toaz.info-advanced-practice-nursing-essentials-for-role-development-4th-edition-b0772rcxd2-pr_cda281e735a4898314b80bbf216f2128.pdf

AdvAnced
PrActice
nursing

essentials for role development

F o u r t h E d i t i o n

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6044_Fm_i-xvi.indd 2 9/11/17 8:51 PM

AdvAnced
PrActice
nursing

essentials for role development
F o u r t h E d i t i o n

Lucille A. Joel, edd, APn, FAAn
Distinguished Professor

Rutgers, The State University of New Jersey
School of Nursing, New Brunswick–Newark, New Jersey

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Library of Congress Cataloging-in-Publication Data

Names: Joel, Lucille A., editor.
Title: Advanced practice nursing : essentials for role development / [edited
by] Lucille A. Joel, EdD, APN, FAAN, Distinguished Professor, Rutgers, The
State University of New Jersey, School of Nursing, New Brunswick-Newark,
New Jersey.
Description: Fourth edition. | Philadelphia, PA : F.A. Davis Company, [2018]
| Includes bibliographical references and index.
Identifiers: LCCN 2017023590 | ISBN 9780803660441
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v

Preface

The content of this text was identified only after a careful
review of the documents that shape both the advanced
practice nursing role and the educational programs
that prepare these individuals for practice. That review
allowed some decisions about topics that were essential
to all advanced practice nurses (APNs)*, whereas others
were excluded because they are traditionally introduced
during baccalaureate studies. This text is written for the
graduate-level student in advanced practice and is intended
to address the nonclinical aspects of the role.

Unit 1 explores The Evolution of Advanced Practice from
the historical perspective of each of the specialties: the
clinical nurse-midwife (CNM), nurse anesthetist (NA),
clinical nurse specialist (CNS), and nurse practitioner (NP).
This historical background moves to a contemporary focus
with the introduction of the many and varied hybrids of
these roles that have appeared over time. These dramatic
changes in practice have been a response to societal need.
Adjustment to these changes is possible only from the
kaleidoscopic view that theory allows. Skill acquisition,
socialization, and adjustment to stress and strain are
theoretical constructs and processes that will challenge
the occupants of these roles many times over the course
of a career, but coping can be taught and learned. Our
accommodation to change is further challenged as we
realize that advanced practice is neither unique to North
America nor new on the global stage. Advanced practice
roles, although accompanied by varied educational require-
ments and practice opportunities, are well embedded and
highly respected in international culture. In the United
States, education for advanced practice had become well

stabilized at the master’s degree level. This is no longer true.
The story of our recent transition to doctoral preparation
is laid before us with the subsequent issues this creates.

The Practice Environment, the topic of Unit 2, dra-
matically affects the care we give. With the addition of
medical diagnosis and prescribing to the advanced practice
repertoire, we became competitive with other disciplines,
deserving the rights of reimbursement, prescriptive author-
ity, clinical privileges, and participation as members on
health plan panels. There is the further responsibility to
understand budgeting and material resource management,
as well as the nature of different collaborative, responding,
and reporting relationships. The APN often provides care
within a mediated role, working through other profession-
als, including nurses, to improve the human condition.

Competency in Advanced Practice, the topic of Unit 3,
demands an incisive mind capable of the highest of
critical thinking. This cognitive skill becomes refined as the
subroles for practice emerge. The APN is ultimately a direct
caregiver, client advocate, teacher, consultant, researcher,
and case manager. The APN’s forte is to coach individuals
and populations so that they may take control of their own
health in their own way, ideally even seeing chronic disease
as a new trajectory of wellness. The APN’s clients are as
diverse as the many ethnicities of the U.S. public, and the
challenge is often to learn from them, taking care to do
no harm. The APN’s therapeutic modalities go beyond
traditional Western medicine, reaching into the realm
of complementary therapies and integrative health-care
practices that have become expected by many consumers.
Any or all of these role competencies are potential areas
for conflict, needing to be understood, managed, and
resolved in the best interests of the client. Some of the
most pressing issues confronting APNs today are how to
mobilize informational technology in the service of the
client, securing visibility for their work, and thinking

*Please note that the terms advanced practice nurse (APn) and advanced
practice registered nurse (APrn) are used interchangeably in this text
according to the author’s choice.

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vi PrEFacE

through publication. The chapters in this section aim to
introduce these competencies, not to provide closure on
any one topic; the art of direct care in specialty practice
is not broached.

