During the late 1950s and early 1960s, specialization in medicine expanded, and this resulted in a shortage of primary care physicians. Rural areas were impacted the most by this shift. Primary care physicians who decided not to specialize in a particular area of medicine, recruited Registered Nurses with clinical expertise and began collaborating with them to identify and treat the primary care needs of children and families.
The Social Security Amendments of 1965 spurred the development of the Medicare and Medicaid programs. Under these programs, low-income children, women, the elderly, and people with disabilities gained new access to health care. This increased the need for primary care throughout the United States, and nurses naturally stepped in to educate families about health promotion and prevention.
Throughout the country, a consensus formed among nursing leaders that nurses were experienced and knowledgeable about the health care needs of children and families. This led to an expansion of their roles to parallel the roles and responsibilities of a primary care physician. In 1965, one of these leaders, Loretta Ford, partnered with a physician, Henry Silver, to create the very first training program for Nurse Practitioners. Their program, offered at the University of Colorado, focused on family health, disease prevention, and the promotion of health.
The introduction of the first Nurse Practitioner program was met with resistance. Ford, Silver, and their students faced opposition from nurses who worried that the title “Nurse Practitioner” was misleading and would be misinterpreted by both the medical and nursing community as well as the public. Health care professionals were concerned that NPs were not qualified to provide medical care that physicians usually delivered without the supervision of a physician.
During the 1970s and 1980s, Nurse Practitioners took up the task of validating their profession. The lack of a credentialing process and training paired with the improvements in health care put pressure on NPs to showcase their abilities and their overall benefit to health care. NPs used this time to document patient satisfaction with their care and create criteria and standards of practice. They also monitored the overall increase of the availability of primary care to patients throughout the country via evidence-based studies.
As time went on, Nurse Practitioners became a more valuable and essential part of health care, and they began to work for economic and professional acknowledgement. Between 1973 and 1985, more than 11 NP organizations were created in the United States. Through these organizations, NPs took certification examinations to earn credentials and adhere to federal regulations and reimbursement policies.
In 1974, the American Nurses Association created the Council of Primary Care Nurse Practitioners, a move that helped solidify the role of Nurse Practitioners in the United States health care system. By 1979, there were approximately 15,000 Nurse Practitioners across the country. The National Council of State Boards of Nursing also set licensure as a Registered Nurse as the standard for pursuing an advanced degree in nursing. Just six years later in 1985, the American Academy of Nurse Practitioners was established.
During the late 1980s, Nurse Practitioners did not have provider status in the eyes of the government. This meant their services had no designated monetary value and were not reimbursable. Lacking this status, NPs were not viewed as autonomous health care providers, making the utilization of their services difficult. During this time, reimbursement typically came via a paycheck from a physician or hospital.
Very much accustomed to fighting to legitimize their profession, nurse leaders throughout the country worked with members of Congress and lobbyists to achieve reimbursement and provider status. Their hard work paid off when the Omnibus Reconciliation Act of 1989 was signed into law by President George H. W. Bush. The act created limited reimbursement for Nurse Practitioners.
In 1993, Nurse Practitioner leaders throughout the country gathered at a leadership summit to develop a unified approach for all NP objectives — including policy and advocacy development. Soon after, the National Nurse Practitioner Coalition (NNPC) was formed, which later became the American College of Nurse Practitioners (ACNP). The NP community strengthened their identity and made it easier for NP advocates to support the profession’s causes.
Nurse Practitioners gained direct reimbursement through the Balanced Budget Act of 1997, which was signed into law by President Bill Clinton. More recently, the Affordable Care Act was passed, and millions of Americans gained new access to health care. The need for primary care throughout the country increased immensely, and current NPs are poised to meet this demand. The scope of practice for NPs varies throughout the country by state. As of November 2014, 19 states have a full scope of practice, 19 states have a reduced scope of practice, and 12 states have a restricted scope of practice. Today, there are more than 192,000 NPs in the United States.