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.