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During the Civil War the ratio of physicians to injuries was low. Due to a lack of formal education in nursing, professional nursing was provided by religious women. These nurses eagerly volunteered to assist the physicians with the care of injured soldiers. Physicians and social norms limited the amount of direct hands on care nurses were permitted to provide. Nurses helped by reading, writing, and preparing food. However, in 1861 Catherine S. Lawrence became the first nurse to administer anesthetics in the face of war opening a portal to the world of Advanced Practice Nursing (Michaels, 2019).

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Sister Mary Bernard became the first nurse anesthetist & practiced at St. Vincent’s Hospital (Murphy, 2002).

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1925 - Introduction of The Nurse Midwife 

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1925 - Introduction of The Nurse Midwife 

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1929- American Association of Nurse - Midwives
1931 - American Association of Nurse Anesthetist (Murphy, 2002).

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In the early 1930's - 1940's the public started to recognize the effects the civil war had on the mental health of soldiers. In 1954 Rutgers university offered the first psychiatric CNS program (Murphy, 2002).

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The early 1960's appears to be when nurses and physicians began to recognize the potential of the Advanced Practice Nurse and how they could provide care physicians historically provided. However, Organized nursing was not supportive of this
advanced practice role and often referred to the NPs as “physician substitutes” (Murphy, 2002).

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This act brought attention to nursing specialization and was essential in the creation of master’s-level nursing programs with clinical specialization. CNS served as role models, provided education, performed research, and studies began to show that the Clinical Nurse Specialist Improved Patient outcomes (Murphy, 2002).

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Negativity and
insufficient funding, contributed to  NP programs being offered through continuing-education programs in medical schools or universities instead of through formal master’s degree programs in nursing (Murphy, 2002). The first NP program was created by Dr. Loretta Ford and Dr. Henry Silver and was
offered at the University of Colorado in Denver. It was created to prepare highly skilled nurses to provide pediatric public
health services (Murphy, 2002).

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The American Nurses Association  defined and supported the Nurse Practitioner Role.
This allowed NPs to be primary care providers for pediatric
and adult populations (Murphy, 2002).

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A shortage of physicians led to the recommendation from educators, hospitals and the ANA and implemented the NP role as house staff substitutes in acute care settings. This guided the development of the Acute Care NP role. This blended nursing and medicine (Murphy, 2002).

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Anne Keane testified on behalf of the Acute Care NP role to the Physician Paymen Review commitee and stated that NP's are educated to provide care in the acute setting and the literature and education demonstrate that they are well qualified to meet hospital service needs. NP's began to practice and perform tasks that were once only completed by physicians such as lumbar punctures, chest tubes insertions etc (Murphy, 2002).

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1. Officially adopt the use of the term Advanced Practice Nurse for CNS and NP's
2. Explore ramifications of second licensure for Advanced Practice Nurse in states that have Implemented this legislation
3. Support Increased funding for post graduate programs
4. Increase Opportunities to expand knowledge and involvement of APN's in the regulatory and legislative process.
5. Incorporate APN outcomes
6. Encourage APN's to
(Murphy, 2002).

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Advanced practice nurses are ready and willing but limited. During Covid-19 President Trump and many governers enacted regulatory change through executive orders to expand telehealth delivery. However, although these orders may be effective they are a temporary fix to this historical issue in nursing (Bachtel et al., 2020).

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Covid-19 proved that nurses must be able to cross state lines for work however, the lack of multistate licensure for APRN's scope of practice has impeded mobilization of the nursing workforce. The APRN compact is on standby and fluid insterstate movement of APRN's is not possible. Although the compact was approved in 2015 only 10 states have passed the proposed model legilsation (Bachtel et al., 2020).

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March 24th Federal Health and Human Services Secretary Alex Azar wrote a letter to the nation's governors recommending they relax the scope of practice requirements for APRN's. The federal government temporarily suspended physician supervision of CRNAs at the national level as well as 28 states that limit NP practice have partially or fully waived APRN practice agreement requirements. (Bachtel et al., 2020).