Career Path For a Nurse

Abstract

This paper celebrates Loretta Ford, a nurse leader critical to the history and development of the nursing profession. Loretta focused her education on public health, but in time introduced an impactful change in the nursing profession, the nurse practitioner role. In 1965, Loretta and her colleague founded the nurse practitioner role, a position in which our society today deems as an advanced practice registered nurse (RN) and primary care provider. The paper discusses how Loretta Ford changed and impacted the nursing profession as well as relates her influence to current nursing practice.

Doctor of Nurse Practitioner, Loretta Ford and Her Impact on the Nursing Profession

Loretta Ford is a nurse leader who transformed the nursing profession by initiating a movement that changed the delivery of healthcare. In 1965, Loretta and Henry Silver, a pediatrician, pioneered the first 7 Nurse Practitioner role at the University of Colorado. It was a period of political and social unrest in nursing and medicine that provided an opportunity for the expansion of the role of nursing.

The nurse practitioner movement has been a leadership journey that began with one fearless public health nurse, Loretta Ford. Thirty-nine years later there are more than 106,000 nurse practitioners around the globe (Houser & Player, 2004).

Early Life

Loretta Cecelia Pfingstel Ford was born on December 28, 1920, in Bronx, New York. She was the fourth born of seven children. Loretta held many names throughout her life including the nickname, Dolly. Born Cecelia, she accepted the nickname Dolly, unofficially changed her name to Lee, and finally designated her name to Loretta.

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Growing up, Loretta was an avid reader and educated well beyond her years. She skipped the third and sixth grades. Loretta loved learning and dreamed of becoming a teacher, but because of the expensive education costs, Loretta’s sister-in-law suggested she apply to nurse school. Loretta enrolled in Middlesex General Hospital’s nursing program in New Brunswick, New Jersey, where she also worked as a nurse aide until she was old enough to enter into the program (Houser & Player, 2004).

Education/Early Career

In 1939, after celebrating her 18th birthday, Loretta Pfingstel entered the Middlesex.General Hospital nursing program. By the time of her entry in 1939, Loretta had read all of the nursing books, which allowed her to start ahead of her class. It was during her time at Middlesex that she met and pursued a relationship with a Navy pharmacist. After graduation in 1941, Loretta worked for a Visiting Nurse Service in New Brunswick and made plans to marry the Navy pharmacist. In 1942, Loretta received news that her fiancé’s ship went down during a World War II battle. To honor her late fiancé, Loretta joined the United States Army Air Forces. As a first lieutenant, she was stationed mainly in Miami, Florida caring for post-combat psychoneurosis patients (Houser & Player, 2004).

After completion of her tour in 1946, Loretta took advantage of the GI Bill to attend the University of Colorado at Boulder (Houser & Player, 2004). According to the United States Department of Veterans Affairs (n.d.), the GI Bill helps qualified veterans and their family members pay for education programs like college, graduate school, and training programs. While at the university, Loretta pursuing a baccalaureate degree in nursing and a public health nursing certificate. During this time, Loretta became particularly interested in the prevention of illness embodied in the public health model (Houser & Player, 2004).

While working part-time and going to school, Loretta met her soul mate, Bill Ford. They married in 1947 and gave birth to their daughter, Valerie, in 1952 (Wells, 1993). In 1949, Loretta graduated from the University of Colorado at Boulder and immediately entered into the university’s Master of Science in Nursing (MSN) program to focus on public health. While in the MSN program, she had  the opportunity to work with professional mentors including Pearl Coulter, Katherine Kelly, Henrietta Loughran, and Irene Murchison. Loretta’s socialization as a professional was influenced greatly by these powerful people. For example, Pearl Coulter persuaded Loretta to accept a position as a public health nurse for Boulder County, Colorado. Henrietta Loughran prompted Loretta to apply for her doctoral degree and assisted her in finding a scholarship (Houser & Player, 2004).

Loretta Ford spent 12 years as a public health nurse, supervisor, and director. After observing that the health of many Colorado communities relied on competent public health nurses, Loretta felt that nurses were underutilized. Loretta started to brainstorm how nurses could become more integral to healthcare solutions, thus the initial idea for the nurse practitioner role was born (Houser & Player, 2004).

Beginning of Nurse Practitioner Movement

Nurses demonstrated their value during World War II and now sought autonomy and independence in practice. In the early 1960s, the Vietnam War allowed an opportunity for the expansion of nurse roles. The war created limited access to healthcare and a shortage of generalized physicians needed to meet the health demands of the community. Healthcare in America was experiencing a crisis, so Loretta presented a solution referred to as the nurse practitioner movement. Loretta made it very clear that this movement was not created to meet the deficit of physician services; however, the physician shortage created an optimal environment for change  in nursing (Judd & Sitzman, 2014).

