primary care nurses, nursing care beyond the ... - School of Nursing

LeadershipA pioneer reflectsFaculty member helped forgethe path for nurse practitionersEven before shefinished her first graduatedegree, Donna Nativio(BSN ’64), knew nurses hada bigger role to play as healthcare providers.Today, that point of viewis widely embraced. But inthe 1960s, it was an untestednotion that challenged manypeople’s concepts of professionalboundaries.But Nativio, PhD,CRNP, FAAN, associateprofessor at the School ofNursing and director of theFamily, Adult, Pediatric, andNeonatal Nurse Practitionerprograms and the Doctor ofNursing Practice Program,does not fear breaking tradition if it means getting better carefor patients and their families. So in an early job as a publichealth nurse for the Allegheny County Health Department, shebegan putting her idea to the test.“A whole lot of mommies and babies would come in. Thenurses would weigh and measure the babies and talk to themothers about how the baby was eating and developing, andthen we’d all wait for the physician to show up—sometimes upto 2½ hours,” she recalls. “I was impressed by the wasted timeand wasted talent of the nursing staff, and the wasted time forthose mothers as well.”Research done at the University of Denver supported herobservations. It found nurses were sometimes the only healthcare providers in the area they served.“They were disconnected from hospital systems, and themore education they had, the more autonomous and confidentthey could be in their ability to carry out what needed to bedone,” Nativio says. The Denver research showed with additionaltargeted education nurses could be front-line providersin areas of need.Nativio … does notfear breaking traditionif it means gettingbetter care for patientsand their families.So, Nativio recruited experienced public health nurses toparticipate in an on-the-job educational program. She enlistedLarry Dunegan, MD, a pediatrician, to help develop a curriculum,which they taught together. This program had 12 graduateswho revolutionized the well-child services to mothers and babiesin Allegheny County.A write-up about the program in a local newspaper ledto an interview with then-Dean Marguerite Schaefer, whooffered Nativio a job creating a similar program at the School ofNursing. Nativio demurred, feeling she still had much to do inthe community, but agreed to serve as a consultant.Not everybody was thrilled with the idea of expandingnurses’ roles. “I think this was a beginning of the concern wehave in health care now about boundaries in practice, and whohas the education to do what,” she says. “Nurses have made a lotof progress.”Critics claimed nurse practitioners might be acceptedamong low-income patients, who had fewer options, but middleorupper-income patients would insist on seeing a physician.As always, Nativio set out to prove the naysayers wrong.She took a job in an upscale suburban private practice where14 university of Pittsburgh