The pediatric nurse practitioner: origins and challenges

During the past decade, a new health professional has evolved--the pediatric nurse practitioner (PNP). Responding to warnings of a shortage of primary care physicians, the American Academy of Pediatrics helped encourage programs to train PNPs who would provide well-child care, working under a physician's supervision. Simultaneously, in response to changing attitudes by and toward nurses, the American Nurses' Association expressed support for the expanded role of nurses in direct patient care functions--an expansion that would supplement other new academic programs in advancing the status of nursing as an interdependent, rather than subsidiary, health profession. Although mutually aiming at improvements in health care, both professions thus acted with different motivations and goals that have produced ongoing conflicts. These conflicts have been intensified by the absence of long-range planning in federal programs that have supported training for nurse practitioners. This paper summarizes the history of the PNP movement and the unresolved problems created by this new health professional.