A New Order of Things

Origins of a Nurse Practitioner Movement

By Cynthia Freund

316 pp., 6 x 9, 1 halftones, 4 figs., 4 maps, appends., notes, index

  • Paperback ISBN: 978-1-4696-7286-1
    Published: August 2022
  • eBook ISBN: 978-1-4696-7287-8
    Published: August 2022

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Distributed for the University of North Carolina at Chapel Hill School of Nursing

Nursing practice changed dramatically in the mid-1960s as experiments across the country demonstrated the effectiveness of nurses’ expanded diagnostic and decision-making authority. The result was a new breed of nurse, the nurse practitioner.

In A New Order of Things, Freund takes readers through that evolution. Beginning with a demonstration project at the University of North Carolina, leading to the emergence of an innovative nurse practitioner training program, the siting of rural clinics with nurse practitioners as the primary providers of health services, a consortium of nurse practitioner training programs spanning the state, and ultimately to a movement: a new order of advanced nursing practice and primary care service delivery.

A New Order of Things is unique in that it documents a history with contemporary relevance, a case study illustrating how a major innovation was strategically engineered toward adoption at the organizational, health system, and state levels. Using multiple sources of historical records and 36 hours of interviews with leaders of the N.C. nurse practitioner movement, Freund illustrates how change leaders formed alliances in a politically nuanced process, thought ahead and of the present moment simultaneously, were adept at recognizing subtle clues and nimble enough to take advantage of opportune moments.

This story is N.C.’s story, but it is far more than that. It is a story for any health professional striving to make change in health services and move an innovative idea into widespread adoption.

About the Author

Cynthia (Cindy) Freund retired as Professor and Dean Emerita of the UNC at Chapel Hill School of Nursing. In the seventies, as a nurse practitioner, she worked with the UNC nurse practitioner leaders for eight years, serving as Director of the N.C. Consortium of NP Programs.
For more information about Cynthia Freund, visit the Author Page.


"Freund vividly brings to life her own and others’ lived experience through captivating first-person accounts of why and how North Carolina’s first nurse practitioners were ushered into being. Her rich narrative, contextual insights, and retrospective analyses are both revelatory and instructive to contemporary nurse practitioners. The levers of change deftly used by Freund and her co-creators—collegial relationships among and between nurses and physicians; professional organizational policy development; and strategic connections to political power—are just as relevant and basic today. Freund’s retrospective is a reminder that North Carolina nurse practitioners have yet to fulfill the potential of our extraordinary origin story. It is simultaneously a tribute to our remarkable past and a thunderous call to action for full practice authority."—Gale Adcock, FNP, NC House Representative

"This historical account of one state’s journey to introduce an expanded role for qualified nurses is exceptionally well written, interesting in its detail, well documented, and historically valuable—not only as a historical piece, but also as a great teaching tool. It lends itself to analyzing, synthesizing, and applying a theoretical framework of change and other theoretical constructs. This story of change describes in detail the strategies, logistics and tactics (personal, professional, political, and social) of a change process that was successful."—Dr. Loretta C. Ford