Module Two: History of Advanced Practice Nursing
Jamie P. Bernard
Louisiana State University Health Science Center School of Nursing

The historical evolution of the four Advance Practice Registered Nurse (APRN) roles date back as early as the 1860s when nurses were administering chloroform anesthesia during the Civil War (Cockerham & Keeling). During the nineteenth century lay midwives were delivering babies without any nursing education, and the first program for psychiatric nursing in America had opened its’ doors (Cockerham & Keeling, 2014). This specialty paved the way for Clinical Nurse Specialists (CNSs). Around the same time the Henry Street Settlement opened its’ doors, and public health nurses started providing primary care to the poor (Cockerham & Keeling, 2014). These nurses and lay midwives were practicing based on skills taught in the fields, because there were no formal education programs at that time for the APRN specialties. During the twentieth century, schools started opening and offering specialty nursing programs for the four Advanced Practice Registered Nurse (APRN) roles: Certified Registered Nurse Anesthesists (CRNAs), Certified Nurse Midwives (CNMs), Clinical Nurse Specialists (CNSs), and Nurse Practitioners (NP). This was also the time when nursing organizations were being formed including: the American Association of Nurse Anesthetists (AANA), the National Organization of Nurse Practitioner Faculties (NONPF), the American College of Nurse Midwives (ACNM), and the Council of Clinical Nurse Specialists (CCNS). These organizations united each specialty giving them a larger voice that could not be ignored, and the written records kept by Alice Magaw and the nurses from the Frontier Nursing Service provided proof of positive patient outcomes (Cockerham & Keeling, 2014). Even though nurses received formal education, many physicians believed that they were still practicing medicine without a license. Tensions grew and many legal battles ensued, such as Frank versus South (Kentucky), a case filed in 1917 against nurse anesthetists (Cockerham & Keeling, 2014). The court’s decision was in favor of the nurse anesthetists. Most of the judgements in cases filed against advanced practice nurses (APNs) were in favor of the APNs. By the twenty-first century there were numerous amounts of colleges offering master degrees in the APRN roles. In 2004 the American Association of Colleges of Nursing (AACN) recommended that licensure, accreditation, certification, and education (LACE) be standardized throughout the United States (NCSBN, 2008). This has led us to the Doctorate of Nursing Practice (DNP) degree. Many events have helped form the four Advanced Practice Registered Nurse (APRN) roles: the Civil War, World War I, World War II, Korean War, Vietnam War, the Great Depression, formation of governing nursing organizations, shortage in doctors and residents, poor people living in rural and urban areas, legislative changes, Medicaid and Medicare reimbursement, and the written records of nurses from past times. In my opinion the documentation by nurses during the nineteenth and twentieth century have had the most significant impact on the evolution of the APRN roles. Alice Magaw kept written documentation of the 1,092 times that anesthesia was administered from January 1, 1899 to January 1, 1900 (Cockerham & Keeling, 2014). Her records revealed positive patient outcomes without complications. The nurses in the Frontier Nursing Service (FNS) also kept detailed records of their work as midwives since 1925 (Cockerham & Keeling, 2014). When their records were reviewed in 1951, they showed a considerably lower maternal mortality rate than the national average (Cockerham & Keeling, 2014). With documentation of positive patient outcomes, it was hard for doctors to dispute the importance of advanced practice nurses. This documentation led to a few doctors hiring nurses for advanced practice, and led more schools to open their doors to formal education of advanced practice nursing candidates. These endeavors have shown to be invaluable to the four APRN roles of today.

References Cockerham, A. Z. & Keeling, A. W. (2014). A brief history of advanced practice nursing in the united states. In A. B. Hamric, C. M. Hanson, M. F. Tracy, & E. T. O’Grady (Eds.), Advanced practice nursing: An integrative approach (5th ed., pp. 1-26). St. Louis: Elsevier Saunders.
National Council of State Boards of Nursing (2008). Consensus model for APRN regulation, licensure, accreditation, certification, & education (Advance Practice Registered Nurse Consensus Work Group and NCSBN APRN Advisory Committee). Available from http://www.ncsbn.org/july_2008_consenus_model_for_aprn_regulation.pdf