Setting a Foundation

Organization's First Officers Reflect on Challenges in Breaking New Ground for NPs

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

By Celia Johnson
CANP Correspondent

As the California Association for Nurse Practitioners celebrates its 40th Anniversary, we wanted to hear firsthand from the original officers how this organization came to exist. We spoke with Mary Margaret Baker, the founding president; Fiona Shannon, who served as secretary for two terms; and Joan Hankin, the second president.

At the time, the association was called the California Coalition of Nurse Practitioners (CCNP), and these officers were part of what they called a “core committee.”

To bring together nurse practitioners from different fields and form the CCNP was no easy task. Plus, the odds were already stacked against them. It was a brand new field. Few people had even heard the term “nurse practitioner.” Many physicians felt threatened by nurse practitioners. But, as you’ll see, these women, remained steadfast and unflinching.

Unsurprisingly, they all went on to impressive careers in health care and nursing fields. Baker launched her own home health agency and nursing practice called Chicken Soup Plus, a California corporation. In 1986, Time Magazine featured her in an article as a groundbreaking entrepreneur. Shannon moved to Washington in 1982. There, she continued her work as an NP and went on to serve on the faculty of the University of Washington. Hankin practiced clinically for about a decade, before moving into management and marketing. In 2000, she moved over to technology. She is now the Global Director of Marketing and Business Development, Health Care Life and Sciences, for the Intel Corporation.

Mary Margaret Baker, President, 1977 – 1979

You and a group of fellow UC Davis students and faculty members came up with the idea for the California Coalition of Nurse Practitioners at a pool party in June of 1977. How did you lay the groundwork for the first meeting?

It was a very intense few months before that meeting. We decided to call it a coalition so that we could include all of the different NP groups. We didn’t want to offend anybody. We wanted everyone to feel comfortable joining, and people had great identity with their own group at that time.

In October, just five months after that pool party, the first official meeting of the CCNP took place at the UC Davis campus, and that’s when you were elected president.

I was actually shocked when I was elected president (we called it chairperson). There wasn’t even a vote! There was the nomination and everyone just acclaimed it. So I was shocked.

Did you know what you were getting into?

Not really, but I take on a task and I move forward. That’s how I am. My charge was to march forward and organize.

What was the biggest challenge you had to tackle as president?

The biggest challenge at that point was figuring out how we would get any money.

Were any people particularly instrumental in helping you achieve that goal?

Yes, Ferd Mitchell and Hughes Andrus MD, who were both at UC Davis.

Hughes was the original chair of the Family Practice department at UC Davis, but he also ran the Foundation of Comprehensive Health Services. That foundation received funding from a Robert Wood Johnson grant to set up rural clinics in California. They would take nurses from rural communities and bring them into UC Davis once a month. That was how our program at UC Davis began.

In the beginning, as students at UC Davis, we all came together once a month. We would go by systems in the body, maybe first overall health care, then cardiovascular, and so on. Every month we did a system, and that took a year. Then we had a six-month long internship, with a physician as a mentor. We’d work in a practice and see patients.

Ferd Mitchell was the main lecturer for our master’s degree program at UC Davis. He was really inspirational and smart. He encouraged everybody, let’s put it that way. After that meeting in October, Ferd said, “Let me see if you can get some kind of a stipend from Hughes from the Foundation for Comprehensive Health Services.” We were given a $1,000 stipend, and we used that to get to the next step, which was to host a conference in Monterey, March 1978.

That’s quite an accelerated approach, planning a state-wide conference that would take place five months after your first official meeting!

What can I say? I’m an ambitious person!

Fiona Shannon was right there with me every step of the way. We lined up speakers, we sent out mailings. We kept drawing in members. We used to meet at Fiona’s house to stuff envelopes. One of my friends, Fred David, would come over and help stuff envelopes, too. He was president and CEO of a wholesale candy and tobacco company in downtown Sacramento called David Candy.

Did he bring candy?

Sometimes he did, because I twisted his arm.

How did you assemble your mailing list?

We were members of the California Nurses Association, because Kaiser had their contract. So, we were able to get the mailing list from the California Nurses Association. Hand in glove, it was very critical, getting that list together. We kind of piggybacked on the California Nurses Association. We called each school of training in California and tried to get their list, too.

I was on the state interest group for nurse practitioners that met in San Francisco. My involvement there gave me the idea, later, when we got our meetings going, to include a California Nurses Association interest group. We got a little funding through that, too, to help send out the mailings.

How did you feel about that first conference?

It was a successful conference. Coming from a graduate class at UC Davis, to a bigger group of around 100 that first year, was a big deal.

Fiona Shannon, Secretary, 1977 – 1980

How did you become involved with the NP program at UC Davis?

As an undergraduate at Sac State, I worked for Kaiser Health Appraisal clinic in the evening. That clinic used nurse practitioners to do annual physicals. I became interested in the NP role and the UCD program at that time. When I graduated, I went to work in a hospital. Then, a couple of years later, I got a call from Charles Henriques, the  physician who trained the nurses in the Kaiser nurse practitioner training program, asking me if I still wanted to become a nurse practitioner.

