interesting historical article on np/pa education. nurse practitioners program vs. physician assistant program
the nurse practitioner profession developed after a failed attempt at duke university
to develop a master's degree program for nurses. the program was called the hanes project, and the tentative title for nurses who completed the coursework was "physician assistant." according to some of eugene stead’s duke university colleagues – the project would likely have evolved into an advanced nursing program, but the national league of nursing would not accredit the program. the biggest obstacle in developing programs that expanded nursing education into the physician’s realm – as the original physician assistant program and the nurse practitioner program did – was opposition by the most powerful and influential nursing groups, the american nurses association and the national league of nursing.
any educational ventures that required collaboration between nurses and doctors also required cooperation between organizations that represented and accredited the two professions. most joint educational ventures that combined nursing education and physician education were unsuccessful due to lack of cooperation between the entities representing the two professions. nurses battle doctors
the american medical association (ama) represented the interests of physicians and the national league of nursing and american nurse association represented the interests of nurses, but the physicians and nurses rarely coordinated their efforts and little progress was made in developing a program for advanced nursing practice.
natalie holt explains in “confusion’s masterpiece, the development of the physician’s assistant profession” that the history of the american nurse association and the american medical association was characterized by a “lack of communication followed by misunderstanding and contentiousness resulting from professional pride.”
although eugene stead collaborated with nurses (thelma ingles in particular) to develop a master’s degree program that was a new innovation in nursing, the american nurses association and the national league of nursing refused to support the program and discouraged participation of its members. history of miscommunication and contempt between nurse and physician
holt noted that “a history of contempt and miscommunication burdens cooperation between medicine and nursing...,” and she observed that the development of the physician assistant program was an example of the problem.
the problem is illustrated in the response of hildegard peplau to a nurse who favored participation of nurses in the master’s program at duke university. protested peplau, “you must consider…whether you want merely to be a 'doctor's assistant' which is to go backward about 50 years.”
holt writes that peplau recalled the historical relationship of nurses and doctors as one “based upon domination-submission,” and feared that nursing profession would be weakened by introducing educational elements from a physician’s program. ironically, despite the nln and ana’s vehement objection to the nurse to physician’s assistant program, the nurse practitioner program which closely resembled the pa program was later developed and accepted. nurse practitioners program
eugene stead and thelma ingles had created a program at duke university in 1958 very similar in scope to the nurse practitioners program created seven years later in colorado, but the national league of nursing refused to accredit the duke program. stead was forced to restructure the physician assistant (pa) project, but in the revised version of the program he expressed a preference for males and abandoned the curriculum developed for advanced practice nursing.
julie fairman, author of making room in the clinic
. nurse practitioners and the evolution of modern health care
, posits that stead preferred that men be considered as physician assistants in the revised version of the program due to “gendered perceptions,” but reginald carter writing “from concept to reality evolution of the physician assistant concept at duke university, 1964-65
” explains that “stead was frustrated with nursing leaders’ reluctance to broaden their professional scope of practice.”
eugene stead and thelma ingles had devoted tremendous time and effort to developing the physician assistant program utilizing nurses. it was called the hanes project, and the program only lacked accreditation. thus stead could not have based his preference for accepting male students on “gendered perceptions” because the students from the original class were almost exclusively female; these were the individuals whom stead originally intended to become assistants to the physicians. american nurse association fears loss of independence
according to carter, dr. eugene stead reverted to an exclusively male student body because he “was not willing to wait for them (american nurses association) to change their stance and turned instead to another source of trainees, ex-military corpsmen, who had been hired and trained to work in the hospital as clinical technicians.” because the national league of nursing (nln) refused to accredit the original master’s program, not because of gendered perceptions, stead had to disband and start over again.
while it is true - as fairman writes - that “henry silver and loretta ford successfully collaborated and developed the nurse practitioner certificate program at the university of colorado the same year stead developed his program for men,” this occurred seven years after stead had developed the original hanes project/physician assistant program
which the nln would not approve. tunnel vision of nursing leaders
also even after stead proclaimed a preference for males, females were accepted into the class, and they participated in the development of the program.
in fact, the website “eugene stead, thoughts, insights, and learning
” includes an excerpt from “a life chasing what i did not understand” and provides the following observation about the failed pa transition program for nurses:
“(t)he program would likely have evolved into the creation of the independent nurse practitioner long before such a training unit was developed at (colorado) university. but it wasn't to be, and stead relates the details of why the venture had to be canceled. it is a most instructive story of administrative tunnel vision.”
the “administrative tunnel vision” refers to the major nursing organizations' lack of vision. their resistance led to the establishment of the physician assistant program
instead of a new branch of nursing education. conflict and emotion
played an unfortunate role in shaping and slowing the growth of the nursing profession.