Health care presently is an ever-changing environment for all Americans, in
cluding the veteran population. New and innovative approaches to health car
e must include goals that maximize quality care, improve access and cost ef
fectiveness, facilitate patient satisfaction, and optimize the functional s
tatus of patients. Recognizing the opportunities in this challenging enviro
nment, advanced practice nurses are stepping forward as competent primary c
are providers who can meet these goals. This article describes the establis
hment of primary care clinics run by advanced practice nurses in the US Dep
artment of Veterans Affairs Upper Midwest Healthcare Network, in the states
of Minnesota, North Dakota, and South Dakota.