In Canada, the nurse practitioner role was well established as early as 1972. Patients were receiving first-contact primary clinical care from nurse practitioners as safe, effective and satisfactory as from family physicians (Spitzer et al. , 1974, p. 255). Canadian nurse practitioners often found themselves isolated in the profession but they continued to evolve until the mid 1990s (Haines 1993, p. 17).
In 1977, the 30th World Health Assembly prompted the world’s health ministers to adopt the “Health for All” goal, a resolution that focuses WHO’s (World Health Organization) and governments’ target by the year 2000 on the attainment of a health level that would permit every citizen throughout the world in order to become socially and economically productive in life (WHO, 1983, p. 1).
The goal is considered as a process that would lead to the progressive improvement of all people’s health (WHO Expert Committee, 1984, p. 9). In 1978, primary health care (PHC) was conceptualized in the Declaration of Alma-Ataas as the key to the attainment of health for all. PHC was defined as essential health care that was made accessible to all individuals and families at a low cost through the use of socially acceptable, scientifically sound, and practical technology and methods (WHO, 1979, p. 3).
In the early 1980’s, family nurse practitioners have also emerged in some Caribbean countries (Land, 1998). Nursing practice in New Zealand focused on primary health care and it continued to evolve to support the New Zealand Nursing Council and the Nurse Executives of New Zealand by providing individualized and attempting to formalize advanced practice programs or roles with some differences from those in United Kingdom.
The role of nurse practitioners was not based on policy framework which made the nurses to call themselves ‘nurse practitioners’. However, it has lead to confusion so the National Health Service in the United Kingdom reassessed the nurse practitioner roles and developed policy initiatives across the health care system in the late 1990s (Lumby & Picone, 2000, p. 44).
In 1991, family nursing in the United Kingdom has shifted from caring in hospitals and institutions to the community in which families had severe health problems and the National Health Service in Scotland made a provision that health care should be available for patients with continuing needs and that nurse should maintain partnership with their patients and other organizations. Due to high rates of mortality and morbidity in the United States and in developed countries, governments have recognized the greatest need to improve mothers’ and babies’ health through the help of nurses.
This health issue paved the way to the implementation of primary health care and community-based services for women and community by family nurses and midwives (Andrews & Janet, 1996, p. 60). Nurse practitioners (NPs) have received significant attention in Canadian and Australian literature focusing on issues such as considering that “all nurses are practitioners of nursing” and the term “practitioner’ is a term that has been historically reserved for doctors” (Haines, 1993).
The Nurse Practitioner Project in New South Wales has led to a nursing profession debate about the advanced practice of nurses and prompted the Lamp editorial to include this issue in August 1994. While some nurses viewed that the Project was not that interesting, others thought otherwise since it was challenging to the nursing profession in developing research regarding its evolution.