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Category: Advanced Practice Registered Nurses (APRN)

ChiroMedBlogAdvanced Practice Registered Nurses (APRN)

Discover the role of Advanced Practice Registered Nurses (APRN): highly skilled healthcare professionals providing specialized care and improving patient outcomes.

Conceptualizations of Advanced Nurse Practitioner: Problems and Imperatives
By admin 0 Comments Advanced Practice Registered Nurses (APRN), El Paso TX

Conceptualizations of Advanced Nurse Practitioner: Problems and Imperatives

Introduction

Despite the usefulness and benefits of conceptual models, conceptual confusion and uncertainty remain regarding advanced nurse practitioner roles. One noted issue is the lack of a well-defined and consistently applied core stable vocabulary used for model building. Despite progress, this challenge remains.

Vocabulary Variations

Different Terms in Different Regions

  • In the United States, “advanced practice nursing” is the term used, but the ICN and CNA use “advanced nursing practice.”
  • Variations in definitions exist between Australia, Canada, New Zealand, the United States, Canada, and the United Kingdom.

Role Confusion

  • The term “advanced practitioner” is used to describe non-APRN experts in the United Kingdom and internationally.
  • Different states in the U.S. use various terms for APRNs:
    • Iowa: Advanced Registered Nurse Practitioner
    • Virginia: Licensed Nurse Practitioner

The APRN Consensus Model

The APRN Consensus Model (APRN Joint Dialogue Group, 2008) represents a major step forward in promulgating a uniform definition of advanced practice in the United States for the purpose of regulation. However, the lack of a core vocabulary continues to make comparisons difficult because the conceptual meanings vary.

Competencies and Concepts

  • Competencies are more commonly used to describe APRN practice concepts.
  • Reflection on and discussion of terms such as roles, hallmarks, functions, activities, skills, and abilities continue, contributing to the urgent need for a common language.

Addressing Nursing’s Metaparadigm

Few models of APRN practice comprehensively address nursing’s metaparadigm (person, health, environment, nursing). Comparing, refining, or developing models is challenging because concepts are often used without universal meaning or consensus, and sometimes with inconsistent definitions.

Evolution and Clarity in APRN Practice

  • The evolution of advanced nurse practitioner roles will be enhanced if scholars and practitioners agree on fundamental concepts of APRN practice.
  • A clear differentiation of APRN practice from registered nurses (RNs) is necessary.

International and Global Models

Current Status

  • Few conceptual models describe the practice and outcomes of APRNs.
  • The United Arab Emirates is emerging in APRN roles but lacks a formal model.

Need for Diverse Models

  • Models addressing diverse health and cultural needs worldwide are required.

Distinguishing APRNs from Physicians

Role Clarity

  • Clarifying differences in practice between APRNs and physicians is crucial.
  • Lack of conceptual clarity in job advertisements can lead to confusion.

Barriers to Practice

  • Organized medicine attempts to limit or discredit APRNs.
  • Lack of conceptual clarity can hinder APRNs from practicing to the full extent of their education and training.

Interprofessional Education and Practice

Interprofessional education and practice are central to high-quality care. Graduate education of APRNs alongside other health professionals is beginning to take place, enhancing collaborative care.

Example: University of Michigan

  • An interprofessional clinical decision-making course includes students from nursing (APRN students), pharmacy, dentistry, medicine, and social work.

Development of Interprofessional Competencies

  • High-functioning interprofessional teams are critical for maximizing patient outcomes.
  • Conceptual models for APRN practice on interprofessional teams are needed.

Imperatives for Conceptual Consensus

Among many imperatives for reaching a conceptual consensus on advanced nurse practitioner roles, the interrelated areas of policymaking, licensing, credentialing, and practice are most important.

Policymaking

  • Not all APRNs are eligible for reimbursement by insurers.
  • The APRN Consensus Model and other reforms call for changes to enable APRNs to work within their full scope of practice.

Continued Dialogue

  • Ongoing dialogue and activity are essential for clarifying advanced nurse practitioner roles and concepts.

