Advanced practice in maternal/child nursing: history, current status, and thoughts about the future

Advanced practice nursing has undergone dramatic growth and change in during the past quarter century. Specialization in maternal/child health started with hospital-developed postlicensure programs which evolved into formal master's level programs. The first nurse-practitioner program in pediatrics was begun in 1965 at the University of Colorado. The last 25 years has seen an increase in clinical specialization and in advanced practice roles within the specialties. The growth of credentials and types of certification available have provided opportunities for nurses, but have also created confusion for consumers and other health care professionals. Current challenges facing advanced practice nurses include issues related to legal authority for scope of practice, direct reimbursement for services, and prescriptive authority. The current health care climate provides challenges and opportunities for nurses in advanced practice.