Journal of Nursing

Nurse Practitioners Changed U.S. Health Care


By Julie A. Stanik-Hutt

Back in the 1960s, while thousands of Americans were "sitting in" for civil rights and burning draft cards to end the Vietnam War, one Colorado nurse started a quiet health care revolution.

At that time many children, especially the poor and those living in rural and medically underserved areas, lacked access to health care services. Loretta Ford, a public health nurse, believed that experienced registered nurses (RNs) could improve children's health if they were trained to provide many of the health care services that were historically provided only by physicians. So she began collaborating with a physician colleague and in 1965 changed health care by creating the first nurse practitioner (NP). Since then, the NP profession has spread like wildfire, expanding to all 50 states and to more than 20 other countries. More than 205,000 nurses have been trained as NPs, and they deliver half of the primary health care in the U.S. This month, NPs and their patients across the world are celebrating the 50th anniversary of the profession.

NPs are registered nurses who have completed specialized advanced graduate education, passed national board examinations, and are licensed to manage a broad range of health problems. NPs do physical exams, order and interpret results from blood tests and X-rays, diagnose and treat illnesses, and write prescriptions. They use a patient and family centered approach to health care, and emphasize health promotion, disease prevention, patient education, symptom control and care coordination. NPs work in primary care clinics, private practices and walk-in clinics, community- and school-based health centers, nursing homes and rehabilitation centers, home care and hospice agencies, Veterans Administration and military medical care facilities, community hospitals and academic medical centers.

You'd be surprised where else you can find NPs. They are professors who teach and conduct research in colleges of nursing, medicine and public health. NPs organize health fairs, screenings and immunization campaigns in their community. They also provide community education programs on diet, exercise, smoking cessation and healthy lifestyle, as well as on diseases and their management (e.g. diabetes, heart disease, hypertension, asthma, sports injuries, etc.). Some NPs travel to developing countries to improve health care services and systems. NPs lead quality improvement projects and patient safety initiatives in their practices. NPs who serve in community organizations, governmental task forces, health department and hospital boards, make sure that the concerns and interests of their patients are heard. They educate and work with elected and appointed governmental officials, members of the Maryland State Legislature and representatives in Congress, to pass laws that will improve the health of Americans. Some NPs even serve in their state legislature.

Eighty seven percent of NPs specialize in the primary care of children, women, adults and older adults, families or those with mental health problems. More than 80 percent of NPs care for the uninsured, and 84 percent see Medicaid and Medicare patients. In rural areas, NPs are often the only health care provider.

Like other health care providers, NPs collaborate with other professionals to provide high quality health care services. More than 40 years of research shows that NPs provide safe, high quality and effective health care. The hundreds of millions of satisfied patients seen annually attest to the confidence patients have in NP care.

Six Maryland universities, including Bowie State University, Coppin State University, Johns Hopkins University, Salisbury University, Uniformed Services University of the Health Sciences and the University of Maryland, train NPs (who earn a median salary of more than $95,000), and more than 3,500 NPs practice in the state. So, the next time you see an NP, say "Happy 50th Anniversary." And, if you don't have a regular health care provider, consider making an appointment to see an NP and join the millions of satisfied patients seen by NPs last year. Be part of the quiet health care revolution!


Articles in this issue:

  • Mary Ellen Sorensen APNP

    December 31, 1969 16:33 36

    Having been an FNP since 1/77 it has been most enjoyable, challenging and satisfying experience I could ever imagine.My graduate school experience at U W Oshkosh, the first MSN NP program in Wisconsin, was excellent preparation for my new role in primary health care. An abstract of my thesis was requested by Preventive Health Magazine. The title and content of the study are as pertinent today as they were in 1976 when it was conducted: The \"Relationship of Client (title nurses were using for patients at that time) Perceptions and Health Education Outcomes\" related to hypertension and obesity preventive activities. I used that patient focused approach in all my patient interactions since they would be in charge of their health related behaviors!

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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer