The improvement of public health necessitates the allocation of resources and the implementation of management strategies that ensure the public health system is founded upon the principles of social equality, non-discrimination, participation and sustainability. These principles must be contextualised within the framework of human development that is both productive and equitable. The objective is to reduce existing disparities and to reinforce the foundations of a just and equitable society. The provision of quality health services, the advancement of health and healthy lifestyles, and the enhancement of the general welfare of all people, enables the country to compete on the global stage in pursuit of national development goals. The advancement of public health is more efficacious, ensures autonomy and encourages the growth of the health sector at the regional and global levels. It also encourages the development of secure, effective and affordable health services for a superior quality of life for the people. Health facilities are places and/or facilities established by the Government, Regional Government, and/or the community, which are utilised to provide health services to individuals or the community through the provision of promotive, preventive, therapeutic, rehabilitative, and/or palliative services (Undang-undang, 2023).

The phenomenon of the provision of services in independent nursing practice settings represents a classic problem that persists to the present day. The practice of medicine is regarded as a common occurrence, and this is further compounded by the low level of public awareness regarding the specific forms of independent nursing practice employed by some unscrupulous nurses (Aulianah & Ismail, 2023). Although Nursing Law No. 38/2014 is in effect, there are no clear limitations on the activities that nurses can perform. This often leads to overlap between nursing duties and delegated medical management duties. This issue may give rise to potential legal risks. Article 32 of Nursing Law No. 38/2014 delineates the distinction between delegated and planned activities.

A shortage of medical personnel in a hospital setting will inevitably result in a reduction in the quality of care provided to patients. Those physicians who are most directly responsible for the care of patients must perform a substantial amount of work. Nevertheless, given that there are frequently multiple doctors responsible for a single patient, there are certain tasks that can be delegated to nurses. In the contemporary era, where nursing services are undergoing a period of rapid expansion, nurses are motivated to make a tangible impact on the practice of their profession. From the outset, their role is to assist doctors in the delivery of care until they are able to provide nursing services independently and to strive to achieve the goals of nursing care (Kusnanto, 2019). A shortage of medical personnel in a hospital setting will inevitably result in a reduction in the quality of care provided to patients. Those physicians who are most directly responsible for the care of patients must perform a substantial amount of work. Nevertheless, given that there are frequently multiple doctors responsible for a single patient, there are certain tasks that can be delegated to nurses. In the contemporary era, where nursing services are undergoing a period of rapid expansion, nurses are motivated to make a tangible impact on the practice of their profession. From the outset, their role is to assist doctors in the delivery of care until they are able to provide nursing services independently and to strive to achieve the goals of nursing care (Undang-undang, 2023). The expansion of specialized nursing services from remote villages to urban areas will facilitate the realization of the Good Indonesia 2025 initiative. It is anticipated that the enactment of the Nursing Practice Act No. 38 of 2014 will afford all Indonesian nurses the opportunity to establish activities within their field and contribute to the development of health services on a small scale (Kusnanto, 2019). The authority of nurses to perform nursing activities independently, implement a comprehensive nursing plan, take preventive measures according to their ability in emergency situations, direct nurses, provide advice to nurses, provide health education and advice, and administer drugs. In accordance with the physician's instructions. (Peraturan Menteri Kesehatan Republik Indonesia Nomor 26 Tahun 2019 Tentang Peraturan Pelaksanaan Undang-Undang Nomor 38 Tahun 2014 Tentang KEPERAWATAN, 2019)

The issue of independent nursing practice represents a significant challenge for the nursing profession, and it is imperative that it be addressed. At present, a relatively modest number of nurses are engaged in independent nursing practice. The demand for independent nursing practice services is on the rise. There are many reasons why nurses may be less interested in opening an independent nursing practice (Permana & Asmirajanti, 2020).

