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).