national health needs and to promote community based continuity of care. The NP provided important access in areas of physician shortages in primary health care (Cukr, 1996). In 1965, Loretta Ford, a nurse, and Henry Silver, a physician, developed the first NP program to improve access to primary health care services. During the next three decades NP certificate and graduate program proliferated in the United States with an expansion in to multiple specializations (Nagelkerk, 2006). The formalization…
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