The fourth medium-term national development plan (2020-2025) prioritizes the expansion of public access to quality health services. It is our contention that the general population is able to access quality health services and health insurance. Another program that is designed to be complementary is that of the independent nurse practitioner, who is licensed to provide nursing care in the context of individual health. The implementation of this program is regulated by Minister of Health Regulation No. 26/2019, Articles 15 to 54. In addition, the PPNI has compiled independent nursing regulations as guidelines. Nevertheless, the implementation of this program continues to face significant challenges, including issues related to licensing and personnel. The state has recognized independent nursing practice since 2001, yet in nearly 17 years, only 4,619 permits have been issued by local authorities in 20 states. This figure is regarded as being considerably lower than would be expected in light of the distribution of nurses and healthcare needs in Indonesia (Rusnawati, 2022-05-17). The primary factors influencing nurses' interest in independent nursing practice are a lack of understanding of the regulations governing independent nursing practice, financial resources, motivational factors, and business practices (Rusiana et al., 2022).

The author presents a practical assessment of this possibility when examining the facts regarding the significance of independent nursing practice, which is supported by legislation, technology, social needs, and encouraging nurses to engage in independent nursing activities. This improves the quality of life of nurses. The challenges and obstacles facing independent nursing practice, including the provision of practical information for nurses, academics, and nursing students, are also addressed.

The search criteria employed in this review pertain to questions that have not yet been subjected to clinical trials. PICO [Population (P) “nurse”, Intervension(I) “challenge”, Comparison (C) (opportunities), and Outcome (O) “Nursing independent practice”]. The initial search was conducted via the database between September 15 and October 9, 2023 : PubMed, ScienceDirect, Google Scholar, Cochrane, Wiley, Scopus, Medline, and proquest. The keywords used are “Nurse” AND “Challange” AND “Opportunities” AND “community OR Clinic”. A combination of search terms was employed, including Boolean operators (and/or). The research included in this review was a study of self-directed nursing practice in English and Indonesian. The aforementioned methodology was employed in the selection of subjects for this study. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The articles included in this study were those published between 2019 and 2023 that pertained to nurses. The articles presented an account of independent nursing practice and the potential for independence, as well as the challenges associated with independent practice. The data can be grouped based on various aspects, including author, year of publication, purpose, study population, and sample size.

On the basis of the fifteen articles reviewed, the authors, the years, the objectives, the methods and the results can be analyzed, as shown in the table below:

Based on 15 articles, we found different conclusions about independent nursing. Health services in Indonesia have progressed in many aspects. Many health service standards in the health professions can be used as business opportunities to create an entrepreneurial culture and expand the role of the business world by including health worker entrepreneurship. education and the environment, so that it will become a development point for health entrepreneurs (Rudiyanto et al., 2020). It is very important to teach entrepreneurship skills in higher education, including nursing departments, which we can call nursing education. We believe that this information can provide ideas and insights on the importance of entrepreneurship in higher education so that students can be motivated to start their own business and reduce unemployment in Indonesia. Students are also expected to be innovative in starting businesses that are profitable and beneficial to others. For nursing students, the type of work is not only related to nursing. Nurses can also sell health products, open a healthy food business, etc. They can also start a business in this field. A lot of students are interested in entrepreneurship. Many also find entrepreneurship or nursing courses very useful for D3 nursing students. Many students are also interested in entrepreneurship. Entrepreneurship or nursing can change the business plan according to (Isnina et al., 2023).