Box 2.1: Clarification and Consensus on Conceptualization of Advanced Nurse Practitioner Roles

  1. Clear differentiation of advanced nurse practitioner roles from other levels of clinical nursing practice.
  2. Clear differentiation between advanced nurse practitioner roles and the clinical practice of physicians and other non-nurse providers.
  3. Clear understanding of APRNs’ roles and contributions on interprofessional teams.
  4. Clear delineation of similarities and differences among APRN roles.
  5. Regulation and credentialing of APRNs that protect the public.
  6. Clear articulation of health policies that:
    1. Recognize APRNs’ contributions to quality, cost-effective healthcare.
    2. Ensure public access to APRN care.
    3. Ensure appropriate billing and payment mechanisms for APRN care.
  7. Maximizing social contributions by APRNs in healthcare.
  8. Enabling APRNs to reach their full potential personally and professionally.

By addressing these issues, the conceptualization of advanced nurse practitioner roles can be clarified, enhancing the understanding and practice of APRNs globally.

Conceptual Models in Advanced Nurse Practitioner Practice
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

Conceptual Models in Advanced Nurse Practitioner Practice

Nature, Purposes, and Components of Conceptual Models

A conceptual model is a critical part of the structure of nursing knowledge, encompassing various levels from abstract to concrete. This structure includes metaparadigms, philosophies, conceptual models, theories, and empirical indicators (Fawcett & Desanto-Madeya, 2013). Traditionally, key concepts in the metaparadigm of nursing are humans, the environment, health, and nursing (Fawcett & Desanto-Madeya, 2013).

What is a Conceptual Model?

Fawcett and Desanto-Madeya (2013) described a conceptual model as:

  • A set of relatively abstract and general concepts addressing the phenomena central to a discipline.
  • Propositions that broadly describe these concepts.
  • Propositions that state relatively abstract and general relations between two or more of the concepts.

Additionally, a conceptual model is a distinctive frame of reference that guides observation and interpretation of phenomena of interest to the discipline. It provides alternative ways to view the subject matter, without a single “best” way (Fawcett & Desanto-Madeya, 2013).

Importance in Advanced Nurse Practitioner Roles

Evolving a more uniform and explicit conceptual model for advanced practice nursing benefits patients, nurses, and other stakeholders by:

  1. Facilitating communication.
  2. Reducing conflict.
  3. Ensuring consistency in advanced practice nursing.

This systematic approach enhances nursing research, education, administration, and practice (Institute of Medicine, 2011).

Applications of Conceptual Models in Advanced Nurse Practitioner Practice

Professional Identity and Clinical Practice

Conceptual models help Advanced Nurse Practitioners (ANPs) articulate professional role identity and function. These models serve as frameworks for:

  • Organizing beliefs and knowledge about professional roles and competencies.
  • Further development of knowledge.

In clinical practice, ANPs use conceptual models for holistic, comprehensive, and collaborative care (Carron & Cumbie, 2011; Dunphy, Winland-Brown, Porter, Thomas & Gallagher, 2011; Elliott & Walden, 2015; Musker, 2011).

Differentiation in Nursing Practice

Conceptual models differentiate among levels of nursing practice, such as:

  • Staff nursing vs. advanced practice nursing (Gardner et al., 2013).
  • Clinical nurse specialists (CNSs), nurse-midwives (CNMs), and nurse practitioners (NPs; Begley et al., 2013).

Guiding Research and Theory Development

Conceptual models guide research and theory development by focusing on specific concepts or examining relationships among select concepts to elucidate testable theories. For example, Gullick and West (2016) evaluated Wenger’s community of practice framework to enhance research capacity and productivity for CNSs and NPs in Australia.

Educating Future Advanced Nurse Practitioners

Faculty use conceptual models to plan curricula for APRN roles, identifying key concepts and their relationships, and making choices about course content and clinical experiences (Perraud et al., 2006; Wong et al., 2010).

Conceptual Questions in Advanced Practice

Fawcett and Graham (2005) and Fawcett et al. (2004) have posed important questions about advanced practice:

  • What do ANPs do that makes their practice “advanced”?
  • To what extent does incorporating activities traditionally done by physicians qualify nursing practice as “advanced”?
  • Are there nursing activities that are also advanced?

Direct Clinical Practice and APRN Competencies

Direct clinical practice is central to ANP competency, raising questions about the meaning of “clinical” in various settings, such as hospitals or clinics. These questions are crucial given the APRN Consensus Model and the evolving role of ANPs in healthcare (Hamric, 2014).

Innovations and Reforms in Advanced Nurse Practitioner Practice

Healthcare legislation changes and regulations emphasize the need for ANPs to be explicitly engaged in delivering care across settings, including:

  • Nursing clinics.
  • Palliative care settings.
  • Interprofessional teams.

