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What Does 'Nurse Practitioner' Mean?

Published March 10, 2011 11:28 AM by Renee Dahring
In states across the country, nurse practitioners are introducing legislation to remove “barriers to practice.” As NPs we all agree this is a great idea, but like any political endeavor its success or failure will depend on our ability to convince others that this is indeed a good thing. Yes, eventually it all comes down to marketing.

No bill has ever passed without public support and no bill has ever been introduced that doesn’t have opposition. No matter how worthy we as advanced practice clinicians feel our cause to be there are those out there that are going to argue otherwise. To be successful, we need more than APRN support; we must also have the support of both the public and all other providers, including physicians.

You will quickly discover that before you can talk about our “barriers” with folks you will be asked first to define a nurse practitioner. We tend to forget that unless you are an NP or a first degree relative of an NP you are unlikely to be able to define the practice of an NP. You might be surprised to find this even includes patients who have seen NPs for their healthcare. In fact, I will take that one step further; most Americans would be hard pressed to define an RN in “scope of practice” terms. If you don’t believe me, find someone outside the medical profession (like most legislators) and try to explain to them why we shouldn’t need a collaborative agreement. (Lay people tend to believe that the doctor supervises everyone in a clinic!)

So what do YOU say when asked what an NP is? I have heard NPs say “Well, I can diagnose, treat and prescribe, so basically I can do about 80% of what a doctor can do.” Then we throw in the ever-popular assertion that we cost less so we will save “the system” money. Ouch, did we really just announce that we are a discounted version of traditional healthcare? Almost sounds too good to be true …

But we don’t stop there. “Studies show that we spend more time with patients so they like us better!” Gosh, I don’t know why MDs would find this threatening …

Let me suggest these are statements that neither appeal to the public nor win support from the physician community. We should be more careful when we describe ourselves and avoid statements that put us at war with our physician colleagues or make us sound like we belong in the healthcare sale bin.

Remember, physicians not only vote - they lobby. 

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I love to hear the vitriolic rhetoric that NPs spew at PAs. They have drawbridge mentality: I'm all right, quick raise the bridge. Not so long ago NPs were screaming that Doctors were unfairly restricting them and that NPs could do the same work despite a clear lack of medical education and residency training (several shamefully biased studies to back up your practice not withstanding, as mentioned in the article above - I suppose the bias of a group of NPs conducting research in patient satisfaction WITH NPs hasn't been noticed by anyone). Then a new group like the PA's start sniffing at your turf and all of a sudden you want to claim some high moral ground about medical training? Hypocrisy has no bounds does it?  

Great idea though, insult BOTH the PAs and MDs/DOs? Clearly you do have great communication skills as you profess. You know why we need PAs? Its simple, the original mandate of NPs was that they were needed to fill underserviced areas of medical care in rural areas but statistics show over 75% work in major cities. PAs are just helping MDs do the work that NPs professed to want to do. In fact some might say that with PAs, the MDs are now able to spend more time with their patients.

buce, emergency medicine - Dr September 7, 2011 12:37 AM
phoenix AZ

Sorry to have upset so many PA's that was not my intention. I checked and found that PA programs range from 20 months to 26 months training.  University of Florida stated they are the only public university that offers a graduate level program. There are also PA programs through several community colleges. I would agree with John G the fact that PA's only need a BA degree to apply (this can be English or whatever) and then can obtain prescriptive authority and dx after 20 - 24 months training is seriously frightening. Prior experience accepted in healthcare was listed as   CNA or EMT work this is not at the level needed for serious or important clinical decisions for someone's health. As mentioned by John G most NP's myself included have minimum 5-30 years clinical expertise prior to obtaining an MS with another year of formal education.

In response to Christine were all the strange marks in your comment mistakes or foul language?? Your profession also deserves better than using possible foul language on a professional commentary forum. PA's are being mistaken for doctors because that is how they are presenting themselves, not because they provide superior care. With 20 years experience in challenging clinical settings ED, ICU, CCU,  then obtaining a Masters with another 1 1/2 years of formal education for my NP. Prescriptive authority in most states requires another 1800 hours of training with an MD and National Certification in the area of expertise for NP.  Presently  finishing my PhD (Another 4 -5 years education), I do find it insulting that ads are lumping me with someone that has a BA in (whatever) minimal healthcare experience and 20-24 months of a training program that most often is NOT a Master of Science. Sorry if this insults you, these are the facts.

