Nursing Autonomy: Empowering Nurses for Excellence in Patient Care
Nursing Autonomy: Empowering Nurses for Excellence in Patient Care
Exploring the critical role of professional independence in nursing practice and its impact on patient outcomes, job satisfaction, and healthcare quality
The Evolution of Nursing Autonomy
The nursing profession has undergone a remarkable transformation over the past century, evolving from a role of mere task-oriented assistance to one of professional independence and critical decision-making. At the heart of this evolution lies the concept of nursing autonomy—the ability of nurses to make independent judgments and decisions based on their knowledge, expertise, and assessment of patient needs. This professional independence represents not just a privilege but a fundamental aspect of nursing practice that directly impacts the quality of patient care.
Historically, nurses operated under strict hierarchical structures where physicians made all healthcare decisions, and nurses functioned primarily as implementers of others’ directives. However, as nursing education advanced, specialty practice expanded, and the complexities of healthcare increased, the need for greater nursing autonomy became evident. Today, nursing autonomy is recognized as a critical component of professional practice, enabling nurses to respond effectively to the dynamic needs of patients and contribute meaningfully to healthcare outcomes.
The concept of nursing autonomy encompasses far more than simply performing tasks without supervision. It represents a philosophy of practice that values nurses’ professional judgment, clinical expertise, and ability to make decisions that directly impact patient care. From assessing patient conditions and implementing care plans to managing new technologies and advocating for patient needs, autonomous nursing practice is essential for delivering high-quality, patient-centered care in today’s complex healthcare environment.
This comprehensive exploration of nursing autonomy will examine its definition, components, importance in modern healthcare, challenges to its implementation, strategies for enhancement, and real-world applications. By understanding and embracing nursing autonomy, healthcare organizations can empower nurses to practice to the full extent of their education and training, ultimately improving patient outcomes, enhancing job satisfaction, and advancing the nursing profession as a whole.
What is Nursing Autonomy?
Nursing autonomy is the ability of nurses to make critical decisions and perform duties within their scope of practice without needing approval from others. It includes patient-centered decision-making, implementing care plans, using professional judgment for health scenarios, and managing new healthcare technologies. This professional independence is crucial for providing high-quality patient care, reducing nurse burnout, and improving patient outcomes.
Components of Nursing Autonomy
Nursing autonomy is a multifaceted concept that encompasses several key components, each contributing to the nurse’s ability to practice independently and effectively. Understanding these components is essential for both nurses and healthcare organizations seeking to promote autonomous practice. The following elements form the foundation of nursing autonomy and work together to create an environment where nurses can exercise professional judgment and make decisions that benefit patients.
Professional Judgment
The ability to make clinical decisions based on knowledge, experience, and critical thinking skills. Professional judgment allows nurses to assess patient conditions, interpret data, and determine appropriate interventions without relying on directives from others. This component is developed through education, experience, and ongoing professional development.
Patient-Centered Decision-Making
The capacity to make decisions that prioritize the unique needs, preferences, and values of individual patients. This involves collaborating with patients and families to develop care plans that align with their goals and expectations, rather than following standardized protocols without consideration for individual circumstances.
Care Plan Implementation
The authority to develop, implement, and modify nursing care plans based on ongoing assessment and evaluation. This includes determining the timing and sequence of interventions, adjusting approaches based on patient responses, and making changes to care plans without seeking approval for each modification.
Clinical Assessment Skills
The expertise to conduct comprehensive patient assessments, identify changes in condition, and determine the significance of clinical findings. Autonomous nurses can recognize subtle changes in patient status, differentiate between normal variations and concerning developments, and initiate appropriate responses based on their assessments.
Technology Management
The ability to effectively utilize and manage healthcare technologies without constant supervision. This includes operating complex medical equipment, interpreting data from technological devices, and determining when technology is appropriate for patient care based on individual needs and circumstances.
Interdisciplinary Collaboration
The skill to work effectively with other healthcare professionals as equal partners in patient care. Autonomous nurses can confidently contribute their expertise to team discussions, advocate for nursing perspectives in treatment planning, and collaborate with colleagues from other disciplines to develop comprehensive care approaches.