When you have completed your course of studies, you
will have many choices to make. There are opportunities
to pursue your practice as an employee, an employer, or
an independent contractor. Each holds different rights and
responsibilities. Each demands Ethical, Legal, and Business
Acumen, which is covered in Unit 4. Each requires you
to prove the value you hold for your clients and for the
systems in which you work. Cost efficiency and therapeutic
effectiveness cannot be dismissed lightly today. The nuts and

bolts of establishing a practice are detailed, and although
these particulars apply directly to independent practice,
they can be easily extrapolated to employee status. Finally,
experts in the field discuss the legal and ethical dimensions
of practice and how they uniquely apply to the role of the
APN to ensure protection for ourselves and our clients.

This text has been carefully crafted based on over
40 years of experience in practice and teaching APNs. It
substantially includes the nonclinical knowledge necessary
to perform successfully in the APN role and raises the
issues that still have to be resolved to leave this practice
area better than we found it.

LuciLLe A. JoeL

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vii

Patricia DiFusco, MS, NP-C, FNP-BC, AAHIVS
Nurse Practitioner
SUNY Downstate Medical Center
Brooklyn, New York

Caroline Doherty, AGACNP, AACC
Advanced Senior Lecturer
University of Pennsylvania
School of Nursing
Philadelphia, Pennsylvania

Carole Ann Drick, PhD, RN, AHN-BC
President
American Holistic Nurses Association
Topeka, Kansas

Lynne M. Dunphy, PhD, APRN, FNP-BC, FAAN, FAANP
Professor and Associate Dean for Practice

and Community Engagement
Florida Atlantic University
Christine E. Lynn College of Nursing
Boca Raton, Florida

Denise Fessler, RN, MSN, CMAC
Principal/CEO
Fessler and Associates
Healthcare Management Consulting, LLC
Lancaster, Pennsylvania

Eileen Flaherty, RN, MBA, MPH
Staff Specialist
Massachusetts General Hospital
Boston, Massachusetts

Cindy Aiena, MBA
Executive Director of Finance
Partners HealthCare/MGH
Boston, Massachusetts

Judith Barberio, PhD, APNC
Associate Clinical Professor
Rutgers-The State University of New Jersey
School of Nursing
New Brunswick-Newark, New Jersey

Deborah Becker, PhD, ACNP, BC, CCNS
Director, Adult Gerontology Acute Care Program
University of Pennsylvania
School of Nursing
Philadelphia, Pennsylvania

Andrea Brassard, PhD, FNP-BC, FAANP
Senior Strategic Policy Advisor
Center to Champion Nursing in America at AARP
Washington, District of Columbia

Edna Cadmus, RN, PhD, NEA-BC
Clinical Professor and Speciality Director-Nursing

Leadership Program
Executive Director NJCCN
Rutgers-The State University of New Jersey
School of Nursing
New Brunswick-Newark, New Jersey

Ann H. Cary, PhD, MPH, FN, FNAP, FAAN
Dean and Professor
University of Missouri
Kansas City, School of Nursing and Health Studies
Kansas City, Missouri

contributors

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viii contributors

Phyllis Shanley Hansell, EdD, RN, FNAP, FAAN
Professor
Seton Hall University
College of Nursing
South Orange, New Jersey

Allyssa Harris, RN, PhD, WHNP-BC
Assistant Professor
William F. Connell School of Nursing
Boston College
Boston, Massachusetts

Gladys L. Husted, RN, PhD
Professor Emeritus
Duquesne University
Pittsburgh, Pennsylvania

James H. Husted
Independent Scholar
Pittsburgh, Pennsylvania

Joseph Jennas, CRNA, MS
Program Director
Clinical Assistant Professor
SUNY Downstate Medical Center
Brooklyn, New York

Lucille A. Joel, EdD, APN, FAAN
Distinguished Professor
Rutgers-The State University of New Jersey
School of Nursing
New Brunswick-Newark
New Jersey

Dorothy A. Jones, EdD, RNC-ANP, FAAN
Professor, Boston College
Connell School of Nursing
Senior Nurse, Massachusetts General Hospital
Boston, Massachusetts

David M. Keepnews, PhD, JD, RN, NEA-BC, FAAN
Dean and Professor
Long Island University (LIU) Brooklyn
Harriet Rothkopf Heilbrunn School of Nursing
Brooklyn, New York

