by Courtney Mitchell
When Cynthia (Cindy) Freund, PhD, MSN ’73, FNP, FAAN, helped a friend to the emergency department a few years ago, it was a nurse practitioner who was coordinating her friend’s care for the orthopedic surgical team.
And, when Freund broke her arm, it was an orthopedic nurse practitioner assessing her injury, setting her bone and creating a full plan for recuperation.
Inside, she couldn’t help but smile, she says.
“Nurse practitioners can be found in every area of the health care system. But in 1970, that was not the case. Most physicians and nurses opposed the notion of nurse practitioners, especially nursing faculty. Gaining acceptance was a struggle,” she says. “Of course, NPs today have no idea what it took to get to where we are today. I am proud to see how far we’ve come.”
Fifty years ago, in the fall of 1970, Freund was getting her master’s degree at the UNC School of Nursing when she became involved in the pilot program of North Carolina’s very first family nurse practitioner (FNP) program, only the third in the nation. The program was borne of the efforts of then-Dean Dr. Lucy Conant, and UNC’s medical and public health schools, to fill a critical health care gap in the state’s rural areas amid a shortage of primary care doctors. However, the nurses who supported NPs at the time saw these shortages as an opportunity to strengthen and advance nurses’ clinical role.
But, it was the seven enterprising nurses themselves – Evelyn Aabel, June Baise, Betty Compton, Ruth Efird, Sandra Hogan, Phoebe Hood (Collins) and Margaret Wilkman – who compiled their collective expertise and experiences into the first curriculum.
Together, on the fifth floor of Carrington Hall, they wrote the first protocols. As they reviewed cases and shared skills, as they entered clinical rotations, as they opened the clinics where they would treat patients and provide care for entire families, and for their own communities, they called a half-century of advanced-practice nursing into being.
“There was always an esprit de corps among those of us who were trying to move this forward…We got the funding and the freedom we needed to pilot this, but the commitment and passion to make a difference? That is something you can’t replace.”
They were activists, says Freund, who later served as Dean of the School from 1990-99 and became the first nurse to serve in the NC Institute of Medicine. Freund is now putting finishing touches on a book about the early years of the NP movement, titled “The Nurse Practitioner Movement in North Carolina: Its Beginnings in Story and Memoir.”
“There was always an esprit de corps among those of us who were trying to move this forward. There were people working within the legislature and medical and nursing boards and getting buy-in to see an advanced level of nursing be what it could really be. We got the funding and the freedom we needed to pilot this, but the commitment and passion to make a difference? That is something you can’t replace.”
By the time the first class graduated in 1971, the incoming FNP class at Carolina had doubled. Today, there are more than 6,600 NPs practicing in North Carolina, and more than 290,000 licensed around the country. From 2000 to 2017, the NP workforce in NC has grown 215.9% in non-rural counties and 187.3% in rural counties, and research consistently shows patients are satisfied with NP care.
“NPs are prepared as RNs, meaning they approach patients holistically. With their advanced skills, NPs assess and manage the physical, mental and psychosocial needs of their patients.”
In their most recent report on the quality of nurse practitioner practice, the American Association of Nurse Practitioners (AANP) stated that “since the NP role was created in 1965, more than 50 years of research has consistently demonstrated the excellent outcomes and high quality of care provided by NPs.”
“NPs bring a different element to patient care,” says Jennifer D’Auria, PhD, RN, CPNP, professor and Associate Dean of the MSN/DNP Division and Programs at the School. “Research findings show that NPs provide high quality, patient-centered care, comparable to the quality of care provided by physicians. NPs are prepared as RNs, meaning they approach patients holistically. With their advanced skills, NPs assess and manage the physical, mental and psychosocial needs of their patients.”
D’Auria came to Carolina’s nursing school in 1991 as a pediatric nurse practitioner from Colorado. UNC’s MSN program added more specialties beyond the FNP to fit the needs of the state’s growing population. By 1978, the FNP certificate program transitioned into the MSN program, and NP tracks in pediatric primary care and adult-gerontology primary care followed in 1993 and 1994 respectively. The School added a psychiatric-mental health track (PMHNP) in 2003.
“The pediatric NP movement grew out of the need for more developmental and educational support for parents and children, to teach about medications and how to live and cope with illness. We always knew there was a place for NPs who brought more depth and breadth to the care of different population areas such as children or the aging populations, and also for psychiatric mental health.”
In May 2021, the school will add their newest population area, the adult-gerontology acute care NP post-graduate certificate program.
“We have known for at least the last 10-to-15 years that our MSN program would need to include acute care NP preparation.,” says D’Auria. “Many primary care NPs are interested in gaining the knowledge and skills to transition into acute care and the management of unstable and/or complex patients.”
D’Auria says that the clinical experiences for NP students are essential for providing a high quality program. The quality of UNC’s program depends on the contributions of preceptors who serve as role models and provide learning experiences that help students apply theory to real-life patient situations.
“And when they are our graduates, that is just the icing on the cake – to have your own return as part of the teaching team,” she says.
The NP programs (both MSN and Doctor of Nursing Practice) at UNC keep moving forward, responding to the needs of the state and anticipating what is to come, says D’Auria. Strong administrative leadership that believes in the power of advanced practice nursing has historically empowered faculty and students to lead. D’Auria credits Dean Nena Peragallo Montano for helping to keep the momentum going for advancing NP education and innovation.
“Dean Peragallo Montano has been tremendous in her support for the growth of the NP programs and instrumental in propelling us forward.”
“Nurse practitioners are the future of primary care,” Dean Peragallo Montano explains. “Carolina Nursing has long been a leader in advanced nursing practice, and it couldn’t be more fitting that this year — the 50th anniversary of our family nurse practitioner program — we are announcing our new adult-gerontology acute care NP post-graduate certificate program.”