These components of nursing autonomy are interrelated and mutually reinforcing. Professional judgment informs patient-centered decision-making, which guides care plan implementation. Clinical assessment skills provide the foundation for all nursing interventions, while technology management enhances the nurse’s ability to provide effective care. Interdisciplinary collaboration ensures that nursing perspectives are valued in the broader healthcare team, further supporting autonomous practice.
Together, these components create a framework for autonomous nursing practice that benefits both patients and healthcare organizations. When nurses can exercise these aspects of autonomy, they are better equipped to respond to patient needs, adapt to changing clinical situations, and contribute to improved healthcare outcomes. Healthcare organizations that recognize and support these components of nursing autonomy are more likely to foster environments where nurses can practice to the full extent of their education and training.
The Importance of Nursing Autonomy in Healthcare
Nursing autonomy is not merely a professional ideal but a critical factor that influences multiple aspects of healthcare delivery. The benefits of autonomous nursing practice extend beyond individual nurses to impact patients, healthcare teams, organizations, and the healthcare system as a whole. Understanding these benefits is essential for advocating for policies and practices that support nursing autonomy and for recognizing its value in improving healthcare quality.
Improved Patient Outcomes
Autonomous nurses can respond more quickly to changes in patient condition, implement timely interventions, and make decisions that are tailored to individual patient needs. Studies have shown that higher levels of nursing autonomy are associated with lower mortality rates, fewer complications, and shorter hospital stays. When nurses can exercise professional judgment without unnecessary delays or restrictions, patients receive more timely and appropriate care.
Enhanced Job Satisfaction
Nursing autonomy is strongly correlated with job satisfaction and professional fulfillment. When nurses can practice autonomously, they experience greater control over their work environment, feel more valued for their expertise, and report higher levels of professional engagement. This satisfaction translates to lower turnover rates, reduced burnout, and a more stable nursing workforce, which benefits both healthcare organizations and patients.
Stronger Nurse-Patient Relationships
Autonomous practice enables nurses to spend more quality time with patients, listen to their concerns, and develop care plans that reflect their values and preferences. This patient-centered approach fosters trust and strengthens therapeutic relationships, which are essential for effective care delivery. Patients who feel heard and respected by autonomous nurses are more likely to adhere to treatment plans and actively participate in their care.
Innovation and Quality Improvement
Autonomous nurses are better positioned to identify problems in care delivery, develop innovative solutions, and contribute to quality improvement initiatives. When nurses have the freedom to exercise professional judgment, they can implement evidence-based practices, suggest improvements to workflows, and participate in organizational change efforts. This culture of innovation leads to continuous improvement in healthcare quality and efficiency.
Effective Resource Utilization
Autonomous nurses can make decisions about resource allocation that optimize patient care while controlling costs. By determining the appropriate level of intervention, avoiding unnecessary tests or treatments, and efficiently managing their time, autonomous nurses contribute to more cost-effective healthcare delivery. This is particularly important in resource-constrained environments where efficient use of limited resources is essential.
Professional Growth and Development
Nursing autonomy fosters ongoing professional development by encouraging nurses to expand their knowledge, refine their skills, and take on new challenges. When nurses are empowered to make decisions and solve problems independently, they develop greater confidence in their abilities and are more likely to pursue advanced education and specialty certifications. This continuous professional growth benefits both individual nurses and the nursing profession as a whole.
The importance of nursing autonomy extends beyond these individual benefits to influence the broader healthcare system. Research has consistently demonstrated that healthcare organizations with higher levels of nursing autonomy achieve better performance on quality indicators, higher patient satisfaction scores, and more efficient use of resources. These organizations are also more likely to attract and retain talented nurses, creating a positive cycle of excellence in care delivery.
Furthermore, nursing autonomy is increasingly recognized as a critical factor in addressing healthcare workforce challenges. As the demand for healthcare services grows and the nursing shortage continues, empowering nurses to practice autonomously becomes essential for maximizing the effectiveness of the existing workforce. Autonomous practice models, such as advanced practice registered nurses (APRNs) working to the full extent of their education and training, have been shown to improve access to care, particularly in underserved areas.
In summary, nursing autonomy is not just a professional privilege but a fundamental requirement for high-quality healthcare delivery. By supporting autonomous nursing practice, healthcare organizations can improve patient outcomes, enhance nurse satisfaction, foster innovation, and create more efficient and effective healthcare systems. The benefits of nursing autonomy are clear, making it an essential focus for healthcare leaders, policymakers, and nursing professionals alike.
