nists, social workers, and other tertiary care specialists as required. There are several significant implications associated with the delivery of health care services through a team approach, among which the more important are the following:
1. Each member of the primary health care team has a special contribution to make.
2. Each member of the primary health care team may under certain circumstances deliver health care services to patients independently of any of the other members of the team.
3. Consultation and collaboration among members of the primary health care team are essential elements in the delivery of effective health care services.
When viewed in the team context, the role of the nurse practitioner appears as less of a departure from accepted practice, and more as an expected and a desirable evolution in the delivery of effective health care services. Opposition to nurse practitioners is still present; however, it is more difficult to justify when the nurse practitioner is viewed as a necessary member of an essential primary health care team (Thibodeau and Hawkins, 1994, pp. 205 218). In the 1990s, the nurse managed clinic frequently serves as a focal point for a primary health care team (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 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 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 pro...