Over the past decade, there has been a steady growth of skilled nurses with advanced degrees. In 1996, there were approximately seven nurse practitioners (NPs) at the National Institutes of Health (NIH). Currently, there are more than 200 nurse practitioners working within the different NIH Institutes.
In general, NPs are nurses who hold a Master's degree in nursing. Most are credentialed by the American Nurses Credentialing Center in specialty areas such as adult, pediatric, family, and acute care. Different States (of the United States (US)) have different statutory definitions of an NP. NPs can perform history and physical examinations; diagnose disease; order, perform and interpret laboratory, radiographic and other diagnostic tests; and prescribe and dispense medications. In some States, NPs can practice independently. Historically, NPs have filled the gap in health care delivery to the underserved such as those living in rural areas, on reservations, and in the inner cities. More recently, NPs may be found in acute care settings, health maintenance organizations (HMOs), private physician practices, and the NIH.
The Pediatric Branch of the National Cancer Institute (NCI) was the first to hire NPs in the early 1980s. Their primary role was and continues to be management of pediatric oncology patients. They also help provide continuity of care in a setting that consists of rotating clinical Fellows.
Several years later, the acquired immune deficiency syndrome (AIDS) epidemic led to an expansion of the pediatric program. With this came the hiring of more NPs. These NPs work in collaboration with a senior attending and a full-time pediatrician to provide medical care for all the children enrolled in human immunodeficiency virus (HIV) treatment protocols in both the clinic and inpatient setting.
In 1992, the NCI's Medicine Branch integrated NPs into its clinical fellowship program. With downsizing of the fellowship program, more NPs were hired. As with pediatric NPs, each one medically manages a population of patients, provides continuity of patient care, and assists in the education of clinical fellows. They also perform all necessary procedures such as lumbar punctures and bone marrow biopsies.
Over the next few years, NPs were established in a variety of settings including: gynecology, rheumatology, endocrinology, pulmonology, cardiology, psychiatry, nuclear medicine, and infectious disease. Each new NP brings to the role a unique variation in his or her practice.
written by Marianna L. Crane and Cathryn Lee