The Evolution of Primary Care: The Role of Advanced Nurse Practitioners
Early Roots of Primary Care
The concept of primary care services has deep roots in the late 19th-century urban areas of the Northeastern United States. Public health nurses played a pivotal role, visiting patients at home to assess and provide medical care.
Notable Early Initiatives
- Boston: The Boston Instructive District Nurses cared for thousands of patients and their families.
- Philadelphia: The Visiting Nurse Society addressed the needs of patients and their families.
- New York: The Visiting Nurse Service of the Henry Street Settlement (HSS) catered to newly arrived immigrants on the Lower East Side.
The Henry Street Settlement: A Case Study
In 1893, Lillian Wald, a graduate nurse, established the Henry Street Settlement (HSS) House in Manhattan. The HSS nurses faced numerous challenges while addressing the needs of a disadvantaged immigrant community living in overcrowded, unsanitary conditions.
Challenges Faced by HSS Nurses
- High infant mortality due to summer bowel complaints.
- Children suffering from measles, ophthalmia, and vermin bites.
- Adults with typhoid and tuberculosis.
Overcoming Interprofessional Conflicts
To resolve conflicts with physicians, HSS nurses obtained standing orders from local doctors to administer emergency medications and treatments. Despite the tensions, the HSS nursing service continued to provide essential care until the 1950s.
Frontier Nursing Service: Pioneering Primary Care
Nurses in rural America, such as those with the Frontier Nursing Service (FNS) in Leslie County, Kentucky, provided extensive primary care services, functioning in roles similar to modern-day Advanced Nurse Practitioners.
Services Provided by FNS Nurses
- Diagnosing and Treating: Nurses made diagnoses and provided treatments, including the administration of herbs and medicines.
- Emergency Care: Nurses handled emergencies, from gunshot wounds to burns and infectious diseases.
- Medication Dispensing: They dispensed a variety of medicines, including aspirin, ipecac, and morphine.
Nursing in Migrant Camps and Indian Reservations
During the 1930s, nurses provided critical care in migrant camps and Indian reservations, often acting autonomously due to the lack of access to physicians.
Farm Security Administration (FSA) Nurses
- Staffed well-baby clinics and coordinated immunization programs.
- Wrote prescriptions and dispensed drugs from the clinic formulary.
- Provided emergency care and referrals as needed.
Bureau of Indian Affairs (BIA) Nurses
- Conducted well-baby “nursing conferences” in the Navajo reservation, focusing on health promotion and disease prevention.
- Provided primary care to children with common ailments, such as ear infections and sore throats.