Vicki, Psychiatry - NP, RMP July 24, 2011 5:12 PM
Denver CO

First things first, I am personally offended when I read an employment AD that lumps an NP with a PA. Because of the vast difference from everything from scope of practice to patient outcomes (numerous research studies have shown) I find insulting and refuse to answer Ad's that are looking for an NP and then throw in "or PA". Numerous research is out there to support full and complete autonomous practice for NP's in all areas. With the DNP finally NP's will truly have the clinical recognition that they not only deserve but most accurately reflects the case mix and workload and patient outcomes that an NP has. Numerous studies have even gone on to show that NP patient outcomes in PRIMARY care are equal if not better when NP's where compared to primary care MD's. So lets be real honest, NP's can prescribe without a MD co-signature, NP's can practice independently without an MD on site and the collaborative practice is RETROspective chart review-- there is NO oversight in NY and the outcomes are equal if not better then primary care MD's.

It is insulting and infuriating that PA's think that they are exempt from working in the context of the interdisciplinary team. The bottom line is that the NP goes through extensive didactic and clinical training.  

An NP first has 4 years of general nursing education plus an additional 2.5-3 years at the masters level of additional didactic and clinical training. With the DNP -- NP's will undergo another 3-5 years of additional didactic AND clinical training to prepare for the DNP. SO, to even try to compare an NP with a PA has no basis whatsoever. ON top of the fact that most NP's and DNP's have already had upwards of 5,10,15,20,30+ years of nursing experience and education before they undergo an NP or a DNP program.

UNLIKE the PA-- who is either bachelor trained (many are) or trained at the masters level. The fact that a PA with a bachelor's degree in English or philosophy can apply to a 2-year masters PA program and then end up with prescriptive authority let alone dx patients-- is very scary to say the least. I don't know about you but I will not allow someone who has only 2 years education--at best-- touch me let alone prescribe anything for myself or family. Let's be real-- PA's will never be able to compare to NP'/DNP's.

John Gerow May 25, 2011 9:35 PM

First things first we are different.  PA's are trained in medical model trained to Dx and treat pt's.  NP are trained in Nursing theory. The amount of clinical hours needed for NP clinical training is lower than PA.  In regards to the "Mid-level" category having taken both PA and NP students the medical background learned in school is greater in PA school.  The NP profession has a big lead in the lobbying power.  For the life of me I stand to question why NP's are able to practice independant.  The answer is not because of training but because of lobby power.  Increasing the NP program to DNP does not change the foundation of NP.  We are two different roles in medicine and have vast difference in training and medical knowledge.  For those who have not looking into the PA training or NP training do yourself a favor and look at the difference and you will be surprised at the difference.  Personally in practicing medicine PA's coming out are more prepared/trained to do so.  In time hopefully the lobby power will follow.

Dan, PA-C March 26, 2011 4:32 PM

To Vickie Grossman:  You ARE wrong and I am correcting you.  Speak to most physicians, who are involved in PA preceptorships, and you will learn that a new graduate PA student, fresh out of school, is equal to a second or third year medical student.  That is because our training is intense and medically oriented, rather than nursing oriented.  If we are mistaken for doctors, in the eyes of our patients, it is because of our expertise and professionalism, rather than our title.  The line between MD/DO/PA becomes blurred as our experience grows.  

David Martin, RPA-C March 17, 2011 9:11 PM

To the prior poster, (Vicki),%0d%0aDo a little research on your other healthcare provider cohorts.  A statement %0d%0alike yours regarding the education of PA's is meant to do nothing more than %0d%0aprovoke. I assume you are aware that most PA programs are Masters programs, so I %0d%0afind your ignorance of the PA profession distressing.  If you expect other %0d%0apeople (patients, physicians) to educate themselves about your profession, you %0d%0ashould do the same.  Don't throw shade girl. Your profession deserves better.

christine , PA-C March 12, 2011 7:52 AM

I am wondering why NP's are being lumped into the same slots as PA's. I thought PA education required only a bachelors or one year over a bachelors degree. Please correct me if I'm wrong this seems counterproductive for NP's. We are like apples and oranges. Because of their name PA's are being mistaken for doctors.

vicki grossman, psychiatry - nurse practitioner, CU March 11, 2011 2:09 PM
Denver CO

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    Occupation: Nurse Practitioners and NP Recruiters
    Setting: correctional healthcare/career consulting/teaching
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