4 hrief History of Advanced Practice Nursing in the United States

INTRODUCTION To understand the challenges facing advanced practice nursing today and determine a path for the future, it is essential to look to the past. This chapter presents some highlights of the history of advanced practice nursing in the United States from the late nineteenth century to the present. It examines four established advanced practice rolescertified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and nurse practitioners (NPs)in the context of the social, political, and economic environment of each decade and within the context of the history of medicine, technology, and scienCe. Legal issues and issues related to gender and health care manpower are considered. Although sociopolitical and economic contexts are critical to understanding nursing history, only historical events specifically relevant to the history of advanced practice nursing are included. The reader is encouraged to consult the references of this chapter for further i'rifo'fmation. A brief comment on terminology: The use of the term specialist in nursing can be tra~ed to the turn of the twentieth century, when it used to designate a nurse who had completed a _p<>St];raduate course in a clinical specialty area or extensive experienc~ .. and expertise in a parclinical practice area. With the introduction of role during the 1960s and 1970s, the terms role and extended role were used, implying a ~iz:ontal movement to encompass expertise from and other disciplines. The more con tempoadvanced practice, which began to be seen J980s, reflects a more vertical or hierarchical encompassing graduate education within •prau1er than a simple expansion of expertise (e:::rv~:::. of knowledge and skills used by ~; Since the 1980s, state nursing pracincreasingly adopted the term advanced (APNs) to delineate CRNAs, CNMs, LATE NINETEENTH CENTURY: HISTORICAL ROOTS