In 1965, while I was meeting the challenges of third grade, amassing a collection of Beatle cards and a year before I would meet “Cherry Ames”, a revolution was brewing in the nursing profession.

Rural areas needed primary care providers. Basic pediatric care was sparse, at best. Physicians were leaving primary care in increasing numbers for specialized areas. The increasing availability of coverage due to Medicare and Medicaid increased the demand, but who could fill the need for providers?

Enter Loretta C. Ford, RN, PhD. A nurse educator with a public health certificate, she saw “…the value of astute clinical decision making and the competence, confidence and authority that nurses needed to fulfill this role” (Hobart and William Smith Colleges, 2003).

Working with Dr. Henry Silver at the University of Colorado, Dr. Ford established a pediatric practitioner program that utilized a nursing model while educating nurses to make medical diagnoses. Technically, they “integrated the traditional roles of the nurse with advanced medical training and the community outreach mission of a public health official” (Evitts, 2004).The first graduates - the first nurse practitioners - began to practice in the late 1960’s.

Surprisingly, the nursing profession wasn’t too enamored with this new role. They believed it to be “…threatening to nursing’s roots and to its exclusive orientation to care”(Health Resources and Services Administration, n.d.), they believed the title itself was “ambiguous and misleading” and would “control and devour nursing education and practice”(O’Brien, 2003).

While there were physicians who were willing to mentor the new NP students, the medical profession as a whole was suspicious of this expansion of nursing and kept a tight rein the NPs scope of practice. The idea of a nurse functioning in an advanced capacity and not under the direction of a physician was not easily accepted. Both nursing and medicine had issues with the new NP role.

The entire creation of the NP role was done in an “…environment of informal training, a lack of credentialing processes, increasing sophistication of medical care and opposition”(O’Brien, 2003). So what did the new NPs do?

They fought back. They began to define and demand recognition for their profession. They started documenting. By the early 1970s, they demonstrated not only that their presence increased the amount of primary care services, but the doctors and patients were happy. The ’80s saw them scientifically studying and documenting their value in the era of cost cutting and physician surplus.

By 1994, a New England Journal of Medicine article cited by O’Brien showed that primary care by NPs was equivalent or better than primary care by physicians. When this was disputed, the NPs just kept the data coming and even the Journal of the American Medical Association published a study that showed no difference in outcomes between an NP or an MD in primary care.

Today, becoming a nurse practitioner requires a master’s degree, post-master’s education, advanced medical and nursing education and an intense period of clinical experience, with certifications available in adult, pediatric, family, acute and critical care.

Nurse practitioners exist today because one nurse and one doctor collaborated, thinking outside the box as they worked to provide primary care to as many Americans as possible.

******************************

Resources

Hobart And William Smith Colleges. (2003, September 2). HWS Blackwell award will be bestowed on founding nurse practitioner. Retrieved July 15, 2007, from http://www.hws.edu/news/update/showrelease.asp?id=5010

Evitts, E. (2004). Rx: nurse practitioners. Retrieved July 15, 2007, from Johns Hopkins University Web Site: http://www.son.jhmi.edu/jhnmagazine/archive/spring2004/pages/fea_RxNPs.html

Health Resources And Services Administration. A comparison of changes in the professional practice of nurse practitioners, physician assistants, and certified midwives: 1992 and 2000. Retrieved July 15, 2007, from U.S. Department of Health and Human Services Web Site: http://bhpr.hrsa.gov/healthworkforce/reports/scope/scope1-2.htm

O’Brien, J. M. (2003, December 17). How nurse practitioners obtained provider status: lessons for pharmacists. Retrieved July 15, 2007, from Medscape Web Site: http://www.medscape.com/viewarticle/464663_2