Theoretical Questions and Conceptualization

Theoretical questions about the conceptualization of advanced practice nursing include:

  • Epistemologic, philosophic, and ontologic underpinnings of advanced practice.
  • Application of nursing theory in practice.
  • Differences between specialty, advanced practice, and advancing practice.

Summary

Well-thought-out, robust conceptual models are essential for guiding ANP practice. Conceptual clarity benefits patients, the nursing profession, and interprofessional education and practice (CIHC, 2010; Health Professions Network Nursing and Midwifery Office, 2010; IPEC Expert Panel, 2016). It supports the creation of accountable care organizations and builds systems for effective communication, collaboration, and coordination, leading to high-quality care and improved outcomes.

Advanced Nurse Practitioner Education
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

Advanced Nurse Practitioner Education

Overview of Advanced Nurse Practitioner Growth

During the 1990s, the number of Advanced Nurse Practitioners (ANPs) increased dramatically in response to the growing demand, the national emphasis on primary care, and a decrease in medical residencies in subspecialties.

Expansion of ANP Programs

  1. 1990s Growth:

    • In 1990, there were 135 master’s degree programs and 40 certificate programs for ANPs.
    • Between 1992 and 1994, the number of institutions offering ANP education more than doubled from 78 to 158.
    • By 1994, institutions offered multiple tracks, leading to a total of 384 ANP tracks in master’s programs across the United States.
    • By 1998, the number of institutions offering ANP education doubled again, resulting in 769 distinct ANP specialty tracks.

  2. Master’s and Post-Master’s Programs:

    • Most programs were at the master’s or post-master’s level.
    • In 2013, there were 368 institutions offering a master’s degree in ANP.
    • Additionally, 92 colleges offered a postbaccalaureate Doctor of Nursing Practice (DNP) degree.

Recent Trends in ANP Education

Since 2015, there has been rapid growth in DNP programs for ANP education nationwide.

Key Developments

  • 2020 Data:
    • According to the DNP Directory, in 2020 there were 357 DNP programs.
    • There were more than 106 new programs in the planning stage.

Nationwide Trends

Clearly, the trend nationwide is toward the DNP as the requirement for ANP practice.

Evolution of Neonatal and Acute Care Advanced Nurse Practitioners
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

Evolution of Neonatal and Acute Care Advanced Nurse Practitioners

Emergence of Neonatal Advanced Nurse Practitioners

  • Historical Background

    • In the late 1970s, the neonatal Advanced Nurse Practitioner (ANP) role was developed to address a shortage of neonatologists.
    • Restrictions on pediatric residents’ time in neonatal intensive care units further highlighted the need for this role.

  • New Responsibilities

    • Highly skilled neonatal nurses took on tasks previously handled by pediatric residents.
    • Responsibilities included interhospital transport of critically ill infants and newborn resuscitation.

Growth of Adult Acute Care Advanced Nurse Practitioners

Responding to Healthcare Needs

  • Residency Shortages

    • Similar to the neonatal role, the adult acute care ANP role emerged due to shortages in intensive care unit residencies.
    • Policies limiting resident physicians to 80 hours per week further drove the need for acute care ANPs.

  • Complex Tertiary Care Systems

    • Increasingly complicated tertiary care systems lacked proper coordination.
    • Advanced Nurse Practitioners stepped in to ensure quality patient care and provide leadership in healthcare delivery.

Academic and Certification Milestones

  1. Early Academic Efforts

    • Professors Anne Keane and Therese Richmond documented the emergence of the Acute Care Nurse Practitioner (ACNP) role, initially termed “The Tertiary NP.”
    • This role focused on providing specialized care in a fragmented healthcare system.

  2. Program Proliferation and Consensus

    • Between 1992 and 1995, master’s programs with ACNP tracks expanded across the country.
    • Annual ACNP consensus conferences began in 1993 to address curriculum content.

  3. Certification and Integration

    • The ANA’s Credentialing Center administered the first ACNP certification examination in December 1995.
    • By 1997, 43 programs prepared ACNPs at the master’s or post-master’s level.
    • In 2002, ACNPs merged with the American Academy of Nurse Practitioners, uniting primary care NPs and ACNPs.

The Rise of Advanced Nurse Practitioners in the 21st Century

  • Increasing Appeal of the NP Role

    • Growth in NP programs, expanded prescriptive authority, and greater practice autonomy made the NP role attractive.
    • More nurses chose to become Advanced Nurse Practitioners.

