November 13 - 19, 2022 is National Nurse Practitioner Week.
In the early 1960s, Loretta C. Ford, Ed.D., R.N., PNP, NP-C, CRNP, FAAN, FAANP, realized that healthcare for families and children was suffering because there weren’t enough primary care doctors to treat them. So she took action. Ford partnered with Henry K. Silver, M.D., a pediatrician then working at the University of Colorado Medical Center, to create and then implement the first pediatric nurse practitioner program.
Now 101 years young, Ford recently reflected on starting that 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 may not know, what is the difference between a nurse and a nurse practitioner?
Loretta Ford: Nursing is our profession, but the role is the nurse practitioner, and it’s an advanced role within the profession of nursing. So, if we didn’t have nursing as our base, we would not have nurse practitioners.
I’m very adamant about that — that nursing is our profession, and we carry that with us in terms of caring and professionalism, as well as coordination of care and compassion, all the things that are so basic to nursing care people. Health and wellness — that differentiates us, too, from the hierarchy in healthcare and other professions.
HealthyWomen: When you started the program for nurse practitioners in 1965, along with Dr. Henry Silver at the University of Colorado, it was absolutely groundbreaking — especially for that time. As you’ve said many times, it was something that nurses wanted. Why did you think it was crucial for nurses to have this certification and be able to do more within the healthcare field?
Loretta Ford: Well, we were faced with community health needs, and for someone like me, who went from the ghettos of New Jersey to the mountains of Colorado, with rural and vulnerable populations, it was obvious to me that, as the Lone Ranger practitioner, we needed advanced skills and an expanded knowledge base to make the decisions. Because it happens in a hospital. Who do they think makes decisions at 3 a.m.?
You’re there by yourself or with very few resources. So you’re making decisions anyway, and in that sense, this prepares you better to make clinical decisions and also to begin to change the culture of health to health, rather than to disease and illness. Medicine is very important, but at the time that I started, it was very hierarchical. The physician was king and that was it. That was the end of it. But a lot of people make contributions to the healthcare decisions that we can convey to patients.
Dr. Eric Topol has a podcast, and he talks about a paradigm shift of power from the health professionals to the patients so that they are more empowered to make the decisions themselves about it. That’s part of what I think is occurring, and technology, of course, is helping that.
People are walking around with wristbands telling them what their blood pressure is and what their heartbeat is, and all sorts of things. So, technology will drive some of that empowerment and make the patient feel as though they know a lot more than we do about them. Nobody knows as much about you and your health and your body as you do.
That’s hard for some people to believe, and each of us is so unique that it’s important information that you know you have. We try to engage people in learning about themselves more.
HealthyWomen: When you started the program for nurse practitioners, did you come up against resistance, and if so, who was it from, and how did you overcome it?
Loretta Ford: My area was public health nursing, and it was community-oriented.
We had a dire need in the community for child health clinic care, which was oriented toward growth and development. Nurses could do that; I knew we could, but I wanted to demonstrate it. I took in a small group of nurses to try it out and see whether this would work in child health conferences. It was really on the basis of community need.
The opportunity came along because physicians were pretty scared of that kind of service, and they weren’t as interested because it was wellness and health. So, I didn’t have as much resistance from physicians and pediatricians as I did from faculty — all the faculty who were tenured who could see that this was going to make big changes, because they hadn’t been in practice for years. That group gave me a hard time, and that was tough. But anyway, water under the bridge.
Students were so enthusiastic about the nurse practitioner role, and the patients accepted it very early. They just loved it.
They asked growth and development questions and were interested in the family and the history in a way that others weren’t.
Henry was interested in it because he was fond of kids. He also recognized that nurses could make these kinds of decisions. So, we had a very good relationship as a team. He and his chairman, who was a superb pediatrician, gave us support so that we didn’t have any trouble with medical resistance early.
HealthyWomen: Tell me about the first class of nurses who studied to become NPs.
Loretta Ford: It was a demonstration program. The students that we took in qualified for graduate school, but it was not a degree program. It was intensive learning, and then you had to do a clinical experience. They were not only qualified for the education, but they were experienced and knowledgeable. They were public health nurses and used to working in the community. In a sense, we had a loaded group because they were so well prepared, and their enthusiasm spread to other nurses very quickly and to patients.
We had a social scientist who worked with us on evaluating all these elements of safety and acceptance and experience, from patients. But it took a while before the school accepted it.
So, in a way, this provided a bridge until the schools of nursing in universities began to accept the idea. Once they did, we got a grant to train some faculty from different schools. The University of Rochester School of Nursing was one of the schools that did the training. I had moved there. [Ford was recruited to serve as the founding dean.]
HealthyWomen: What are some of the biggest advances that have happened in your lifetime for women’s health?
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 if you look at the data on maternity health, it’s really shocking what our country is ranked. Eighty percent of that is women who are vulnerable or without resources, and nobody’s looking after that. There’s no wonder that there are so many problems when you see that kind of data.
There are four categories that nursing programs are recognizing and trying to do things with regulation or statutory authority: nurse midwives, nurse practitioners, nurse clinicians and nurse anesthetists.
Unless we can practice to the extent that we’re prepared to do, we’re depriving many people, and particularly vulnerable groups, of care that is basic healthcare, and other things that go along with that — [responding to] the poverty and social inequities. The WHO — the World Health Organization — in 1978 talked about community health and all these things of equity and advancing things in terms of nurses taking part. 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’m most proud of what the nurse practitioners are and have been doing and how they are our friends, in terms of the health of people. Because I haven’t met any nurse practitioners who are not just delighted with their role, and I think it’s helped nursing, so that we can help others. I’m more proud of that than anything.
I get a lot of credit for what other people do, but when it comes right down to it, they, themselves, have done it, and they continue to do it. I really am impressed with how enthusiastic they all are.
HealthyWomen: What would people be surprised to know about you?
Loretta Ford: I’m just an ordinary person. I’m no celebrity.
HealthyWomen: Is there anything I haven’t asked you about, regarding the nursing field or women’s health, that you think is important for our readers to know?
Loretta Ford: I think that we’re finally getting recognition, but it’s taken the pandemic to bring it to the fore more.
HealthyWomen: In what way?
Loretta Ford: We’re there. It’s presence that makes a difference, and we’re there 24/7, and in that sense, I think that … I give them all A’s. Accessibility, acceptability, advocacy, accountability, affordability, affability. Now, how many more A’s does nursing need? How do you like that?
