Abstract
The competing demands of caring for high-acuity patients, reducing health care costs, and improving access to specialty care are complex challenges facing all health care providers. One approach-empowering nurses to expand their scope of practice-has been successfully employed for two decades by the nurse and physician leadership of a neurology department in an urban academic medical center. This article discusses the department's implementation of a quality improvement initiative to enhance access to neurology services in an ambulatory clinic by extending nursing practice to include lumbar puncture. Outcomes data from 2005 to 2016 demonstrate that through the department's comprehensive instructional program, RNs have competently and safely acquired new skills that have led to an expansion of their traditional roles, improved patient access to specialty care, and reduced costs.