So I went to work for Kaiser in 1973, and started the NP training. There were about 10 nurses training with me. Kaiser provided a six-month program learning physical examination and assessment. We were tested at Kaiser facilities. The agreement or understanding was that we’d also apply to the UC Davis NP/PA program.

What was it like for NPs in those early days?

There were no laws or regulations in place to define a nurse practitioner at that time, even so, working in California at Kaiser, that role was pretty secure. The patients in that facility all knew what nurse practitioners were and what they did. Outside of Kaiser, NPs weren’t well known and CCNP made marketing nurse practitioner a goal. When I came to Washington in 1982, it was hard, as an outsider, to find other nurse practitioners. At that time there was no state NP organization, no obviously networking. However, Washington had a legal definition for nurse practitioners and they had prescriptive authority. This was a striking difference to me. The State of Washington recognized the nurse practitioner role and encoded regulations to protect it.

What was one of your tasks, as secretary for the CCNP?

I ran the newsletter, wrote letters to other small NP groups, contacted NP programs to enlarge our mailing list, as well as work on the conference. I remember typing up the newsletter, and then spreading out on my living room floor the letters to be mailed, attaching mailing labels and then dividing the newsletter by zip codes, all to get a discount on the bulk mailing.

You were instrumental in pulling together that first conference together with Mary Margaret Baker.

Mary Margaret Baker was a strong leader. She was amazing. We worked together well and our goal was clear. We kept our fingers crossed that all the speakers would show up and that nurse practitioners would attend. When I think about the meeting and that the tools of the trade were the telephone, the typewriter, and letter writing, I am amazed that all went so well.

Conference planning was new for me. I learned a lot about conference planning from our work on this initial meeting.

What stands out to you about that first CCNP conference?

It was an amazing experience to pull together a diverse group of mostly women who wanted to be, what I call, pioneers. They were interested in education, because it really wasn’t available for nurse practitioners at that time. They wanted to talk with other people about their practices. The networking part of that first conference was amazing. People had so many stories. They supported each other, offering tactics and ways to enhance practice. It was a pretty amazing gathering of people. For participants, that experience helped broaden your mind about the possibility and the scope of your work, because you saw how others worked in all different parts of the state.

Joan Hankin, President, 1979 – 1980

What was your affiliation with the NP program at UC Davis?

I remember when I first became a nurse practitioner. The San Francisco Bay Area is pretty progressive, as far as health care is concerned, but nurse practitioners really were not utilized at all. I graduated in 1980, in one of those earlier NP classes. I went to the UC Davis Stanford cooperative education program, where they educated physician’s assistants and nurse practitioners. The program was excellent. It was the best thing I ever did.

Then I had to go out and find a job, and it was interesting, the comments you got, like, “Oh, wait, nurses can do things that physicians do?” Physicians felt quite threatened in those days, that their jobs would be taken over by nurse practitioners.

One of my first jobs, aside from NP, was at the University of California San Francisco, with a Robert Wood Johnson Foundation grant, bringing back primary care to a tertiary center and allowing residents and physicians to help learn how to work with nurses. That was a fun role, and it was extremely successful.

How did you become involved with the CCNP?

I became involved with the CCNP after I’d finished school, through Mary Margaret Baker. We worked together at the time.

I remember that we wanted to get Nurse Houlihan from M*A*S*H* to be a speaker. I got ahold of (actress Sally Kellerman's) agent and he said, “You know, she really doesn’t know anything about nursing.”

When you joined did you expect to become president?

No. There were just so few people. There was an NP, Jo Hubbard. She lived here in the Bay Area. She was on a medical mission to Mexico through Doctors Without Borders and tragically died in a plane crash. She was going to be CCNP president. She and I were working on a lot of things together, and there were things I knew she wanted to carry out, so I stepped in to help things move forward.

How did you help grow the organization as president?

We started to bring even more cohesiveness to the group. We continued to increase membership and market the organization, particularly branching out to Southern California. We had a successful educational Monterey Conference, which was one of the first of its kind for NPs in the state of California. We launched a discussion about initiating a lobbyist to represent the group. We also established the Jo Hubbard Memorial lectures. She did a tremendous amount for the group and her death was a real tragedy.

What did you see as CCNP’s role in the industry during your tenure as president?

CCNP over the years evolved as an agent to help legislation come to fruition. In the early years, though, it was a matter of defining ourselves and marketing what we did. NPs were a small group that consisted of all different types of nurses. If you were an NP at that time, it was sort of like being a medic in the army. With enough training and seeing things over and over again (I was a trauma nurse in the ER), NPs could treat common problems. And yet it was a big deal if a nurse practitioner put out her own shingle. Very few physicians would hire them. Universities would, progressive physicians would. Through CCNP, we did what we could to help people understand who we were and what we did.

This is the second installment in a series about key figures and events from the beginning days of what is now known as the California Association for Nurse Practitioners. Read the first story in the series, and look for additional features in upcoming editions of Connections as CANP marks its 40th anniversary.