Brief History of the
Nurse Practitioner
in the United States
Elaine Leinung DNP, FNP-BC, CNE
Assistant Professor,
New York City College of Technology
President, Brooklyn/Queens Chapter,
Nurse Practitioner Association of NY
What is a Nurse Practitioner?
• RN with advanced education
– Master’s Degree
– Doctor of Nursing Practice
When, Where & Why
• 1965 - Dr. Loretta Ford EdD, RN, PNP FAANP
• University of Colorado
• Cost effective for first contact health care in rural
regions
• Pediatric Nurses were the first NP’s
• Certificate Program, then MSN, now DNP
Scope of Practice
• Diagnosing, treating, evaluating and managing acute and chronic
illness and disease (e.g. diabetes, high blood pressure)
• Obtaining medical histories and conducting physical examinations
• Ordering, performing, and interpreting diagnostic studies (e.g.,
routine lab tests, bone x-rays, EKGs)
• Prescribing physical therapy and other rehabilitation treatments
• Prescribing pharmacologic treatments and therapies for acute and
chronic illness (extent of prescriptive authority varies by state
regulations)
• Providing prenatal care and family planning services
Scope of Practice (cont.)
• Providing well-child care, including screening and immunizations
• Providing primary and specialty care services, healthmaintenance care for adults, including annual physicals
• Providing care for patients in acute and critical care settings
• Performing minor surgeries and procedures
– dermatological biopsies
– Suturing
– casting
• Counseling and educating patients on health behaviors, self-care
skills, and treatment options
Practice Settings
• Community clinics, health
centers, urgent care
centers
• Health departments
• Health maintenance
organizations (HMOs)
• Home health care
agencies
• Hospitals
• Hospice care
• NICUs or PICUs
• Nurse practitioner
practices/offices
• Nursing homes
• Private & public schools,
universities and colleges
• Physician/private medical
practices
• Veteran's administration
facilities
Legitimization Period
• 1970’s
– Across the US, legislative initiatives to change
state laws and nurse practice acts
• 1971
– 1st Family Nurse Practitioner Program at
University of Washington
• 1973
– 65 FNP programs
Certification
1977 - The American Nurses Association
• The first nurse practitioner certification
exams
• Legitimized the role of NPs and led to
more standardized practice outcomes
1980 - 1990
Slow Steady Growth
Due largely to Federal Government funding NP
education through grant programs
administered by the United States Public
Health Service, Division of Nursing.
1991-2000
New Expansion & Rapid Growth
• In 2001, the number of NPs in the United States is
estimated to be 78,251 (Pearson, 2001, p. 26)
• Legislative victories lead to an increasingly independent
role for the NP in practice:
– Third party reimbursement
– Prescriptive authority
• By the turn of the century, nurse practitioner programs had
entered the mainstream of graduate education in nursing.
The Present
NP specialties
have grown
• ACNP (Acute Care NP)
• ANP (Adult NP)
– Adult Cardiovascular Care
NP
– Adult Primary Care NP
– Adult Critical Care NP
– Adult Acute Care NP
• ENP (Emergency NP)
•
•
•
•
•
•
•
•
•
FNP (Family NP)
GNP (Geriatric NP)
HNP (Holistic NP; APN program)
NNP (Neonatal NP)
PMHNP (Psychiatric/Mental
Health NP)
APMHNP (Adult
Psychiatric/Mental Health NP)
FPMHNP (Family
Psychiatric/Mental Health NP)
OHNP (Occupational Health NP)
ONP (Oncology NP)
The Present
NP specialties
have grown
• AONP (Adult Oncology NP)
• PONP (Pediatric Oncology NP)
• PCNP (Palliative Care NP; APN
program)
• PNP (Pediatric NP)
• PCCNP (Pediatric Critical Care
NP)
• ACPNP (Acute Care Pediatric
NP)
• PA/CCNP (Pediatric Acute/Chronic
Care NP)
• WHNP (Women's Health NP)
• BC-PCM (Board Certified Palliative Care Management, disc’d
by ANCC)
• BC-ADM (Board Certified Advanced Diabetes Management)
• BC-ADM (Board Certified Advanced Diabetes Management)
• ACHPN (Advanced Certified
Hospice & Palliative Nurse)
THE END!
