Objective: In the mid 20th Century societal changes, demographics and economics supported nurses’exploration of practice boundaries in the United States. The Nurse Practitioner (NP) is a useful exemplar to examine the trend and also illuminate the highly complex and tenuous negotiations between larger professional organizations, emerging specialties, and individual practitioners.

Design and Methods: This study uses the National Association of Pediatric Nurse Associate/Practitioner (NAPNAP) founding in 1973 to illustrate the competing demands NPs faced from both nursing and medical organizations as they carved out their practice arena. Using primary sources from the American Academy of Pediatrics (AAP), NAPNAP and American Nurses’ Association (ANA), this study analyzes early debates surrounding clinical practice boundaries.

Findings: NAPNAP chose the AAP as its partner instead of ANA. The AAP presented opportunities more neatly enmeshed with the organizational needs and practice philosophies of the NPs. The ANA was distracted by financial problems and the entry into practice debate, and hampered by a structure powerless to address practice issues. The ANA disregarded NPs, although it later organized practice councils when it failed to control the independent groups, such as NAPNAP.

Conclusions: In the 1970s, the ANA struggled to identify the education needed for clinical expertise, and to develop a strategy incorporating rapidly emerging clinical roles into their organization. Inadequate resources and a failure to anticipate the opportunities and hazards accompanying the complex reality of clinical practice hindered the organization. While the ANA struggled, specialty groups formed independent organizations that fragmented nurses’ power for negotiating with larger medical and governmental organizations, but collectively created a more constructive practice agenda for individual practitioners.

Implications: Understanding the history of NPs provides a needed background for contemporary debates about the interface of collective power, knowledge and skills in clinical practice.

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Sigma Theta Tau International
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