What is going on with the hatred toward Mid-levels


I'm an aspiring NP. I have to ask all of the practicing NP's here. What's with all the mid-level (ML) hate? Toxic statements being put out by medical associations, talking heads and on certain websites make it seem like ML's are 4 eyed aliens from another galaxy bent on destroying the human race.

I see three arguements being used:

1. The Businessman: "Mid-levels are competition; it's nothing personal it's business." I can respect that because not about skills but the pocketbook. Heck I can with work with a person like this. As long he gets paid, he'll leave you alone. I say remember healthcare is business. The way to make money in business is buy low and sell high. Don't hate the Mid-level player. They didn't make rules. Hate the game.

2. The Patient Advocate: "Mid-levels are not trained for the practice of medicine. This put the patient at risk." I can respect this point view too. I say we both want the same thing. Quality care for our patients and practitioners who are safe and competent. Your criticisms are important and welcome. Please become more involved but to educate and improve not denigrate. We both need each other.

3. The Mountain King: "I worked hard. I had it rough. I went to medical school. I went to residency. If you want to practice medicine you have to as well." Ok, no one is demeaning your hard work a hard, your intelligence, or other qualities. Please understand that the healthcare system is evolving. You will always have a job. Mid-levels cannot exist without you. This attitude I am king and you can't play on my mountain guarantees you will be left behind as the tide changes. Your rigidness to tradition will blind you to future opportunites that await you. We must all adapt. Mid-levels are able to legally practice in most states for many years now. Many reputable universities offer programs. If these professionals can safely practice with abbreviated training, maybe examination of the role of the physician, and physician education is needed.

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,229 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

Where are you getting this attitude?

I've been a mid-level for over 4 years now and just don't see it. I'm on the Governmental Affairs board of my state's APN committee and and I know most politicians look to nurses for a take on the health care legislation.

IMHO - if that is the opinion being expressed to you, I'd be looking elsewhere for a job.

Advanced Practice Columnist / Guide

juan de la cruz, MSN, RN, NP

9 Articles; 4,338 Posts

Specializes in APRN, Adult Critical Care, General Cardiology. Has 31 years experience.

Well, practicing NP's like us will likely not run across such animosity to the degree the OP is describing because we are employed alongside physicians who either hired us to join in their practice or have allowed the addition of NP's to their existing clinical practice. Sure, there are some negative media out there about NP's but that's not something we typically have to hear or deal with in our day to day jobs.


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Healthcare is a team effort. That ship has sailed. How they feel about it is irrelevant. I also believe that people's personal experiences with NP's trumps anything they read or hear from AMA. Though I agree, those attitudes may be out there and no one will say it to my face. Either way - irrelevant.

In a way, you can gauge how far we've come by the degree of opposition.

Specializes in Behavioral health. Has 10 years experience.

I'm sorry for the confusion. I'm not a NP yet but I got so worked up about the article on another thread and other outlets that I let my emotions take over and wrote a rant to stick up for you instead of question.

My question that I ment to ask was if practicing NP's see in the workplace the animosity that is written about mid-levels from medical associations and other media. I already see from the responses that it's not that bad as it seems.