[Tammy79, RN]

Why are NP's with terminal degrees (MSN for now DNP by 2015) with advanced NP certification considered midlevels? Does the affirmation and utility of this title suggest NP's lay somewhere in the spectrum between basic RN (within the discipline of nursing) and physician (not within the discipline of nursing)?

In reviewing ANCC and AANP NP certifications it appears that the ARNP and NP certification appears to be the highest certification for NP's. So if NP's are midlevel, and the ANCC/AANP NP certification process is considered at the highest-level certification for NP's, what exactly would be the next step to advance out of the "mid-level" tier in the nursing discipline in the context of NP practice?

I understand PA's are considered midlevel providers because PA's practice medicine under the supervision and direction of the physician. There is no doubt or contest as to PA's following medical-based models for both training and care of patients. Do you think because PA functions (medicine) overlap with NP functions (nursing practice) that by association NP's and PA's are lumped together as "midlevels?" If so, since many basic functions of unlicensed assistive personnel (UAP's) overlap the practice of nursing, would it be appropriate to categorize UAP's and RN's both as "nurses"?

For those NP's that work in states where no physician supervision is required for NP practice including independent prescribing (AK, AZ, DC, IA, ME, MT, NH, NM, OR, UT, WA, WI, WY) do you consider yourself a "midlevel" practitioner?

Lastly, if NP's are truly "midlevels" wouldn't a better title be "Midlevel Practice Nurse" instead of "Nurse Practitioner?"

[JDCitizen]

I am considered a mid level where I work: Staff & Nurses under me Doctor over me... But I practice at an advanced level granted by my license under the stipulations listed by my protocols.

My degree states MSN. The focus was for FNP which is not mentioned on my degree

I am certified by AANP as a FNP because I passed there test after I paid a fee to take it. At the end of 5 years I have to pay more money and either show I met their recertification qualifications or retest.. My certificate that hangs on my wall from them is a certificate of recognition
and only states that I am a member of the AANP in good standing.

With those two I was allowed to apply for a license in Georgia which reads: Advance Practice NP. Which I will have to resubmit information from the AANP and pay another fee to get my license renewed.

From the AANP site:

Purpose of the AANP-Certification Program

The purpose of the American Academy of Nurse Practitioners National Certification Program is to provide a valid and reliable program for entry-level nurse practitioners to recognize their education, knowledge and professional expertise. The Academy Certification Program provides a process for validation of an advanced practice nurse's qualifications and knowledge for practice as a nurse practitioner.

The National Certification Program was established as a certification body for the evaluation of individuals who wish to enter, continue and/or advance in the profession through the certification process. The certification program is an independent incorporated non-profit organization.

Those certified (referred to as certificants) have successfully completed the required certification process, which includes meeting certain educational requirements, passing a certification test verifying professional knowledge in the specialty, and maintaining continued competency in the profession through an established recertification process. Certificants of the American Academy of Nurse Practitioners Certification Program subscribe to the scope and standards of practice established by the American Academy of Nurse Practitioners.


Websters definition of a Nurse:
1nurse
Pronunciation:
\ˈnərs\
Function:
noun
Etymology:
Middle English norice, norce, nurse, from Anglo-French nurice,nutricia, from Latin, feminine of nutriciusnutritious from Late Latin nourishing — more at
Date:
13th century
1 a: a woman who suckles an infant not her own : wet nurse

b: a woman who takes care of a young child : dry nurse

2: one that looks after, fosters, or advises

3: a person who cares for the sick or infirm; specifically : a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health — compare licensed practical nurse, registered nurse

4 a: a worker form of a social insect (as an ant or a bee) that cares for the young b: a female mammal used to suckle the young of another


Websters definition of a Nurse Practitioner:nurse–prac·ti·tion·er Pronunciation: \-prak-ˈti-sh(ə-)nər\ Function:noun Date:1969 : a registered nurse who is qualified through advanced training to assume some of the duties and responsibilities formerly assumed only by a physician



So all of the above just to say yep I am a midlevel provider. The NP in the next office, town or state may not be.

[sirI]

While I'm not fond of the term, "midlevel provider", this is exactly what I am. Pretty simple explanation and doesn't really offend me.

RN, LPN=lower level provider
physician=upper level provider
APN (CRNA, NP, CNS, CMN) and PA=midlevel provider

And, no, I would not want the title to change to Midlevel Practice Nurse.

