Sunday, January 30, 2011

What's in a name?

One of my favorite bloggers (thanks EMS12Lead) sent me the link to a great article* written by a pediatric NP, about the negative impact the term "mid-level provider" has on nurse practitioners, physician assistants and patients a like. I did a quick search of the term and was surprised at some of the 'definitions' that returned:
  • A mid-level provider, sometimes referred to simply as a "mid-level", is a clinical medical professional who provides patient care under the supervision of a physician. Mid-levels are referred to as such, because they are somewhat "in between" physicians and less qualified nurses, techs, and allied professionals in the level of health care they are licensed to administer. From: Health Careers
  • A health care provider–eg, nurse practitioner, physician assistant, etc, whose activities are directed and/or dictated by a supervising physician on whom liability for those activities rests. From: MedicalDictionary

The results are many when you search the term "mid-level providers." Not surprisingly, the term is not supported by professional nursing organizations. In fact, the AANP has published a position paper regarding the use of the term and its consequences. The position taken is that the term is demeaning and confusing for both patients and health care providers; the implication is that NPs provide less than adequate care. This issue is more than semantics, but another facet of how nurse practitioners and other advanced practice nurses (CNS, CRNA, Midwives) impact the delivery of high-quality care in a climate of meeting ever changing quality standards, CMS reimbursement and preventing complications and never events.

No doubt as the health care reform debate continues, with more patients seeking access to the health care system in addition to the shortage of all types of providers, these sort of debates detract from the ever growing problem of ensuring the delivery of safe, quality patient care. At the risk of sounding Kum-By-Yah-ish, should we not be focusing on ensuring that all health care providers work to the full extent of their scope of practice and deliver appropriate, cost-effective care?

See also a previous post on APRN practice

An interesting take written by a physician (be sure to read the comments): The Eroding Physician Brand

*Link to referenced article: I Am a Nurse Practitioner, NOT a Mid-Level Provider!

Other links:

Future of Nursing: IOM Recommendations

The Case for Shifting More Services to Midlevel Providers (a physician perspective)

APRN Consensus Model - NCSBN


  1. Love your post, and I am the "coldfeet65" mentioned in the post by Dr. Wes thank you link to above. I guess I got his feathers ruffled, but not nearly as much as he did mine :). Just more opportunity to educate the masses that we are here to stay and they may as well embrace it. Have a great day, and you are now on my "follow" list.

  2. Oh, I forgot to mention, I just renewed my DEA license, and they refer to us as Mid-levels. Not sure where to start, but perhaps the nursing organizations should contact them.

  3. It saddens me to say this, but I think we as a nursing profession have contributed to some of the confusion with the entry into practice debate and so on. For instance, Clinical Nurse Specialists - practice varies from state to state and some states don't recognize them as advanced practice nurses. All of this to say, gives some the added ammunition to perpetuate arguments.

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