Appex header 6 2014
Appex avatar
Advanced Practice Provider Executives, Inc. - APPex

Should NPs & PAs just get over being called "mid-levels"?

Posted over 3 years ago by Nicholas M Perrino

It appears the author (Vicryl Contessa) is not an NP yet and holds a personal position on the term mid-level.  Perhaps it would be best to approach this from the profession's standpoint and the collective interests of NPs and PAs.  She should review AANP's position statement on this terminology.  Whether or not intended, it does carry negative implications.

APPex advocates for the term "advanced practice provider" (APP), one that recognizes these roles as advanced (in education and training) and as clinical providers--those treating, managing, diagnosing, prescribing, etc.

"While on Facebook, a coworker and fellow dweller in hell (i.e., Nurse Practitioner school) posted a link to an article about Nurse Practitioners (NPs) that lead me to another article written by a physician about the demeaning term used within healthcare to describe NPs: "mid-level provider." This term also applies to Physician Assistants (PAs), though the article doesn't really mention this. To summarize, the author asks people to stop using the phrase because it's demoralizing and it diminishes NP's role and education. Moreover, it implies that nurses are low-level providers while physicians are high-level providers. Frankly, I was surprised to hear a doctor say this, since MDs and NPs have a historical turf war, though those attitudes are quickly changing. When I worked in the Emergency Department, I asked several doctors their opinion regarding NPs that hold a Doctor of Nursing Practice. Pretty much every one thought it was ridiculous, and strongly objected to NPs being called "doctor" even if their degree entitles them to it. At the time, I was offended: if one has a doctorate, one should be able to be called "doctor." If I had read the article above when I was new to nursing, I would have strongly agreed with the spirit of it as well.

With experience, my feelings have changed. The call in the article to stop calling NPs "mid-levels" seems like just another PC crying of micro-aggression. I don't need others taking up the banner of imagined slights against me, whether it's this or men who wear the "I'm a feminist" t-shirt. As a soon-to-be NP, my value and expertise as a clinician is not tied to my title or what category hospital administration places me in. I don't need to be called "doctor" by my patients, though they likely will anyway. If I really wanted to be a doctor, I would have gone to med school. Like other PC whiners, they fail to recognize the obvious: there is a difference! As an NP, I will gladly learn from the surgeons I work with, go to them when I'm uncertain, and lean on their superior knowledge. In no way does that minimize the role NPs play. They do wonderful work, and I would rather see a great NP than a mediocre MD any day."