(Nurlina et al., 2022) described that the product mix exerts a moderate influence on the decision to utilize a service, with indications suggesting a favorable impact. In light of these findings, the implemented strategy is a product life cycle comprising four stages: the initial stage and the initiative stage. At this juncture, product-related strategies are designed to instill confidence in customers regarding the quality and acceptability of the product. The subsequent stage is the development phase, where this strategy is employed to foster customer loyalty. One strategy that can be employed is to persuade customers that the products they are purchasing are useful to them. In the subsequent stage, which is characterised by growth and maturation, this strategy can also be demonstrated in the context of the independent nursing director creating a new life or achieving specific market targets. Finally, the decline phase presents a further opportunity for the application of this strategy, as sales experience continues to wane. This occurs when the revenue generated from sales is insufficient to meet the budgetary allocation for marketing. Nursing services provided by an independent nurse to patients are comprehensive services based on psycho-social, bio-psychological, and spiritual aspects. Nursing as a profession is held to a standard of responsibility and accountability based on professional practice standards and professional ability standards. These standards aim to ensure that nurses provide safe and effective nursing care. Many nurses engage in independent practice, yet they perform diagnostic and therapeutic procedures that are typically the domain of medical professionals, namely doctors. In the provision of health and nursing services, nurses are permitted to provide nursing care in both healthcare institutions and independent practice activities (Widjadja & Putri, 2022). Holistic care is a comprehensive approach that considers the interrelationship between various aspects of an individual's health. When one aspect is compromised, it can have a ripple effect on other aspects of health as well. Nurses are inclined to perform medical activities in private practices due to economic, social, and public trust considerations. Conversely, if a nurse who acts independently but performs medical actions commits an illegal act, the nurse will be held legally responsible for the consequences of the violence committed by the nurse, namely the legal consequences of the actions committed by the nurse (Utomo et al., 2021).

Nurses who have obtained the requisite professional qualifications, as well as those who have established a SIPP and obtained a certificate of competence, are duly authorized to perform invasive procedures. Inherent authority represents a more radical form of authority than that of the law of commitment. This authorization is contingent upon adherence to the established standards. Despite the absence of regional regulation governing this practice, nurses are afforded legal protection through the implementation of preventive measures, including guidance and oversight by the health service system and the PPNI professional organization (Santoso et al., 2022).

Given that nurses operate autonomously, they are responsible for fulfilling their obligations and fulfilling their duties in accordance with the scope of their authority. The authority of self-employed nurses is constrained by the stipulations set forth in Article 15, paragraph (d), of the Minister of Health Decree Number 1239/Menkes/SK/XI/2001 concerning Nurse Registration. In addition to providing independent health services, there are also nurses who assume managerial responsibilities (Purnomo & Chumaidah, 2020).

Nurses who work from home are required to possess an independent nursing credential. Nurses express confidence in this form, indicating that they believe and feel it is useful and easy to use. They also demonstrate a positive attitude toward the form, as evidenced by their participation in socialization programs and advocacy activities with professional organizations. Additionally, they recognize the numerous benefits of the form in practice, including an increase in the number of bed sheets. The implementation of exercises and their use during home visits at puskemas also reflect good behavior (Primadilla et al., 2023). (Aulianah & Ismail, 2023) indicates a significant correlation between nurses' knowledge of independent nursing practice, their capacity to perform independent nursing tasks, and their motivation to engage in independent nursing work. The primary factors influencing nurses' interest in independent nursing practice are a lack of comprehension of nursing practice regulations, financial resources, motivational factors, and finally, business practices. (Rusiana et al., 2022)(Permana & Asmirajanti, 2020). The results of the chi-square test indicated a significant influence between internal conditions and external factors and nurses in independent nursing practice in Kigali City and West Jakarta. The learning factors were identified as comprising both internal factors (self-esteem, performance, job satisfaction, and needs and expectations) and external factors (type and nature of work, work group, work environment, and interpersonal relationships). The chi-square test yielded results indicating a significant influence between internal conditions and external factors and nurses (p-value = 0.05). No significant difference was observed between job satisfaction and self-efficacy (p-value = 0.11). In light of these findings, it can be concluded that there is an internal and external influence, as well as job satisfaction factors, on selfmotivation.

The results of the chi-square test indicated a significant influence between internal conditions and external factors and nurses in independent nursing practice in Kigali City and West Jakarta. The learning factors were identified as comprising both internal factors (self-esteem, performance, job satisfaction, and needs and expectations) and external factors (type and nature of work, work group, work environment, and interpersonal relationships). The chi-square test yielded results indicating a significant influence between internal conditions and external factors and nurses (p-value = 0.05). No significant difference was observed between job satisfaction and self-efficacy (p-value = 0.11). In light of these findings, it can be concluded that there is an internal and external influence, as well as job satisfaction factors, on self-motivation (Qolbiatun et al., 2020).