The Nurse Practitioner
in
New York State
Dr. Elaine Leinung DNP, FNP-BC,CNE
President of Brookyln Queens Chapter
Dorothy Grasso, MSN FNP-BC
Vice President B/Q Chapter
License Requirements:
Nurse Practitioner in New York State
• Graduate from approved program with minimum
Master’s Degree (30 -30 credits above a BSN
and 600 - 1000 practice hours)
• Infection control class (on line)
• Child abuse reporting class (4 hours)
• Obtain a DEA (Drug Enforcement Agency)
number
• Obtain National Provider Identifier Number
License Restrictions:
Nurse Practitioner in New York State
• Can only practice & prescribe in your specialty
• Establish a collaboration agreement with an MD
or DO and keep on file
• Identify a protocol text to be used for patient care.
NPs in New York State
NP title(s) used in this state:
Number of NPs in state:
National certification required
for recognition/practice?
BON sole state authority over NPs?
Physician involvement required
for any aspect of practice?
NP (nurse practitioner)
14,272
NO
Yes
Yes. For details, log on
to www.webnp.net
CE requirements for NP practice? No
“Doctor Nurse?”
Q:
A:
Is there a statutory restriction against an NP with
doctorate being addressed as “Doctor?”
No, but, according to General Business Law
statute, if you use the term “Doctor” when offering
to perform health services, you must indicate the
profession in which you hold a doctorate.
Additional limitations/prohibitions
to NP practice?
• Write home health personal aid services,
NPs may:
•
•
•
•
•
Act as medical inspectors
(In school districts) order respiratory therapy
Obtain limited test-site permits under CLIA
Declare an emergency in response to ordering
utilities turned back on after “shutoff” action
Prescribe non-patient-specific orders
– (certain) immunizations
– Anti-anaphylactic agents
– PPD tests
– rapid HIV tests
NP Scope of Practice – Prescribing
• The practice agreement and protocols govern the prescribing of
drugs.
• May prescribe drugs for treatment of patients within their
specialty area of practice.
• In terms of CS, NPs may order drugs from Schedules II-IV
without restriction.
• Drugs, immunizing agents, tests, devices, and procedures
ordered by NPs do not require a co-signature from the
collaborating physician.
Why an Nurse Practitioner?
• NP’s Provide Patient Centered Care
• NPs take the time to listen to patients'
concerns, health and otherwise.
• NPs concentrate on preventative health
care.
• NPs provide individualized, holistic (all
encompassing) care.
The NPA of New York State
• The NPA was established in 1980 as a non-profit organization
under the name The Nurse Practitioner Association, Inc. Since
1980, the NPA has grown financially, programmatically and
increased the visibility and credibility of NPs within the
healthcare community, at both the national and State levels of
government, and with consumers throughout New York.
• The NPA is the voice of Nurse Practitioners in New York State.
We offer our members the tools, resources, and information to
advance the NP profession, and an effective and successful
advocacy program dedicated to advancing and protecting NPs
in all of New York State.
Historical Overview of NPA
1980 –
The Nurse Practitioner Association, Inc. was formed
1981 –
Organized meetings begin in Syracuse, NY under the name of
Coalition of Organized Nurse Practitioners Associations (COONPA)
1985 –
First Annual Convention and Educational Conference in Albany, NY
1988 –
Landmark legislation authorizing title and scope of practice for NPs
1988/1992 – Acquired prescriptive authority and ultimately full DEA prescriptive
authority
1991 –
The Coalition of Nurse Practitioners renamed New York State
Coalition of Nurse Practitioners (NYSCONP)
Historical Overview of NPA
1992 –
The American College of Nurse Practitioners (ACNP) established with
NYSCONP as a founding member with a seat on the Board
1993 –
Education Law amended allowing referrals for physical and
occupational therapy
1993 –
Medicaid reimbursement at 100% of the physician’s rate enacted
1997 –
Medicare reimbursement at 85% of the physician's rate enacted
1998 –
1999 –
NYSCONP forms a Political Action Committee (PAC)
NYSCONP hires its first full-time paid executive and professional staff
and opens Albany office
NYSCONP begins doing business as The Nurse Practitioner
Association New York State (The NPA)
2002 –
Historical Overview of NPA
2002 – The Practice Area Bill is passed, becoming Chapter 600 of the Laws of 2002
2003 – The Respiratory Therapy Bill enacted allowing Respiratory Therapists to
accept orders from NPs
2004 – Clinical Lab Bill is passed
2005 – The NPA grows to 21 Chapters and 7 Regions with over 2,500 Members
2006 – Four bills introduced at the request of NPA pass both houses of the NYS
Legislature:
Death Certificates Bill, Patient Restraints Bill, Handicap License
Plates Bill, and the Medical Emergency Utility Services Bill.
