How the role of advanced registered nurse transformed over time

NUR-513 Topic 1 DQ 1 how the role of advanced registered nurse transformed over time

how the role of advanced registered nurse transformed over time

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Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?

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.”

Re: Topic 1 DQ 1
Advanced practice registered nurse tittle, according to DeNisco & Barker (2016) is for masters prepared nurses who are responsible for providing clinical care to individuals. Historically, the role of an advanced practice nurse has commonly be associated to clinical roles and they include “clinical nurse specialist,

how the role of advanced registered nurse transformed over time
Assignment Describe how the role of advance registered nurse transformed over time

nurse practitioner, certified nurse-midwife, and certified registered nurse anesthetist” (DeNisco & Barker, 2016).




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In the 1970s, there was a severe shortage of primary care physicians in the United States. To address this, the federal government provided funding to establish more advanced registered nurses to fill positions for diagnosis and treatment in both urban and rural areas, preventing shortages (DeNisco & Barker, 2016). The most advanced practice nurses in the United States are Nurse Practitioners. Nurse practitioners, nurse anesthetists, clinical specialists, and midwives are all examples of advanced practice registered nurses whose roles have expanded over time (DeNisco & Barker, 2016).

Because of the shift in nursing scope and the emphasis on higher expectations and dependability in the twentieth and twenty-first centuries, advanced education is required of nurses to work at the forefront of providing direct and preventative care. Hiring advanced practice registered nurses is seen as a cost-effective way to address physician shortages and other issues confronting the health-care system (Barton, Bevan, & Mooney, 2012). how the role of the advanced registered nurse evolved over time

Also Read: NUR 513 Topic 1 DQ 2 Do you agree or disagree with how the Institute of Medicine (IOM) describes the advanced practice registered nurse role evolving?

How the role of advanced registered nurse transformed over time

Advanced nursing education has led in an increase in advanced nursing activities and responsibilities across the lifetime, including but not limited to primary, acute, and specialty health care, as well as evaluation, diagnosis, treatment, and pain management (Tiffin, 2015). “As a result, advanced practice nurses include nurse administrators, public health nurses, and policymakers, even if they do not provide direct care or have advanced practice licensing in the state in which they work” (DeNisco & Barker, 2016).

Intensive instruction Registered nursing is a career that focuses on the long-term care and monitoring of people under the care and supervision of nurses. Advanced nursing education improves or adjusts organizational standards of practice through the use of evidence-based practice.

Intensive instruction Registered nurses are trained to be ready for changes in the nursing sector, as well as to use newly acquired skills, information, and technology (DeNisco & Barker, 2016). Advanced registered nurses are expected to have a positive impact on the health-care system in the United States in the future.

References: how the role of advanced registered nurse transformed over time

Barton, T. D., Bevan, L., & Mooney, G. (2012, June 8). Advanced nursing 1: the development of advanced nursing roles. Retrieved from Nursing Times:

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential

knowledge for the profession. Third edition. Burlington, MA: Jones & Bartlett


Tiffin, C. (2015, January 15). The Changing Role of Todays Nurses. Retrieved from The Journal of advanced Practice Nursing:

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Re: Topic 1 DQ 1
Nursing has always been a noble profession that demands hard work, dedication, skills and expertise. As described in the book, nursing and advanced nursing has always focused on treating the ailments of patients. However, over the years, the role of Advanced Registered Nurse has evolved and will continue to change as more policies and procedures are being implemented towards the advancement and achievement of quality Nursing care. As a result, advanced nursing has come to focus more on preventative care and measures through the modernization of equipment and treatment as well as the advancement in education and research associated with the roles and functions of ARNs. The broad medical scope of Nursing practice continues to become more defined, more goal-oriented, more holistic and more collaborative. As a result, NPs have been given full autonomy to function independently and thrive in a more challenging and competitive health care system. The increasing demand for Advanced RN ’s in the health care setting is becoming more popular and will continue to grow in the 21st century. In conclusion, there have been many changes in the health care system that can create a great impact on health care delivery and focus of care. Promotion of health and preventative care approach to nursing practice is what I can expect in the 21st century. It’s like going back to what Florence Nightingale stated, “Nursing focuses on illness and suffering with the goals of easing suffering and promoting disease prevention (Nightingale, 1859/2009).”Denisco, S. M., & Barker, A. M. (2016). ADVANCED PRACTICE NURSING Essential Knowledge for the Profession (3rd ed.). Jones & Bartlett Learning.