To help initiate her vision of the nurse practitioner movement, Loretta sought out help from a pediatrician, Dr. Henry Kempe. Ford and Kempe co-served on the dean search committee for the school of nursing at the University of Colorado Medical Center in Denver. Together, they vocalized the importance of advancing the practice of public health nurses for the pediatric population. A large part of Loretta’s public health practice was promoting maternal-child health while Henry Kempe was the chairman of the pediatric department at the university (Houser & Player, 2004).

Dr. Kempe introduced Loretta to his pediatric colleague and second-in-command, Dr. Henry K. Silver. After months of collaboration, Henry Silver and Loretta Ford constructed the pediatric nurse practitioner model. The model was designed so that nurses could be an extension of their patients. The job of the pediatric nurse practitioner was to ‘monitor pediatric growth and development, promote optimal health, provide anticipatory guidance for parents, and facilitate self-care by the child, whenever possible,to maintain wellness” (Houser & Player, 2004, p. 8). At the time, public health nurses were already running unsupervised clinics, so the movement was simply to formalize and augment an advanced practice nurse role.

In 1965, Ford and Silver tested the nurse practitioner model for the first time with Sue Stearyl, an experienced public health nurse with master’s level education. The Pediatric Nurse Practitioner (PNP) program was comprised of a four-month theory and practice classroom component, followed by an eight-month supervised practice clinical rotation. For the graduates of the PNP program to be credible, Loretta worked to build a program that met academic standards by upholding admission guidelines, academic requirements, and accreditation criteria (Houser & Player, 2004). Sue Stearyl successfully demonstrated the PNP model and became the nation’s first nurse practitioner in the summer of 1996 (Casey, 2015).

Impact on the Future of Nursing

Along with the success of the program, came some challenges. Many people, especially Loretta’s fellow faculty members, had concerns associated with the nurse practitioner movement. They believed that public health education was not a valued program. The concept of a nurse practitioner threatened the skill level of many faculty members who had little or no experience in public health settings. They feared that the nursing profession was selling out to medicine. As Loretta struggled to explain these concerns, she also had a hard time finding clinical settings for student practice.

Regardless of the challenges Loretta was facing, she had created a successful program and was determined to continue moving forward. In 1966, Loretta and Henry formed the first class of five to six nurse practitioner students. The Denver Visiting Nurse Services (VNS), directed by Margaret Lewis, RN, Ph.D., provided the students with a space for their clinical practice. ‘I have to give the leadership of the Denver VNS a lot of credit because they provided us with a testing ground, and thus the data, to adapt the model and advance the pediatric nurse practitioner movement,’ said Loretta (Houser & Player, 2004, p. 11).

After publishing the concepts and findings of the nurse practitioner movement, Loretta traveled the nation spreading the nurse practitioner message. During her travels, Loretta discovered that the movement was being embraced by the military, Veterans Administration, and physicians; however, nurses, nurse faculty, and nursing organizations were not supporting or even acknowledging the new advanced nurse role.

Due to the simultaneous development of the Physician Assistant (PA) role by military and physicians, the nursing community believed that the nurse practitioner movement had been diverted by medicine. Eventually, the role was accepted into academic nursing, and nurses in all capacities began to recognize the role of their nurse practitioner colleagues (Houser & Player, 2004).

The American Academy of Pediatrics, under the National Association of Pediatric Nurse

Associates/Practitioners, first credentialed the PNP program. However, organized medicine took over management too late and lost control. Nurse practitioners began to create their  specialty organizations including the National Association of Pediatric Nurse Practitioners (NAPNAP) and the American Association of Nurse Practitioners (AANP) (AANP, 2018). The rapid, uncontrolled growth of the program almost led to its demise.

The list of concerns that grew throughout the nurse practitioner movement created real questions of legality and fear of legal retribution. Because some state legislation prohibited nurses from making diagnoses and writing prescriptions, Loretta had to start answering to the American Medical Association (AMA) and nursing faculty. The AMA wanted nurse practitioners to be controlled by physicians and led legislative battles over the scope of practice and prescriptive authority of nurse practitioners. Over the years, nurse practitioners had to organize and fight for each small victory.

By 1972, the nurse practitioner movement was strong with specialties and leadership across the nation. Loretta decided to change her leadership role in hopes of unifying practice, research, and education as the founding dean of the School of Nursing at the University of Rochester. During her time at Rochester, Loretta held positions such as dean for the School of Nursing and Chief Nurse Officer for the hospital. Loretta’s leadership skills were tested in many ways during her new role as well as in her previous role as the founder of the nurse practitioner movement.

In 1985, several Missouri physicians charged two nurse practitioners with  illegal practice of medicine. During this economically challenging time for physicians, nurse practitioners were becoming more evident in healthcare, growing to a strong number of 20,000. The debate brought concerns of nurse practitioners practicing medicine independently without education and experience to do so. Loretta publicly debated with American Academy of Family Physicians president, Gerald Gehringer, on national television. She defended the two nurse practitioners called into question with the evidence and data that supported the successes of the nurse practitioner role. Loretta told the nation, “patients receive better care when nurses and physicians collaborate, that nurses are not a substitute for physicians and physicians are not a substitute for nurses, that medicine wants to claim all of the healthcare without recognizing the contribution of other disciplines, and the charges of illegally practicing medicine were financially motivated” (Houser & Player, 2004, p.16).