Two bills are signed into law:
The Medical Emergency Utility Services Bill, and the Handicap
License Plates Bill.
Bills NPA is Sponsoring
Before NYS Legislature
•
Patient Access & Advocacy Act - A.765 (Gottfried)/S.2948 (Montgomery)- Removal
of Statutory Collaboration & Reimbursement
•
Reimbursement Assurance - A.6651 (Gottfried)/S4490 (Duane) - To assure health
plans do not deny reimbursement for services rendered by nurse practitioners acting
within their lawful scope
•
Access Protection - A.7877 (Gottfried)/S4491 (Duane) - To promote practice
opportunities for nurse practitioners by prohibiting health plans from excluding nurse
practitioners from their provider networks and to insure that reimbursement rates are
reasonable
•
NP Worker's Compensation Access Act - A.3704 (John)/S.3908 (Duane) Authorizing NPs to fully participate within and be reimbursed under the worker's
compensation program in NYS as a legislative study bill
Bills NPA is Sponsoring
Before NYS Legislature
•
Immunization Bill - A.6654 (Gottfried)/S.4070 (Montgomery) - To add NPs to the
category of persons legally qualified to certify that an immunization required by
section 2164 of the public health law may be detrimental to a child's health
•
NPA License Plates - A.4829 (Morelle) - Adding a new Section 404-x to the vehicle
and traffic law to provide for the issuance of distinctive plates for members of the NPA
•
Death Certificate Bill - A.2028-A (John)/S.2969 (Montgomery) - Authorizing NPs to
sign death certificates
•
Do-Not-Resuscitate (DNR) - A.1719 (Gottfried)/S.2947-A (Hannon) - Authorizing
NPs to issue orders not to resuscitate
Bills NPA is Sponsoring
Before NYS Legislature
Other bills monitored for provider neutrality:
•
•
Timothy's Law - A.5301 (Morelle) - this legislation would make technical
amendments to make the law "provider neutral" by adding language to
include nurse practitioners.
Collaborative Drug Management Therapy - A.6848 (Canestrari)/S.3292
(LaValle) - Authorizes pharmacists to perform collaborative drug therapy
managment with physicians in certain settings.
The Future
• Removal of collaborative Practice agreements in
NYS (we hope!)
• NP’s as Primary Care Providers on Major Insurance
Carriers
• Health Care for all
•
Americans and
NP’s as Primary Care Providers
External Links
•
American Academy of Nurse Practitioners (AANP)
http://www.aanp.org/AANPCMS2
•
American College of Nurse Practitioners (ACNP)
http://www.acnpweb.org/
•
The National Organization of Nurse Practitioner Faculties
http://www.nonpf.org/
•
The Nurse Practitioner Association of New York State
http://www.thenpa.org/
•
New York State Department of Health, Office of the Professions
http://www.op.nysed.gov/
References
•
Berlin, L.E., Bednash, G.D. & Stennett, J. (2001). 2000-2001 Enrollment and
graduations in baccalaureate and graduate programs in nursing. Washington,
D.C.: AACN.
•
Carnegie Commission on Higher Education. (1968). Quality and equality: New
levels of federal responsibility for higher education. NY, NY: Carnegie
Commission.
•
Geolot, D. (1987). NP education: Observations from a national perspective.
Nursing Outlook, 35 (1), 132-135.
•
Geolot, D. (1990). Federal funding of nurse practitioner education: Past, present
and future. Nurse Practitioner Forum, 1 (3), 159-162.
•
Harper, D. & Johnson, J. (1996). NONPF Workforce policy project technical report
(1997)
•
Pearson, L. (2001). Annual legislative update. Nurse Practitioner, 26 (1), 7-57.
•
Pearsson L. (2009). The Pearson Report American Journal for Nurse Practitoners
vol 13 no 6