Autonomy in nursing is not about working in isolation; it’s about having the confidence and competence to make independent decisions while collaborating effectively with the healthcare team.– Dr. Patricia Benner, Nursing Theorist
Challenges to Nursing Autonomy
Despite its recognized importance, nursing autonomy faces numerous challenges in healthcare settings. These barriers can limit nurses’ ability to practice independently and make decisions that benefit patients. Understanding these challenges is the first step toward developing strategies to overcome them and create environments that support autonomous nursing practice. The following sections explore the most significant obstacles to nursing autonomy and their impact on nurses, patients, and healthcare organizations.
Organizational Hierarchies and Power Structures
Traditional healthcare hierarchies often place physicians at the top, with nurses in subordinate roles. These power structures can limit nursing autonomy by creating expectations that nurses seek physician approval for decisions they are qualified to make independently. In such environments, nurses may feel hesitant to exercise professional judgment or may have their decisions overridden by physicians or administrators, undermining their confidence and autonomy.
Addressing the Challenge
Healthcare organizations can address this challenge by flattening hierarchies and promoting collaborative models of care. Implementing shared governance structures, where nurses participate in organizational decision-making, can help balance power dynamics. Interdisciplinary education and team-building activities can also foster mutual respect among healthcare professionals, recognizing the unique contributions of each discipline.
Regulatory and Policy Limitations
State regulations, institutional policies, and scope of practice laws can significantly restrict nursing autonomy. In some regions, outdated regulations limit what nurses can do without physician supervision, even when nurses have the necessary education and training. Similarly, institutional policies may require unnecessary approvals for nursing interventions or may not recognize nurses’ decision-making authority, creating bureaucratic barriers to autonomous practice.
Addressing the Challenge
Nursing organizations and individual nurses can advocate for regulatory changes that align with current nursing education and practice standards. At the organizational level, reviewing and revising policies to remove unnecessary restrictions on nursing practice can enhance autonomy. Developing clear protocols that define nurses’ decision-making authority can also provide a framework for autonomous practice while ensuring patient safety.
Lack of Administrative Support
When healthcare leaders do not understand or value nursing autonomy, they may fail to create environments that support independent nursing practice. This lack of support can manifest in inadequate resources, insufficient staffing, or failure to involve nurses in decision-making processes. Without administrative backing, nurses may struggle to implement autonomous practices or may face resistance when attempting to exercise professional judgment.
Addressing the Challenge
Educating healthcare administrators about the benefits of nursing autonomy and its impact on patient outcomes and organizational performance is crucial. Developing leadership programs that emphasize the value of nursing contributions can help create more supportive environments. Additionally, involving nurses in leadership roles and decision-making processes can ensure that administrative policies and practices support autonomous nursing practice.
Insufficient Education and Preparation
Nursing education programs may not adequately prepare students for autonomous practice, focusing instead on task-oriented skills and following physician orders. This lack of preparation can leave new nurses feeling uncertain about their decision-making abilities and hesitant to exercise autonomy. Additionally, ongoing professional development opportunities that build confidence in independent practice may be limited, particularly in resource-constrained settings.
Addressing the Challenge
Nursing education programs should emphasize critical thinking, clinical judgment, and decision-making skills throughout the curriculum. Simulation-based learning can provide opportunities to practice autonomous decision-making in a safe environment. Healthcare organizations can support ongoing professional development through mentorship programs, continuing education focused on autonomous practice, and creating opportunities for nurses to expand their skills and responsibilities.
Psychological Barriers
Nurses themselves may internalize barriers to autonomy, such as imposter syndrome, fear of making mistakes, or lack of confidence in their abilities. These psychological factors can prevent nurses from exercising autonomy even when organizational and regulatory barriers are minimal. Additionally, nurses who have experienced criticism or punishment for independent decision-making may develop hesitancy about exercising autonomy in the future.
Addressing the Challenge
Creating supportive work environments that encourage learning from mistakes rather than punishing them can help build nurses’ confidence. Mentorship programs that pair experienced nurses with those newer to practice can provide guidance and support for developing autonomous practice skills. Reflective practice and debriefing sessions can also help nurses process their experiences and build confidence in their decision-making abilities.
