In 1975, while pop culture was obsessed with pet rocks and bellbottoms, a quiet revolution was reshaping the landscape of American healthcare. The time was ripe for an entirely new kind of medical professional: the nurse practitioner (NP). This role wasn’t designed to replace existing nurses or physicians; rather, it served as a vital bridge closing the expanding gap between patients and healthcare access during a time of a national physician shortage.

At the forefront of this movement were trailblazers like Judy Collins, WHNP-BC, RN, FAAN, who established what is now the VCU Women’s Health Center through the university's burgeoning NP program. Simultaneously, Barbie Dunn, Ph.D., PNP, RN, stepped up as president of the National Association of Pediatric Nurse Practitioners, and Ginger Edwards, FNP, joined VCU’s inaugural family nurse practitioner cohort.

The Rise of the NP

Following early NP programs launched in Colorado and Kansas, the educational trend rapidly caught fire in Virginia. VCU, having started the state's first nursing graduate program in 1968, launched the commonwealth’s first NP certificate programs in family care and OB/GYN by the mid-1970s. Programs in pediatrics (1976) and gerontology (1984) soon followed, before transitioning into full master's programming in 1985.

For early pioneers, the path was thrilling but uncharted. Friends of Ginger Edwards even questioned what she would do if the entire NP concept failed to catch on. Though uncertain about the program's future, she eagerly absorbed the vast new knowledge it offered.

“I never would have dreamed it would become what it has become,” Edwards says. “It still blows my mind.”

Overcoming the Skeptics

Breaking the mold meant facing resistance. After earning her certificate, Edwards worked part-time in rheumatology before moving into an inpatient cardiology department.

“There were so few of us,” she remembers. “Nobody knew what to do with us. The physician who hired me was obviously very supportive, but there were other physicians who were either kind of befuddled or appalled that I was there doing things that the physicians had been doing. Not all of it, obviously. But they learned. They figured out I was actually pretty helpful to have around.”

One major ally was Dr. George Vetrovec, an innovator who directed VCU’s Adult Cardiac Catheterization laboratory for 39 years. Vetrovec immediately recognized the value of adding NPs to his team. Despite others' varying opinions, he boldly embraced the idea of changing the traditional care model.

“Nurse practitioners were smart people,” he says. “They were well educated. We tried it, and it worked very well. Nurses work very well with patients in general. That’s a big part of their training. There was some anxiety when we started having nurse practitioners take care of sick patients. I remember saying, ‘It’s kind of easy; you, as a nurse, have always decided whether somebody’s sick or not, and how sick they are, and do I need to call the doctor right now? This is the same thing.’”

Over time, physician relationships strengthened, anxieties faded and Edwards eventually found herself supervising 13 to 14 nurse practitioners.

Writing the Rules of the Game

In those early days, many NP programs relied on federal grants aimed at delivering healthcare to vulnerable populations. But while these grants required physicians and NPs to act as co-directors, actual state and national guidelines didn't exist. This new category of nursing professional urgently needed formal laws, regulations and program approvals. By necessity, faculty involved with NP programs played a part in formalizing laws and regulations around the new role.

“The Board of Nursing in Virginia ended up having an advisory board that included nurses and doctors,” Judy Collins remembers. “The advisory board was quite helpful because nurse practitioners and physicians had honored this new way of practicing. Several of us had an opportunity to serve, and I was the first nurse practitioner on the board.”

By stepping into governance, NPs became powerful, albeit unwitting, lobbyists for their profession. Collins leveraged a Robert Wood Johnson Health Policy Fellowship in Washington, returning energized to amplify her political involvement. She founded the VCU Health Policy Office, which benefited the schools of nursing, medicine, dentistry and pharmacy.

“We were beautifully positioned to bring legislators in to see what was going on and how we were doing it,” she says.

Her advocacy culminated in a massive 1991 victory: securing prescriptive authority for Virginia NPs, who previously could only write prescriptions for a physician to sign.

Barbie Dunn—a colleague of Collins and a graduate of UVA's first pediatric NP master's program—recalls how she and her colleagues were creative in care provision to collaborate most effectively with physician colleagues, which speaks to the long-acknowledged creativity of nurses. “At that time, I was working in a free clinic doing physicals and immunizations for homeless kids to get into school. I had a backup pediatrician at VCU who supervised me from afar,” says Dunn.

Problem Solvers and Future Changers

These NP trailblazers laid the foundation for today's dynamic change agents.

“We’re problem solvers, those are the people who get attracted to nursing,” says Lana Sargent, Ph.D., RN, FNP-BC, GNP-BC, FAAN, associate professor and associate dean for practice and community engagement. “We see a problem, and we want to fix it.”

Modern NPs are anchored in a framework of holistic care, viewing patients beyond mere biological disease states to include their community, culture and access to food.

“So, if there’s a barrier to someone getting healthy food, for example, we’re going to go after that, and problem-solve until we can get their diabetes under good control. We don’t see logistics as barriers. We see them as problems that need to be solved or things we need to work around, or we just push forward, and someone else is going to catch up with us.”

The VCU School of Nursing remains deeply committed to this legacy of patient care and student success.

“We have a long history of people who have advocated and shown up,” says Patricia Kinser, Ph.D., RN, WHNP-BC, FANN, Doris B. Yingling Chair and Distinguished Professor, and dean of the VCU School of Nursing.

“Time and again, we’ve proven that nurse practitioners enhance healthcare, quality care and patient satisfaction. I am so grateful to our alums and our former faculty who did that initial work to move us forward.”

Today, the educational standard is the rigorous Doctor of Nursing Practice (D.N.P.) program.

“Now we only educate our nurse practitioners at that level, which is important because we’re helping our students not only become expert clinicians, but also change agents,” says Kinser.

“They are learning how to identify problems and solutions, and to stand up for change that they see needs to be made in order to create a better future for our patients and for our communities. That’s the thing I’m most proud of.”

This impact is highly tangible. Recently, D.N.P. students successfully reduced post-hospital discharge appointment wait times from 21 days to just two weeks.

“That might seem insignificant to some,” Kinser says, “but if you think about yourself as a patient and having that follow-up appointment for something very significant in your life, it’s critical.”

Always a Nurse First

Whether navigating the uncharted waters of 1975 or driving clinical innovations today, the core philosophy remains unchanged: thinking about the patient is the hallmark of the profession. As Kinser, Collins, Dunn and countless others affirm, nurse practitioners are nurses first, no matter the moniker.

Just ask VCU alumna Hannah Padgett, M.S.N., APRN, FNP-C, a former cardiac surgery nurse who celebrated her one-year anniversary as an NP in September 2024. After a year of learning the ropes, she felt completely at ease in her role. And, staying true to the spirit of the trailblazers before her, if she ever encounters a question she can't answer, she knows exactly where to find it.