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: About.com 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

Systems of Care

In this month's issue of Critical Care Medicine, there was a fantastic article on systems-based cardiac arrest care. The authors showcase implementation of the "Take Heart America" program in two Minnesota towns. The study objective was to evaluate care before and after implementing the program. The focus of the THA program is to train entire communities from the lay public to providers of emergency services in early recognition and evidence-based intervention of cardiac arrests. Such interventions include:

• AEDs widely available in communities


• Public education to include CPR & AED training


• Early activation of EMS


• Quality pre-hospital care to include: advanced airways, intra-osseous drug delivery, ipedence threshold devices and automated CPR devices


• Hospital care, centers of excellence to include: accessibility to revascularization, ICDs and EP, therapeutic induced hyptothermia


• Data collection and analysis

The goal: to improve survivability after cardiac arrest events by ensuring all stakeholders have the knowledge and resources they need to reach that goal. This is a excellent example of how a system-wide evidence-based and standardized approach to care can greatly impact patient outcomes.

I have provided a link to the abstract below.

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest Lick et al. Critical Care Medicine: January 2011 - Volume 39 - Issue 1 - pp 26-33
doi: 10.1097/CCM.0b013e3181fa7ce4

Making it personal

I read a great a great article in a recent issue of ADVANCE for Nurse regarding nurses and healthcare providers working in areas of clinical practice that they have personal experience with. Often patients and families are discouraged and frustrated as nurses educate them on making healthy lifestyle changes that seem to take something away from them or require strict adherence to medical regimes. The nurses showcased in this article have taken their struggles and victories with various diseases and illnesses to dedicate their professional practice to caring for those with the same issues. It is more than simply practicing what they preach, but relating to patients on a intimate and human level, applying personal experiences to caring practices.

Many of us have stories of illness and struggle. Choosing to use those stories in professional practice is truly inspiring.


Follow this link to the article:

"Being a Good Role Model: Nurses' health histories - good and bad - influence patients." By Sandy Keefe, MSN, RN

APRN Scope of Practice Issues Revisited

There has been much discussion in the media and among professional nursing and medical organizations regarding the impact the Affordable Care Act, the health care law that was passed March 2010 on providers of healthcare. It is an understatement to suggest that this law will impact all levels of providers within the healthcare system and it is important that we as providers and caregivers alike understand the impact the Affordable Care Act will have on our current and future roles as nurses and physicians. I encourage you to read this very positive article from the New England Journal of Medicine: Perspective (see link below). I also encourage you to stay informed and involved with your professional organizations and state licensing boards as we embark on certain changes in the way we deliver health care.

Broadening the Scope of Nursing Practice

See also:

National Association of Clinical Nurse Specialists

American College of Nurse Practitioners