Imagine embarking on a mission that would transform one of the cornerstones of American health care: The role of the family doctor.
That was the challenge University of Florida College of Nursing professor David Williams, MSN, PhD, faced more than 40 years ago when spearheading the creation of the nurse practitioner program at UF. While nurse practitioners are now an integral partner in the health care system, in the late 1970s and early 1980s allowing anyone but a physician to diagnose or prescribe treatment was unthinkable, particularly to the physicians.
This year, the program celebrates the 40th anniversary of the inaugural class of what is now the Doctor of Nursing Practice program.
“We faced significant resistance from physicians. Many saw the expansion of nurse practitioners as a threat to their territory, especially as the medical field was evolving to accommodate physician assistants,” Williams recalled.
But in the late 1970s, health care in the United States faced a critical challenge. The traditional “family doctor” model, which had been the cornerstone for generations, was rapidly disappearing. A shortage of physicians, particularly in rural and underserved areas, left many patients struggling to access care. Recognizing this, the Robert Wood Johnson Foundation set out to find a solution.
The foundation identified a University of Colorado project that trained registered nurses to provide primary care services. Nurses received additional training in pediatric care, and researchers found the nurses were able to diagnose and treat 90% of the conditions presented.
Inspired by the Colorado program, the Robert Wood Johnson Foundation funded a fellowship program aimed at training nurse faculty members to become leaders in primary care. Over the next five years, 20 nurse faculty members from across the country were selected to participate in this fellowship, preparing them to return to their institutions and create nurse practitioner programs of their own. One of those selected was Williams, who traveled to the University of Maryland in 1978 to attend the fellowship.
“At the University of Maryland, I began my own journey, using the university’s clinics and Johns Hopkins Hospital to gain hands-on experience in pediatric care,” Williams said. “But the challenge wasn’t just about training. It was about establishing a new practice model that some weren’t quite ready for. It was an entirely new concept.”
When he returned to UF, he started developing the nurse practitioner program including curriculum and clinical practice. He also was part of the push to have the Florida Legislature pass laws and rules allowing for the new designation.
“One of the biggest hurdles at the time was the lack of nurse practitioners to serve as mentors or preceptors for the students,” Williams said. “There were very few role models in the field, and many physicians were resistant to the idea of nurses expanding their scope of practice.”
So, in 1983 Williams recruited 17 nurses from across the state to take weekend classes to train as nurse practitioners, though they were not in a degree program.
“They came from across North Central Florida — places like Hernando, Pasco, Volusia, and Clay counties — to enroll in the program,” he said. “These preceptors were invaluable in training the first generation of nurse practitioners.”
The next year, the first degree-seeking students enrolled in UF’s nurse practitioner program. Since many physicians were strongly opposed to the program, students found little assistance.
“In the beginning, we had to be resourceful, finding creative ways to offer clinical experiences,” Williams said. “They did their clinical work at local health departments. That’s where we needed to be anyway.”
Over time, physician attitudes shifted as they realized the value that nurse practitioners brought — especially in the face of physician shortages and increasing patient demand — collaboration became the norm. Nurse practitioners began working alongside them, creating a more seamless system of care.
“Looking back now, I feel a deep sense of pride in being part of this movement,” Williams said. “It was a long road, and at times, it felt like swimming upstream. But we were part of something much larger than ourselves. We were laying the groundwork for a new model of care—one where nurse practitioners played a central role in improving access to health care, especially for underserved communities.”
Williams continued teaching and expanded his own practice, working closely with the public health departments, starting infant care programs, and later, contributing to the establishment of the Alachua County Organized Rural Needs clinic.
“For 17 years, I worked at the ACORN clinic, helping to care for children and families in a largely underserved area,” he said.
Today, in his 90s, Williams, a College of Nursing emeritus professor, is delighted to see the fruits of his labor. More than 20 years ago, the College of Nursing established Archer Family Health Care, a nurse practitioner-led primary care clinic offering comprehensive health services, including behavioral health counseling and treatment. He also cheered the passage of a 2020 Florida law that allowed nurse practitioners full practice authority without the supervision of a physician. As of 2023, 27 states in the U.S. have similar laws.
“Today, when I walk into a clinic and see Advanced Practice Registered Nurses (APRNs) alongside physicians, I know that we’ve arrived,” Williams said. “The field has evolved into a respected, integral part of the health care system.”