Advanced Practice Nurses are Registered Nurses who hold a masters or doctoral degree with a specialization from area of advanced nursing and they have supervised practice during graduate education, and have ongoing clinical experiences. Therefore advanced practice in nursing brings an enhanced level of accountability. There are four major advanced practice nursing roles in United States. They are Nurse Anesthetists, Nurse Midwife, Clinical Nurse Specialist, and Nurse practitioner (NP). This paper will address the history and development of advanced practice in nursing and the role of nurse practitioners in primary care (Hamric, Spross &Hanson, 2005). Nurse practitioners are expert clinicians, who conduct comprehensive health assessment, make diagnosis, prescribe pharmacological and non pharmacological interventions, evaluate outcomes in the direct management of individual patients with acute and chronic illness and also engage in health promotion and disease prevention education (Hamric, Spross &Hanson, 2005).
History and development of Advanced Practice roles In 1963, the Surgeon General issued a report in response to shortage of primary care providers who were needed to improve access to care and meet the needs for health promotion and disease management. In that report he recommended to educate nurses to provide primary care in collaboration with physicians. At that time the term “nurse practitioner” referred to a nurse providing primary care in ambulatory care setting such as clinic or outpatient facility. In 1965 University of Colorado established the first graduate level nurse practitioner programme (Hickey, Ouimette, Venegoni, 2000). As stated by Hickey, Ouimette &Venegoni (2000), Nurse practitioners rapidly became one of the primary care resources, when the Nixon price control hit hospitals in 1970, as most of the patients were cared for by NPs in
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