In tandem with growing scientific knowledge, programs have expanded their duration and credit loads. Nurse specialties such as cardiology and critical care have appeared in graduate programs across the country with educational programs targeting their specialized knowledge. NAPNAP was founded in 1973 as one of the first national advanced practice organizations of specialty nurses. By the late 1980s, nursing was part of the regular menu of services offered by many healthcare institutions, supported by the 1986 OTA study which found that NPs “provide care whose quality is equivalent to that of care provided by doctors,” particularly when such care depends on prevention services and communication with patients (Office of Technology Assessment, 1986, 5). In 2003, healthcare institutions began hiring large numbers of NPs in response to the Accreditation Council for Graduate Medical Education's resident hours standards, which limited the number of hours medical residents could work (Nasca, Day & Amis, 2010). Numerous studies, including a Cochrane review, reports from the Rand Health Foundation, the Commonwealth Fund, and the Western Governor's Association, have all provided positive evidence of the value and quality of services provided by NPs. Today, NPs have proven their effectiveness in providing high quality, at a lower price