NUR 513 Describe how the role of advanced registered nurse transformed over time

NUR 513 Describe how the role of advanced registered nurse transformed over time

NUR 513 Describe how the role of advanced registered nurse transformed over time

The role of advanced registered nurse has transformed over time primarily by shifting from a role to fill shortage in availability of physicians, to a role with structured education and professional definition. Historically, advanced practice nursing roles including nurse practitioners, nurse midwives and nurse anesthetists came into being as an attempt to improve care access in regions, or specialties, where access to physician care was limited (DeNisco & Barker, 2019). However, these roles, initially had variable educational requirements, and authority often based on region. This lack of role definition was paralleled by other advanced practice nursing roles that did not necessarily have direct clinical contact with patients such as nurse educators, nurse managers and nurse researchers. In 2004 the American Association of Colleges of Nursing (AACN) defined advanced practice nursing as:

“Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.”

While this definition continues to leave room for variable interpretation, this has served as a point of delineation regarding current and future educational requirements (DeNisco & Barker, 2019). Undoubtedly, the role of advanced registered nurse will continue to be refined by professional and regulatory bodies. The responsibilities of the advanced registered nurse will evolve to continue to meet population health needs, while maintaining strong roots in nursing practice and applications. 

American Association of Colleges of Nursing (AACN). (2004). AACN position statement on the practice doctorate in nursing. Retrieved from

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

The role of registered nursing has come a long way since the 19th century when Florence Nightingale revolutionized modern nursing on the front lines of the Crimean war and Lillian Wald’s nurses elevated nursing to provide primary medical care for inner city low income families. Initially education of nurses who provided advanced specialized care was in the form of apprenticeship training, but it is now a requirement to have obtained a master’s degree or higher to qualify as an official Advanced practice Nurse. Currently there are four degrees that meet  the criteria to qualify as an advanced practice nurse (APRN). They are Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist (DeNisco & Barker, 2019). As the demands and expectations of the healthcare system continue to increase, the number of roles qualifying to be an advanced practice nurse are bound to expand. Two roles that have potential to be included as APRNs are the roles of case managers, and nurse navigators. Along with the expansion of the field of APRNs in the near future, there will also be an increase in the expectations of their education, training and responsibilities. 

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One example of how the education and training of an Advanced Practice Nurse has changed over time is in the role of nurse practitioner(NP). From the time that the role of nurse practitioner was formally developed in 1965 by Loretta Ford, EdD and Henry Silver, MD, until the 1980s and 1990s, when it moved to the university setting as a master’s level program, most NP training programs were continuing education programs. (DeNisco & Barker, 2019). The goal of the American Association of Colleges of Nursing was to have all entry level Nurse Practitioners be educated at the Doctorate level by 2015, but this has proven “impossible to achieve” (DeNisco & Barker, 2019, p. 30).

Doctorate-level nursing education has become the bar for the role of nurse practitioner because NPs have been proven to be a cost effective way to provide high quality care, and the expectations of nurses in this increasingly complex healthcare system are becoming more demanding. The Institute of Medicine (IOM) has “identified the need for nurses to be placed at the forefront of healthcare” (DeNisco & Barker, 2019, p. 24). Nurse practitioners are currently working alongside other doctorally prepared clinicians such as physicians (MD), pharmacists (PharmD), and physical therapists (DPT) to name a few (DeNisco & Barker, 2019). Requiring nurse practitioners to be doctorally prepared would ideally elevate them to be equal with other doctorally prepared clinicians in their respective fields. 


DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.) Jones & Bartlett Learning.

The medical sector has always been and will continue to evolve in response to a seemingly limitless number of obstacles. As a result, the precise functions of medical professionals have evolved dramatically and will certainly continue to do so. It is believed that the position of the advanced practice nurse began in the 1960s (Weberg et al., 2018). Initially, the advanced practice nurse was responsible for providing care to patient populations with limited access to healthcare (DeNisco, 2019). In essence, advanced practice nurses were utilized as a less expensive alternative to conventional healthcare at the time.

In the 1960s, when the role of the advanced practice nurse was originally introduced, the process did not always involve university study; rather, the majority of these individuals became advanced registered nurses through continuing education, often lasting between three and twelve months. In the 1980s and 1990s, obtaining a master’s degree became a prerequisite for becoming an advanced registered nurse, as the role and scope of practice grew with time (DeNisco, 2019).

Currently, the phrase advanced practice is utilized. Clinical nurse specialists, nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and registered nurses are all examples of registered nurses. Beyond this, numerous new responsibilities have been established for registered nurses, the most of which require additional education. Nurse administrators, public health nurses, policymakers, clinical nurse leaders, and nurse educators are a few of these roles (DeNisco, 2019).

It is difficult to fully forecast how the position of the advanced practice nurse will evolve in the future, but it is certain that the responsibilities and scope of practice will continue to evolve to meet the ever-changing requirements of the global patient population. The endeavor to expand access to high-quality healthcare without rising costs will undoubtedly have a significant impact on the evolution of the advanced practice nurse. It is anticipated that numerous new nursing professions will be established to help manage care for an aging population, chronic diseases, gender-specific healthcare, etc (DeNisco, 2019). Although the future of advanced practice nursing is unknown, imagining how the role will change is really exciting.


DeNisco, S.M. (2019). Advanced nursing practice: knowledge essential to the profession. Jones & Bartlett Learning.

Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Jones & Bartlett Learning.