A review of the nursing literature, including ANA's House of Delegates reports over several years, reveals widely differing views on whether the rapid spread of managed care will ultimately have a positive or negative impact on the nursing profession. This is because managed care exists along a wide continuum, encompassing a broad range of capitated and discounted health systems with wide variations in individual health plans practice patterns. It is important to recognize trends as they develop, whether toward greater recognition for primary care nurses, or toward compromises in safety and quality. ANA has produced a number of materials that offer more analysis and viewpoints on managed care, including prominent articles in both the June 1995 and October 1996 issues of The American Nurse.

The articles contained in this issue of the Online Journal of Nursing Issues are intended to raise a number of the controversial issues surrounding the evolution and practice of managed care. It is hoped that readers will respond with letters to the editor and authors stimulating even further discussion and debate on this important topic.

In the meantime, the way for nurses to have a part in shaping the future of health care is to belong to their ANA constituent state nurses association and to work directly with managed care insurers, providers, and consumers to educate them about how nurses are the most cost-effective health care professionals that provide quality patient care. The profession must analyze and evaluate current and future roles for nurses, document the quality and cost-effectiveness of nursing services, identify the link between nursing action and patient outcomes and work together to affect public policy at the federal, state and institutional level.