Making Room in the Clinic: Nurse Practitioners and the Evolution of Modern Health Care (review)

In the 1980s, I had an excellent health care provider, a nurse practitioner who worked at a health maintenance organization, or HMO, in Madison, Wisconsin. Ida Gear was in high demand among many of the women I knew because of her health care skills and caring approach. Thus, I was delighted to learn more about the history of this health care profession in Julie Fairman's new book on the history of nurse practitioners.

Making Room in the Clinic: Nurse Practitioners and the Evolution of Modern Health Care not only documents the development of a new type of health care worker but sets it clearly within the wider context of nursing and medicine in the 1960s and 1970s. Fairman's history of the nurse practitioner movement adds an important dimension to scholarship on health care in the post–World War II era, a period of increasing interest among historians. Her insights into professional health relations illuminate some of the central themes in the history of modern health care.

Fairman's study of nurse practitioners is attentive to the multiple perspectives regarding how best to provide optimum patient care. In particular, she analyzes the ideas and concerns of doctors and organized medicine, including the American Medical Association, as well as those of nurses and organized nursing, including the American Nurses Association. Fairman demonstrates that the nurse practitioner movement was the product of nurse–physician relations and attempts at cooperation in both individual clinical practices and larger policy discussions. She shows that the nurse practitioner could be part of a collaborative health care practice with shared responsibility and equity among health professionals.

In one especially interesting aspect of her study, Fairman draws on gender analysis to analyze the separate but related paths of nurse practitioners and physician assistants. Physician assistants, most of whom were men, emerged as complementary health workers within the field of medicine. Nurse practitioners, most of whom were women, were specialists with advanced training within the field of nursing. The two types of health care providers performed similar tasks and had similar degrees of autonomy in their work in this borderland between medicine and nursing. However, there were differences, as men became "less-than doctors" and women became "more-than nurses." Physician assistants were men looking for ways to use their health care skills without undertaking the lengthy physician training. Many of them had had military experience as medics and thus sought a parallel profession in civilian life. Nurse practitioners were women looking for more training and ways to expand their roles. Many of them had worked in areas of nursing that offered opportunities for specialization and independent work, such as public health nursing.

Fairman's study of the coalition efforts of nurses and physicians in the 1960s and 1970s shows how and why the nurse practitioner movement emerged, but it also raises questions for future research. For example, sprinkled throughout the book are references to the fact that most nurse practitioners were white. Although Fairman does not analyze how "whiteness" shaped the emergence of this health care field, her work provides an excellent starting point for scholars. In addition, research is needed on how and why racialized minority women were drawn to the field and with what results. For instance, the Wisconsin nurse practitioner Ida Gear was an African American woman, and there were no doubt others across the nation.

In sum, Fairman provides the first comprehensive investigation of the history of nurse practitioners and in the process reveals much about the complexities of professional health relations, clinical authority, and specialization. Her work makes the case for the benefits of collaboration when there is shared power between nurses and doctors and shows that although it is not easy, it can be done.