Re: Topic 1 DQ 1

Throughout history, the patient population has influenced the evolution of advanced practice nursing professions (DeNisco & Barker, 2016). Nurse Practitioners (NPs), Certified Nurse Midwives (CNMs), Certified Nurse Anesthetists (CNAs), and Clinical Nurse Specialists (CNSs) are four advanced registered nurses with a Master’s degree or higher who work in the healthcare field (DeNisco & Barker, 2016). The Clinical Nurse Specialist function was established in the 1960s in response to the need for nurses who could provide more complex care for psychiatric patients, and the NLN and ANA have generally supported this broad profession (DeNisco & Barker, 2016). While the clinical nurse specialist role began as a requirement for mental health care, its numerous benefits have been identified, and these nurses are now educated in a variety of specialties (DeNisco & Barker, 2016).

Nurse Practitioners, like clinical nurse specialists, have been caring for patients since the 1960s, when the position was created in response to a pediatric physician shortage (DeNisco & Barker, 2016). Programs began as three- to twelve-month training courses, and by the 1990s, master’s degrees were required of all NPs. Nps are the most common type of APRN, and they are licensed to practice with prescriptive power in all 50 states and the District of Columbia.

Because of the high maternal and infant mortality rates in rural Kentucky, Certified Nurse Midwives were established (DeNisco & Barker, 2016). These early midwives were trained to provide family care, and patient outcomes in this area outperformed the rest of the country, demonstrating midwives’ inherent value. In today’s world, all midwives are educated in educational institutions, and those who complete their studies and obtain their license are granted privileges and prescriptive authority in all states (DeNisco & Barker, 2016).

The nurse anesthetist (CRNA) profession dates back to the American Civil War 150 years ago (DeNisco & Barker, 2016). This unusual APRN employment is most common in rural America, with CRNAs covering certain underserved areas entirely. CRNAs are licensed individuals who can care for themselves.

Healthcare is constantly changing and adapting. The 2010 Institute of Medicine (IOM) report was influential in the decision (IOM Future of Nursing Report, n.d.). The 2010 IOM Report emphasized the importance of nurses practicing to the full extent of their license, in response to a need identified as a result of the changing healthcare system (IOM Future of Nursing Report, n.d.). Health-care providers are in high demand as the baby boomer generation ages. A large number of nurses from that generation are retiring, resulting in a nursing shortage. The report also discusses how nurses and physicians can work together to drive change and meet the changing needs of the healthcare system (IOM Future of Nursing Report, n.d.).

Re: Topic 1 DQ 1
In the last century, the role of the advance practice nurse (APN) has evolved significantly. The function of the nurse practitioner (NP), for example, arose from a scarcity of primary care physicians who could treat children (DeNisco & Baker, 2016). The American Nurses Association, however, prohibited nurse practitioners from diagnosing and prescribing during this time (Keeling, 2015). This meant that NPs’ autonomy in their profession was severely curtailed. Given the widespread belief that NPs provide higher-quality, more cost-effective care than their physician counterparts, one may conclude that this was done to keep NPs inside the realm of nursing rather than straying into physician territory. NPs’ responsibilities and educational requirements have increased in recent years. The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) both advocate for nurses to “practice to the full extent of their education and training,” as well as for nurses to acquire better levels of education and training through improved educational systems (DeNisco & Baker, 2016). In all 50 states and the District of Columbia, over 192,000 NPs are presently licensed and practicing with some level of authority (DeNisco & Baker, 2016). As the country strives to enhance access to excellent health care while lowering costs, the APN’s role will continue to expand and emerge (DeNisco & Baker, 2016). As a result, the need for APNs and nurses in general will grow as the breadth of their responsibilities expands.

