Catherine Luria, an AAPPN member who is possibly the first nurse in the United States to receive prescriptive authority solely from a Board of Nursing without input from medicine or pharmacy boards. Her reflections on her early days in advanced nursing practice also provide a timeline for the development of autonomous practice in Washington State.
AAPPN: You’ve had a long and productive career. How did you start out?
Catherine Luria: I started my life as an advanced practice nurse in 1969 at the Rochester Neighborhood Health Center as a public health nurse. Our practice was located in the inner center, and the neighborhood had witnessed riots just the year before. The nursing staff were the “generalists” on a multidisciplinary team. We saw patients both in the pediatric and OB clinic, as well as in their homes. We taught childbirth education classes and accompanied some of our extremely young pregnant patients (13-16 years old) through their delivery.
My mandate for that time was to “Create a New Role for Nursing.” At the health center we were functioning more and more in the role now termed nurse practitioner. I was fortunate to learn from Barbara Bates, MD, who was instrumental in developing the role of the nurse-practitioner, and who wrote a guide to patient history-taking that has become the standard text for health practitioners and medical students. After attending her six-week program, I was able to arrange for Dr. Bates to teach her physical assessment course to all of us at the health center, using a mimeographed version of her textbook! It was a very exciting and heady time.
AAPPN: You moved to Washington in 1976. How was the Washington nursing environment different from where you worked before?
Catherine: Nurse practitioners were quite rare when I started in Washington. I found that I had to explain my role over and over, but with time the public became more used to seeing the ARNP instead of the MD. I think patients were pleased to have longer visits. I had a lot of advanced practice experience before moving to Washington, so I think I had a confidence level that helped patients accept me.
I was really fortunate to be in the right place at the right time to be involved in the evolving NP role—to begin to expand my practice at the very beginning of the NP movement. And, of course, receiving prescriptive authority was very helpful in that.
I soon saw the need to continue my education in psychiatry. I was seeing patients with histories of abuse, as well as treating them for depression and anxiety as part of their regular health care. For many people, receiving care in the “family doctor’s office” was more acceptable than being referred to psychiatrists, who were in scarce supply.
AAPPN: You helped work on the rules and regulations that implemented the complete prescriptive authority law passed in 2001. What was your role?
Catherine: I worked with two other nurse practitioners and between the three of us, we attended every hearing in Olympia as the rules were being developed.
We didn’t have a copy machine, so I used our IBM typewriter to write up the results of the meeting. I would send out the onion skin copies to 10-12 other nurse practitioners for their review. We would then send our comments and recommendations to the Board of Nursing.
Fast fact: Did you know Washington was the first state where the Board of Nursing was autonomous in granting prescriptive authority? Our state continues to be a leader in autonomy in nursing practice.
It took perhaps two years to get the rules and regulations written. I was fortunate to receive license 0000001 – and could finally write my own prescriptions.
AAPPN: Where was the most exotic place you practiced nursing?
Catherine: In 1975, as a member of the US Public Health Service, I served as one of four medical providers in a bush hospital above the Arctic Circle in Kotzebue, Alaska. This experience stretched me to learn more and more. In addition to working in the out-patient clinic, I admitted patients to the inpatient section, delivered babies, and learned to hand-dip x-rays.
AAPPN: And lastly, what words of advice can you share with our Students members or recent graduates?
Catherine: It is extremely important for new grads to be involved in your professional organization. Besides the support and interesting programs, the presence of our lobbyist in Olympia is important. With all the challenges and changes in health care, it is important to keep ourselves up-to-date and “at the table” to be involved and consulted as decisions are being made which affect our patients and potentially our practice.