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National alliance of nurse practitioners
Public Policy National Alliance of Nurse Practitioners of the nurse practitioners were within the legal scope of nursing practice in the state) .4 This author has analyzed eight other legal challenges of nurse practitioners that have occurred since 1980.~ Only one of these challenges was a malpractice case, which reached the appellate level and became a precedent case. It involved both a nurse practitioner and a physician who failed to diagnose a myocardial infarctionA 7 The other cases were all actions brought by board, of medicine, state medical societies, other groups of physicians, and/or attorney generals. The challenges were aimed at individual nurse practitioners or boards of nursing. In all instances, the goal was to stop nurse practitioners from functioning. As a consequence, in some states nurse practitioners reduced their scope of function; others were forced to rewrite laws or engage in costly defense activities. In general, the challenges created a climate of concern that motivated nurse practitioners to come together for the collective action that formed the Alliance. Probably the major early barrier to organizing came from those who feared the fragmenting effect of another organization. This group tried to get one of the existing organizations to be the voice for all nurse practitioners, and the most likely candidate for this umbrella function was the ANA. 8a The idea of a semiautonomous nurse practitioner group with its own Washington lobbyist under ANA sponsorship was discussed at length. However, the new federation model of the ANA actually shifts most of the power to the state organizations, and the state organizations did not seem ready to seriously consider such a freewheeling group within the ANA structure. In the end, the ANA Council of Primary Health Care Nurse Practitioners supported the Alliance. This does not, of course, answer the concerns of those who fear further fragmentation. As the specialty movement continues to develop in nursing, fragmentation is occurring. It may be that nursing is too large a group with too many diverse interests to avoid organizational fragmentation.
REPRESENTATIVESof nine nurse practitioner organizations met in Washington this past summer to establish a coalition that will be called The National Alliance of Nurse Practitioners. Goals of the Alliance are to facilitate communication between the nation's estimated 25,000 nurse practitioners; participate in the political process, particularly at the national level; market the concept of nurse practitioners to consumers; and furnish technical and legal assistance to individual nurse practitioners who face legal challenges. The organizational process that produced the Alliance started with two national meetings of nurse practitioners. The first meeting, held in 1984, was sponsored by the American Nurses' Association (ANA) and its affiliated Council of Primary Health Care Nurse Practitioners. The challenges facing nurse practitioners were explored, and it was decided that a stronger organizational structure was needed if the nurse practitioner movement were to survive, since existing nurse practitioner groups are fragmented. These groups range in size from the 2,500member National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) to organizations and state interest groups with fewer than 100 members. The ANA Council of Primary Care was at one time larger, but it now includes only approximately 900 members. The six major national nurse practitioner organizations called the second meeting, which was held in Chica~o in May 1985. Attended by 310 persons representing the spectrum of nurse practitioner groups plus some totally unaffiliated persons, the assembly decided to establish an organization made up of organizations. Unaffiliated persons could participate through state ANA interest groups, the freestanding state nurse practitioner groups, or a newly established membership organization called The American Academy of Nurse Practitioners. The major impetus for this flurry of organizational activity seems to be the escalating legal challenges that have been made against nurse practitioners since the publication of the Report of the Graduate Medical National Advisory Committee (the GMENAC Report), which predicted an impending oversupply of physicians,ta As a result, nurse practitioners, who had been viewed as friendly colleagues of physicians since the role developed in 1965, Were suddenly reconceptualized as a competitive threat. The most well-known of these challenges started in 1981 when two rural Missouri family planning nurse practitioners were charged with the unauthorized practice of medicine. The nurse practitioners lost their case at the county court level, and the physicians they worked with were threatened with the loss of their licenses to practice. In 1983, the Missouri Supreme Court overturned the lower court decision and ruled that the actions
BONNIE BULLOUGH, PHI), RN, FAAN
Dean, SdJool of Nursing State University of New York at Buffalo 1010 Stockton Kimball Tower 3435/vlain Street Buffalo, N Y 14214 References I. SummaryReport of the Graduate Medical Education National AdvisoryCommittee. HRA Publication 81-651-657. Washington, DC, Department of Health and Human Services, 1980, volumes I-7
Continued on page 385
324
From Our Columnhts, continued
6. Fein v Permaneme Medical Group (175 CA Rptr 177 CA 1981) 7. Cushing M: The legal side: g'hen medical standards apply to nurse practitioners. AmJ Nurs 82:1274, 1276. 1982 8. Harper DC, Billingsley MC: Organizing for power. Nurse Practitioner 8:24, 26-27, 30, 33, 1983 9. Readers support national nurse practitioner organization. Nurse Practitioner 8:39, 1983
The Nurse Executire, continued from page 322
ciplines than for the consultants to be working together as a team? Together we can provide new insights and facilitate a better working arrangement between nursing and social work services. This is a relatively new kind of consultation for us, but we believe it holds great promise. MARl'HA WILLIAMS,PHD
Dean, School of Social FP'or~ University of Texas at Austin S.W..B. 2.112 Austin, TX 78701-1499
Professional Practice, continued from page 323
agnostic reasoning has been proposed as a framework for examining the process of advanced practice qualitatively and quantitatively. Through this nexus of qualitative and quantitative research on process, the theory and practice used by advanced nurses will be distinguished.