Jane M. Flanagan, PhD, ANP-BC
Associate Professor and Program Director
Adult Gerontology
Boston College
Connell School of Nursing
Chestnut Hill, Massachusetts

Rita Munley Gallagher, RN, PhD
Nursing and Healthcare Consultant
Washington, District of Columbia

Mary Masterson Germain, EdD, ANP-BC, FNAP,
D.S. (Hon)

Professor Emeritus
State University of New York–Downstate

Medical Center College of Nursing
Brooklyn, New York

Kathleen M. Gialanella, JD, LLM, RN
Law Offices
Westfield, New Jersey
Associate Adjunct Professor
Teachers College, Columbia University
New York, New York

Shirley Girouard, RN, PhD, FAAN
Professor and Associate Dean
State University of New York-Downstate

Medical Center
College of Nursing
Brooklyn, New York

Antigone Grasso, MBA
Director
Patient Care Services Management Systems

and Financial Performance
Massachusetts General Hospital
Boston, Massachusetts

Anna Green, RN, Crit Care Cert, MNP
Project Manager
Australian Red Cross Blood Service
Melbourne, Australia

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contributors ix

Beth Quatrara, DNP, RN, CMSRN, ACNS-BC
Advanced Practice Nurse–CNS
University of Virginia Health System
Charlottesville, Virginia

Kelly Reilly, MSN, RN, BC
Director of Nursing
Maimonides Medical Center
Brooklyn, New York

Valerie Sabol, PhD, ACNP-BC, GNP-BC, ANEF,
FAANP

Professor and Division Chair
Healthcare in Adult Population
Duke University
School of Nursing
Durham, North Carolina

Mary E. Samost, RN, MSN, DNP, CENP
System Director Surgical Services
Hallmark Health System
Medford, Massachusetts

Madrean Schober, PhD, MSN, ANP, FAANP
President
Schober Global Healthcare Consulting International
Indianapolis, Indiana

Robert Scoloveno, PhD, RN
Director–Simulation Laboratories
Assistant Professor
Rutgers-The State University of New Jersey
School of Nursing
Camden, New Jersey

Carrie Scotto, RN, PhD
Associate Professor
The University of Akron
College of Nursing
Akron, Ohio

Dale Shaw, RN, DNP, ACNP-BC
ACNP–Acute Care Neurosurgery
University of Virginia Health System
Charlottesville, Virginia

Alice F. Kuehn, RN, PhD, BC-FNP/GNP
Associate Professor Emeritus
University of Missouri-Columbia
School of Nursing
Columbia, Missouri
Parish Nurse
St. Peter Catholic Church
Jefferson City, Missouri

Irene McEachen, RN, MSN, EdD
Associate Professor
Saint Peter’s University
Division of Nursing
Jersey City, New Jersey

Deborah C. Messecar, PhD, MPH, AGCNS-BC, RN
Associate Professor
Oregon Health and Science University
School of Nursing
Portland, Oregon

Patricia A. Murphy, PhD, APRN, FAAN
Associate Professor
Rutgers-The State University of New Jersey
New Jersey Medical School
Newark, New Jersey

Marilyn H. Oermann, RN, PhD, FAAN, ANEF
Thelma Ingles Professor of Nursing
Director of Evaluation and Educational Research
Duke University
School of Nursing
Durham, North Carolina

Marie-Eileen Onieal, PhD, MMHS, RN, CPNP,
FAANP

Faculty, Doctor of Nursing Practice
Rocky Mountain University of Health Professions
Provo, Utah

David M. Price, MD, PhD
Founding Faculty
Center for Personalized Education of Physicians

(CDEP)
Denver, Colorado

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x contributors

Caroline T. Torre, RN, MA, APN, FAANP
Nursing Policy Consultant
Princeton, New Jersey
Formerly, Director, Regulatory Affairs
New Jersey State Nurses Association
Trenton, New Jersey

Jan Towers, PhD, NP-C, CRNP (FNP), FAANP
Director of Health Policy
Federal Government and Professional Affairs
American Academy of Nurse Practitioners
Washington, District of Columbia

Maria L. Vezina, RN, EdD, NEA-BC
Chief Nursing Officer/Vice President, Nursing
The Mount Sinai Hospital
New York, New York

Benjamin A. Smallheer, PhD, RN, ACNP-BC,
FNP-BC, CCRN, CNE

Assistant Professor of Nursing
Duke University
School of Nursing
Durham, North Carolina