According (Kaka, 2021), registered nurses are entitled to address cases of unlawful teaching practices provided they possess the requisite competencies in the relevant field. This authority is reinforced by the existence of specific authorisation in limited cases. Registered nurses are legally protected by government institutions through the applicable regulations governing nursing practice.

The objective is to determine and analyze the legal responsibility of nurses in the implementation of independent nursing care in full service activities. In addition, the impact of laws and regulations on independent nurses in the implementation of nursing care must be identified and analyzed (Utomo et al., 2021). Furthermore, the autonomy of nurses and the influence of economic factors, social behavior factors, and public interest in free medical treatment programs must be determined. Conversely, nurses who act independently but perform medical actions are held legally responsible for any violence they perpetrate, provided that they violate the law. In such cases, the legal consequences of the nurse's actions are covered. In the event that a nurse contravenes regulations, both legally and ethically, the nurse may be subject to sanctions in the form of administrative sanctions, civil sanctions, criminal sanctions, or civil sanctions. The legal ramifications of such violations may include the nurse being deemed incompetent, held to a higher standard of accountability towards individuals, groups, and institutions, receiving negative feedback from the community, and being subject to ethical sanctions that can affect the quality of life of the workforce (Lintang, 2021). Digital documentation represents a significant advancement in the field of nursing care reporting. It offers numerous advantages over traditional manual documentation, including enhanced communication between nurses and medical personnel and greater efficiency in the creation of nursing care documentation. As a crucial aspect of nursing care, documentation requires the acquisition of specialized skills and expertise (Antika et al., 2023) .

A comprehensive investigation was conducted to identify the factors that facilitate or impede the establishment of independent nursing practices in Badung Regency, Bali Province (Taukhit, 2020). The analysis revealed that the prevailing structured system of nursing practice in the region serves as a significant driver for the growth of independent nursing practices. The vision and mission of independent practice development in Badung Regency were found to be evolving towards the provision of holistic services. Inhibiting factors in the establishment of practices were identified, including a pessimistic attitude among nurses, competition with other health workers, lack of support from families, and the difficulty of obtaining land for practice sites.

The advent of opportunities for the establishment of independent nursing practices commences with the delivery of lectures to nursing students, which facilitate the development of an entrepreneurial mindset in students, thereby fostering a high level of motivation among them to pursue the opening of independent nursing practices. The rapid development of technology also presents opportunities for the establishment of independent nursing practices, including the availability of affordable services and the ability to document nursing care in an efficient manner. The provision of effective and efficient services, which are in high demand by the community, represents a significant opportunity for nurses to enhance the quality of life through entrepreneurship, given the large number of nurses and the fact that not all of them are adequately prepared for the demands of the industrial world. The nursing law offers nurses legal protection in the implementation of independent nursing practice. The challenges that nurses must overcome include pessimistic attitudes that often originate from within the nursing profession and the external environment. Another challenge is the possibility of legal consequences due to violations committed by nurses. As a result of the actions taken by these nurses, nurses will be held accountable.

This study has identified a number of limitations, including a lack of detailed research on nurse entrepreneurship in the development of independent nursing practice. Furthermore, the study did not employ qualitative or quantitative methods.

The nursing care provided by private practice nurses is comprehensive and holistic. Freelance training represents an opportunity to cultivate an entrepreneurial culture and transform one's role as an entrepreneurial health professional. It is recommended that nurses be encouraged to practice independently in order to improve the quality of life. However, independent practice as a nurse is problematic due to the limited authority, rights, duties, and responsibilities that must be carried out in order to provide professional care. It is recommended that further research be conducted on nursing entrepreneurship with the objective of developing nursing independent activities that can be utilized as a tool in the development of continuing education in nursing education.