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Like a speeding car down a dusty county road on a hot summer afternoon sometimes we are moving so fast that we can barely see what lies ahead, and with a cloud of dust being created, we cannot see where we have been. Given some of the current national debate about the future of advanced practice nursing, I would like to let some dust settle and take a brief look back at where we have been with regard to independent nursing practice.


Throughout our history, nursing has enjoyed tremendous leadership exemplified by nurses with intelligence, courage, dedication, and determination. Among our leaders were members of the New York State Nurses Association who early on worked to secure licensure for nurses and thereby assure that those who practiced nursing were educated and competent to do so. In addition, the New York State Nurses Association led the way to removing the barriers created by the legal requirement for physician supervision of nursing practice. Through their efforts, nursing practice was articulated as a unique and independent contribution to the public good. Furthermore, the efforts of these and other leaders in the 1970s provided the impetus for the revision of nurse practice acts that, through various state statutory iterations, established nursing as an autonomous profession in all 50 states.


It was my pleasure to discover a historical study titled Legitimizing the Profession on Nursing: The Distinct Mission of the New York State Nurses Association1 by Dr Veronica M. Driscoll. Here are the opening 2 sentences of the Prologue:


On March 15, 1972 the Governor of New York State signed into law the Laverne-Pisani bill, a measure to amend the Education Law in relation to the practice of nursing. The intent of the amendment was twofold: (1) to distinguish nursing practice from medical practice, and (2) to remove the long-standing statutory requirement of physician supervision of nursing practice.1(pvii)


Lately, conversations involving advanced practice nursing have suggested that advanced practice nurses should be granted the legal authority to practice independently. For example, the National Council of State Boards of Nursing (NCSBN) 2006 vision paper2 stated that after successfully completing the NCSBN's proposed requirements, advanced practice nurses would be "fully licensed" and, therefore, "independent practitioners." In response, Ballard asked, "Are not all licensed registered nurses (RN) independent practitioners of nursing?" and further noted, "There is not a single nurse practice act in the nation that confers dependent status on RNs or requires medical supervision of nursing practice. This constant confusion of advanced practice nursing as the only form of independent nursing practice does a severe injustice to all RNs, who every day engage in independent practice of nursing to the satisfaction of their patients."3(p117)


Indeed, it may be an injustice to nurses who practice everyday, but it is particularly denigrating to those leaders who fought fear, ignorance, and prejudice to put in place our statutory autonomy. As advanced practice nurses, it is imperative that clinical nurse specialists be keenly aware of the independence granted by the registered nurse license. Clinical nurse specialists are entrusted with advancing that independent practice and role modeling for other nurses the responsibility and accountability that comes with independence. It is timely to wipe the dust off Driscoll's work and reread it or, for most of us, to read it for the first time. To that end, a reprint of "Chapter V: The Movement to Secure Statutory Definition of the Unique and Independent Practice of Nursing" follows this editorial, published with permission from the New York State Nurses Foundation. I hope you find it interesting and you will share your thoughts in a letter to the editor.



Thanks to Dr. Brenda Lyon for the "discovery" of Dr. Driscoll's work and for sharing her personal copy of the publication.




1. Driscoll VM. Legitimizing the Profession of Nursing: The Distinct Mission of the New York State Nurses Association. New York: New York State Nurses Foundation; 1976. [Context Link]


2. National Council of State Boards of Nursing. Vision Paper: The Future Regulation of Advanced Practice (Draft). Chicago: Author; 2006. [Context Link]


3. Ballard KA. National Council of State Boards of Nursing's paper on the regulation of advanced practice of nursing: is this really a vision? Policy Polit Nurs Pract. 2006;7:114-118. [Context Link]