Azusa Pacific University
The Development of Advanced Practice Nursing: The Role of Health Care Reform
The purpose of this paper is to describe the role of health care reform with regards to the evolution and development of advanced practice nursing (APN) in the United States. Foundational aspects prominent in the development of defined APN roles include the health needs in society, support for innovation in health care, governmental health policy and regulation, health workforce supply and demand, and the development of advanced education, among other factors (Ketefian et al., 2001). APNs are comprised of nurse anesthetists, nurse midwives, clinical nurse specialists and nurse practitioners (NPs). With the requirements of this class in mind, further references to APNs will generally suggest NPs. Historically, the development of the nursing profession has been associated with improvements and the availability of advanced educational opportunities (Ketefian et al., 2001). Currently, the momentum of change and advancement in APN roles has shifted to reforms in health care and the increased need for primary care physicians (PCPs) to serve the continually increasing population without access to comprehensive health care (Chapman, Wides, & Spetz, 2010). A brief history of nursing, and more specifically APN, in the United States will be discussed, followed by the expected associations of APN with health care reform and the very current situation regarding President Barack Obama’s newly passed health care reform law.
The need for nurses was first realized on a national scale during the United States Civil War. Following the Civil War, the national population experienced exponential growth fueled by the prominence of national industrialization, furthering the need for additional nurses in the work force (Sullivan-Marx et al., 2010). In 1872, the first permanent nursing school in the United States was established at the Women’s Hospital of Philadelphia. In 1901, New York, New Jersey, Illinois, and Virginia were the first states to organize nurses’ associations, which paved the way for nursing licensures throughout the rest of the states. That same year, an Act of Congress established a permanent Army Nurse Corps, and military nursing continued to thrive, eventually achieving prominence in 1917 during World War I (Egenes & Burgess, 2001). The Goldmark Report of 1923, written by the Committee for the Study of Nursing Education, and supported by the Rockefeller Foundation, recommended that nursing education should have educational standards. The report also recommended that nursing education be conducted in universities, a change from the hospital-based education that was common at the time. These changes did not last as hospital administrators resisted change in nursing education that would eliminate the “free” labor provided by nursing students (Egenes & Burgess, 2001). The events surrounding the next Great War, World War II, saw the United States Congress pass the Nurse Training Act, known as the Bolton Act of 1942, which created the U.S. Cadet Nurse Corps, a program which quickly prepared nurses for work in civilian and government hospitals. The Division of Nurse Education was established in the United State Public Health Service, aimed at supervising the Cadet Nurse Corps and was influential in its own right in leading up to the important Nurse Training Act of the 1960s (Egenes & Burgess, 2001).
In 1964, President Lyndon Johnson signed what is perhaps the most influential piece of legislation with regards to nursing, known as the Nurse Training Act of 1964 (Lynaugh, 2008). The Nurse Training Act (NTA) required higher standards for nursing education and was undeniably important to the role of current APNs in today’s workforce. The NTA authorized federal grants to build and renovate nursing schools,...