National Reports and Federal Funding In the early 1970s, U.S. Department of Health, Education, and Welfare (HEW) Secretary Elliott Richardson established the Committee to Study Extended Roles for Nurses. This group of health care leaders was charged with evaluating the feasibility of expanding nursing practice ( Kalisch & Kalisch, 1986 ). They concluded that extending the scope of the nurse's role was essential to providing equal access to health care for all Americans. According to an editorial in the AJN, “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 ). The committee urged the establishment of innovative curricular designs in health science centers and increased financial support for nursing education. It also advocated standardizing nursing licensure and national certification and developed a model nurse practice law suitable for national application. In addition, the committee called for further research related to cost-benefit analyses and attitudinal surveys to assess the impact of the NP role ( HEW, 1972 ). This report resulted in increased federal support for training programs for the preparation of several types of NPs, including family NPs, adult NPs, and emergency department NPs. Controversy and Support for the Nurse Practitioner's Role Conflict and discord about the NP role continued to characterize relationships between NPs and other nurses. Some members of academia who believed that NPs were not practicing nursing continued to pose resistance to the role ( Ford, 1982 ). Nurse theorist Martha Rogers, one of the most outspoken opponents of the NP concept, argued that the development of the NP role was a ploy to lure nurses away from nursing to medicine, thereby undermine 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 NPs in mainstream master's programs. Over time,
the standardization of NP educational programs at the master's level, initiated by the group of faculty who formed NONPF, would serve to reduce intraprofessional tension. Despite the resistance to NPs in nursing, physicians increasingly accepted NPs in individual health care practices. Working together in local practices, NPs and MDs established collegial relationships, negotiating with each other to construct work boundaries and reach agreement about their collaborative practice. “In the NP-MD dyad, negotiations centered on the NP's right to practice an essential part of traditional medicine: the process or skill set of clinical thinking … to perform a physical examination, elicit patient symptoms, … create a diagnosis, formulate treatment options, prescribe treatment and make decisions about prognosis” ( Fairman, 2002 , pp.
- Winter '17
- Nursing, nurse anesthetists