  • Organizational Developments

    • Various organizations represented different NP specializations, including:
      • American Academy of Nurse Practitioners
      • National Association of Pediatric Nurse Associates and Practitioners (NAPNAP)
      • Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
    • Despite offering competing certification exams, these groups agreed on requiring master’s education for the NP role.

  • Unified Representation

    • In 2013, the American Academy of Nurse Practitioners and the American College of Nurse Practitioners merged to form the American Association of Nurse Practitioners (AANP).

Conclusion

The evolution of the Advanced Nurse Practitioner roles, particularly in neonatal and acute care, reflects a dynamic response to healthcare needs. From addressing physician shortages to ensuring coordinated and specialized patient care, Advanced Nurse Practitioners have become integral to modern healthcare delivery.

Advanced Nurse Practitioner: Growth, Organization, and Legislation
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

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.

Resistance to the Advanced Nurse Practitioner by Organized Medicine
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

Resistance to the Advanced Nurse Practitioner by Organized Medicine

Overview

Although physicians and Advanced Nurse Practitioners (ANPs) collaborated at the local level, organized medicine began to express its resistance to the ANP role. One of the most contentious areas of interprofessional conflict involved prescriptive authority for nursing.

Nurse Practitioners and Prescriptive Privileges

The fight for prescriptive authority for Advanced Nurse Practitioners (ANPs) spanned the latter decades of the 20th century.

Historical Context

  • 1983: Only Oregon and Washington granted ANPs statutory, independent prescriptive authority.
  • Other States: Required direct supervision by a licensed physician.

Prescription Handling

  • Physician Availability: Depended on the negotiated boundaries of the physician–ANP team and locality.
  • Remote Clinics: Physicians might countersign prescriptions weekly or pre-sign prescription pads for ANPs.
  • State Variations: Practices varied, with some states requiring physicians to write and sign prescriptions at the ANP’s request.

Legal and Regulatory Developments

  • 1971: Idaho recognized diagnosis and treatment as part of the specialty nurse’s scope of practice.
  • Drug Enforcement Act: Required practitioners to obtain DEA registration numbers to prescribe controlled substances.

Progress and Challenges

Throughout the 1980s, ANPs worked tirelessly to convince state legislatures to pass laws and establish reimbursement policies that would support their practice. Interprofessional conflicts with organized medicine and, to a lesser extent, with pharmacists, centered on control issues and the degree of independence the ANP was allowed. These conflicts intensified as ANPs moved towards a more autonomous model.

Seminal Legal Case

Sermchief v. Gonzales (1983)

  • Initial Ruling: Missouri medical board charged two women’s healthcare ANPs with practicing medicine without a license.
  • Appeal: Missouri Supreme Court overturned the decision, allowing the scope of ANP practice to evolve without statutory constraints.

Policy and Perception

In 1986, a government report concluded that ANPs and Certified Nurse-Midwives provided care equivalent in quality to that provided by physicians. However, the American Medical Association House of Delegates opposed empowering nonphysicians to become unsupervised primary care providers.

Access to Cost-Effective, Quality Health Care for All Americans

Key Findings

  • 1986 Government Report: Concluded that ANPs provided care equivalent in quality to physicians within their areas of competence.

Opposition

  • American Medical Association: Passed a resolution to oppose any attempt at empowering nonphysicians to become unsupervised primary care providers and be directly reimbursed.

Summary

The evolution of prescriptive authority and practice autonomy for Advanced Nurse Practitioners has been marked by significant legislative and legal challenges. Despite resistance from organized medicine, ANPs have achieved recognition and expanded roles, contributing to accessible and high-quality healthcare.

The Concept of Advanced Nurse Practitioner
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

The Concept of Advanced Nurse Practitioner

Defining Advanced Nurse Practitioner in the 1980s

During the 1980s, the concept of Advanced Nurse Practitioner (ANP) began to be defined and discussed extensively in the literature. In 1983, Harriet Kitzman, an associate professor at the University of Rochester, explored the interrelationships between Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs). She used the term “advanced practice” throughout her discussion, applying it not only to advanced education but also to CNS and NP practice. Kitzman noted:

“Recognition for advanced practice competence is already established for both NPs and CNSs through the profession’s certification programs. … advanced nursing practice cannot be setting-bound, because nursing needs are not exclusively setting-restricted” (Kitzman, 1983, pp. 284, 288).

