On the Job

Nurse Practitioners at Work in the Early Days of the Profession

This article originally appeared in the November, 2017 edition of Connections

By Celia Johnson
CANP Correspondent

Forty years ago, according to Janet Mentink, if you were thinking of becoming a nurse practitioner, it was like heading out to the Wild West. Mentink was one of the early graduates of the nurse practitioner program at UC Davis. As she recalls, “We made it up as we went along.” It was brand new territory, and with no precedent. When asked whether she thought she could do things that only doctors had done before, Mentink replied, “Well, sure, they weren’t born knowing that!” Mentink went on to become a faculty member at UC Davis, and later the director.

The program at UC Davis grew from an overwhelming need in rural areas. Previously Mentink hadn’t thought of herself as an adventurous person, but on the job, as a faculty member at UC Davis, she spent much of her time on the road, working with emerging nurse practitioners, teaching and recruiting, going to places she’d never been. Mentink remembers navigating treacherous mudslides on a Native American reservation in an only somewhat reliable car, among many other adventures. She covered Northern California, all the way over to the coast. And, as she says, “I loved it!” Mentink worked at UC Davis until she retired in 2002.

Mentink’s Wild West sentiment is shared with other early California NPs. Shelly Stewart, early UC Davis graduate and faculty member, and California Coalition of Nurse Practitioners (CCNP) member, observes, “We were just trying to be recognized by the ‘establishment.’” (The California Association for Nurse Practitioners was originally called the CCNP, and the CCNP grew out of the UC Davis program.)

There was a lot of pushback against the nurse practitioner field, from doctors, fellow nurses, and that difficult establishment. In the Ukiah Daily Journal, in 1978, one doctor proclaimed, “I cannot see the use of anyone other than a trained physician as being qualified to examine, to treat or to follow a patient’s care.” Mary Margaret Baker, CCNP’s first president, confirms, “So many doctors didn’t want to participate. They felt we would take over their business.”

At every turn, it seems, the critical and much needed new field of nurse practitioners was obstructed. Early CCNP member and NP Elinor Peters says, “The obstacles were numerous. CMA fought us on all legislation.” Joan Hankin, who served as second CCNP president, notes, “The field was new. Physicians were threatened and anxious that nurses could do tasks for much less salary. It was tough for NPs to get positions.” Mentink remembers that, when she was getting clinic experience at a private practice in Sacramento, a letter arrived from the attorney general’s office. The letter stated that the practice must cease and desist working with or training NPs. Still, thankfully, they all carried on!

Hankin’s clinical work took place at the beginning phase of the AIDS epidemic in San Francisco. She notes, “We had no idea what was causing many men to die. We launched new roles of NPs in understanding and assisting in the treatments.” Hankin shifted later to health care technology, an area where she was worked for the past 17 years, paving the way for advances that improve our health care system globally.

Joanne Trolinger graduated in the second NP class at UC Davis and also went on to teach for the university. She describes a poster from the time that illustrates what NPs were up against. The poster had a headline that read: “Don’t be seen by quacks.” Below was a picture of a duck and a nurse practitioner.

Trolinger was inspired to become an NP to expand her skill set in order to help with her work at a clinic that served migrant farm workers. Trolinger notes about going into the NP field, “You weren’t going to make money, but you loved it.” After graduating, she recalls walking into a job with her ophthalmoscope and other items in a bag, and a doctor saying, “What have you got in that little purse?” That job, as she says, was “not going to work!”

Trolinger moved to UC Davis’s Salud Clinic, working with underserved communities, and encountered wonderful doctors and fellow NPs there. She has enjoyed teaching, and continues to teach and practice. “It’s been a great life,” she says. Last year, she attended a CANP meeting and was impressed to see how much the organization has grown, from a handful of fledging NPs to the great community it is today.

Many articles at the time focused on educating the public about this curious new role in the nursing field. Headlines read: “So what is a nurse practitioner?” and “Nurse image undergoes change.” In fact, when asking many early NPs about the practice at that time, a recurring theme emerges: They were all tasked with helping to define the very field they worked in. These NPs needed to explain how they fit in and prove that they were capable. The Woodland Daily Democrat, in 1972, published a feature piece on NPs and the pioneering students at UC Davis. Vicki McKee, one of those students, told the paper, “I don’t look upon myself as a frustrated physician and I’m not interested in becoming a junior doctor. I think traditional nursing is on the way out and that all nurses will be trained as we are.” This new area in health care produced a versatile group of professionals. Nurse practitioners could also use their skills in non-clinical settings.

Despite the difficulties inherent in the job, these early NPs did not waver—and they maintained a positive spirit throughout. Stewart describes those years as “challenging and fun times!” An NP was a special type of person (and still is!). They were adventurous and committed. Stewart notes, “At the time, nurse practitioners were seen as being ‘different,’ sort of stepping out of the mold, and, as such, did not readily buy into joining or conforming.” Because there was little definition, it was essential for NPs to band together, if they were to forge ahead without being shut down. Stewart notes, “We kept the group together (referring to the CCNP), as we knew we were stronger if we could accomplish that goal.”

One of the key strengths of early NPs was that, despite their differences and various specialties, they worked together to achieve great things. When asked about early years on the job, Baker noted a key collaboration. Baker was on the advisory board for NSO (Nurse Services Organization, which provides malpractice insurance to nurses and nurse practitioners.). That advisory board worked with NSO to educate their carrier partner on the role/scope of practice for NPs and, ultimately, to provide professional liability insurance to NPs. As Baker says, “It obviously has been a fabulous partnership!”

NSO president Michael Loughran couldn’t agree more. He was first introduced to CANP when it was still CCNP, in the early 90s. He recalls, “Mary Margaret, one of our board members, encouraged us to develop a product for NPs.” And, as a result, NSO wrote its first NP policy in 1992 and continues to provide professional liability insurance to NPs today. After that success, Baker connected NSO with CCNP. CCNP chose to be one of the first association groups to endorse NSO. And for decades now there has been a wonderful synergy between the two groups, including a longtime partnership through which NSO serves to this day as the supporting sponsor for CANP's annual conference.

Again, it was a matter of defining something new. Loughran points out that the support of CCNP helped NSO gain the confidence of a carrier, and thus provide essential coverage for NPs. Loughran was recognized by CANP for his support in 2006, when the organization named him as its NP Advocate of the Year. Baker adds, “Michael has been great all through the years.”

Forty years ago, NPs had to master so much more than simply becoming a nurse practitioner. They defined their roles as they went along. They were adaptable—they had to be. They had to fight for protection and recognition. Consider Baker, who worked tirelessly to create a foundation for the field, in her work as the first CCNP president and on several advisory boards, among many other efforts. Baker also started her own company, Chicken Soup Plus, a home health agency and nursing practice. She ran Chicken Soup Plus for 22 years. Baker recalls, “The department of health was two or three blocks from my office.” Eventually, after establishing the business, Baker would walk right over and knock on the door of the department of health to talk about issues like reimbursement. She says, “It was hard work, but we were all dedicated.”

As we celebrate 40 years of CANP, it’s awe-inspiring to consider the work that went into paving the way for generations ahead, and all by a group of good-humored, determined renegades, who weren’t about to let a series of obstacles stand in their way.