Nurse Practitioners Reshaping Health Care: From Roots to Shoots

Abstract

Purpose: The purpose of this historical case study is to describe the development of the first nurse practitioner programs in Massachusetts, analyzing the socio-historical context and factors that contributed to the successful program development and role implementation. Methods: This historical qualitative case study includes the use of primary documents resources and interview of more than twenty key informants. Primary resources include program materials and records, records from the Massachusetts General Hospital and School of Nursing, MGH/Bunker Hill program and Peter Bent Brigham Program, literature from professional journals, governmental reports and the local press. Results: Historical documents and interviews revealed the importance of governmental and institutional politics in shaping the demand for role expansion of nurses. The unmet demand for health service and or provider shortage and a professional culture and interest in innovation propelled program development. This occurred despite, an environment acknowledged as paternalistic and medically dominated. The development of ambulatory and community based health care was dependent on nursing labor in the short term. Close physician and nursing collaboration in program planning and implementation contributed to success in terms of organizational acceptance and post-graduate employment. Many of the first NP students had little knowledge about the emerging nurse practitioner role. But, those students who came from ambulatory or community settings were already on a career trajectory toward greater autonomy. Conclusion: The development of nurse practitioner educational programs and role development occurred with support of medicine. The nurse practitioner was viewed as adjunctive colleague, providing care in areas and to populations viewed as not financially lucrative or medically challenging. The nurse practitioner student and physician preceptor alignment created a bond or allegiance that supported employment, developing trust and support for role expansion. Early nurse practitioners, and many of their physician preceptors were risk-takers and innovators, willing to challenge the status quo and suffer the wrath of their professional colleagues.