sacrificing, undemanding, unquestioning, and tireless as a worker. Today nurses have become autonomous professionals. Since the 1980s nurses have been involved in decision-making authority and they are more active in practice (Betz, 1995). The changing conditions in health care are leading to new demands for accountability. For example, studies show that diagnostic procedures are performed for inappropriate reasons in 30 percent of cases (Winkenwerder, 1990). Nurses are questioning common practices such as these. In addition, nurses are now expected to use research for decision making in their professional practice. New roles are including activist, research, research evaluation, and deficiency identification (Selby, Gentry, Riportella-Muller, Quade, Legault, & Monahan, 1990).
Nurse practitioners (NPs) are those registered nurses trained at a master's level. NPs are independently licensed, 20 states allow complete autonomous practice and 48 states allow some form of prescribing authority (Pickwell, 1997; Sherwood, Brown, Fay, & Wa
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