Thomas D. Smith, DNP, RN, NEA-BC, FAAN
Chief Nursing Officer
Maimonides Medical Center
Brooklyn, New York

Mary C. Smolenski, MS, EdD, FNP, FAANP
Independent Consultant
Washington, District of Columbia

Shirley A. Smoyak, RN, PhD, FAAN
Distinguished Professor
Rutgers-The State University of New Jersey
School of Nursing
New Brunswick-Newark, New Jersey

Christine A. Tanner, RN, PhD, ANEF
Professor Emerita
Oregon Health and Science University
Portland, Oregon

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xi

Sheila Grossman, PhD, APRN, FNP-BC, FAAN
Professor and Coordinator
Family Nurse Practitioner Program
Fairfield University
Fairfield, Connecticut

Elisabeth Jensen, RN, PhD
Associate Professor
School of Nursing
York University
Toronto, Ontario
Canada

Linda E. Jensen, PhD, MN, RN
Professor Graduate Nursing
Clarkson College
Omaha, Nebraska

Julie Ann Koch, DNP, RN, FNP-BC, FAANP
Assistant Dean of Graduate Nursing
DNP Program Coordinator
Valparaiso University College of Nursing & Health

Professions
Valparaiso, Indiana

Linda U. Krebs, RN, PhD, AOCN, FAAN
Associate Professor
University of Colorado
Anschutz Medical Campus, College of Nursing
Aurora, Colorado

Nancy Bittner, RN, PhD
Associate Dean
School of Nursing Science and Health Professions
Regis College
Weston, Massachusetts

Cynthia Bostick, PMHCNS-BC, PhD
Lecturer
California State University
Carson, California

Susan S. Fairchild, EdD, APRN
Dean, School of Nursing
Grantham University
Kansas City, Missouri

Cris Finn, RN, PhD, FNP
Assistant Professor
Regis University
Denver, Colorado

Susan C. Fox, RN, PhD, CNS-BC
Associate Professor
College of Nursing
University of New Mexico
Albuquerque, New Mexico

Eileen P. Geraci, PhD candidate, MA, ANP-BC
Professor of Nursing
Western Connecticut State University
Danbury, Connecticut

reviewers

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xii rEviEwErs

Julie Ponto, RN, PhD, ACNS-BC, AOCN
Professor
Winona State University–Rochester
Rochester, Minnesota

Susan D. Schaffer, PhD, ARNP, FNP-BC
Chair, Department of Women’s, Children’s

and Family Nursing
FNP Track Coordinator
University of Florida College of Nursing
Gainesville, Florida

Beth R. Steinfeld, DNP, WHNP-BC
Assistant Professor
SUNY Downstate Medical Center
Brooklyn, New York

Lynn Wimett, EdD, APRN-C
Professor
Regis University
Denver, Colorado

Jennifer Klimek Yingling, PhD, RN, ANP-BC,
FNP-BC

Advanced Practice Nurse
Faxton-St. Luke’s Healthcare
SUNY Institute of Technology
Utica, New York

Joy Lewis, CRNA, MSN
Interim Assistant Program Director Nurse

Anesthesia
Lincoln Memorial University
Harrogate, Tennessee

Laurie Kennedy-Malone, PhD, GNP-BC, FAANP,
FGSA

Professor of Nursing
University of North Carolina at Greensboro School

of Nursing
Greensboro, North Carolina

Susan McCrone, PhD, PMHCNS-BC
Professor
West Virginia University
Morgantown, West Virginia

Sandra Nadelson, RN, MS Ed, PhD
Associate Professor
Boise State University
Boise, Idaho

Geri B. Neuberger, RN, MN, EdD, ARNP-CS
Professor
University of Kansas School of Nursing
Kansas City, Kansas

Crystal Odle, DNAP, CRNA
Director, Assistant Professor Nurse Anesthesia

Program
Lincoln Memorial University
Harrogate, Tennessee

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xiii

This book belongs to its authors. I am proud to be one among them. Beyond that, I have been the instrument to
make these written contributions accessible to today’s students and faculty. I thank each author for the products of
his or her intellect, experience, and commitment to advanced practice.

