1. Curry, Kim PhD, FNP-C, FAANP
  2. Editor in Chief

Article Content

You will find that all editorials published in JAANP address the topic of writing for publication in some way. Many of our editorials are devoted exclusively to this topic. Others address broader concepts that may influence choice of topics, approaches to writing, and other musings that may be of general assistance to authors and to those who enjoy critically reading the professional literature.


This editorial addresses the seemingly very broad topic of what it is that nurse practitioners are and are not. It is apparent that we need to have an ongoing dialog about this topic in our schools, workplaces, and professional meetings. Although the topic may seem to be extremely basic, I assure you that it is not. In fact, it is critical to your professional writing, yet frequently mischaracterized and misunderstood, even among nurse practitioners.


From time to time, the journal receives manuscripts that describe the nurse practitioner (NP) role as one that is justified by a "physician shortage." Explaining the work of NPs as physician gap fillers is disturbing for a number of reasons that I will briefly point out, but let me start by saying that I have found that this problem is in no way limited to student papers or novice writers. A colleague recently sent me a link to a scientific study published within the past year that was written by a team of senior nurse scientists, two of whom are nurse practitioners. A lengthy section of the introduction addresses a shortage of physicians. The authors then go on to point out, by way of justifying the study they present, that nurse practitioners can assist in relieving the shortage of physicians. We have got to stop doing this to ourselves.


We are not gap fillers. We are nurse practitioners, with the emphasis on "nurse." We were never designed to be substitutes for a profession with a different philosophical approach to health care, one that focuses on locating an existing problem and fixing it. That approach has resulted in an upside-down triangle of care in our country that downplays prevention and has resulted in an unaffordable, tertiary care-based system. It is severely lacking in continuity and efficiency, provides the highest rewards to proceduralists, and largely ignores those who can keep people well. Who would want to be a gap filler in that system?


You will see a mention of the original Silver, Ford, and Stearly paper from 1967 later in this editorial. The article, which provided the first description of the conception and development of a nurse practitioner program, never once mentions NPs as stand-ins when allopaths or osteopaths are not available. In fact, 53 years ago, the authors were careful to point out that the intent of the role was to meet increasing needs for access to care. They were training providers who could meet many health care needs. Ford and Silver never implied that there was a preferred provider type with all others being secondary. Instead, they took care to say that a team approach was best, employing various types of clinicians at various times, depending on the patient's needs. And yet, some very strange assumptions about the NP role continue.


Assumption 1

A "best" type of provider exists. There is a long-standing mystique around the topic of medical education that seems to persist in this country. It casts graduates of MD and DO clinical doctoral programs as the gold standard for all types of patient care, and it continues despite substantial evidence that it is untrue. One example of the arguments made for the universal superiority of MD and DO programs has to do with hours of training. However, an ideal length of training has never been established for any particular type of patient care, and we all know the extreme range of care needs that exist. Today few would question the wisdom of providing high-quality, efficient classroom and clinical education that is less financially burdensome to both society and the student. In fact, many academic physicians are now challenging the traditional medical education model. There are well over 100 allopathic programs in the United States that are three years in length, not four, with many more being considered.


Assumption 2

The work of a physician is established and unchanging. I would bet that my physician colleagues would agree with NPs (and physician assistants) that the lines have been blurring since the inception of the different types of provider education that now exist. Still, there are a number of areas of advanced training, often procedurally oriented, to which only licensed allopaths and osteopaths are deemed eligible for admission. So be it. The point is that if the work needed is "physician's work" but you are recommending NPs as a solution, then you are wrong by definition. If we as NPs do the work, then it cannot be physician work, plain and simple.


Assumption 3

There is unquestionably a physician shortage. There may be shortages of MDs and/or DOs, in some areas, at some times, for some specialties. But here are the much more important shortages we should be referencing: patient access to care and nurses with the expertise and freedom of practice to keep the population healthy. Hospitalization and specialist intervention, with their exceedingly high inherent risks, should only be needed on rare occasions. The vast majority of the time primary care, prevention and patient education can allow everyone to live long, healthy lives. This scenario will only be manifested if we learn to speak up for ourselves and our patients, and that includes characterizing ourselves accurately.


Although it is disappointing to receive papers with introductory statements documenting the need for nurse practitioners by citing a physician shortage, a better understanding of some of the above assumptions that are pervasive in our culture can overcome the problem. Authors should avoid submitting manuscripts that explain our role as that of gap fillers. These manuscripts are being returned for correction before ever moving to the peer review process because of their demonstrated errors with accuracy, and basic knowledge of our professional role.


Do not buy in to old assumptions that have caused the current problems in our health care system. You are doing your job, not someone else's job. You are greatly enhancing access to care. You are giving patients a choice of providers. That is all there is to say, and that is all you need to explain.


The year of the nurse and midwife

Each month this year, we are featuring historic nurses and their accomplishments to celebrate our year as designated by the World Health Organization. In May, there is much to celebrate. A few highlights include:


May 7th: the birthday of Mary Eliza Mahoney. Born to freed slaves who had moved to Boston, Massachusetts from North Carolina, she became the first African American licensed nurse in the United States. Following a long and successful career as a private duty nurse, undertaken to avoid discrimination in public hospitals, she retired but maintained her activism for women's rights. After the 19th Amendment was ratified in August 1920, Mahoney was among the first women who registered to vote in Boston (Spring, 2017).


May 12th: the birthday of Florence Nightingale and why our modern-day Nurses Week falls in May of each year.


May of 1967 is the publication date of Henry Silver, Loretta Ford, and Susan Stearly's seminal article, "A program to increase health care for children: The pediatric nurse practitioner program" (Silver et al., 1967). The article described the conception and implementation of the first NP program in the United States and kickstarted the movement that has led to where we are today.




Silver H., Ford L., Stearly S. (1967). A program to increase healthcare for children: The pediatric nurse practitioner program. Pediatrics, 39, 756-760.


Spring K. (2017). Mary Eliza Mahoney. National Women's History Museum.