Research. continued from page 325
descriptions of the 39 other organized research units and centers on the University of Iowa campus. The campus-wide definition of an organized research unit (ORU) is that it performs research and is generally intended to be complementary to the activities performed by academic departments. An ORU frequently crosses departmental boundaries and may include instruction and public service as well as activities in continuing education and cooperative extension.. To be considered an ORU at the University of Iowa, a unit must: 1. Receive budgetary support from internal and/or external sources independent of departmental allocation. 2. Occupy temporary or permanently assigned space with access to university-operated physical facilities and support services.,
DOREEN C. HARPER, PHD, RN
Department Chairperson, RN Program University of Maryland School of Nursing Baltimore County Campus Catonsville, AID 21228
3. Be directed by an administrator drawn from faculty or equivalent ranks. 4. Participate in the university's broad-gauged educational functions but not be degree granting. 5. Be more than a facilitator of research. Facilitators include units such as a computer center or nuclear reactor; a diagnostic, testing, and/or evaluation unit servicing internal or external clients; an institutional research and/or coordinating office; museums; and herbaria. If, however, a facilitator also sponsors research or is the recipient of a research contract or grant, such a unit would be considered an ORU.
References 1. Bloch D: Evaluation of nursing care in terms of process and outcomes. Nurs Res 24:256-63, 1975 2. Bednash G, Harper D: Provider process and documentation. Unpublished manuscript. 1985 3. SwansonJM, Chevitz WC: Why qualitative research in nursing? Nurs Outlook 30:241-45, 1982 4. Benner P: From Novice to Expert. Reading, MA, Addison-Wesley, 1984, pp 30-50
6. Located on the central campus or, if physically removed, accountable to the parent institution.
5. Kitzman H: The CNS and the nurse practitioner, in Hamric A, SprossJ (eds): The Clinical Nurse Specialist in Theory and Practice. New York, Grune & Stratton, 1983 6. Camevali DL, Mitchell PH, Woods NF, Tanner CS: Diagnostic Reasoning in Nursing. Philadelphia, Lippincott, I984 7. CreasiaJ: Personal communication, May 26, 1985
Using this definition, it would appear that in all its arrogance of good intentions, the office or center for nursing research in the college of nursing is yet another stage in our evolution and maturation as a discipline. As we gain in experience, knowledge, and intellectual stature, we can look forward to the time when such a unit will become part of nursing's research tradition, rooted in a specific time and place, as well as one of our "rites of passage" to be abandoned in quiet triumph when it no longer serves its purpose.
Public Polic3. continued from page 324
2. Whitney F: The GMENAC report: an opportunity for nursing, in Bullough V. Bullough B, Soukup MC (eds): Nursing Issues and Nursing Strategies for the Eighties. New York, Springer, 1983 3. Wolff M: Success in Missouri: court recognition of nurses' independent and collaborative roles. Pediatr Nurs 10:183-85, 1984 4. Sermchief et al. v Gonzales et al. and State of Missouri, No. 64692 5. Bullough B: Legislative update: legal restrictions as a barrier to nurse practitioner role development. Pediatr Nuts 10:439. 1983
GERALDENE FELTON, EDD, R N , FAAN
Professor and Dean College of Nursing University of Iowa IOIF Nursing Building Iowa City, IA 52242
385
REPRESENTATIVESof nine nurse practitioner organizations met in Washington this past summer to establish a coalition that will be called The National Alliance of Nurse Practitioners. Goals of the Alliance are to facilitate communication between the nation's estimated 25,000 nurse practitioners; participate in the political process, particularly at the national level; market the concept of nurse practitioners to consumers; and furnish technical and legal assistance to individual nurse practitioners who face legal challenges. The organizational process that produced the Alliance started with two national meetings of nurse practitioners. The first meeting, held in 1984, was sponsored by the American Nurses' Association (ANA) and its affiliated Council of Primary Health Care Nurse Practitioners. The challenges facing nurse practitioners were explored, and it was decided that a stronger organizational structure was needed if the nurse practitioner movement were to survive, since existing nurse practitioner groups are fragmented. These groups range in size from the 2,500member National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) to organizations and state interest groups with fewer than 100 members. The ANA Council of Primary Care was at one time larger, but it now includes only approximately 900 members. The six major national nurse practitioner organizations called the second meeting, which was held in Chica~o in May 1985. Attended by 310 persons representing the spectrum of nurse practitioner groups plus some totally unaffiliated persons, the assembly decided to establish an organization made up of organizations. Unaffiliated persons could participate through state ANA interest groups, the freestanding state nurse practitioner groups, or a newly established membership organization called The American Academy of Nurse Practitioners. The major impetus for this flurry of organizational activity seems to be the escalating legal challenges that have been made against nurse practitioners since the publication of the Report of the Graduate Medical National Advisory Committee (the GMENAC Report), which predicted an impending oversupply of physicians,ta As a result, nurse practitioners, who had been viewed as friendly colleagues of physicians since the role developed in 1965, Were suddenly reconceptualized as a competitive threat. The most well-known of these challenges started in 1981 when two rural Missouri family planning nurse practitioners were charged with the unauthorized practice of medicine. The nurse practitioners lost their case at the county court level, and the physicians they worked with were threatened with the loss of their licenses to practice. In 1983, the Missouri Supreme Court overturned the lower court decision and ruled that the actions
