Nurse Practitioner Role’s Historical Development


The evolution of the nurse practitioner role can be traced back to the 1960s. Widespread specialization in the field of medicine resulted in a shortage of primary care physicians, which led to a crisis in the provision of primary care. As a result, physicians started hiring registered nurses to work with them to mitigate the crisis. In 1965, demand for primary care increased due to the implementation of the Social Security Amendments (Joel, 2013). The Amendments initiated the development of the Medicare and Medicaid programs that provided more access to health care to people with disabilities, the elderly, and individuals from low-income backgrounds. These programs increased the need for primary care, so nurses embraced new roles that involved educating families on the importance of primary care, health promotion, and health prevention (Joel, 2013).

Nurses began working alongside physicians. The collaboration provided nurses with an opportunity to broaden their knowledge and skills regarding the health needs of communities. The roles of the nurses were expanded to match those of the primary care physicians and as a result, the nurse practitioner role was created. The first nurse practitioner program was created by Loretta Ford in partnership with Henry Silver and was offered at the University of Colorado (Joel, 2013). The new role received widespread resistance and criticism from nurses and physicians. The role of nurse practitioners was fully accepted after the American Nurses Association formed the Council of Primary Care Nurse Practitioners. In 1985, the American Academy of Nurse Practitioners was founded and solidified the role in the United States’ health care system (Joel, 2013).

Developing the role of nurses in the US health care system

The development of the nurse practitioner role was influenced by several forces including a shortage of physicians, the creation of the Medicare and Medicaid programs, and the increased demand for primary care. The growth of the role has been most influenced by the increasing demand for primary care throughout the United States due to changes that have taken place in the health care system. In addition to Medicare and Medicaid programs, the introduction of Obamacare influenced the development of the nurse practitioner role. The program increased access to health care by Americans and as a result, created a high demand for health services that physicians could not meet. Forces that have influenced the development of the nurse anesthetist role include patient safety, publications of techniques in anesthesiology, the creation of an anesthetist program, and the need to lower the rate of mortality during surgery (Schober, 2016). The need to improve patient safety has had the most influence because patient safety is the most important aspect of the provision of health care.

Forces that have shaped the development of the nurse-midwife role include increased population health needs, organizational requirements, the development of childbirth education, and the promotion of breastfeeding (Schober, 2016). Increased population health needs have been the most influential force because of the high demand for a more holistic approach to care that focuses on individualized care, minimal interventions, health, wellness, and prevention. Moreover, there is an increased need for preconception care, gynecologic and family planning services, care during pregnancy, and primary care for women of different ages. Forces that have influenced the development of the clinical nurse specialist’s role include increased demand for direct patient care, nursing practices research, and collaborations with other nurse personnel (Schober, 2016). I think that increased demand for direct patient care has had the most significant impact because of the increased access to health care by American citizens due to the expansion of the health care system as well as the introduction of new programs that support affordable care.


Joel, L. A. (2013). Advanced practice nursing: Essentials of role development. New York, NY: F. A. Davis.

Schober, M. (2016). Introduction to advanced nursing practice: An international focus. New York, NY: Springer.

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