Congratulations on 50 years of excellence: The Nurse Practitioner

Today, as we celebrate this golden anniversary, we not only honor the journal's profound impact on the nurse practitioner (NP) profession but also reflect on the journey that brought us here. Serving as editor-in-chief from January 1984 to April 2004, I acknowledge the collective contributions of previous editors, the editorial board, consultants, advisory boards, publishers, authors, and contributors. Fifty years ago, The Nurse Practitioner journal (NPJ) was launched from a basement apartment by Dr. Cynthia JoAnn Leitch, my master's thesis advisor at the University of Washington School of Nursing. I worked very closely with her until the January 1984 issue, when she honored me with a promotion to the editor-in-chief position. Newly at the helm, and with strong support from an early publisher—Geoff Vernon—the NPJ and I pledged to continue our role in tying the growing NP profession together by covering timely clinical, political, social, and economic issues affecting the movement. Remember, 1984 was before personal computers, the internet, and any wide acknowledgment of the extreme value of NPs. Our NP readers contacted me by landline and/or mail to my extra-large home mailbox, sending tons of correspondence and article submissions. I hand typed all correspondence back to readers, authors, and letters to the editor. During my 20-year tenure as editor-in-chief, I witnessed firsthand the evolution of NPs facilitated by NPJ. It provided a space to exchange clinical knowledge and clinical insights, share cutting-edge research, discuss NP role challenges, promote NP organization plans, help prevent professional loneliness and isolation, and advocate for full legislative authority to practice. Here are a few of NPJ's historical highlights: In the October 1984 issue, we asked readers for legislative updates and NP cost-effectiveness and quality of care studies. Information from readers assisted the Office of Technology Assessment to begin working on ways to improve NP practice and reimbursement. April 1985 surveys highlighted NP prescribing practices, revealing their influence on numerous prescriptions. My November 1986 editorial summarized another survey, showing NPs used various methods to prescribe medications, including using personal authority, using presigned pads, seeking physician signatures, calling pharmacies, using joint signatures, and/or distributing stocked medications. A January 1986 article compared physicians' attitudes in health maintenance organizations toward NPs, finding that physicians believed NPs were more likely to improve care quality and less likely to increase malpractice risk than physician assistants (PAs). My NP Profile Columns (May 1986, September 1986, January 1987, February 1988) focused on a variety of maverick NPs who demonstrated creativity, perseverance, and a willingness to accept the responsibility of increased autonomy in each of their different roles. In my June 1986 editorial, I discussed the NP malpractice insurance crisis resulting from changes in ANA Liability Coverage. I urged NPs to unite through organizations like the National Alliance of NPs to secure affordable malpractice insurance, based on their excellent claims history. In my February 1987 editorial, “The Power of the Name,” I argued that renaming NPs to “primary care specialists” was “marketing suicide.” Despite being 14 years into my NP career, this topic was still being debated. I urged NPs to focus on pressing issues like the AMA's stance against NPs. A follow-up editorial in May 1987, co-written with Janet Stallmeyer, MSN, RN, confirmed that the proposed title change was overwhelmingly opposed, thanks to reader action. In my June 1987 editorial, “The Liability Crisis: Address it Now or Pay Later,” I argued that the NP insurance crisis stems from various societal and business pressures, not because NPs are prone to malpractice claims. I stressed the importance of NPs understanding their own malpractice coverage and the specifics of their employers' policies. Additionally, I underscored the need for NPs to stay informed and active within NP organizations to address this issue. In my December 1987 editorial, I presented actuarial data on NPs based on a readership survey. Over the previous 11 years, 0.1% of NPs had been sued in any given year, which is lower than the rate for physicians. The survey feedback indicated that these data helped NP organizations and insurance carriers collaborate to secure affordable insurance for all NPs, regardless of their employment status or specialty. The January 1989 issue presented the first of our famous annual article: “Annual Update of How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice,” which covered legal authority, reimbursement status, and prescriptive authority. Each year I used questionnaires and phone calls to collect updates from each state's board of nursing, state NP organizations, and national NP leaders. Still to this day, I cannot thank enough all those devoted RNs and NPs who helped with this annual update. The annual survey was widely utilized by NP organizations, boards of nursing, and legislators across the nation, aiding in the replication of effective legislation. Feedback over the years indicated that the annual survey was used by numerous readers, legislators, and policymakers to address restrictions on advanced nursing practice. In addition to the Annual Update, I authored editorials to motivate NP action toward enhanced professional autonomy. In January 1993, I highlighted that physician-based economic monopolies might disregard humanitarian concerns to secure their interests. Exposing unethical limitations often leads to change. In January 1994, I criticized physician power abuse, noting no evidence against advanced practice nursing quality. Legislative reforms are needed for advanced practice nurses (APNs) to realize their potential. Misconceptions about physicians' knowledge and leadership in healthcare were challenged, advocating for a consumer-led shift with APNs facilitating client empowerment. In the seventh Annual Update on APNs, I wrote another essay about the need for APNs to play political hardball and be astute about business needs. I urged NPs to continue to be politically active to break down more barriers. In my January 1996 update, I alerted APNs to significant changes in healthcare due to corporate takeovers, managed care groups, and provider panels controlled by administrators. I urged NPs to advocate for legislation supporting NP autonomy and to help administrators appreciate the value of APNs for a healthy bottom line. My numerous subsequent editorials in the following years continued to support and advocate NP assertiveness and pride. The editorials recognized that NPs achieve high patient satisfaction scores and provide cost-effective, safe, and effective care, which is both comparable to and distinct from physician care. Here's to 50 years of NPJ, a testament to the power of dedication and the enduring spirit of a profession that has changed the world. May the next half-century be as transformative and inspiring as the first. History shows that the wisdom, cooperation, and energy generated by earlier struggles was a blessing in disguise for NPs because it helped us realize our collective power. Look how influential and impactful NPs are today. I am proud of NPJ for its role in helping NPs reach where they are today.