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History of Nurse Practitioners

What is a Nurse Practitioner?

In general, NPs are nurses who hold a Master's degree in nursing. Most are credentialed by the American Nurses Credentialing Center in specialty areas such as adult, pediatric, family, and acute care. Different States (of the United States (US)) have different statutory definitions of an NP. NPs can perform history and physical examinations; diagnose disease; order, perform and interpret laboratory, radiographic and other diagnostic tests; and prescribe and dispense medications. In some States, NPs can practice independently. Historically, NPs have filled the gap in health care delivery to the underserved such as those living in rural areas, on reservations, and in the inner cities. More recently, NPs may be found in acute care settings, health maintenance organizations (HMOs), private physician practices, and the NIH.

History of Nurse Practitioners at the NIH

The Pediatric Branch of the National Cancer Institute was the first to hire NPs in the early 1980s. Their primary role was and continues to be management of pediatric oncology patients. They also help provide continuity of care in a setting that consists of rotating clinical Fellows.

Several years later, the acquired immune deficiency syndrome epidemic led to an expansion of the pediatric program. With this came the hiring of more NPs. These NPs work in collaboration with a senior attending and a full-time pediatrician to provide medical care for all the children enrolled in human immunodeficiency virus treatment protocols in both the clinic and inpatient setting.

In 1992, the NCI's Medicine Branch integrated NPs into its clinical fellowship program. With downsizing of the fellowship program, more NPs were hired. As with pediatric NPs, each one medically manages a population of patients, provides continuity of patient care, and assists in the education of clinical fellows. They also perform all necessary procedures such as lumbar punctures and bone marrow biopsies.

Over the next few years, NPs were established in a variety of settings including: gynecology, rheumatology, endocrinology, pulmonology, cardiology, psychiatry, nuclear medicine, and infectious disease. Each new NP brings to the role a unique variation in his or her practice.

Over the past decade, there has been a steady growth of skilled nurses with advanced degrees. In 1996, there were approximately seven nurse practitioners at the National Institutes of Health. Currently, there are more than 200 nurse practitioners working within the different NIH Institutes.

Written by Marianna L. Crane and Cathryn Lee

What is a Physician Associate?

Physician Associates are licensed clinicians who practice medicine in every specialty and setting. Trusted, rigorously educated and trained healthcare professionals, PAs are dedicated to expanding access to care and transforming health and wellness through patient-centered, team-based medical practice.

The PA profession was created to improve and expand healthcare. The concept was lauded early on and gained federal acceptance and backing as early as the 1970s as a creative solution to physician shortages. Many of the first PA students had served as US Navy Hospital corpsmen in the Vietnam War, where they gained extensive practical experience in medicine and surgery before entering PA programs

As the profession grew, more programs such as Med-ical Ex-tenders (MEDEX) opened, and civilians, women, college graduates, and other under-represented groups increasingly entered the field. There are approximately 150,000 PAs practicing in the United States.

 

Reference: American Academy of PAs

History of Physician Associates at the NIH

Physician assistant students began training at the NIH in 1972 and the NIH continues to be a center for PA student training to this day. In 1979, Gino Gianola was hired as the first PA at NIH working for the NCI Surgical Branch which was evaluating new chemotherapeutic agents for abdominal cancers. He was responsible for managing patients who were found to have abdominal Kaposi’s sarcoma at the start of the HIV/AIDS epidemic as well as precepted PA students.

Over the years, NIH continued to provide preceptorships for PAs and the number of PAs working at NIH has grown over the years. PAs now work in a variety of settings including: hematology/oncology, cardiology, pulmonology, infectious disease, and rehabilitation medicine.

Currently, there are more than 50 PAs working within the different NIH institutes.