BONNIE BULLOUGH, PHI), RN, FAAN
Dean, SdJool of Nursing State University of New York at Buffalo 1010 Stockton Kimball Tower 3435/vlain Street Buffalo, N Y 14214 References I. SummaryReport of the Graduate Medical Education National AdvisoryCommittee. HRA Publication 81-651-657. Washington, DC, Department of Health and Human Services, 1980, volumes I-7
Continued on page 385
324
From Our Columnhts, continued
6. Fein v Permaneme Medical Group (175 CA Rptr 177 CA 1981) 7. Cushing M: The legal side: g'hen medical standards apply to nurse practitioners. AmJ Nurs 82:1274, 1276. 1982 8. Harper DC, Billingsley MC: Organizing for power. Nurse Practitioner 8:24, 26-27, 30, 33, 1983 9. Readers support national nurse practitioner organization. Nurse Practitioner 8:39, 1983
The Nurse Executire, continued from page 322
ciplines than for the consultants to be working together as a team? Together we can provide new insights and facilitate a better working arrangement between nursing and social work services. This is a relatively new kind of consultation for us, but we believe it holds great promise. MARl'HA WILLIAMS,PHD
Dean, School of Social FP'or~ University of Texas at Austin S.W..B. 2.112 Austin, TX 78701-1499
Professional Practice, continued from page 323
agnostic reasoning has been proposed as a framework for examining the process of advanced practice qualitatively and quantitatively. Through this nexus of qualitative and quantitative research on process, the theory and practice used by advanced nurses will be distinguished.
Research. continued from page 325
descriptions of the 39 other organized research units and centers on the University of Iowa campus. The campus-wide definition of an organized research unit (ORU) is that it performs research and is generally intended to be complementary to the activities performed by academic departments. An ORU frequently crosses departmental boundaries and may include instruction and public service as well as activities in continuing education and cooperative extension.. To be considered an ORU at the University of Iowa, a unit must: 1. Receive budgetary support from internal and/or external sources independent of departmental allocation. 2. Occupy temporary or permanently assigned space with access to university-operated physical facilities and support services.,
DOREEN C. HARPER, PHD, RN
Department Chairperson, RN Program University of Maryland School of Nursing Baltimore County Campus Catonsville, AID 21228
3. Be directed by an administrator drawn from faculty or equivalent ranks. 4. Participate in the university's broad-gauged educational functions but not be degree granting. 5. Be more than a facilitator of research. Facilitators include units such as a computer center or nuclear reactor; a diagnostic, testing, and/or evaluation unit servicing internal or external clients; an institutional research and/or coordinating office; museums; and herbaria. If, however, a facilitator also sponsors research or is the recipient of a research contract or grant, such a unit would be considered an ORU.
References 1. Bloch D: Evaluation of nursing care in terms of process and outcomes. Nurs Res 24:256-63, 1975 2. Bednash G, Harper D: Provider process and documentation. Unpublished manuscript. 1985 3. SwansonJM, Chevitz WC: Why qualitative research in nursing? Nurs Outlook 30:241-45, 1982 4. Benner P: From Novice to Expert. Reading, MA, Addison-Wesley, 1984, pp 30-50
6. Located on the central campus or, if physically removed, accountable to the parent institution.
5. Kitzman H: The CNS and the nurse practitioner, in Hamric A, SprossJ (eds): The Clinical Nurse Specialist in Theory and Practice. New York, Grune & Stratton, 1983 6. Camevali DL, Mitchell PH, Woods NF, Tanner CS: Diagnostic Reasoning in Nursing. Philadelphia, Lippincott, I984 7. CreasiaJ: Personal communication, May 26, 1985
Using this definition, it would appear that in all its arrogance of good intentions, the office or center for nursing research in the college of nursing is yet another stage in our evolution and maturation as a discipline. As we gain in experience, knowledge, and intellectual stature, we can look forward to the time when such a unit will become part of nursing's research tradition, rooted in a specific time and place, as well as one of our "rites of passage" to be abandoned in quiet triumph when it no longer serves its purpose.
Public Polic3. continued from page 324
2. Whitney F: The GMENAC report: an opportunity for nursing, in Bullough V. Bullough B, Soukup MC (eds): Nursing Issues and Nursing Strategies for the Eighties. New York, Springer, 1983 3. Wolff M: Success in Missouri: court recognition of nurses' independent and collaborative roles. Pediatr Nurs 10:183-85, 1984 4. Sermchief et al. v Gonzales et al. and State of Missouri, No. 64692 5. Bullough B: Legislative update: legal restrictions as a barrier to nurse practitioner role development. Pediatr Nuts 10:439. 1983
GERALDENE FELTON, EDD, R N , FAAN
Professor and Dean College of Nursing University of Iowa IOIF Nursing Building Iowa City, IA 52242
385