Advanced Nurse Practitioner: Growth, Organization, and Legislation

Significant Growth in Advanced Nurse Practitioners

The latter part of the 20th century witnessed substantial growth in the number of Advanced Nurse Practitioners (ANPs) and their national organizations. The ANP role diversified significantly, giving rise to new specializations such as:

• Emergency Nurse Practitioner
• Neonatal Nurse Practitioner
• Family Nurse Practitioner
• Acute Care Nurse Practitioner

By 1984, approximately 20,000 graduates from ANP programs were employed in various settings envisioned by the founders (Kalisch & Kalisch, 1986, p. 715):

• Outpatient clinics
• Health maintenance organizations
• Health departments
• Community health centers
• Rural clinics
• Schools
• Occupational health clinics
• Private offices

Expansion to Tertiary Care Centers

By the late 1980s, ANPs, particularly those with specialty training, were increasingly employed in tertiary care centers, reflecting their success in neonatal intensive care units (Silver & McAtee, 1988).

Organizational Development and Legislative Influence

The multiple roles of ANPs created competing interests, impacting their ability to unify on legislative issues. Key organizational developments included:

1. Primary Health Care Nurse Practitioner Council – Established by the ANA to address legislative challenges.
2. American Academy of Nurse Practitioners – Formed in 1985 as the first organization for ANPs across all specializations.
3. American College of Nurse Practitioners – Created in 1995 to serve as a “SWAT team” on policy during President Clinton’s healthcare reform initiative, aiming to unite all ANP organizations.

Legislative Milestones in the Early 1990s

Federal legislation in the early 1990s, particularly the Controlled Substances Act, significantly impacted ANP prescriptive authority:

1. DEA’s Initial Proposal (1991) – Proposed registration for “affiliated practitioners” with prescriptive authority tied to a collaborating physician’s number. This was criticized and revoked in 1992.
2. DEA’s Amended Regulations (1992) – Introduced the category of “mid-level providers” (MLPs), allowing ANPs to receive individual DEA numbers starting with an M, provided they had state-granted prescriptive authority.

Key Outcomes

• The MLP provision, effective in 1993, greatly expanded ANPs’ ability to prescribe controlled substances (DEA, 1993).

Through these organizational and legislative advancements, Advanced Nurse Practitioners solidified their role and authority in the healthcare landscape, ensuring broader access to healthcare services and enhanced professional recognition.