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.