By Carla MillsCarla Mills is a licensed and accredited Nurse Practitioner who has been a practicing clinician for more than 20 years. She is the author of A Nurse Practitioner’s Guide to Smart Health Choices, an easy to understand, medical reference guide for patients with no prior medical knowledge. Read her blog at maverickhealth.com.
If NPs are to have a positive impact on health and health care, we must clearly define ourselves for the public and the media. People need to know what makes us distinct and different from doctors and other types of nurses. Ignorance about NPs has stunted our professional development and slowed our evolution as a profession.
Health challenges confront a world with a rapidly aging population and an epidemic of chronic lifestyle diseases. NPs can keep people well and manage the care for those who become sick. But in order to do so, the special talents and skills of NPs need to be clearly defined. If given the necessary authority and the opportunity, NPs are prepared to dramatically and positively change the way health care is delivered.
To define something, one must understand both the meaning of the term (in this case, “nurse practitioner”) and the nature, essential qualities, and boundaries of the words’ meaning (that is, what makes nurse practitioners different from doctors and other types of nurses). Defining our particular uniqueness is challenging because nurse practitioners are both doctors and nurses, yet we are neither.
When Organized Medicine Defines NPs
Our failure to clearly define ourselves created a vacuum that enabled organized medicine, under a pretext of protecting the public, to presume to define us. Long ago, organized medicine appointed itself arbiter of all health care and all health care providers. For years, it has defined NPs using rhetoric that is aimed at shaping public opinion and restricting NP practice.
Terms like “non-physicians,” “physician extenders,” and “mid-level providers” have been widely used to refer to both NPs and physician assistants—as if the two are indistinguishable. These labels diminish NP authority and impede the growth and expansion of NP practice. Constant repetition of these doctor-centric terms in the media has successfully wormed them into the common vernacular and misled everyone about the true nature of NPs. These pejorative terms define NPs not according to what we are, but rather according to what we are not. They obscure the quality of our expertise and deny the potential benefits we can deliver as independent providers. These terms do not protect public trust at all; rather, their use more closely resembles antitrust.
NP Titles Obscure NPs’ Nature
As nursing professionals earn additional degrees, certifications, and honors, they add more and more letters after their names until their titles become unwieldy and indecipherable. These titles are meaningless to the public and media, and they obscure NPs’ common characteristics.
Much has been written about the use of the title “doctor” by DNPs and other doctorate-educated nurses. Nurses who have earned a doctorate degree have every right to use the title “doctor.” But just because one has a right to do something, does that make it the right thing to do? Until a universally understood nomenclature is used by the nursing profession to clearly communicate to the public what distinguishes different types of nursing professionals from doctors and from each other, confusion will prevail. Creating this unnecessary confusion is a disservice we inflict on both the public and ourselves.
The public understands the words “doctor” and “nurse.” It needs to understand “nurse practitioner” better. Sticking with just these 3 titles and not cross-pollinating them would make it easier on everyone. We make more productive use of our valuable time when, instead of explaining and reexplaining what kind of nurse or doctor we are, we spend it on substantive matters that affect our patients.
All NPs are RNs, but all RNs are not NPs. Although both RN and NP practice is rooted in the profession of nursing, the scope of practice is different. NPs and RNs share the same core values and mission. All nurses stand up for and stand by patients suffering mental or physical illness.
As RNs, we are formally educated and clinically trained to care for the sick and the infirm. As NPs, after receiving more formal education and more clinical training, we advance our nursing practice to enable us to prevent, diagnose, and treat diseases. The term “nurse” refers to RNs and the term “nurse practitioner” refers to NPs. We all must see to it that the titles are used correctly on every occasion, and we should request a correction every time and every place they are not.
The medical profession’s expertise is disease; the nursing profession’s expertise is a patient’s experience of disease and the process of healing. NPs diagnose and treat illness within a larger context than doctors do, because NP care encompasses a patient’s whole life. Personal choices, family circumstances, community, and society as a whole all come under NPs’ scrutiny. The most expert medical care in the world cannot produce healthy citizens so long as lifestyles, the community, and society remain sick.
Compared with doctors, NPs tend to spend more time with each patient. NPs do not work more slowly or take more time because they are less intelligent or less efficient than doctors. NPs simply must spend more time, because it is the nature of NP practice. Treatment plans are not dictated to patients by NPs, as they often are by doctors. Rather, NP treatment plans are collaborative agreements reached in partnership with patients after a process that includes evaluating problems, teaching about causes, discussing options, and exploring patients’ own needs and wishes. With this extra time and the knowledge that is gained about the patient and by the patient, NPs are able to deliver care accurately, safely, and according to the patient’s own directives. NPs help patients manage the life changes that come with a chronic disease or a catastrophic event. When it is inevitable, helping patients face death with dignity and grace is intrinsic not just to NP care, but to all nursing care.
When people ask me what an NP is, the one-sentence defInition I give is: “I am a nurse who does the same thing a doctor does, but I do it from the perspective of a nurse.” Personally, I wish we had been named “nurse doctors” instead of “nurse practitioners”—it’s a title that’s less vague and more precise. But then nobody ever asked me.
As always, this column is also posted on Carla’s blog at www.maverickhealth.com/blog, where you are invited to leave comments.