This paper is an examination of the effects that managed care and newer health delivery systems have had on the growing profession of nurse practitioners. As nursing as a whole has become increasingly professionalized, the health care field has come to recognize that advanced specialization within nursing is of vital importance. Some hospitals are beginning to experiment with allowing nurse practitioners to prescribe medications and take on other responsibilities formerly restricted to physicians alone. At the same time, health management organizations (HMOs) and other forms of managed care are changing the ways in which health care is funded and delivered. The impact of fiscal and other kinds of accountability, streamlined delivery, and increased public awareness of health care costs, benefits, and challenges are all working to expand the role of nurse practitioners. Because these highly trained specialists can fill in many of the gaps in routine care, the profession of the nurse practitioner will continue to develop well into the 21st century.
The profession of nurse practitioner (NP) began to emerge during the 1960s. The title designates a nurse whose advanced training, usually a masters degree in nursing, has taken him or her beyond a general nursing background and into a specific area of specialization. According to the American Nurses' Association, the recognized nurse practitioner specializations as of 1986 were (in order of numbers of nurses certified in these areas of advanced practice) family, adult, obstetrics and gynecology, pediatric, gerontological, neonatal, and school (pp. 90-91). During that year, the ANA recorded 20,000 nurse practitioners certified nationwide, almost twice as many as were represented in the field nearly a decade earlier; less than half were employed in hospitals, while the majority were working in other settings within the community. Although the Bureau of Labor Statistics does not sepa...