Purpose: The purpose of this paper is to examine the history of prescriptive authority in nursing in the United States during the 20th century. It reviews the work nurses have done with regard to medications, the reaction of the medical profession, and the legal issues involved.

Methods: The methods of social history were used. Primary sources included the Frontier Nursing Service Collection, University of Kentucky; the Appalachian photographic collection, the University of Louisville, Kentucky; papers of the Lillian Wald Collection, New York Public Library, legal cases and federal drug laws among others. Secondary sources were also used. All sources were subject to external and internal criticism.

Findings: In the 1910s and 1920s, Visiting Nurses in New York City funished medications to the urban poor. In the 1930s-50s, nurses in the Frontier Nursing Service dispensed and furnished medications to patients in rural Appalachia. In the 1970s to 1980s, nurse practitioners obtained legal authority to prescribe. Since then, nurses have been furnishing or prescribing medications according to their education preparation and state laws, sometimes with minimal resistance and at other times challenged for "practicing medicine without a license." What is noteworthy is that nurses have been permitted to furnish or prescribe when the patients are poor or live in remote areas - places where nurses pose no economic threat to physicians.

Implications: This examination of the historical evidence of nursing's role in dispensing, furnishing and prescribing drugs provides insight today as we try to establish a coherent vision to enhance the nation's health.

Funded: G13, National Library of Medicine, NIH

Back to Nursing History
Back to 15th International Nursing Research Congress
Sigma Theta Tau International
July 22-24, 2004