November 13-19, 2022 is National Nurse Practitioner Week.
In the early 1960s, Loretta C. Ford, Ed.D., RN, PNP, NP-C, CRNP, FAAN, FAANP realized that family and child health care was suffering because there were not enough primary care physicians to treat them . So she acted. Ford worked with Henry K. Silver, MD, a pediatrician then working at the University of Colorado Medical Center, to develop and implement the first pediatric nursing program.
Ford, who is now 101, recently reflected on the launch of this program and what it has done for nursing over more than five decades.
This interview has been edited for clarity and length.
HealthyWomen: For those who might not know, what is the difference between a registered nurse and a registered nurse?
Loretta Ford: Nursing is our profession, but the role is that of nurse practitioner, and it’s an advanced role within the nursing profession. So if we didn’t have nursing as a base, we wouldn’t have nurses.
That’s what I hold on to – that nursing is our profession and we carry that with us in terms of care and professionalism and the coordination of care and compassion, all the things that are so fundamental to nurses. Health and wellness – this also distinguishes us from the hierarchy in healthcare and other professions.
HealthyWomen: In 1965, when you and Dr. Henry Silver at the University of Colorado started the Nurse Practitioner program, it was absolutely groundbreaking – especially for the time. As you’ve said many times, it was something the nurses wanted. Why do you think it was critical for nurses to have this certification and be able to do more in the healthcare field?
Loretta Ford: Well, we were faced with the health needs of the community, and for someone like me, moving from the ghettos of New Jersey to the mountains of Colorado with rural and vulnerable populations, it was obvious to me as a Lone Ranger the practitioners we needed advanced skills and an expanded knowledge base to be able to make the decisions. Because it happens in a hospital. Who do you think makes decisions at 3 a.m.?
You are there alone or with very few resources. So you’re making decisions anyway, and in that sense, that better prepares you to make clinical decisions and also to start changing the healthcare culture into health rather than disease and affliction. Medicine is very important, but at the time I started it was very hierarchical. The doctor was king and that was it. That was the end. But many people contribute to the health decisions that we can communicate to patients.
dr Eric Topol has a podcast and he talks about a paradigm shift in power from healthcare professionals to patients so they have more empowerment to make decisions about themselves. That’s part of what I think is happening, and of course technology is helping with that.
People walk around with bracelets that tell them what their blood pressure is and what their heart rate is and all kinds of things. So technology will drive some of that empowerment and make the patient feel like they know a lot more about them than we do. Nobody knows as much about you and your health and body as you do.
That’s hard for some people to believe, and each of us is so unique that it’s important information to know you have. We try to get people to learn more about themselves.
HealthyWomen: When you started the Nurse Practitioner program, did you encounter resistance, and if so, from whom and how did you overcome it?
Loretta Ford: My area was public health and it was community oriented.
We had an urgent need in the community for children’s hospitals designed for growth and development. Nurses could do that; I knew we could, but I wanted to demonstrate. I invited a small group of nurses to try it and see if it would work at child health conferences. It was really based on the needs of the community.
The opportunity arose because doctors were quite scared of this type of service and they weren’t that interested because it was about wellness and health. So I didn’t have as much resistance from doctors and pediatricians as I did from faculty – all the faculty that were tenured and who could see that this was going to make big changes because they hadn’t practiced in years. This group gave me a hard time and it was tough. But anyway, water under the bridge.
The students were so enthusiastic about the Nurse Practitioner role and the patients accepted it very early on. They just loved it.
They asked growth and development questions and took an interest in family and history in a way that others didn’t have.
Henry was interested in it because he was fond of children. He also recognized that nurses could make such decisions. So we had a very good relationship as a team. He and his chairman, an excellent pediatrician, supported us in such a way that we didn’t have any problems with medical resistance from an early age.
Healthy Women: Tell me about the first class of nurses who studied to become NPs.
Loretta Ford: It was a demonstration program. The students we accepted qualified for graduate school, but it wasn’t a major. It was intense learning, and then you had to have a clinical experience. Not only were they qualified for the training, but they were also experienced and knowledgeable. They were public health nurses and used to working in the community. In a way we had an invited group because they were so well prepared and their enthusiasm spread very quickly to other nurses and patients.
We had a social scientist who worked with us to assess all of these elements of patient safety, acceptability and experience. But it took a while for the school to accept it.
So in a way this bridged the gap until university nursing schools started to embrace the idea. When they did, we got a grant to train some teachers from different schools. The University of Rochester School of Nursing was one of the schools that ran the training. I had moved there. [Ford was recruited to serve as the founding dean.]
HealthyWomen: What are some of the biggest advances you’ve made in women’s health in your life?
Loretta Ford: Oh, I don’t know. It goes up and down. Frankly, women are finally getting into the political sphere and I think that will help the whole situation because when you look at the maternity health data it’s really shocking how ranked our country is. Eighty percent of them are vulnerable or destitute women and no one cares. It’s no wonder there are so many problems when seeing this type of data.
There are four categories that nursing programs recognize and seek to do things with regulation or legal authority: midwives, nurses, clinicians, and anesthesiologists.
If we cannot practice to the extent that we are willing, we are depriving many people and vulnerable groups of the care that is basic health care and other things that come with it – [responding to] poverty and social injustice. The WHO – the World Health Organization – was talking about community health in 1978 and all these things of equity and promoting things related to nurse participation. Social change is so slow, and cultural change is even slower. So it’s a little frustrating.
HealthyWomen: What do you think are some of your greatest achievements?
Loretta Ford: I’ll tell you what I’m most proud of. I am very proud of what the nurses do and do and how they are our friends when it comes to people’s health. Because I haven’t met nurses who aren’t just passionate about their role, and I think it helped nursing so we can help others. I’m prouder of that than anything else.
I get a lot of credit for what other people do, but basically they did it themselves and continue to do it. I’m really impressed by how enthusiastic they all are.
HealthyWomen: What would surprise people if they knew about you?
Loretta Ford: I’m just an ordinary person. I’m not a celebrity
HealthyWomen: Is there anything I haven’t asked you about, related to the field of grooming or women’s health, that you feel is important for our readers to know?
Loretta Ford: I think we’re finally getting recognition, but it’s taken the pandemic to bring it more to the fore.
HealthyWomen: In what way?
Loretta Ford: We’re here. It’s presence that makes a difference, and we’re there 24/7, and in that sense I think that… I’ll give them all A’s. Accessibility, acceptance, advocacy, accountability, affordability, friendliness. Well, how many more A’s does nursing need? How do you like that?
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