WHAT IS THE ORIGIN OF THE USE OF THE TERMS MLP AND PE?
The terms mid-level provider (MLP) and physician extender (PE) were originally used by physicians, physician groups, medical organizations, and medical corporations. These terms suggest that the role of the nurse practitioner (NP) is an “extension” of physician care rather than acknowledging that NPs are licensed independent practitioners. Although most NPs practice in primary care, the role of the NP has been expanded over the years to include specialty and sub-specialty NP practice (e.g., emergency care).
WHAT DO THESE TERMS IMPLY?
The terms MLP and PE are vague, implying that NPs are “midway” or “halfway” between something ... what is that something? Nurse practitioners are not “intermediate” providers of care. Nurse practitioners are licensed independent practitioners who practice in a variety of settings (e.g., hospitals, urgent care, primary care). As clinicians, NPs practice autonomously and in collaboration with other health care professionals. Because an NP's scope of practice is not “dependent” on or an “extension” of any other provider's care, it is imperative that the appropriate terms be used to describe NP's roles.
WHY ARE THESE TERMS INAPPROPRIATE FOR USE BY PHYSICIANS, PHYSICIAN GROUPS, MEDICAL ORGANIZATIONS, AND CORPORATIONS?
These terms are inappropriate because they appear to question the legitimacy of NPs as independently licensed practitioners, according to their established scopes of practice. Although these terms are used by others, they are not interchangeable with the title “NP” (AANP, 2010). The terms MLP and PE imply an inaccurate hierarchy in clinical practice and should not be used because they lack specificity and are not descriptive of an NP's scope of practice.
Most government agencies use the term “NP” or “advanced practice registered nurse” when describing provider roles and responsibilities and for NP billing purposes. Additionally, many physician employers of NPs, policy makers and other health care professionals appropriately refer to nurse practitioners using the correct title “NP.”
WHY ARE THESE TERMS INAPPROPRIATE FOR USE WITH PATIENTS, CONSUMERS, AND THE PUBLIC IN GENERAL?
These terms are inappropriate for use with patients because they are ambiguous thereby confusing patients, consumers, and the public. The terms MLP and PE imply that the care rendered by NPs is “less than” some other (unstated) higher standard (AANP, 2010) or care is “extended” by a physician. NPs, unlike PAs, are licensed independent practitioners.
WHICH GROUPS SUPPORT THE USE OF THE TERM NP RATHER THEN MLP OR PE?
The American Academy of Nurse Practitioners (AANP, 2010) and the Emergency Nurses Association (ENA, 2011) have position statements supporting the use of the term NP rather than MLP and PE. In these statements ENA and AANP purport that the standard of care for patients is the same as that provided by a physician. NPs provide high-quality, comprehensive, affordable care equal to that of other providers (e.g., medical doctor, doctor of osteopathy; AANP, 2007a, 2007b).
In 2010, The Institute of Medicine (IOM) published a landmark report The Future of Nursing: Leading Change, Advancing Health. In this report, the IOM recommends that all nurses practice to the “full extent of their education and training.” According to the IOM, these recommendations can best be achieved by having nurses pursue higher education, becoming partners with other health care providers in redesigning US health care, and promoting planning and policy making through the utilization of cutting-edge information and data management systems. Nurses, including NPs, contribution to patient care is indisputable (AANP, 2007a, 2007b). At this time more than ever, emergency nurse practitioners have the opportunity to transform emergency NP care. Emergency nurse practitioners have a unique set of competencies (knowledge, skills, and behaviors). It is timely, that as this health care transformation occurs, a “titling transformation” occurs with providers, patients, and other health care professionals. That is why the terms “mid-level provider” and “physician extender” no longer work. Call me what I am—an NP.
—K. Sue Hoyt, PhD, RN, FNP-BC,
CEN, FAEN, FAANP
Emergency Nurse Practitioner
St. Mary Medical Center
Long Beach, CA
American Academy of Nurse Practitioners. (2007a). Nurse practitioner cost-effectiveness. Austin, TX: Author.
American Academy of Nurse Practitioners. (2007b). Quality of nurse practitioner practice. Austin, TX: Author.
American Academy of Nurse Practitioners. (2010). Use of terms such as mid-level provider and physician extender. Austin, TX: Author.
Emergency Nurses Association. (2011). Use of terms such as mid-level provider and physician extender. Des Plaines, IL: Author.