December 28, 2024
Today, on the 104th anniversary of Loretta Ford’s birth, the National Association of Pediatric Nurse Practitioners (NAPNAP) honors and celebrates her as the innovative pioneer who co-founded the nurse practitioner (NP) role.
Dr. Ford collaborated with Dr. Henry K. Silver to launch the first NP program, focused on pediatrics, at the University of Colorado in 1965. The program responded to a projected shortage of primary care providers, especially in underserved areas, as the Social Security Act was enacted to provide health care coverage to low-income individuals and families. By 1972, the program had prepared 64 pediatric nurse practitioners (PNPs).
The Nurse Training Act of 1971 further supported the expansion of the PNP role by providing federal aid for nursing education and enabling expanded nursing opportunities, including NP programs. In the early 1970s, PNP Janet McCleary began a campaign to identify and communicate with other PNPs nationwide. After two initial investigational meetings and the first newsletter, The Pediatric Nurse Practitioner, Ms. McCleary convened a national meeting in Chicago on Oct. 21, 1973, which attracted approximately 400 PNPs who voted to establish a professional society to support their practice needs. Guided by Ms. McCleary’s leadership, volunteer leaders founded the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP), now known as the National Association of Pediatric Nurse Practitioners, as the first national professional society for nurse practitioners.
Working with PNP scholars, NAPNAP published its first journal, Pediatric Nursing, in 1974. That same year, the American Nurses Association elevated the PNP role by recognizing primary care nurse practitioners. In another important PNP milestone, the National Board of Pediatric Nurse Practitioners and Associates, later renamed the Pediatric Nursing Certification Board, established itself in 1975 as a separate entity to develop national PNP primary care certification. This board administered its first certification exam to 958 PNPs in 1977.
In 1980, NAPNAP presented its first national award in honor of Dr. Loretta C. Ford to PNP Katie Barton Frantz. As of today, the only national association exclusively supporting the professional needs of pediatric nurse practitioners has bestowed this distinguished honor upon 26 PNPs.
In 1982, NPs achieved a significant milestone with the Revised Scope of Practice Statement, which amended the physician-NP relationship from supervisory to collegial. Grassroots support from PNPs and pediatricians positively facilitated the revision, benefiting all NPs. To advocate for PNP professional needs at the federal level, NAPNAP hired its first lobbyists in 1983. Even as the NP profession continued to grow, NPs did not have provider status in the eyes of the government and thus were not eligible for reimbursement. NP leaders, including NAPNAP members, worked with Congress to pass the Omnibus Reconciliation Act of 1989, which created limited reimbursement for NPs and culminated with Medicaid direct reimbursement for PNPs by July 1990.
As PNPs and their fellow NPs gained increasing recognition as valuable healthcare providers in the 1980s, these leaders recognized the need to branch out beyond clinical and faculty duties. Member experts worked with NAPNAP to publish Risk Management for Pediatric Nurse Practitioners to guide PNPs across the country. NPs also started grassroots advocacy campaigns to win scope of practice, prescriptive authority and reimbursement state legislation.
As medical science continued to evolve in the latter part of the century, PNPs served as critical front-line providers in increasing immunization rates for newly available life-saving vaccines, caring for children with emerging threats such as HIV and advocating for key federal public programs like Vaccines for Children and the Children’s Health Insurance Program. The growing need for specialized advanced practice nurses in pediatric acute and critical care settings in the 1990s led to the development of the acute care PNP role. This development occurred as the scope of the PNP role expanded beyond primary care into more complex, hospital-based care.
From 2004-2008, NAPNAP’s PNP members played a critical role in the nursing consortium that researched and published the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education, a seminal document used to guide NP policy and advocacy to this day. To support NPs seeking to further their education and contributions to health care, educators developed the Doctor of Nursing Practice (DNP) degree.
As one of the founders of the PNP role, Dr. Ford attended many NAPNAP chapter and national events, including NAPNAP’s first PNP student reception in 2008 where she wore her famous red cape to show her superpowers as an NP leader. In 2015, NAPNAP celebrated the 50th anniversary of the PNP role at its national conference. The event underscored the incredible contributions PNPs have made to primary, acute and specialty care through clinical practice, education and research. PNPs continue to expand their purview in child health including addressing child trafficking and the current pediatric mental health crisis.
Today, Dr. Ford’s legacy continues through the more than 20,000 PNPs and 350,000 NPs in the U.S. and abroad. Nurse practitioners have full practice authority in 27 states, the District of Columbia and two territories. Advocates continue to work tirelessly to reduce barriers in other states so that patients have increased access to the high-quality, evidence-based care that NPs are educated, certified and licensed to provide.
NAPNAP celebrates Dr. Ford and recognizes her profound and lasting impact on health care and generations of pediatric nurse practitioners. Happy 104th birthday!
Daniel Crawford, DNP, ARNP, CPNP-PC, CNE, FAANP
NAPNAP President 2024 – 2025