In 1984, Joy Calkin, an associate professor at the University of Wisconsin–Madison, proposed a model for advanced nursing practice. She specifically identified CNSs and NPs with master’s degrees as Advanced Practice Registered Nurses (APRNs).

Organizational Efforts and Integration

During the 1980s, significant efforts were made to explore the commonalities between the roles of CNSs and NPs:

  • The Council of Primary Health Care Nurse Practitioners and the Council of Clinical Nurse Specialists began examining their shared roles.
  • In 1988, these councils conducted a survey of all NP and CNS graduate programs, identifying considerable overlap in curricula.
  • Between 1988 and 1990, discussions about a merger took place, leading to the formation of the Council of Nurses in Advanced Practice in 1991.

Key Developments

  1. 1988-1990: Discussions and survey about merging roles.
  2. 1991: Formation of the Council of Nurses in Advanced Practice.

Despite the short-lived merger due to the restructuring of the American Nurses Association (ANA) in the early 1990s, this was a pivotal step in the organizational coalescence of advanced practice nursing.

Evolution of Advanced Nurse Practitioner Terminology

By the mid-1990s, the nursing literature increasingly used the term Advanced Nurse Practitioner to reflect an integrative vision of advanced practice. The first edition of this textbook, published in 1996, included Certified Registered Nurse Anesthetists (CRNAs) and Certified Nurse Midwives (CNMs) under the umbrella of advanced practice nursing.

Important Milestones

  • 1996: Publication of the first edition of the textbook, including CRNA and CNM roles.
  • Late 1990s: Increasing use of the term Advanced Nurse Practitioner in the literature.

The evolution of the Advanced Nurse Practitioner concept highlights the ongoing development and integration within the nursing profession.

Support From Physicians for Advanced Nurse Practitioners
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

Support From Physicians for Advanced Nurse Practitioners

Increasing Acceptance Among Physicians

Despite resistance within the nursing profession, physicians have increasingly accepted Advanced Nurse Practitioners (ANPs) in individual healthcare practices. In these local practices, ANPs and MDs established collegial relationships, negotiating work boundaries and reaching agreements about their collaborative practice.

Negotiations in the ANP-MD Dyad

In the ANP-MD dyad, negotiations centered on the ANP’s right to practice essential parts of traditional medicine, including:

  • Performing physical examinations
  • Eliciting patient symptoms
  • Creating diagnoses
  • Formulating treatment options
  • Prescribing treatment
  • Making decisions about prognosis

(Fairman, 2002, pp. 163–164)

Importance of Proximity and Supervision

The proximity of a supervising physician was considered key to effective practice, and on-site supervision was the norm. Grassroots acceptance of the ANP role depended on tight physician supervision and control of the protocols under which ANPs practiced. This supervision benefitted newly certified, inexperienced ANPs. According to Corene Johnson:

“Initially, we had to always have a physician on site. … I didn’t resent that. Actually, I needed the backup” (Fairman, 2002, p. 164).

Intraprofessional Conflict Over the Advanced Nurse Practitioner Role
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

Intraprofessional Conflict Over the Advanced Nurse Practitioner Role

Early Controversies in Educational Preparation

The role of the Advanced Nurse Practitioner (ANP) was not without significant intraprofessional controversy, particularly regarding educational preparation. Early on, certificate programs based on the Colorado project rapidly emerged. According to Ford (1991), some of these programs shifted the emphasis of ANP preparation from a nursing to a medical model, contrasting with the original University of Colorado demonstration project that stressed collaboration between nursing and medicine.

Major Areas of Academic Controversy

One of the major areas of controversy among academics was the fact that ANPs made medical diagnoses and wrote prescriptions for medications, essentially crossing the boundary between nursing and medicine outlined earlier in the century by the ANA. Because of this, some nurse educators and other nurse leaders questioned whether the ANP role could be conceptualized as being within the discipline of nursing, a profession historically ordered to care rather than cure (Reverby, 1987; Rogers, 1972).

Opposition from Nurse Theorists

  • Nurse theorist Martha Rogers, one of the most outspoken opponents of the ANP concept, argued that the development of the ANP role was a ploy to lure nurses away from nursing to medicine, thereby undermining nursing’s unique role in health care (Rogers, 1972).
  • Subsequently, nurse leaders and educators took sides for and against the establishment of educational programs for ANPs in mainstream master’s programs.

