In 1965, the first students entered an experimental pediatric nurse practitioner graduate program at the University of Colorado. Of the 12 women in that class, some are now heads of practice programs, others are professors or academic deans. Many have earned their doctorates, and most of them are leaders in today's nursing community.
"They were risk-takers, and they had a level of dissatisfaction with the status quo," said Loretta C. Ford.
It was Ford who laid the groundwork for these risk-takers by designing the curriculum and teaching many of the classes.
Now there are more than 330 individual master's programs for nurse practitioners in the United States. The rise of professional nursing has sparked a return of the caregiver's basic commitment to public health.
By the time the Colorado program was 10 years old, there were more than 10,000 nurse practitioners in the country. Now, approximately 30,000 registered nurses are also certified nurse practitioners.
These nursing professionals take on many of the routine tasks of physicians, as well as many of the not-so-routine decisions and responsibilities.
Ford, born Dec. 28, 1920, in New York, created and headed that movement.
"It takes a lot of courage and creativity to literally create a new program," said Carolyne Davis, a consultant with Ernst & Young and former HCFA administrator. Davis was dean of nursing at the University of Michigan in the mid-1970s when Ford had the same role at the University of Rochester (N.Y.).
"She really broke new ground in nursing and in healthcare delivery," Davis said.
The long way.
Ford had always wanted to become a teacher, and eventually arrived at that goal "the long way around," she says.
After graduating from high school at 16, she started as a nurse's aide at Middlesex General Hospital in New Brunswick, N.J. She graduated from the diploma nursing program there in September 1941, just before the bombing of Pearl Harbor.
Taking a public health nursing course while she was in the diploma program opened Ford's eyes to the possibilities of nursing beyond the confines of the hospital. After graduation she joined the Visiting Nurse Service of New Brunswick.
The cases the VNS served ranged from patients with maternity needs-including the occasional home delivery unsupervised by a doctor-to the chronically and acutely ill.
Despite her interest in community nursing, and the commitment to the agency, she considered signing up with the military. Her fiance at the time was killed in battle, fueling her personal commitment to serve the country in wartime.
In 1942 she joined the Army Air Force, hoping to get into flight nurse training. However, because of problems with her vision, she remained stationed at U.S. base hospitals until 1946.
The initial disappointment of not being able to serve overseas soon was eased. After the war, Ford found she could go on to college on the GI Bill of Rights. She chose the University of Colorado because of a desire to see the West.
She then began to seriously pursue her curiosity about public health issues, a curiosity that started in the VNS.
In Colorado, she met William Ford, also a World War II veteran. They married in 1947 and had a daughter in 1952.
At the University of Colorado, Ford went on to earn a bachelor's degree and a public health nursing certificate in 1949, a master's in public health nursing two years later, and a doctorate in education in 1961.
She cites Pearl Parvin Coulter, the chairman of public health nursing at the university, and Henrietta Loughran, the dean, as key mentors.
It was Coulter who pushed Ford to take a position as a public health nurse
in rural Boulder County, Colo., while she finished her master's degree.
There Ford worked in the public schools with tuberculosis patients, in clinics serving crippled children and in well-baby clinics. After the Boulder city and county health departments combined, she served as the public health nursing supervisor from 1947 to 1958.
Her two loves-teaching and nursing-merged when she became an assistant professor and then a full professor at the University of Colorado School of Nursing in Boulder, where she taught from 1960 to 1972.
During the many years she spent in hands-on community nursing, Ford realized that nurses involved in public health outreach needed authorization to make higher-level medical decisions about the health of their patients.
"I often said that public health nursing was the art and science of professional nursing that was practiced clandestinely to make the physician think he was the Lord of Health," she said in a 1993 interview published in Public Health Nursing.
In 1964, Ford had the chance to help create what would become the nurse practitioner program curriculum while participating in a long-term Western Interstate Commission for Higher Education in Nursing project.
In that program, faculty members from 13 Western states were developing the clinical curriculum content for various nursing specialties. As part of the community health group, Ford focused on developing a model for a pediatric nurse practitioner.
She teamed up with Henry Silver, M.D., a pediatrician at the University of Colorado. Silver had attended a child health conference that year, sponsored by the Colorado state health department, which had addressed the issue of nurses contributing to pediatric health.
He faced a lack of interest when he returned and tried to implement ideas from the conference, especially from within the nursing faculty.
Ford learned of Silver's interest in the elements of prevention and protection emphasized in her ongoing project, and the two combined their backgrounds, his in pediatrics and hers in community health and maternal-child health.
They put their ideas to the test. Through a survey of nurses and physicians, they identified major problems in child care. That list of problems enabled them to evaluate the gray area of decisionmaking between nurses and physicians.
Out of that collaboration, they formulated the curriculum for the pediatric nurse practitioner program.
The medical establishment struck at all sides of the fledgling program. Both doctors and nurses were initially wary of the role this new type of health professional would play.
Ford and Silver shared the brunt of the criticism. "We got flak from everybody," she said.
However, "the more experience people had with the nurse practitioner (concept), the more they could see that the nurses were serving as real nurses and not as `mini-doctors,'*" Ford said. Nurse educators were slow to accept that concept even when presented with data on the program.
"Sometimes it's fear of the unknown that gets people to react to something they perceive as a threat," she added.
The concept of sharing responsibility was a new one, and the nurse practitioner program produced documented evidence that physicians and nurses could coordinate care as a team, Davis said.
"The whole concept of collegial working relationships grew out of the nurse practitioner program," she said. "The impact has been phenomenal."
Ford said health professionals need not worry about any others invading their territory. "There's enough work to go around for everybody. The patient needs team care."
Since the first program kicked off at the University of Colorado in 1965, nurse practitioner preparation has advanced to the master's degree level. "Professional nurses are coming into their own," Ford said.
In 1972, when the School of Nursing at the University of Rochester became autonomous, she served as founding dean. Concurrently, she was director of nursing at the University of Rochester Medical Center.
Ford has aimed to combine education, practice and research within the field of nursing throughout her career.
"Dr. Ford is a pioneer," said Mary O. Mundinger, dean of the Columbia University School of Nursing, New York, who has known Ford for 15 years as a colleague and personal friend. "She not only had the ideas and the vision to advance the profession of nursing, she made them happen. She lived those ideas."
At Rochester, Ford was known for her strength in initiatives and the innovative ideas she brought to her colleagues, Davis said.
Trouble winding down.
Since retiring in 1986, Ford has been professor and dean emeritus at the University of Rochester School of Nursing.
She is trying-"unsuccessfully," she said-to wind down, but presentations, consultations and involvement in various development efforts keep her occupied.
Ford served as program director for the Commonwealth Fund's Executive Nurse Fellowship Program from 1983 to 1987. In 1988, she stepped in for a year to act as dean of the Graduate School of Education and Human Development at the University of Rochester.
These days, she is also, of course, celebrating the 30th anniversary of the kickoff of that first program at the University of Colorado.
In today's evolving healthcare market, she views nurse practitioners as instrumental in the orientation to a wellness-based system that requires patient responsibility.
Ford said she anticipates the shift from a system that treats sickness to a system that emphasizes wellness. "It's a most opportune time for nursing and all of healthcare," she said.