Acknowledgments

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xv

8 the Kaleidoscope of collaborative
Practice 116
Alice F. Kuehn

9 Participation of the Advanced Practice
nurse in Health Plans and Quality
initiatives 143
Rita Munley Gallagher

10 Public Policy and the Advanced Practice
registered nurse 158
Marie-Eileen Onieal

11 resource Management 165
Eileen Flaherty, Antigone Grasso, and Cindy Aiena

12 Mediated roles: Working
With and through Other People 184
Thomas D. Smith, Maria L. Vezina , Mary E. Samost,
and Kelly Reilly

Unit 3 competency in Advanced
Practice 203

13 evidence-Based Practice 204
Deborah C. Messecar and Christine A. Tanner

14 Advocacy and the Advanced Practice
registered nurse 218
Andrea Brassard

15 case Management and Advanced Practice
nursing 227
Denise Fessler and Irene McEachen

16 the Advanced Practice nurse
and research 240
Beth Quatrara and Dale Shaw

contents

Preface v

contributors vii

Unit 1 the evolution of Advanced
Practice 01

1 Advanced Practice nursing: doing What
Has to Be done 02
Lynne M. Dunphy

2 emerging roles of the Advanced
Practice nurse 16
Deborah Becker and Caroline Doherty

3 role development: A theoretical
Perspective 33
Lucille A. Joel

4 educational Preparation of Advanced
Practice nurses: Looking
to the Future 43
Phyllis Shanley Hansell

5 global Perspectives on Advanced nursing
Practice 54
Madrean Schober and Anna Green

Unit 2 the Practice environment 91

6 Advanced Practice nurses
and Prescriptive Authority 92
Jan Towers

7 credentialing and clinical Privileges
for the Advanced Practice registered
nurse 100
Ann H. Cary and Mary C. Smolenski

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xvi contEnts

25 Advanced Practice registered nurses:
Accomplishments, trends, and Future
development 387
Jane M. Flanagan, Allyssa Harris, and Dorothy A. Jones

26 starting a Practice and Practice
Management 395
Judith Barberio

27 the Advanced Practice nurse as employee
or independent contractor: Legal and
contractual considerations 418
Kathleen M. Gialanella

28 the Law, the courts, and the Advanced
Practice registered nurse 433
David M. Keepnews

29 Malpractice and the Advanced Practice
nurse 445
Carolyn T. Torre

30 ethics and the Advanced Practice
nurse 474
Gladys L. Husted , James H. Husted , and Carrie Scotto

index 491

available online at davisplus.fadavis.com:
bibliography

17 the Advanced Practice nurse: Holism
and complementary and integrative
Health Approaches 251
Carole Ann Drick

18 Basic skills for teaching
and the Advanced Practice
registered nurse 276
Valerie Sabol , Benjamin A. Smallheer,
and Marilyn H. Oermann

19 culture as a variable in Practice 295
Mary Masterson Germain

20 conflict resolution in Advanced
Practice nursing 328
David M. Price and Patricia A. Murphy

21 Leadership for APns: if not now,
When? 336
Edna Cadmus

22 information technology
and the Advanced Practice nurse 349
Robert Scoloveno

23 Writing for Publication 354
Shirley A. Smoyak

Unit 4 ethical, Legal, and Business
Acumen 365

24 Measuring Advanced Practice nurse
Performance: Outcome indicators, Models
of evaluation, and the issue of value 366
Shirley Girouard, Patricia DiFusco, and Joseph Jennas

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1

U n i t

1
The Evolution

of Advanced Practice

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2

1
Advanced Practice Nursing

Doing What Has to Be Done
Lynne M. Dunphy

Learning Outcomes

Learning outcomes expected as a result of this chapter:

• Recognize the historical role of women as healers.
• Identify the roots of professional nursing in the United States including the public

health movement and turn-of-the-century settlement houses.
• Describe early innovative care models created by nurses in the first half of the

20th century such as the Frontier Nursing Service (FNS).
• Trace the trajectory of the role of the nurse midwife across the 20th century as well

as the present status of this role.
• Recognize the emergence of nurse anesthetists as highly autonomous practitioners

and their contributions to the advancement of surgical techniques and develop-
ments in anesthesia.

• Describe the development of the clinical nurse specialist (CNS) role in the context
of 20th-century nursing education and professional development with particular
attention to the current challenges of this role.

• Describe the historical and social forces that led to emergence of the nurse practi-
tioner (NP) role and understand key events in the evolution of this role.

• Describe the development of the doctor of nursing practice (DNP) and distin-
guish this role from the others described in this chapter.

• Describe the current challenges to all advanced roles and formulate ways to meet
these challenges going forward.