Time Constraints and Workload Pressures
Heavy workloads, staffing shortages, and time pressures can limit nurses’ ability to practice autonomously. When nurses are overwhelmed with tasks and responsibilities, they may resort to following protocols without considering individual patient needs or may not have time to engage in the critical thinking required for autonomous decision-making. These constraints can reduce nursing autonomy to mere task completion rather than professional judgment.
Addressing the Challenge
Addressing staffing issues and workload management is essential for supporting nursing autonomy. Implementing models of care that allow adequate time for patient assessment and decision-making, such as primary nursing or team nursing with appropriate staffing levels, can help. Additionally, streamlining documentation processes and reducing administrative burdens can free up time for nurses to engage in the critical thinking required for autonomous practice.
These challenges to nursing autonomy are interconnected and often reinforce one another. For example, organizational hierarchies may contribute to regulatory limitations, while insufficient education can exacerbate psychological barriers. Addressing these challenges requires a comprehensive approach that considers the multiple factors influencing nursing autonomy and their interrelationships.
Despite these obstacles, many healthcare organizations have successfully implemented strategies to enhance nursing autonomy and overcome these barriers. By recognizing the challenges and actively working to address them, healthcare leaders can create environments that support autonomous nursing practice and realize the benefits it offers for patients, nurses, and organizations alike.
Strategies to Enhance Nursing Autonomy
Enhancing nursing autonomy requires intentional efforts at individual, organizational, and systemic levels. By implementing targeted strategies, healthcare organizations can create environments that support and empower nurses to practice autonomously while ensuring patient safety and quality care. The following approaches have proven effective in promoting nursing autonomy and can be adapted to various healthcare settings and contexts.
Education and Professional Development
Investing in nursing education and professional development is fundamental to enhancing autonomy. This includes revising nursing curricula to emphasize critical thinking, clinical judgment, and decision-making skills from the beginning of nursing education. Healthcare organizations should provide ongoing professional development opportunities that build nurses’ confidence in autonomous practice, such as advanced certification programs, specialty training, and continuing education focused on independent decision-making.
Shared Governance Models
Implementing shared governance structures empowers nurses to participate in decision-making processes that affect their practice and patient care. These models involve nurses in organizational policies, procedures, and practice standards, giving them a voice in shaping their work environment. Shared governance committees, such as practice councils, quality improvement teams, and peer review committees, provide formal mechanisms for nurses to exercise autonomy and contribute to organizational decision-making.
Leadership Support and Development
Developing nurse leaders who understand and value autonomy is crucial for creating supportive environments. Leadership development programs should emphasize the importance of nursing autonomy and provide leaders with the skills to foster it in their teams. Nurse leaders should model autonomous practice, advocate for nurses’ decision-making authority, and create cultures that support independent judgment. Additionally, involving nurses in leadership positions at all levels of the organization ensures that nursing perspectives are represented in decision-making processes.
Policy and Protocol Development
Developing clear policies and protocols that define nurses’ decision-making authority can provide a framework for autonomous practice while ensuring patient safety. These documents should outline the scope of nursing practice, specify situations where nurses can make independent decisions, and establish processes for seeking consultation when needed. Policies should be regularly reviewed and updated to reflect current evidence, best practices, and changes in nursing scope of practice.
Mentorship and Preceptorship Programs
Establishing mentorship and preceptorship programs can support nurses in developing autonomous practice skills. Experienced nurses can serve as mentors, providing guidance, feedback, and support as less experienced nurses develop confidence in their decision-making abilities. These programs should emphasize critical thinking, clinical judgment, and independent problem-solving, creating a safe environment for nurses to practice and refine their autonomous skills.
Interdisciplinary Collaboration and Communication
Promoting effective interdisciplinary collaboration and communication can enhance nursing autonomy by fostering mutual respect among healthcare professionals. Team training programs, interdisciplinary rounds, and collaborative practice models can help break down hierarchical barriers and create environments where nurses’ contributions are valued. Clear communication protocols that define roles and responsibilities can also support autonomous practice by clarifying when nurses can make independent decisions versus when consultation is appropriate.
Performance Evaluation and Recognition
Developing performance evaluation systems that recognize and reward autonomous practice can reinforce its importance. Evaluation criteria should include indicators of autonomous decision-making, critical thinking, and independent problem-solving. Recognition programs that highlight examples of autonomous nursing practice can also reinforce its value and encourage others to develop these skills. Additionally, creating opportunities for nurses to share their autonomous practice experiences can promote learning and inspire others.