The judge favored the nurse practitioners, leading to the recognition and definition of another level of a healthcare provider, a nurse practitioner (Houser & Player, 2004). The definition of a nurse practitioner was now a professional one. However, with professional identity, Loretta reminds her students “we are professional nurses in an advanced practice role, that of nurse practitioner” (Berg, Hicks, & Roberts, 2017, p. 5).

After retiring from the University of Rochester School of Nursing deanship in 1986, Loretta was remembered for “embodying the values and principles of a leader who exemplifies outstanding service to humanity and  the profession of nursing” (Houser & Player, 2004, p. 21). In 1990, Loretta Ford was awarded the prestigious Gustav O. Lienhard Award presented annually by the National Academy of Medicine in honor of Mr. Lienhard, Chairman of the Robert Wood Johnson Foundation’s Board of Trustees. The award was established in 1986 and is given to “individuals for outstanding achievement in improving healthcare services in the United States” (National Academy of Medicine, 2018, p. 1) with a focus on “creative or pioneering efforts that have appreciably improved personal health services” (Houser & Player, 2004, p. 20). Loretta received the award for fostering the concept of the nurse practitioner. She never had work commitments but rather commitments to people, making her especially deserving of the Gustav O. Lienhard Award.

The National Academy of Medicine was not the only committee to recognize the contributions Loretta Ford made to the nursing profession. In 1995, the University of Rochester dedicated an endowed chair in Loretta’s name. Loretta insisted that the chair be called the William J. Ford and Loretta C. Ford Chair in honor of her husband’s contribution to her professional success (Houser & Player, 2004). Loretta often showed great selflessness giving credit to others in times of celebrating her honors and achievements, the success of the nurse practitioner movement being among her most proud.

Nurse Practitioner Today

Michael Carter, a nurse and early nurse practitioner pioneer strongly believed that ‘the blood of many paved the road for nurse practitioners of today” (Houser & Player, 2004, p. 16). Because of one courageous public health nurse in Denver, Colorado, there are more than 248,000 nurse practitioners licensed in the United States today. Of those 248,000 nurse practitioners, 97.8% have graduate degrees, 86.6% are certified in an area of primary care, and 77.8% of all nurse practitioners deliver primary care. Nurse practitioners hold prescriptive privileges, including controlled substances in all 50 states in which 95.8% of nurse practitioners prescribe medications daily. Malpractice rates remain low, only 1.9%, with the majority of nurse practitioners (60.8%) seeing three or more patients per hour (AANP, 2018).

Nurse practitioners are Advanced Practice Registered Nurses (APRNs) who are helping to minimize the effects of the national physician shortage by serving as primary care providers. To become a nurse practitioner today, a student must complete an accredited nursing program and obtain a Bachelor of Science in Nursing (BSN). Upon graduating with a nursing degree, successful completion of the National Council Licensure Examination (NCLEX) is needed for licensure (Nurse Journal, 2018). The NCLEX is a nationwide examination, developed by the National Council of State Boards of Nursing, Inc. (NCSBN), for the licensing of nurses in the United States and Canada (NCSBN, Inc., 2018). To advance to a nurse practitioner role, registered nurses must complete a Masters of Science in Nursing (MSN) or a Doctor of Nursing Practice program (DNP); obtain national certification in a patient population focus, and a state APRN licensure (Nurse Journal, 2018). As more students enter into healthcare, society is enriched with the great possibilities nursing has in the 21st century; the nursing profession will continue to prove the worth of its contributions to society through eradication of the unnecessary and promotion of the essential, just as Dr. Loretta Ford did.

References

1. American Association of Nurse Practitioners. (2018). About NPs and AANP. Retrieved October 7, 2018, from https://www.aanp.org/about
2. Berg, J. A., Hicks, R. W., & Roberts, M. E. (2017). Professional growth and development. Journal of the American Association of Nurse Practitioners,29(8), 429-433. doi:10.1002/2327-6924.12491
3. Casey, C. (2015, May). Celebrating the History of Nurse Practitioners. Retrieved October 7, 2018, from http://www.ucdenver.edu/academics/colleges/medicalschool/administration/alumni/CUMedToday/features/Pages/Nurse-Practioners-50th-Anniversary.aspx
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7. National Council of State Boards of Nursing, Inc. (2018). NCLEX & Other Exams. Retrieved October 7, 2018, from https://www.ncsbn.org/nclex.htm
8. Nurse Journal. (2018, September 06). Requirements to Become A Nurse Practitioner. Retrieved October 7, 2018, from https://nursejournal.org/nurse-practitioner/what-to-know-to-become-a-nurse-practitioner/
9. U.S. Department of Veterans Affairs. (n.d.). About GI Bill Benefits. Retrieved October 7, 2018, from https://www.va.gov/education/about-gi-bill-benefits/
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