This proposal requests funding to conduct a three year historical investigation on nurses and prescriptive authority in the United States, 1900 to the present. Given (1) the disparity in the accessibility and availability of health care services in both rural and urban settings and (2) changes in the settings in which nurse practitioners (NPs) practice (now including acute and specialty care), it is time to rethink professional roles and responsibilities. In fact, it is imperative that we consider the possibility of expanding prescriptive authority for advanced practice nurses (APNs) in order to use health care personnel effectively. Today, there is considerable controversy among the professions of medicine, nursing and pharmacy and in the state legislatures concerning the issue of granting and/or expanding prescriptive authority for APNs. Nurses must address this issue for the public and the profession, and in some cases, provide testimony to state legislatures. To do so, they need the perspective of nursing history. The history of how nurses have managed patient care by dispensing and furnishing drugs, as well as the outcomes of how nurses have fared with the limited prescriptive authority, must be studied to determine if increasing their prescriptive privileges is indeed a viable solution to improving accessibility to health care while controlling costs. Unless this history is understood, proposed solutions may repeat the problems of the past or complicate matters further. Little is written on this history. In fact, the history is embedded in am assortment of legal cases and other primary documents in archives across the nation. These historical data have not been synthesized and described, nor have they been analyzed in historical context. A social history framework will be used to conduct this research. Primary sources, chosen as representative case studies, will include legal cases, the American Association of Nurse Anesthetists papers, the Frontier Nursing Service collection, archival materials from The Center for Nursing Historical Inquiry at the University of Virginia (UVA), the Lillian Wald Collection at Columbia University, and materials from the Federal Drug Administration (FDA). The findings will be analyzed within the history of health care in a changing socio-political, medical, economic, and legal environment. UVA, with its Center for Nursing Historical Inquiry is well positioned to support this project. Recommendations for future legislation will be made.
