101chapter THREE
Refl ective Response 1
Ann L. O’Sullivan
My first response after reading this succinct history of an advanced practice registered
nurse’s (APRN’s) growth and development was to say, “It was the best of times, it
was the worst of times” (p. 5) from Charles Dickens’s (1859/ 2003) A Tale of Two Cities.
He was speaking of London and Paris during the time of the French Revolution, just
two decades after our own revolution, which certainly had influenced their French
Revolution. So, each APRN has had revolutionary behavior to be able to serve people
(and society) in the way they need and deserve. In order to have access to care by nurses
in any of the four APRN roles, certified registered nurse anesthetists (CRNAs), certified
nurse- midwives (CNMs), clinical nurse specialists (CNSs), and/ or certified nurse prac-
titioners (CNPs), scopes of practice often overlap with other health care professionals.
Another immediate response is to reflect on a picture from our Barbara Bates
Center for the study of the History of Nursing ,^1 of a young nurse carrying a velvet box,
holding a thermometer for the physician to use to take a patient’s temperature. Today,
skill and knowledge, as depicted in this picture, which had traditionally been part of
medicine, are part of everyday parenting, as we see a revolution in knowledge and
skill acquisition by all. Sadly, when reading each profession’s response to the American
Medical Association’s (AMA) 2005 Scope of Practice Data Series^2 that profiles 10 nonphy-
sician professions’/ professionals’ (including audiologists, dentists, naturopaths, nurse
anesthetists, nurse practitioners (NPs), optometrists, pharmacists, physical therapist,
podiatrists, and psychologists) education, accreditation, certification, and licensure,
I sense the revolution goes on into the 21st century. The AMA disputes that unwar-
ranted scope of practice (SOP) expansions by nonphysician professionals will threaten
the health and safety of patients (Devitt, 2006).
In fact, the Scope of Practice Partnership (SOPP) is a coalition of national medical
specialty organizations and state medical societies established by the AMA in 2005 to
study the qualifications, education, certification, and licensure of nonphysician provid-
ers. In addition to NPs, they are concerned about chiropractors, podiatrists, acupunctur-
ists, naturopathic physicians, and psychologists. They will oppose inappropriate SOP
expansion, or encroachments on physician practice. The AMA staffed the partnership
and had allocated $170,000 to pay staff and fund studies that examined the education,
accreditation, certification, and licensure of allied health professionals. The partner-
ship had 12 founding members: six state medical associations and six medical specialty
groups (Devitt, 2006).