Hate "Midlevel"

Specialties NP

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I am not an NP, but am an experienced RN. I have always hated the term "midlevel" and discourage it's use among my coworkers. mainly I hate it because what does it imply about us nurses?

I found this brief article written by a pediatrician that expresses my views very well. Some of you might find it interesting.

http://www.kevinmd.com/blog/2014/07/stop-calling-nurse-practitioners-mid-level-providers.html

Specializes in CVICU.

duplicate post

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Specializes in CVICU.

Oh please, get serious. A stray dog would have little trouble with the FNP curriculum in it's current incarnation. Or any so-called "advanced" nursing curriculum for that matter. All the APN role is doing is lowering the bar for care which horrible for our country. Get rid of the nonsense and add a real curriculum and maybe people would take it seriously.

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Specializes in CVICU.

"Contrast that number to the number of hours US trained physicians spend in medical school, internships, residencies and specialty training. I would suggest that the enormous difference between NP education and training and physician education and training has something to do with the situation you are referring to."

Now, now, just because someone got their FNP cert by taking a few online classes, delving deep into "nursing theory", and doing a minimal amount of actual rotations doesn't mean the care they provide is of any less quality than a physician....er wait, yes it does.

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Just curious, has it changed to where an NP can write Home Health orders or sign a patient onto hospice yet? I used to work for an NP in Arizona in 2013 and at the time she still needed the collaborating physician for his signature for ONLY those two things. She said that there was some legislation in the works to get rid of that. I just didn't know if it got voted on or went into effect yet. The NP I worked for has her own practice and only sees patients via house-calls. With AZ being a very large retirement state, she is doing very well. :)

I personally hate the term mid-level as well. Unfortunately, in the state that I now live in (NJ). NPs cannot practice on their own. Apparently, it may change soon in NJ I just read.

Not sure about AZ, but there are plenty of states out there that NP's can write home health orders, completely independently --- no physician collaboration needed. Not quite sure about hospice. I know that they can make the referal and see hospice patient's.

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Specializes in Adult Internal Medicine.
I would suggest that the enormous difference between NP education and training and physician education and training has something to do with the situation you are referring to.

What does this enormous difference account for in patient outcomes?

Sent from my iPhone.

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Specializes in Adult Internal Medicine.

Now, now, just because someone got their FNP cert by taking a few online classes, delving deep into "nursing theory", and doing a minimal amount of actual rotations doesn't mean the care they provide is of any less quality than a physician....er wait, yes it does.

Er wait, the outcomes of NP care and physician care are equal, so....

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.

Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

Litaker, D., MION, L. C., Planavsky, L., Kippes, C., Mehta, N., & Frolkis, J. (2003). Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care. Journal of interprofessional care, 17(3), 223-237.

Dozens more if you want to keep reading...

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Now, now, just because someone got their FNP cert by taking a few online classes, delving deep into "nursing theory", and doing a minimal amount of actual rotations doesn't mean the care they provide is of any less quality than a physician....er wait, yes it does.

I am curious what TX911 does for a living? NPs bring a LOT more than clinicals and classes to their practice. For example I (not just me, tens of thousands of nurses) spend my days working with some fantastic physicians while caring for very sick people. I have closely observed world class physicians treating all of the common conditions, and quite a few uncommon conditions. I read their notes, ask them questions, have discussions about disease processes and treatments, and most importantly implement their plans of care and treatments then closely observe the effects on the patients. After years of doing so I have learned a few things. There is a reason those physicians tell their interns to "listen to PMFB and the other experienced nurses". I don't need a physician to tell me that increased WBCs, infiltrates and consolidation on a chest x-ray, fever and increasing O2 needs indicate pneumonia.

Name any common condition and I have closely observed excellent physicians diagnose and treat that condition hundreds of times over almost two decades of practice. There is a reason that a resident with 4 years of medical school, a year of internship, and another year or more of residency commonly ask me "PMFB what do you think is going with this guy (girl)?" and "what would you suggest?". Again not just me by any means. Many, many nurses can say the same thing.

NPs typically bring all that experience to their practice. It's usually not just 600 (or whatever) hours of clinicals and classes.

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Specializes in Internal Medicine.
I feel compelled to make a few comments, they aren't directed at the poster, just good for thought.

Now in 19 states NPs CAN practice autonomously without a collaborating physician. The question to be asked is why can't NPs practice autonomously? The outcomes for NPs have consistently been demonstrated to be equal or superior to that of our physician colleagues. If outcomes are the same, what is the true motivation for requiring NPs to have collaborative agreements with physicians in over half the country. Follow the money....

I am not the middle of any hierarchical ladder. I am held to the same responsibility, make the same decisions as, and have the same scope at my medical physician colleagues. I sign the orders and take the responsibility. There is no middle ground. I suspect other APNs feel the same.

Exactly right, they don't provide higher or better care! So why should they be required to supervise?

Why again are they on the top of the totem pole? Because historical they have been?

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THANK YOU. My presentation for my oral boards revolves around a paper of this very nature. There is nothing "Midlevel" about NP's. Head to head with physicians we are equal or better on numerous measured outcomes AND patient satisfaction. When you throw in that fewer and fewer MD's, DO's, and PA's are entering into primary care, there's no reason NP's in every state shouldn't have full autonomy.

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Specializes in Internal Medicine.
"Contrast that number to the number of hours US trained physicians spend in medical school, internships, residencies and specialty training. I would suggest that the enormous difference between NP education and training and physician education and training has something to do with the situation you are referring to."

Now, now, just because someone got their FNP cert by taking a few online classes, delving deep into "nursing theory", and doing a minimal amount of actual rotations doesn't mean the care they provide is of any less quality than a physician....er wait, yes it does.

You troll too hard. What's actually sad about your post is MD's spend all that time in school, and an NP with some online classes and 2-3 years towards a masters degree meets and often exceeds that MD in quality and outcomes. If anything, you help make an argument that MD's spend too much time in school (which is probably why some schools are cutting down to 3 year medical programs instead of 4).

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Nurses are so funny. They just concentrate on the minutiae of absolutely everything. Saved your patient's life through 12 hours of hard work? Don't care, you forgot to relabel the IV lines. Doctor of Nursing PRACTICE curriculum? I know, let's add about a billion utterly useless "theory" courses. Don't have an M.D., D.O., or PhD? Don't care, don't call me mid-level!

/mini-rant

I'm currently in a "DNP" CRNA program which thus far has been underwhelming to say the least. Out of 2 semesters we've taken one useful course- Advanced pharm. The rest of this stuff is more of the same ol' nursing fluff that every other profession laughs at. That's why we are considered mid-level; because we are.

LOL... I agree with your first statement. (Shift change)- "oh, so you started 4 pressors, gave 12 blood products, started sepsis protocol, drew blood cultures, etc for the patient..did you notice this drop of NG drainage under the pillow? Why did you not change that fitted sheet?"

I wouldnt say "all" nurses are like that because we arent. And if your DNP program is so underwhelming, perhaps you should go to med school? Im not a NP, so I cant argue your point about all the nursing fluff in the curriculum. Every program probably has varying amounts of this so called "fluff".

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