title: Reflections on independence in nurse practitioner practice.
abstract: OBJECTIVE
  To examine factors that influence the ability of nurse practitioners (NPs) to practice as independent primary care providers.
  
  
  METHODS
  Extensive literature search on CINAHL, OVID, MEDLINE, Internet journal sources, and professional association Web sites.
  
  
  CONCLUSIONS
  The legal authority for NPs to practice independently is recognized; however, the ability to put that authority into practice is undermined by the historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously. Nonrecognition is responsible for complex reimbursement policies (both federal and state) that economically and professionally restrain the NP role; hence, NPs remain in a financially dependent relationship despite 40 years of proven safe practice. NPs must articulate their independence as practitioners more vociferously in order to meet society's healthcare requirements, as well as to attain professional fulfillment and forge collegial relationships.
  
  
  CONCLUSIONS
  NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee's voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.
authors.affiliation: Tri-County Family Health Clinic, Wapanucka, Oklahoma 73461, USA. tricountyhealth@att.net
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Weiland
mesh_terms: D002983:Clinical Competence; D006291:Health Policy; D006801:Humans; D006278:Medicare / Q000191:economics*; D009722:Nurse Practitioners / Q000191:economics / Q000458:organization & administration* / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology*; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D012051:Reimbursement Mechanisms / Q000191:economics*; D012956:Societies, Nursing; D014481:United States