Advanced practice nursing used to refer to one of four jobs: certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP) (CNP). The American Association of Colleges of Nursing (AACN) defined advanced practice nursing in 2004 as “any form of nursing intervention that influences health care outcomes for individuals or populations, including direct patient care, management of care for individuals and populations, nursing and health care organization administration, and the development and implementation of health policy” (Denisco & Barker, 2016).Since the publication of this definition, many other nursing occupations, such as nurse administrators and public health nurses, have been classified as advanced practice nursing responsibilities. Advanced practice nursing was once only employed in clinical settings, but it is now being applied in non-clinical contexts as well. Numerous new nursing positions are expected to arise as the role of nurses expands, as well as the aim to improve access to and minimize the cost of health care. These occupations will require advanced degrees even if they are not in clinical areas, hence they should be classified as advanced practice nursing.

An advanced registered nurse encompasses many different roles, including nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. Primarily focusing on the role of a nurse practitioner (NP), NPs have become more common in the health care setting, with licensure, accreditation, and certification requirements evolving in response to the growing demand of the public (Penn Nursing, n.d). During the 20th century, a major factor that revolutionized the role of an NP was the lack of health services. The ability to specialize in medicine created a shortage of primary care physicians. This shortage affected the rural areas or those who lack access to care in inner cities (Keeling, 2015). Primary care physicians, who did not specialize, decided to recruit registered nurses with clinical expertise and collaborate with them to identify and treat the needs of children and families (Penn Nursing, n.d). In addition, the creation of Medicare and Medicaid allowed low-income children, women, the elderly, and people with disabilities to gain access to health care, thus increasing the need for primary care. This allowed nurses to have more of an expansion in their roles, working parallel with primary care physicians (Penn Nursing, n.d). With the demand for healthcare and more healthcare professionals, the first training program for nurse practitioners was developed in 1965. It was created by Loretta Ford, who partnered with a physician named Henry Silver (Penn Nursing, n.d). This program was used to bridge the gap between physicians and nurses, allowing them to work in a collaborative relationship, and not as a physician substitute.

Early in the 20th century, there was not much regulation as to what nurses did. The Henry Street Settlement (HSS), established in 1893, was a group of 12 nurses who made home visits, providing not only care, but other services including ice, sterilized milk, and meals. The HSS nurses also routinely dispensed physician-prescribed medicines. These medications were obtained from local pharmacists and carried in their nursing bags (Keeling, 2015). This practice was questioned in 1903 with the passage of the state nursing registration act, declaring “Nothing contained in this act shall be considered as conferring any authority to practice medicine or to undertake the treatment of disease” (Keeling, 2015). This act brought up numerous questions as to what nurses were allowed to do. For example, were the nurses able to administer certain medications that were prescribed by physicians? Because the nurses had been routinely doing this during their home visits. Over the years, the HSS grew exponentially. By 1926 these nurses made over 300,000 home visits a year, treating illnesses such as pneumonia, polio, measles, influenza, and tuberculosis (Keeling, 2015). “At the turn of the 20th century, the medical/nursing professional boundaries changed almost daily as new treatments became available and state/federal legislative acts regulated the professions of medicine, pharmacy, and nursing” (Keeling, 2015). Nurse practitioners in the 21st practiced in almost every health care setting, ranging from hospitals, clinics, urgent care, nursing homes, schools, and public health departments. NPs practice autonomously and in coordination with other healthcare physicians, providing healthcare services (Scope of practice for Nurse Practitioners, 2022). NPs are expected to practice with a code of ethics, using best evidence-based practice, and be nationally certified. Their scope of practice includes, “assessment, ordering, performing, supervising, and interpreting diagnostic and laboratory tests; making diagnoses, initiating and managing treatment including prescribing medication and non-pharmacologic treatment” (Scope of practice for Nurse Practitioners, 2022). Over the years, the scope and expectations of a nurse have grown exponentially.

As health care changes, the role of advanced registered nurses will also evolve. With the affordable care of 2010, many demands were placed on health care professionals. The act shifted the focus of healthcare from acute and specialty care to primary care, including care coordination and prevention/wellness (National Academy of Sciences, n.d). This is to help prevent chronic conditions. With the increase in the insured population, there will be more of a demand for nurse practitioners to help close the gap between physicians and physician assistants (National Academy of Sciences, n.d).  In the United States, physicians account for 287,000 of the primary care providers, while NPs account for 83,000, and physician assistants account for 23,000 (National Academy of Sciences, n.d). The education and roles of NPs continue to evolve, allowing nurses to enter the workplace qualified and willing to provide more services than before. NPs work with a team of providers, help to integrate a range of skills, coordinating care from nutrition services, physical therapy, and social work (National Academy of Sciences, n.d). Nurses have come a long way since Florence Nightingale almost 150 years ago and will continue to grow.


