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Advanced Practice Nurses


The need for specialized nurses has grown in the last century as a result of the development of new technologies, the growing body of medical knowledge, and the increasing number of patients requiring specialized care. The following paragraphs provide a brief overview of the origins of nurse-midwives, nurse anesthetists, clinical nurse specialists, and nurse practitioners.

Women have been giving birth by "natural" methods for thousands of years, since pain medication, hospitals, and medical intervention were largely unavailable until recent years. Early midwives coached mothers-to-be through their pregnancy and labor. They helped women deliver their babies and taught new mothers how to care for their infants. In the early 1900s, new pain medications and medical procedures took birth from a natural event into a technological marvel, and childbearing moved from home to hospital. The Maternity Association and the Lobenstine Clinic (both in New York) established the first U.S. midwifery school and graduated its first class in 1933. In 1968, the American College of Nurse-Midwives, the premier midwife organization in the United States, was established. The nurse-midwife, officially known as a certified nurse-midwife, has become a respected member of the health care team.

Reliable methods of putting a patient to sleep were first developed in the 1840s, when the discovery of ether anesthesia revolutionized surgery. Sister Mary Bernard was the first nurse anesthetist. She practiced in Pennsylvania in the 1870s. The first school of nurse anesthetists was founded in 1909 at St. Vincent Hospital in Portland, Oregon. Since then, many schools have been established, and the nurse anesthesia specialty was formally created in 1931, when the American Association of Nurse Anesthetists held its first meeting.

The National League for Nursing Education first drew up a plan to create the clinical nurse specialist role in the 1940s. The first master's degree program opened in 1954 at Rutgers University; the only specialty offered at that time was psychiatric nursing. By 1970, clinical nurse specialty certification had become available in a number of fields in response to the increased specialization in health care, the development of new technologies, and the need to provide alternative, cost-efficient health care in the physician shortage of the 1960s.

Nurse practitioners first appeared on the scene after World War II, partially in response to the severe shortage of physicians. In some settings, nurses had already been performing simple but time-consuming tasks formerly regarded as the physician's responsibility, such as taking blood pressures or administering intravenous feedings or medications. The physician shortage created demand for skilled nurses who could take on these and other duties previously handled by doctors. In addition, a larger number of medical corpsmen who served in World War II entered the field to fill the void of medical practitioners. In 1965, the first training program for nurse practitioners was established at Duke University. The American Academy of Nurse Practitioners (ACNP) was founded in 1985 to serve the professional needs of nurse practitioners. In 2013, the ACNP and the American College of Nurse Practitioners (founded in 1995) merged to form the American Association of Nurse Practitioners.

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