Historical Analysis of Advanced Practice Nursing: Family Nurse Practitioner Roles

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Table of Contents

Introduction
The History of APN and FNP Roles
First Nursing Practitioner in Colorado, USA
Historical Regulations of APN Services in the US
The Legitimization Process
The Status of Advanced Nursing in the World Today
Conclusion
References

Introduction

Advanced practice nursing (herein referred to as APN) has evolved over the years in America and other nations in the world. Today, the profession has risen to become a significant aspect of the world’s healthcare system (DeNisco & Barker, 2013). In this paper, the historical trends and influences of APN are analyzed. The author will highlight how APN has developed in Mississippi and other states about family nurse practitioner (FNP) roles.

Several factors have facilitated the development of APN and FNP roles in America. Similarly, the advancement of these two phenomena has been affected negatively by various factors. The factors notwithstanding, advanced practice nursing has recorded positive growth in the past few decades. As such, the future of this nursing profession in the Mississippi healthcare system is promising.

To analyze the hypothesis stated above, the author of this paper will review the historical development of FNP roles with regards to the who, what, where, when, and why attributes of this evolution. A comparison of this development will be made between Mississippi (state level), the USA (national level), and other nations in the world.

The History of APN and FNP Roles

Before the foundations of modern APN were laid down, nuns and military personnel offered nursing-like services to the public. It is for this reason that different religious organizations are regarded as patrons of nursing in general. For example, in its teachings, Christianity encourages people to look after the sick (Conrad, Haworth & Millar, 1993). Christ, the founder of this religion, led this by example when He healed the sick and raised the dead.

Informally, nursing was practiced in rural areas of Mississippi. In most cases, the nursing responsibilities were taken over by family members. The family members in this case can be regarded as FPNs of the time. In the early 1800s, most nurses were affiliated with different missionary organizations. Some came from as far as England. They were led by Wilfred Grenfell, a British Missionary. They provided healthcare services to Mississippi people under very challenging conditions. According to Conrad et al. (1993), this was what was referred to as traditional nursing. The works of Grenfell and other missionaries give the history of APN in America an international touch.

Other than traditional nurses, there were other nursing practitioners in Mississippi and the larger America. For example, in times of war, military nursing came into existence. Military nurses played a significant role in World War I. However, it was not until World War II that the nursing profession was transformed. Many of the nursing responsibilities were taken over by civilian nursing practitioners. However, in America, army and navy nursing practitioners were still held in high esteem, especially due to the critical roles they played during wars. For example, President Franklin praised the important contribution made by the nurses to the healthcare system during his reign. In 1945, he pressed for an induction act that raised the number of nurses not only in war services but also in the larger American society (Conrad et al., 1993).

First Nursing Practitioner in Colorado, USA

The development of APN in Colorado is comparable to that in Mississippi. Henry Silver played an important role in the early development of APN in America. In the 1960s, he established programs to assist physicians in their work. In Colorado, Silver established the Pediatric Nurse Practitioner (PNP) program. It was the first such program in the nation. As a physician, he worked alongside Dr. Ford Loretta, who served as a nurse. The two established a working relationship between physicians and nurses. They realized that such collaborations led to better results among patients. Several programs came after PNP. They led to the establishment of APN in different states. APN aimed to help children and their families to access quality healthcare services (Conrad et al., 1993).

Historical Regulations of APN Services in the US

Historically, the provision of APN services in the US is regulated by the state. As a result, the care provided by FNPs varies from one state to the other. The variation is especially dependent on the levels of knowledge among the nursing practitioners. In some states, FNPs work independently. However, collaborations are evident between FNPs and other nursing practitioners in other states. As such, APN differs sharply between states, especially in Mississippi, where scope and practice are different from other places (Pearson, 2012).

In states where collaboration agreement is an option, the nature of roles, duties, tasks, and prescription varies. For instance, in Mississippi, the role of the FNP is limited to routine lab tests, prescription of physical therapy, and interpretation of diagnostic studies. Such a scenario is not the same in other states like California, where diagnostic studies are left to physicians. In other states, lab tests are the preserve of lab technicians.

The provision of prenatal care and family planning services by FNPs is, however, similar between Mississippi and other states (Pearson, 2012). Similarities are also seen in the provision of, among others, child care, primary healthcare, minor surgeries, and counseling services. The practice and setting of FNPs are also similar between Mississippi and the rest of the US. For example, FNPs practice in almost all healthcare settings in the US. Their services are evident in healthcare departments, hospitals, community clinics, and healthcare centers (Pearson, 2012). Such similarities and differences have remained constant over the years.