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Chapter 1 •  ADvAnceD PrActice nUrsing 3

Advanced practice is a contemporary term that has evolved
to label an old phenomenon: nurses or women providing
care to those in need in their surrounding communities.
As Barbara Ehrenreich and Deidre English (1973) note,
“Women have always been healers. They were the un-
licensed doctors and anatomists of western history . . .
they were pharmacists, cultivating herbs and exchanging
the secrets of their uses. They were midwives, travelling
from home to home and village to village” (p. 3). Today,
with health care dominated by a male-oriented medical
profession, advanced practice nurses (APNs) (especially
those cheeky enough to call themselves “doctor” even
while clarifying their nursing role and background) are
viewed as nurses “pushing the envelope”—the envelope of
regulated, standardized nursing practice. The reality is that
the boundaries of professional nursing practice have always
been fluid, with changes in the practice setting speeding
ahead of the educational and regulatory environments. It
has always been those nurses caring for persons and families
who see a need and respond—at times in concert with the
medical profession and at times at odds—who are the true
trailblazers of contemporary advanced practice nursing.

This chapter makes the case that, far from being a new
creation, APNs actually predate the founding of modern
professional nursing. A look back into our past reveals
legendary figures always responding to the challenges
of human need, changing the landscape of health care,
and improving the health of the populace. The titles may
change—such as a doctor of nursing practice (DNP)—but
the essence remains the same.

PRECURSORS AND ANTECEDENTS

There is a long and rich history of female lay healing with
roots in both European and African cultures. Well into
the 19th century, the female lay healer was the primary
health-care provider for most of the population. The sharing
of skills and knowledge was seen as one’s obligation as a
member of a community. These skills were broad based and
might have included midwifery, the use of herbal remedies,
and even bone setting (Ehrenreich, 2000, p. xxxiii). Laurel
Ulrich, in A Midwife’s Tale (1990), notes that when the
diary of the midwife Martha Ballard opens in 1785, “. . .
she knew how to manufacture salves, syrups, pills, teas,
ointments, how to prepare an oil emulsion, how to poultice

wounds, dress burns, treat dysentery, sore throat, frost bite,
measles, colic, ‘whooping cough,’ ‘chin cough,’ . . . and ‘the
itch,’ how to cut an infant’s tongue, administer a ‘clister’
(enema), lance an abscessed breast . . . induce vomiting,
assuage bleeding, reduce swelling and relieve a toothache,
as well as deliver babies” (p. 11).

Ulrich notes the tiny headstones marking the graves
of midwife Ballard’s deceased babies and children as
further evidence of her ability to provide compassionate,
knowledgeable care; she was able to understand the pain
and suffering of others. The emergence of a male medical
establishment in the 19th century marked the beginning
of the end of the era of female lay healers, including mid-
wives. The lay healers saw their role as intertwined with
one’s obligations to the community, whereas the emerging
medical class saw healing as a commodity to be bought
and sold (Ehrenreich & English, 1978). Has this really
changed? Are not our current struggles still bound up with
issues of gender, class, social position, and money? Have
we not entered a phase of more radical than ever splits
between the haves and have-nots, with grave consequences
to our social fabric?

Nursing histories (O’Brien, 1987) have documented
the emergence of professional nursing in the 19th century
from women’s domestic duties and roles, extensions of
the things that women and servants had always done for
their families. Modern nursing is usually pinpointed as
beginning in 1873, the year of the opening of the first three
U.S. training schools for nurses, “as an effort on the part
of women reformers to help clean up the mess the male
doctors were making” (Ehrenreich, 2000, p. xxxiv). The
incoming nurses, for example, are credited with introducing
the first bar of soap into Bellevue Hospital in the dark days
when the medical profession was still resisting the germ
theory of disease and aseptic techniques.

The emergence of a strong public health movement
in the 19th century, coupled with the Settlement House
Movement, created a new vista for independent and au-
tonomous nursing practice. The Henry Street Settlement,
a brainchild of a recently graduated trained nurse named
Lillian Wald, was a unique community-based nursing
practice on the lower east side of New York City. Wald
described these nurses who flocked to work with her
at Henry Street Settlement as women of above average
“ intellectual equipment,” of “exceptional character, mentality
and scholarship” (Daniels, 1989, p. 24). These nurses, as

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4 Unit 1 •  tHe evolUtion of ADvAnceD PrActice

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