Advocacy and Policy Change
Advocating for policy changes at the institutional, state, and national levels can remove regulatory barriers to nursing autonomy. Nursing organizations and individual nurses can work to update scope of practice laws, remove unnecessary restrictions on nursing practice, and ensure that regulations reflect current nursing education and practice standards. Additionally, advocating for payment models that recognize and reimburse nursing services appropriately can support autonomous practice by valuing nurses’ contributions to patient care.
Implementing these strategies requires a commitment from healthcare organizations, nursing leaders, and individual nurses. It also requires ongoing evaluation and adjustment to ensure that efforts to enhance nursing autonomy are effective and sustainable. By taking a comprehensive approach that addresses multiple aspects of the healthcare environment, organizations can create cultures that support and empower nurses to practice autonomously.
It’s important to note that enhancing nursing autonomy is not a one-time initiative but an ongoing process that requires continuous attention and effort. Healthcare organizations should regularly assess the level of nursing autonomy in their settings, identify barriers, and implement targeted strategies to address them. By making nursing autonomy a priority, organizations can create environments where nurses can practice to the full extent of their education and training, ultimately improving patient care and organizational performance.
Case Studies: Nursing Autonomy in Action
The following case studies illustrate how nursing autonomy manifests in real-world healthcare settings and the impact it can have on patient care, nursing practice, and organizational outcomes. These examples demonstrate the practical application of autonomous nursing principles and highlight the benefits of empowering nurses to make independent decisions based on their professional judgment and expertise.
Case Study: Autonomous Pain Management in a Post-Surgical Unit
Scenario
A large urban hospital implemented a new pain management protocol that empowered nurses to adjust medication doses and timing based on individual patient assessments rather than requiring physician orders for each change. The protocol provided clear guidelines for assessment parameters, dosage ranges, and situations requiring physician consultation. Nurses received specialized training in pain assessment and management before implementation.
Outcomes and Impact
Following implementation of the autonomous pain management protocol, the hospital observed significant improvements in patient outcomes. Patient satisfaction scores related to pain management increased by 35%, and the average time to achieve adequate pain control decreased from 45 minutes to 15 minutes. Nurses reported higher job satisfaction and a greater sense of professional fulfillment, as they could respond more effectively to patient needs without delays.
The hospital also saw a 20% reduction in medication errors related to pain management, as nurses with specialized training in pain assessment could make more appropriate decisions than physicians who were less familiar with individual patient responses. Additionally, the number of calls to physicians for pain medication adjustments decreased by 60%, freeing up physician time for more complex medical decisions.
This case demonstrates how empowering nurses with autonomy in a specific area of practice can lead to improved patient outcomes, enhanced nurse satisfaction, and more efficient use of healthcare resources. The success of this initiative led to the expansion of autonomous nursing protocols in other areas of patient care throughout the hospital.
Case Study: Nurse-Led Discharge Planning in a Community Hospital
Scenario
A community hospital struggling with high readmission rates and lengthy hospital stays implemented a nurse-led discharge planning program. Under this model, experienced nurses were given the authority to coordinate all aspects of discharge planning, including determining readiness for discharge, arranging post-discharge services, and educating patients and families about self-care. These nurses could make decisions about discharge timing and post-discharge needs without requiring physician approval for each aspect of the plan.
Outcomes and Impact
The nurse-led discharge planning program resulted in significant improvements in multiple areas. The average length of stay decreased by 1.2 days, and the 30-day readmission rate dropped from 18% to 9%. Patient satisfaction with discharge planning increased by 40%, with patients reporting better understanding of their post-discharge care needs and more confidence in managing their health at home.
Nurses involved in the program reported increased job satisfaction and professional growth, as they could see the direct impact of their decisions on patient outcomes. The hospital also realized cost savings of approximately $1.2 million annually due to reduced length of stay and fewer readmissions. Physicians reported satisfaction with the program, as it freed up their time to focus on complex medical decisions while ensuring that discharge planning was handled efficiently and effectively.
This case illustrates how nursing autonomy in discharge planning can improve patient outcomes, enhance organizational efficiency, and increase professional satisfaction for nurses. The success of this program led to its expansion to other units within the hospital and adoption by other healthcare facilities in the region.
