The Nurse Practitioner Profession: How Did it Begin?

The nurse practitioner role is constantly growing and changing.  Treating over 6 million patients each year, NP’s are gaining more recognition and independence across the country.  But how did the nurse practitioner profession begin?  Let’s take a look at our roots.

In the 1940’s and 50’s, Loretta Ford, a nurse living in Boulder Colorado, saw a need in her community.  She was working in public health toting her supplies around the community setting up clinics in churches and schools.  With the political and social upheaval of the 1950’s and 60’s things only got worse.  Ford believed that if nurses had morse specialized training, they would be more effective in meeting the needs of their community.  She wanted nurses to be able to make their own decisions about the health status of their patients rather than rely so heavily on the physician.

At the same time, physicians across the country had begun to unofficially mentor and collaborate with experienced nurses teaching them to increase their roles within their medical practices.  More and more physicians at this time were also moving to specialize rather than work in family practice creating a lack of primary care services across the country.

In 1965, Loretta Ford and physician Henry Silver partnered to found the nation’s first pediatric nurse practitioner program at the University of Colorado’s School of Medicine and Nursing.  The goal of the new program was to expand the role of the public health nurse with an emphasis on health promotion and preventative health.  Ford received pushback from the nursing and medical community.  Nursing leaders were concerned the nursing role was becoming “ambiguous”.  Physician organizations opposed the concept arguing that nurses should not function without direct physician supervision.  In a CNN interview, Ford stated “There was great concern, I think, that the kind of direction that we were taking was much more medical than nursing”.

Initially the nurse practitioner role was ill-defined and informal.  No formal certifications or legal regulations surrounded the profession.  Nurse practitioners began to increasingly legitimize their role in the medical field in the 1970’s by documenting patient satisfaction with their care and their ability to provide primary care services in areas lacking in healthcare services.

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By the 1980’s, nurse practitioner programs had begun to appear across the country even though there was no longer a shortage of primary care physicians.  Employers, however had begun to focus on decreasing healthcare costs, an advantage for NP’s.  Nurse practitioners continued to further legitimize the profession with a famous 1994 study in the New England Journal of Medicine.  In the study, researcher Mundiger concluded that “virtually every study indicates that primary care provided by nurse practitioners is equivalent or superior to that provided by physicians”.

Nurse practitioners continue to increase their influence on healthcare with sixteen states currently allowing NP’s to practice independent of physician oversight.  In 2011, 90 year old Loretta Ford was inducted to the National Women’s Hall of Fame for her role in developing the nurse practitioner career.  I think we owe her a ‘Thank You’ for recognizing nurses’ ability to diagnose and treat patients independently and initiating the expansion of the role of nursing.

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