499chapter TWENTY-TWO
Refl ective Response 1
Carol Savrin
Dr. Bloch begins her chapter by asking who “we” are. I think that at this juncture, that is
a reasonable question that needs to be addressed. She clearly states that the individual
with a Doctor of Nursing Practice (DNP) degree is just that, a person with a degree, and
that does not necessarily confer a new role. How will we all as advanced practice regis-
tered nurse’s (APRN) change with the increase in the number DNPs? The future lies in
all of us as we move forward.
If one looks at the history of the nurse practitioner (NP) role, one will see that the
role has been evolving and changing ever since it was envisioned by Loretta Ford in
the 1960s. The advanced practice roles developed out of a need that was identified and
nurses were the ones who stepped in to fill the need. In the case of the nurse anesthe-
tist, the job was being done by the surgeons, but since they had a greater interest in the
surgery than in the anesthesia, the job was not being done well (Diers, 1991). The mid-
wife role was initially brought here from England and filled a need in rural and under-
served areas where people could not afford a doctor to assist with delivery. With the
advent of the World War I, there were not enough English midwives who either came
to or stayed in the United States, and so the Frontier Nursing Service (FNS) under Mary
Breckinridge began to train nurse midwives to fill the need (FNS, 2000). In the second
reflective response in Chapter 3, Dr. Zuzelo writes that Dr. Hildegard Peplau is credited
with first coining of the term “clinical nurse specialist” in 1938 to describe “an advanced
practice nurse with expertise in nursing practice in the care of complex patients.” The
final advanced practice role to develop was the NP role, which began in the 1960s and
1970s in direct response to a shortage of primary care physicians in the underserved
areas, especially the rural areas of the country. Traditionally, the role is agreed to have
begun with the continuing education program developed by Loretta Ford and Henry
Silver in Colorado during the period from 1965 to 1966 (Ford, 1967).
All of the advanced practice roles have been fluid. They have changed over the
years, and have evolved as the society changed and as the need changed. The latest
development in the advanced practice nursing (APN) role is that it is evolving globally
(Savrin, 2009). The individual culture of the local entity clearly shapes the role, so that
the APN role in Botswana is different from the APN role in Singapore, which is differ-
ent from the APN role in South Korea. Although students might find it comforting to
be told by current educators exactly what the role will be in the future, it is not how
nursing has evolved, nor is it how the APN role has evolved. There was a point in time