Keeling, A. W. (2015, May). Historical perspectives on an expanded role for Nursing. Retrieved August 4, 2022, from

National Academy of Sciences. (n.d.). Transforming practice – the future of Nursing. Retrieved August 4, 2022, from

Penn Nursing. (n.d.). Nurse practitioners: Shaping the future of Health Care. Nursing, History, and Health Care. Retrieved August 4, 2022, from

Scope of practice for Nurse Practitioners. American Association of Nurse Practitioners. (2022). Retrieved August 4, 2022, from

Transformation of the role of advanced registered nurses over time. 

According to DeNisco & Barker (2021), the advanced registered nurse role has evolved with time to assist the growing needs in the healthcare system. Such functions include Certified Registered Nurse Anesthetist, Clinical Nurse Specialist, Certified Nurse Midwife, and Nurse Practitioners. Since the 1960s, nurse practitioners have helped to supply the paucity of primary care physicians to underprivileged populations in urban and rural settings. Initially, the education process was less than one year; however, as the responsibilities expanded, so did the need for further education (Woodland, Foster, & Robertshaw,2022). Fast forward to the 1990s, and acquiring a master’s degree in nursing became the standard for practice. With the growing trend of increasing comorbidities, aging population, and the predicted physician shortage, the scope of nursing and transition from sole bedside care to more specialized nursing roles is evolving (DeNisco & Barker, 2021).

Shifts in scope and expectations in the 20th and 21st centuries. 

Health care has drastically expanded between the 20th and 21st centuries. Considering the national lifespan of the 21st century has lengthened in comparison to the early 1900s, more specialized services are available to meet individual health needs. For example, nursing in the 20th century was more generalized as one nurse was multifaceted, and primary nursing care and functional nursing care were practiced. However, as the 21st century advanced with complex healthcare needs, nursing has become more specialized. According to the International Council of Nurses (ICN), nursing responsibilities include a broad spectrum encompassing varied environments (Woodland, Foster, & Robertshaw,2022).

Ways in which the advanced registered nurse role changes 

Nursing is the most trusted profession in the United States (American Nurses Association, 2022). With trust comes obligations. The current healthcare system is complex and places more demands on healthcare providers, especially nurses. The complex healthcare system includes an aging population, a rise in chronic diseases, emerging infectious diseases, increasing health care costs, and an acute shortage of healthcare providers (DeNisco & Barker, 2021; Vos et al., 2020). The U.S. spends 18% of its GDP on healthcare costs, which is 3.35 trillion (WHO, 2022). The advanced registered nurses’ roles and responsibilities must continue to evolve to meet the challenges of our healthcare system. A unique and highly skilled workforce is necessary to meet these demands. One way to continue to grow is to advance the knowledge. According to the International Council of Nurses (ICN), advanced nurses hold a master’s degree and possess expert knowledge. The role also continues to evolve through expert coaching, research, specialized care, participation in evidence-based practice, nursing standards, the scope of practice, and professional leadership (Chau et al.,2022).


Chaum J. P., Lo, S.H., Lam, S.K., Saran, R., & Thompson, D. R. (2022). Critical elements in nursing graduates’ transition to advanced practice roles and their perceived impact on patient care: an exploratory, descriptive study of graduates and their managers’ perception. BMC Nursing, 21(1), 2-7.

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

Woodland, J., Foster, K., & Robertshaw, D. (2022). Nursing in the 21st century: results of a pilot survey on attitudes towards nurses and nursing. British Journal of Nursing (4). Vol 31.

Vos, T, Lim, S., Abbafati, Abbasi, & Abbasifard, et al., (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. (396). Pg. 204–22. 6736(20)30925-9

World Health Organization (WHO) (2022). than-half-a-billion-people-pushed-or-pushed-further-into-extreme-poverty-due-to-health-care- costs