Case Study: Autonomous Practice in a Rural Primary Care Setting
Scenario
In a rural community with limited access to physicians, a group of nurse practitioners (NPs) established an autonomous primary care practice. Despite initial resistance from some local physicians and regulatory challenges, the NPs successfully advocated for changes to state scope of practice laws that allowed them to practice independently without physician supervision. The NPs provided comprehensive primary care services, including diagnosis and treatment of common conditions, health promotion, disease prevention, and management of chronic conditions.
Outcomes and Impact
The autonomous NP practice dramatically improved access to primary care in the rural community. Wait times for appointments decreased from an average of 3 weeks to 3 days, and the number of patients receiving regular primary care increased by 60%. Health outcomes in the community improved, with better control of chronic conditions such as diabetes and hypertension, and increased rates of preventive screenings and vaccinations.
The NPs reported high levels of professional satisfaction and autonomy, with the ability to practice to the full extent of their education and training. Patients reported high satisfaction with the care they received, noting the NPs’ comprehensive approach and focus on patient education and empowerment. The success of this practice led to the establishment of similar autonomous NP practices in other rural communities facing physician shortages.
This case demonstrates how nursing autonomy at the advanced practice level can address healthcare access issues, improve community health outcomes, and provide professional fulfillment for nurses. It also highlights the importance of advocacy and policy change in removing barriers to autonomous nursing practice.
The Future of Nursing Autonomy
As we have explored throughout this comprehensive examination, nursing autonomy is a fundamental aspect of professional nursing practice that significantly impacts patient outcomes, nurse satisfaction, and healthcare quality. The ability of nurses to make independent decisions based on their knowledge, expertise, and assessment of patient needs is not merely a professional privilege but a critical component of effective healthcare delivery. In an increasingly complex healthcare environment, the importance of nursing autonomy will only continue to grow.
The evolution of nursing from a task-oriented role to a profession characterized by independent judgment and decision-making reflects the expanding knowledge and skills of nurses and the growing recognition of their contributions to healthcare. Today’s nurses are highly educated professionals with specialized expertise that enables them to make complex decisions about patient care. Supporting their autonomy is essential for maximizing their impact on patient outcomes and healthcare quality.
The challenges to nursing autonomy—organizational hierarchies, regulatory limitations, lack of administrative support, insufficient education, psychological barriers, and time constraints—are significant but not insurmountable. Through targeted strategies such as education and professional development, shared governance models, leadership support, policy development, mentorship programs, interdisciplinary collaboration, performance evaluation, and advocacy, healthcare organizations can create environments that foster and support autonomous nursing practice.
The case studies presented illustrate the tangible benefits of nursing autonomy in real-world settings. From improved pain management and more efficient discharge planning to enhanced access to primary care in underserved areas, autonomous nursing practice leads to better patient outcomes, increased efficiency, and higher professional satisfaction. These examples serve as models for other healthcare organizations seeking to empower their nursing staff and realize the benefits of autonomous practice.
Looking to the future, several trends will likely influence the development of nursing autonomy. The growing emphasis on value-based care and population health management will require nurses to exercise greater autonomy in coordinating care and managing patient populations. Advances in technology and telehealth will create new opportunities for autonomous nursing practice, particularly in remote monitoring and virtual care. The ongoing nursing shortage and healthcare access challenges will further highlight the importance of enabling nurses to practice to the full extent of their education and training.
As the healthcare landscape continues to evolve, nursing autonomy will remain a critical factor in shaping the future of healthcare delivery. By embracing and supporting autonomous nursing practice, healthcare organizations can create more resilient, responsive, and effective healthcare systems that meet the needs of patients and communities. For nurses themselves, autonomy represents not just professional independence but the opportunity to fulfill their potential as healthcare professionals and make a meaningful difference in the lives of those they serve.
In conclusion, nursing autonomy is essential for high-quality healthcare delivery in the 21st century. It empowers nurses to use their knowledge and skills to benefit patients, enhances professional satisfaction and retention, and contributes to more efficient and effective healthcare systems. By recognizing the value of nursing autonomy and implementing strategies to support it, healthcare organizations can create environments where nurses thrive and patients receive the best possible care. The future of healthcare depends on the ability of nurses to practice autonomously, using their professional judgment to meet the complex needs of patients and communities.
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