An advanced registered nurse encompasses many different roles, including nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. Primarily focusing on the role of a nurse practitioner (NP), NPs have become more common in the health care setting, with licensure, accreditation, and certification requirements evolving in response to the growing demand of the public (Penn Nursing, n.d). During the 20th century, a major factor that revolutionized the role of an NP was the lack of health services. The ability to specialize in medicine created a shortage of primary care physicians. This shortage affected the rural areas or those who lack access to care in inner cities (Keeling, 2015). Primary care physicians, who did not specialize, decided to recruit registered nurses with clinical expertise and collaborate with them to identify and treat the needs of children and families (Penn Nursing, n.d). In addition, the creation of Medicare and Medicaid allowed low-income children, women, the elderly, and people with disabilities to gain access to health care, thus increasing the need for primary care. This allowed nurses to have more of an expansion in their roles, working parallel with primary care physicians (Penn Nursing, n.d). With the demand for healthcare and more healthcare professionals, the first training program for nurse practitioners was developed in 1965. It was created by Loretta Ford, who partnered with a physician named Henry Silver (Penn Nursing, n.d). This program was used to bridge the gap between physicians and nurses, allowing them to work in a collaborative relationship, and not as a physician substitute.
Early in the 20th century, there was not much regulation as to what nurses did. The Henry Street Settlement (HSS), established in 1893, was a group of 12 nurses who made home visits, providing not only care, but other services including ice, sterilized milk, and meals. The HSS nurses also routinely dispensed physician-prescribed medicines. These medications were obtained from local pharmacists and carried in their nursing bags (Keeling, 2015). This practice was questioned in 1903 with the passage of the state nursing registration act, declaring “Nothing contained in this act shall be considered as conferring any authority to practice medicine or to undertake the treatment of disease” (Keeling, 2015). This act brought up numerous questions as to what nurses were allowed to do. For example, were the nurses able to administer certain medications that were prescribed by physicians? Because the nurses had been routinely doing this during their home visits. Over the years, the HSS grew exponentially. By 1926 these nurses made over 300,000 home visits a year, treating illnesses such as pneumonia, polio, measles, influenza, and tuberculosis (Keeling, 2015). “At the turn of the 20th century, the medical/nursing professional boundaries changed almost daily as new treatments became available and state/federal legislative acts regulated the professions of medicine, pharmacy, and nursing” (Keeling, 2015). Nurse practitioners in the 21st practiced in almost every health care setting, ranging from hospitals, clinics, urgent care, nursing homes, schools, and public health departments. NPs practice autonomously and in coordination with other healthcare physicians, providing healthcare services (Scope of practice for Nurse Practitioners, 2022). NPs are expected to practice with a code of ethics, using best evidence-based practice, and be nationally certified. Their scope of practice includes, “assessment, ordering, performing, supervising, and interpreting diagnostic and laboratory tests; making diagnoses, initiating and managing treatment including prescribing medication and non-pharmacologic treatment” (Scope of practice for Nurse Practitioners, 2022). Over the years, the scope and expectations of a nurse have grown exponentially.
As health care changes, the role of advanced registered nurses will also evolve. With the affordable care of 2010, many demands were placed on health care professionals. The act shifted the focus of healthcare from acute and specialty care to primary care, including care coordination and prevention/wellness (National Academy of Sciences, n.d). This is to help prevent chronic conditions. With the increase in the insured population, there will be more of a demand for nurse practitioners to help close the gap between physicians and physician assistants (National Academy of Sciences, n.d). In the United States, physicians account for 287,000 of the primary care providers, while NPs account for 83,000, and physician assistants account for 23,000 (National Academy of Sciences, n.d). The education and roles of NPs continue to evolve, allowing nurses to enter the workplace qualified and willing to provide more services than before. NPs work with a team of providers, help to integrate a r
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