The Legitimization Process

In the 1960s, there emerged various forces that saw the introduction of APN roles into the country’s healthcare system. The forces included the need for publicly funded health insurance, shortage of medical personnel, and increased need for primary healthcare services. All these factors motivated nursing practitioners to assume important roles in the healthcare system in Mississippi and other parts of America (Buppert, 2011).

As already indicated, several factors hindered the development of FNP roles in America. For example, APN roles were limited by the knowledge of the personnel. The scope of these roles was especially limited in states with low education levels. The government addressed this issue by putting in place regulations that stipulated the requirements to enter into this profession. In the 1970s, all states embraced legislative initiatives that changed laws on nursing practice. The new developments saw the introduction of FNP programs at the University of Washington. By 1973, more than 65 FNP programs were established in America (Buppert, 2011).

However, there was no single FNP program in Mississippi until the early 1980s. During this time, acts by the federal government required all nurses to be certified using the same standards. Mississippi was forced to introduce FNP programs to comply with the regulations put in place by the American Nurses Association in 1977 (Buppert, 2011).

In the 1980s, APN recorded slow but steady growth in all states. There were more than 133 programs and over 15,000 NPs engaged in this sector (Pearson, 2012). Mississippi was not left behind as it registered an impressive number of NPs in this field. However, the numbers varied from one state to the other, with some registering more than double the NPs in other places. Mississippi made use of federal government funds to support these programs. By the end of the 1980s decade, the state had spent over $100 million to educate more than 24,000 NPs (Buppert, 2011).

There are several reasons why Mississippi recorded a low number of NPs compared to other states. For example, training programs were largely funded through grants from public health organizations situated in other states. The development of APN in this state saw the introduction of a Master’s program for NPs with a post-graduate certificate. In the early 1990s, NPs could choose between master and post-Masters degree programs. In Mississippi, there was the introduction of the National Organization of Nurse Practitioners during this time. Various publications, especially on FNP curricula, were made (Buppert, 2011).

In the early 2000s, there was an expansive and rapid growth of NPs not only in the US but also in other parts of the world. According to Pearson (2012), the number of NPs in the world rose to over 130,000. Education, accreditation, and certification are important aspects of Advanced Practitioner Registered Nurse (APRN) accreditation in the world.

For one to be accredited as an APN, they have to be certified by a legislative body in their state. Such bodies are controlled by the federal government. In addition to these accredited bodies, Mississippi has a grandfather clause. The clause allows individuals who were practicing before 1980 to automatically qualify for a Masters’s Degree program (Buppert, 2011).

Historical studies have been carried out to analyze the outcomes brought about by the collaboration between APRNs and physicians. Such studies have indicated that collaboration yields better results compared to instances where physicians operate in isolation. According to the Commonwealth Health Fund, Mississippi is ranked 50^th (or the last) in healthcare services in the US. Scholars contend that this occurrence is attributed to the negative perceptions that physicians have towards nursing (Buppert, 2011).

The Status of Advanced Nursing in the World Today

Today, nursing is characterized by two distinct elements in the US and other parts of the world. The two are regulation and governance, which have historically determined the number and attributes of NPs joining the healthcare sector. Nurses are in short supply both in the US and the rest of the world. The shortage is significant given that the demand for nursing services continues to rise (Pearson, 2012). Over the years, the roles of NPs have evolved significantly. Such evolutions have led to the differentiation of roles among APNs, leading to the rise of FNPs and other practitioners. However, confusion has rocked the nursing field as there are no clear boundaries between the various nursing professions.

Conclusion

It is the opinion of this author that different nursing practices have evolved in the world’s healthcare system. The author holds that advanced nursing practices are critical in the development of future healthcare systems. The importance of FPNs and other APNs is not limited to Mississippi or the US. On the contrary, the significance of advanced nursing practice permeates the global healthcare framework. The evolution of APN roles has benefited patients and other stakeholders in the health sector. However, the boundaries between the various APN roles should be delineated to avoid inefficiencies and confusion.

References

Buppert, C. (2011). Nurse practitioner’s business practice & legal guide (4th ed.). Sudbury, MA: Jones and Bartlett.

Conrad, C., Haworth, J., & Millar, S. (1993). A silent success: Master’s education in the United States. Baltimore, MD: The Johns Hopkins University Press.

DeNisco, S., & Barker, A. (2013). Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed.). Burlington, MA: Jones & Bartlett.

Pearson, L. (2012). The 2012 Pearson Report: A national overview of nurse practitioner legislation and health care issues. Monroe Township: NP Communications.

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