By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

This year marks the 50th anniversary of the nurse practitioner (NP) role. Themes of innovation and sustainability emerge as one examines an illustrated timeline of the history of NPs in AJN‘s October issue and reads the accompanying text. (The first section of the timeline is below. Click to enlarge.)

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How did this advanced practice nursing role come into being? As the timeline explains, “[d]uring the 1960s, health care was becoming increasingly specialized. Physicians were moving out of general practice and into more complex and lucrative specialties, creating a void in primary care and prevention services, and in care of the chronically ill.”

To fill this void, public health nurse Loretta Ford, working with Dr. Henry Silver at the University of Colorado in 1965, launched the first NP certificate program, a seminal moment in the history of this prevention-driven, primary-care-focused nursing role.

Ford wrote about the compelling need for NPs. Calling health care a capital investment, Ford said:

“We have failed to realize the full potential of professional nurses to improve the quality of life. This group has great unused potential for bringing about health care reforms. Properly prepared and effectively utilized, nurses could advance the nation’s health in preventing illness and helping people maintain their health states, both by educating the population in self-care and by increasing access to, quality of, and equity in health services.”

While the need for the types of care NPs are uniquely prepared to provide was great, the process of standardizing practice and academic requirements has not been an easy one. The timeline outlines some important steps in standardizing academic preparation, as well as the legal and practice barriers that the profession has faced and continues to face.

A major part of the struggle to define and perpetuate this nursing role lay within academia. The authors of the timeline, Briana Ralston, PhD, RN, Tiffany Hope Collier, MA, and Julie Fairman, PhD, RN, FAAN, from the Barbara Bates Center for the Study of the History of Nursing, say that it wasn’t until the early 1980s—two decades after the role’s inception—that the majority of states mandated a graduate degree in order to practice as a nurse practitioner.

Despite setbacks and opposition, study after study has shown that nurse practitioners fill the void in primary care—and do so just as well, if not better in some respects, than their physician counterparts. As the timeline shows, in 1986, a study by the Unites States Congress Office of Technology Assessment was the first to report that nurse practitioners were as capable of delivering quality primary care as physicians. Similar studies emerged in subsequent years, from reputable sources like Cochrane, Rand, and even the National Governors Association. In fact, just this week, a new study by the Journal of the American College of Cardiology shows that collaborative teams that include nurse practitioners fare better than physician-only teams in outpatient cardiovascular care.

Although there’s plenty of evidence confirming the quality of the care NPs provide, the American Association of Nurse Practitioners (AANP) says that, 50 years later, only 21 states allow NPs full practicing privileges. The remainder of the country limits practice through regulated collaborative agreement with an outside health discipline or more fully restricts practice through supervision or delegation by an outside health discipline member.

Seeing a need for care, nurse practitioners like Ford challenged the status quo. Their remarkable contribution to nursing and health care—a successful, still evolving advanced practice nursing role—continues to gain ground despite ongoing opposition. Nurse practitioners have provided access to care for millions, improved disease prevention, and pioneered health care delivery models that simply did not exist 50 years ago.

May the next 50 years be marked by new successes and continued innovation.
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