[pinoyNP]

While many NP's do get offended by the term Mid-Level Provider or Physician Extender, it is unfortunately used by many healthcare organizations to describe professionals who are not licensed as physicians but perform roles similar to a physician. The hospital I work for puts NP's, CNM's, and PA's in a single group called Mid-Level Providers. We have a Mid-Level Council at the hospital composed of the said professionals and the purpose of the group is to provide representation of our roles when it comes to hospital-wide affairs. As a NP, I am not under the nursing department anymore (or what we call Patient Care Services Department) and I am not represented by that department in the hospital. We can argue that the term Mid-Level should be changed at our hospital but at the current time, there are more issues to contend with than semantics.

[core0]

You can put me in the category that hate the term mid level. It is a creation of the insurance companies seeking to lump certain providers together. The main problem that I have is that it intrinsically implies that the care that I give is of a different (lower) level than a physician. As a PA the care that I give should be indistinguishable from that of a physician in my specialty. The standard of care is identical legally. I do not provide mid level care, I provide top level care.

The other issue is that there is no real definition of who is a "mid level provider". It is similar to the term allied health provider. Who fits in this depends on who makes definition. It is similar to the term APN. Some use it as synonymous with NP, CNS etc. Others include nurses with additional training such as RNFA or ostomy nurses.

I'm a PA and and have a medical license that says so. It does not say mid level or anything else. If someone insists on lumping people together I prefer the term NPP (non physician provider). This is a category defined by Medicare of those providers who can bill medicare for provider services and have the ability to diagnose, treat and prescribe.

David Carpenter, PA-C

[dhigbee]

Originally Posted by core0

If someone insists on lumping people together I prefer the term NPP (non physician provider). This is a category defined by Medicare of those providers who can bill medicare for provider services and have the ability to diagnose, treat and prescribe.

I like this designation better as well. I'd take it over mid-level provider any day.

Dana

[johnson0424]

of just plain health care provider would work for me!

[dansingrn]

[QUOTE]I do not provide mid level care, I provide top level care. [/quote]

Yes! Says it all right there! And the term "provider" works for me. In the heirarchy of things, midlevel isn't exactly inaccurate, but if it confuses one into thinking the level of care is somehow "less" than that provided by a physician, then let's not use the term.

[traumaRUs]

I'm not offended by mid-level practitioner either. In IL, we (NP, CNS, CNM, CRNA) are all identified as APN - advanced practice nurses. That is what we are to use in our charting and prescriptions. Anything else we might add: NP, CNS, MSN, RN, etc., is just superfluous. However, we MUST haveve APN immediately following our name.

Personally, I feel we have bigger fish to fry and the name doesn't mean much either positive or negative - it just is.

[pinoyNP]

Originally Posted by core0

You can put me in the category that hate the term mid level. It is a creation of the insurance companies seeking to lump certain providers together. The main problem that I have is that it intrinsically implies that the care that I give is of a different (lower) level than a physician. As a PA the care that I give should be indistinguishable from that of a physician in my specialty. The standard of care is identical legally. I do not provide mid level care, I provide top level care.

The other issue is that there is no real definition of who is a "mid level provider". It is similar to the term allied health provider. Who fits in this depends on who makes definition. It is similar to the term APN. Some use it as synonymous with NP, CNS etc. Others include nurses with additional training such as RNFA or ostomy nurses.

I'm a PA and and have a medical license that says so. It does not say mid level or anything else. If someone insists on lumping people together I prefer the term NPP (non physician provider). This is a category defined by Medicare of those providers who can bill medicare for provider services and have the ability to diagnose, treat and prescribe.

David Carpenter, PA-C

Any designation that includes the word "physician" can be offensive to most NP's. The term non-physician provider is also frowned upon because it implies that the service provided is not as good as a physician's. I personally do not get all riled up with all these designations. I always introduce myself as a nurse practitioner and use the letters NP in all my documentation. I have no problem with the NP title because that's what we've used histotrically and many in the public are beginning to be knowledgeable of what a NP is. Changing that would only add more public confusion about a profession that is gaining public acceptance.

See Carolyn Buppert's response regarding the designation non-physician provider in this Medscape Q&A:
http://www.medscape.com/viewarticle/413397