Hagerott, 1991, pp. 30-34).
In the 1990s also, government has found that nurse practitioners and clinical nurse specialists can play a vital role in the delivery of health care services to the indigent. As costs associated with the delivery of health care services soared in the 1980s and continue to increase in the 1990s, third party funders, health care providers, and users of health care services sought and continue to develop and implement procedures and programs that will either stabilize costs or reduce the rate of increase of such costs. Health care services funded by government received special scrutiny. Indigent people are almost entirely dependent upon cost-free or sliding-scale fee health care services delivery. Thus, cost containment measures that affect the delivery of governmentally funded health care services tend to have a devastatin...