IntraHealth’s Barbara Stilwell has been named one of the top 20 most influential nurses of the last 60 years by the UK’s Nursing Times. She earned the award because she developed the first nurse practitioner training program in the UK. As part of the weekly magazine’ s coverage of the 60th anniversary of the National Health Service, the publication identified and revealed the list of 20 nurses at a special celebration in London on Thursday, December 4.

Originally from the UK, Stilwell, Director of Technical Leadership for IntraHealth, saw the need for nurse practitioners through her first job after earning her nursing and public health nursing degrees. “I was working in the inner-city in Birmingham which had a population predominantly from the Asian subcontinent—India, Pakistan, Bangladesh—and it struck me that many of them were coming to consult the general practitioner about things that essentially weren’t very medical,” Stilwell said, noting, for example, that many asked for advice such as where to get their children immunized. She added, “It seemed to me there was a gap. You needed someone who could spend time with people, especially those who had language barriers. You needed someone to listen to them and help them sort it out.” 

Stilwell particularly remembers a female patient from Pakistan. “She had come to England to join her husband, and she hardly spoke a word of English, and she had complained she could not swallow properly,” says Stilwell. The doctor had referred the woman to hospitals throughout Birmingham to investigate her health issue, but no one had diagnosed the problem, so the patient kept returning to the general practitioner. He finally asked Stilwell to see her. “He essentially said, ‘I can’t get anywhere, I am washing my hands of her.’”  

Unsure whether she could help, Stilwell began to ask the patient general questions about the symptoms. “I established that she felt a lump in her throat, and through an interpreter, I asked her, ‘Did anything happen at about the time that you first felt the lump in your throat?’ and she said ‘Yes. My husband died.’ So I then said to her, ‘Did you know that in England people say they have a lump in their throat when they are very, very sad about something?’” Stilwell says the woman burst into tears. Stilwell explains that the woman could not go back to Pakistan, had lost her husband, had very few friends, and “she was grieving and didn’t know how to grieve because she was trying to be strong.” She just needed someone to take the time to look beyond the symptoms and see the context, says Stilwell. This experience and others helped Stilwell form her vision: “They convinced me that people could get a lot out of nurse practitioner care.”  

It was about 1979 that Stilwell heard about nurse practitioners in the US, wrote an article about the need for them in the UK and was subsequently offered an award to study in the US to be a nurse practitioner. Stilwell went through the University of North Carolina (UNC) at Chapel Hill’s nurse practitioner program, which made a huge impact on her. “In England, at that time, there was a very old traditional attitude toward nurses—nurses were traditionally women; doctors were men. I did a survey of what nurses did, and many did housekeeping types of things. Here in the US, nurses had broken out of that—doing PhDs, research. I’d never seen anything like that, and it was such an inspiration. It really changed my life.”  

After her UNC training, Stilwell vowed to break nurses’ traditional mold in England. 

“When I went back to England I was absolutely fired with enthusiasm because I realized the nurse practitioner program could really meet a need.” She went to the Department of General Practice in Birmingham to talk to them about the need to start a nurse practitioner program, and “it just so happened that one of the guys there had just come back from UNC, the Department of Family Medicine, and he thought it was a great idea.” 

Together they did research on it—they set up a program in a general practice in Birmingham, where nurse practitioner care was offered to any patient who wished it. A study evaluated patient attitudes, nurses and physician attitudes and safety of the care given, over a three-year period. Results were published in the Journal of the Royal College of General Practitioners and used widely to influence ongoing policy reviews in the National Health Service.  

Publication of the research led to the Royal College of Nursing Institute requesting Stilwell to set up the first program for training nurse practitioners. It began in 1990 with 15 students, and by 1993 more than 75 were being recruited into each cohort, and franchises with two other universities were being negotiated. Stilwell continued practicing as a nurse practitioner, working with homeless people who had no other access to care.

She says the program got a lot of publicity, and she was asked to speak on it frequently as there were lots of questions and controversy about what nurses were allowed to do. “The thing that kept me going was I really believed I was right—that nursing had a lot to offer in terms of what patients wanted, and that it was safe,” she says. “It was a very early example for me of task shifting.”  

Today, nurse practitioners are still a strong cadre of health workers in the UK. And Stilwell’s early interest in improving access to care for disadvantaged people led to international work with a number of organizations, including the World Health Organization and Liverpool Associates in Tropical Health, for whom she served as a senior advisor to the IntraHealth-led Capacity Project.  

For more information on Barbara’s award, please go to: http://www.nursingtimes.net/This_weeks_issue/2008/12/nursing_champions__the_nt_diamond_20.html