While hospitals evaluate ambulatory clinics as a revenue generating service alternative,, nursing executives develop new areas for nursing practice in nurse-managed clinics. The authors describe the five-year growth of a nursemanaged ambulatory clinic providing primary health care to those aged 55 and older. The discussion explains nurse practitioner leadership and practice, and accountability between professions. The concept and structure of services and marketing strategies are elated to the people served. Financial feasibility, cost containment, and other factors demonstrate the clinic's contribution to its sponsoring hospital.