Do you think NP's are "midlevels"?

[Dr. Tammy, FNP/GNP-C]

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?"

[Dr. Tammy, FNP/GNP-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

Thanks. Great response by Buppert.

[JDCitizen]

Actually when I am at work I don't think about it. I see my patients, who all know I am a Nurse Practitioner and I order any test, medications or needed consults that are needed and go home at the end of the day.

One large factor: If anyone of my patients problem is deemed to be over my head:

1) Immediate consult with my MD

2) Referral consult with my MD

I have the choice of turning the case over to the MD or just seeking advice/options.

If that makes me a mid-level, physician extender, APRN or whatever I know that my patients are getting the best care possible. ..

Yep it's true I suck in my pride and ask for advice, 2nd opinion or whatever it may be called. I have been around long enough to see what happens to patients when their provider doesn't.

Family Nurse Practitioner works for me.... Nurse Practitioner works for me... Most of my patients I refer come back to me because:

1) I take the time to talk with them

2) I listen

3) I am upfront...

4) etc..

I hope dealing with semantics and billing terms I never get in a predicament where thats not true.

[DaisyRN, ACNP]

one large factor: if anyone of my patients problem is deemed to be over my head:

1) immediate consult with my md

2) referral consult with my md

i have the choice of turning the case over to the md or just seeking advice/options.

if that makes me a mid-level, physician extender, aprn or whatever i know that my patients are getting the best care possible.

just remember though, physicians refer amongst themselves and confer with one another if something is over their heads, too. it's got to be a team approach... "where we rely on each other... uh huuuuhhh." *lol* did i really just say that?

[JDCitizen]

just remember though, physicians refer amongst themselves and confer with one another if something is over their heads, too. it's got to be a team approach... "where we rely on each other... uh huuuuhhh." *lol* did i really just say that?

humor... i have been told laughter is good for you

[HeartsOpenWide, RN]

The FNPS and PAs at the family practice I worked at before going back to nursing school were call mid-levels. I wonder when the PhD requirement in 2015 kicks in if that term would inaccurate. I sure hope they grandfather everyone because all the FNPs that I worked for only have their ASN other than their FNP certification/license (one has been an FNP since 1980 and the other since 98-99ish) now you have to have a BSN to apply and get a MSN when you graduate. A lot changed in the last 10 or so years. No offense to PAs, but it does not seem fair to put them in the same catagorty as FNPs and CNMs who hold masters since many PA programs only require a certification and not even a AS or BS degree!!

[traumaRUs, MSN, APRN]

Most PA programs today now confer a masters degree for the PA.

[JDCitizen]

Most PA programs today now confer a masters degree for the PA.

I have been reading that. One of the oldest programs around (MCG) has switched over and they are also offering some specialty training: ER and urology...

MCG also offers a DNP and PhD tract for NP's as well as a clinical leader program...

[angel337, MSN, RN]

i always thought that NP's were midlevel providers. i never viewed it as a negative thing, its just that doctors have completley different training (and much longer) so i just automatically assumed that anyone that was not a doctor was not as qualified to make certain decisions about patient treatment and diagnosis. i work with some great NP's and PA's but as a patient I prefer a doctor.

[DaisyRN, ACNP]

*sighs*

[christvs, DNP, RN, NP]

Even though I don't really use the term "midlevel provider", that is what NPs are. We are neither staff RNs nor physicians, so we fall somewhere in between. However, the way I really like to think of it is we have the best of both worlds. We are expert RNs and we also know how to practice medicine, and know to refer patients who are unstable and too complex for one provider to handle. At any rate, no matter how you categorize an NP, I cannot wait to take my NP exam (soon!!!) and join the ranks. :)

[Joan Z]

We are not physicians, we do not have the same scope of practice. I like the idea of being the best of both worlds, since we can consult someone if need be. What irks me is the idea that "only" an MD can provide full-spectrum care... if so, why do they refer to specialists?

For my own care I don't have a preference. I love NPs but that isn't an option here--if I ever get certified and licensed I will be the only one in the area providing primary care. There are some MDs that I would flat-out refuse to be seen by. Choice is a good thing. NPs will be their own best advertisements.

[Dr. Tammy, FNP/GNP-C]

i always thought that NP's were midlevel providers. i never viewed it as a negative thing, its just that doctors have completley different training (and much longer) so i just automatically assumed that anyone that was not a doctor was not as qualified to make certain decisions about patient treatment and diagnosis. i work with some great NP's and PA's but as a patient I prefer a doctor.

When you say "doctor" do you mean a doctor of nursing practice, or the other doctor that goes to school for the same period of time as a DNP (e.g. DNP=4 years BSN/2 years MSN/2 years DNP; MD=4 years of undergrad + 4 years of medical school)?