The U.S. healthcare system has changed significantly over the past 2 decades, affecting the environment in which nurses provide care. Advances in technology and greater emphasis on cost-effectiveness have led to changes in the structure, organization, and delivery of health care services. While hospitals traditionally were the primary providers of acute care, advances in technology, along with cost controls, shifted care from traditional inpatient settings to ambulatory or community-based settings, nursing facilities, or home health care settings.