Formation of the National Organization of Nurse Practitioner Faculties (NONPF)

  1. In 1974, a group of pro-nurse practitioner faculty, already teaching in ANP programs, held their first national meeting in Chapel Hill, North Carolina.
  2. This meeting laid the foundation for the formation of the National Organization of Nurse Practitioner Faculties (NONPF).
  3. Over time, the standardization of ANP educational programs at the master’s level, initiated by the faculty who formed NONPF, would serve to reduce intraprofessional tension.

Support from Health Policymakers

While nursing professors debated the discipline’s responsibility to educate ANPs, the ANP role attracted considerable attention from health policymakers. Health policy groups, such as the National Advisory Commission on Health Manpower, issued statements in support of the ANP concept (Moxley, 1968). At the grassroots level, physicians accepted the new role and hired ANPs—they needed the help.

Government Initiatives and Support

  • Early in the 1970s, the US Department of Health, Education, and Welfare Secretary Elliott Richardson established the Committee to Study Extended Roles for Nurses.
  • This committee was charged with evaluating the feasibility of expanding nursing practice (Kalisch & Kalisch, 1986).
  • The committee concluded that extending the scope of the nurse’s role was essential to providing equal access to health care for all Americans.

The kind of health care Lillian Wald began preaching and practicing in 1893 is the kind the people of this country are still crying for. (Schutt, 1971, p. 53)

Recommendations from the Committee

  • Establish innovative curricular designs in health science centers
  • Increase financial support for nursing education
  • Standardize nursing licensure and national certification
  • Develop a model nurse practice law suitable for national application
  • Conduct further research related to cost-benefit analyses and attitudinal surveys to assess the effect of the ANP role

The committee’s report resulted in increased federal support for training programs for the preparation of several types of ANPs, including family ANPs, adult ANPs, and emergency department ANPs (Kalisch & Kalisch, 1986).

The Importance of Primary Care in the Mid-20th Century
By admin 0 Comments Advanced Practice Registered Nurses (APRN)

The Importance of Primary Care in the Mid-20th Century

Introduction of the Advanced Nurse Practitioner Role

The concept of the Advanced Nurse Practitioner (ANP) emerged in the 1960s, a time when outpatient pediatric clinics began to formalize and implement this role. This initiative was partly a response to the shortage of primary care physicians. As medical specialization grew, many physicians moved away from primary care, leading to numerous areas in the country being underserved.

Challenges in Primary Care

  • The American Medical Association (AMA) and the Association of American Medical Colleges frequently reported a shortage of physicians in poor rural and urban areas (Fairman, 2002, p. 163).
  • During this period, there was a growing demand for accessible, affordable, and sensitive healthcare.
  • Healthcare delivery costs were escalating annually by 10% to 14% (Jonas, 1981).

The Birth of the Modern Advanced Nurse Practitioner Role

Key Milestone

The establishment of the first pediatric Nurse Practitioner (PNP) program by Loretta Ford, RN, and Henry Silver, MD, at the University of Colorado in 1965, marked the inception of the modern Advanced Nurse Practitioner role.

Program Objectives

  • Funded by the Commonwealth Foundation, the program aimed to prepare professional nurses to provide comprehensive well-child care and manage common childhood health problems.
  • The 4-month program educated certified registered nurses as PNPs without requiring a master’s degree, emphasizing health promotion and family inclusion.

Program Outcomes

  1. The study evaluating the project demonstrated:

    • PNPs were highly competent in assessing and managing 75% of well and ill children in community health settings.
    • PNPs increased the number of patients served in private pediatric practice by 33% (Ford & Silver, 1967).

  2. Positive findings from early nurse-midwife and nurse anesthetist studies supported this new nursing role.

Loretta Ford: Cofounder of the Pediatric Nurse Practitioner Role

Exemplar 1.4

  • In the 1960s in Colorado, nurse Loretta Ford and Dr. Henry Silver, a pediatrician, introduced the concept of the nurse practitioner.
  • Both recognized the potential of expanding access to healthcare by enabling nurses to practice to the fullest extent of their advanced nursing education.
  • The term “nurse practitioner” was coined to emphasize the clinical practice role (Jacox, 2002, p. 162).
  • According to Ford, nurse practitioners should diagnose and treat patients within the context of the patient’s health status, social qualities, physical characteristics, and economic realities.

The establishment and success of the first PNP program were pivotal in demonstrating the capability and importance of Advanced Nurse Practitioners. This role has continued to evolve, significantly contributing to healthcare accessibility and quality, particularly in underserved areas.