Talk:Nurse practitioner/Archive 1

Archive 1

Archive 2

plagiarism?

a lot of the text on the wikipedia page for "nurse practitioner" is identical to the text on this page:

http://www.womenshealthchannel.com/nursepractitioner.shtml

If this (above) link is the original, shouldn't it -- at the very least -- be cited?

More important, the page is essentially an advertisement for nurse practioners, i.e. it's far from an objective discussion of what an NP is. I have nothing against NPs, but there should be a difference between an encyclopedia and an endorsement.

I agree, it also is missing some important information regarding scope of practice. It seems to want to make comparisions with physicians and does not communicate that NPs are mid levels and have a clearly defined scope of practice that is not the same or similar to a physicians.Gtadoc 02:52, 18 June 2007 (UTC)

Please post in the talk page if you wish to make changes to the page that alter the NP scope of practice. Several editors have tried to alter the page to make NPs appear to be basically physicians in all but name, this is not at all accurate. Gtadoc 20:07, 16 July 2007 (UTC)

Should

Should there be a link to CNP in the entry and at the "see also"? All they do is loop back to this page

Its because (at least in the US) they refer to the same thing. Gtadoc 00:23, 17 July 2007 (UTC)

Worldwide view

Someone tagged this article as saying it does not reflect a worldwide view. As far as I know "Nurse Practitioner" is a term only used in the US // it only reflects a US occupation. Thus I'm removing it for now 167.193.84.7 19:18, 26 February 2007 (UTC)

That tag appears to have been added by User:Lima Golf on 10th Jan 2007 - but I wuld agree with it. Nurse practitioner is a term used in the UK & I feel the article only reflects the view in the USA - particularly the sections relating to post-nominal letters & Education, licensure, and board certification. — Rod ^talk 19:49, 26 February 2007 (UTC)

This article most certainly reflects only the application of "nurse practitioner" in the United States. It does not reflect the rest of the English-speaking world and should state such.

So why not add nominal letters and education for nurse practitioners in the rest of the English-speaking world?

This is, I know, original research, which is why I have not edited the article page, but my wife is currently undertaking an Advanced NeoNatal Nurse Practitioner course in the UK (University of Southampton, as a reference) and I am surprised to see that the article concentrates only on the American field, whilst in the UK ANPs have been recognised for over 10 years. -- Simon Cursitor (talk)

I believe I should also point out that Nurse Practitioners have existed in Canada just about as long as they have in the US!! They are an essential element in our healthcare system...why they've been left out of this article is beyond me!

--Dan —Preceding undated comment was added at 21:26, 25 October 2008 (UTC).

I work in the US and my experience is mostly in the US and India, I don't know very much about NPs elsewhere, perhaps some of our Canadian and UK residents could contribute to the article? —Preceding unsigned comment added by 67.132.98.44 (talk) 20:19, 27 December 2008 (UTC)

WP:NURSE priority review

As part of a review of all nursing wikiproject articles, I have changed this article's importance to high per Wikipedia:WikiProject Nursing/Assessment#Importance scale. I have also added B class. If you disagree, please leave a note here so we can discuss it. Cheers, Basie (talk) 04:18, 23 January 2009 (UTC)

This section skips around a lot and is confusing. Plus minor edits/spell check. How about this:

Education, board certification, and licensing (United States)

To be educated as a nurse practitioner, the candidate must first complete the education, training, and licensing necessary to be a registered nurse (RN).

Note that the educational level of RNs is highly variable in the US: candidates may take the RN licensing exam after completion of either of three types of programs: a 4-year Bachelor of Science in Nursing (BSN) program, a 2-year Associate's Degree in Nursing (ADN) program, or in some states, a hospital diploma program. The commonality is that, upon completion of the program, all candidates must pass the licensing exam (NCLEX-RN) in order to become RNs and practice nursing.

Nurse practitioner programs currently offered in the US are at either the masters degree (or post-master's) level (MSN), or the doctoral degree (DNP) level. NP programs deal with the varied educational levels of RNs by either requiring the BSN (bachelor's degree in nursing) prior to matriculation, or by offering some type of "bridge program" for those with ADNs or diplomas. Most also require one or more years of work experience as an RN prior to matriculation. NP programs are typically specialty-specific, e.g. family health, adult health, adult acute care, pediatric acute care, women's health, oncology, etc., and many programs may expect that the RN-level work experience is relevant to the desired specialty, e.g. pediatrics, ICU, labor-and-delivery, oncology, etc.

Upon successful completion of the MSN (or DNP) program, all candidates must pass the appropriate board certification. (As recently as the mid 2000s, not all states required board certification; this is now required in all 50 states.) The two largest certifying bodies, the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP), currently require an MSN degree (or post-master's certificate) prior to taking the board certification exam. In 2015 these organizations will require a DNP for a candidate to be eligible to take the certification examination.

Several organizations oversee certification, including the following:

• American Association of Critical-Care Nurses
  
• American Psychiatric Nursing Association
  
• Board of Certification for Emergency Nursing
  
• Pediatric Nursing Certification Board
  
• National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
  
• Oncology Nursing Certification Corporation
  

In order to legally practice, the NP must then be licensed by the state in which he or she plans to practice. The state boards of nursing regulate nurse practitioners, and each state has its own licensing and certification criteria. Re-licensing criteria also vary by state; some require biennial relicensing, others require triennial, and the number of required continuing education (CE) credits varies.

The variety of educational, certification, and licensing paths for NPs is a result of the history of the field. In 1965, the nurse practitioner profession was instituted and required a master's degree. In the late 1960s into the 1970s, predictions of a physician shortage increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs. Today all certifying organizations, states, and employers require a minimum of a master's degree for new NPs, and all states require board certification and licensure (already established NPs with lesser education were grandfathered in). —Preceding unsigned comment added by 71.242.234.90 (talk) 21:02, 20 February 2009 (UTC)

Removal of list formatting in Post Nominal Initials?

Please explain why the list formatting was removed here. Thanks. Proofreader77 (talk) 21:24, 21 December 2008 (UTC) I see it has been restored. Proofreader77 (talk) 21:54, 21 December 2008 (UTC)

I think that the long list of post nominal initials looks like a terrible alphabet soup. Is there a better way to format this? —Preceding unsigned comment added by 128.172.28.45 (talk) 18:10, 19 March 2009 (UTC)

Americacentric

This is quite possibly the most americacentric article I've seen in a long, long while - we do have Nurse Practitioners in other parts of the world y'know! Will try to work in some stuff about NPs in the UK, does anybody else have any experience of them abroad? --John24601 20:48, 27 August 2006 (UTC)

How interesting! This citation was placed in 2006.. and STILL there is not much in the article on NP's around the world... hmmm... maybe that's because the rest of the World has little support for Advanced Practice Nursing... Face it Chaps.... this is one area that only the U.S. excels in.. However, I can't very well add this statement to the article now..Can I ? 97.82.248.155 (talk) 13:55, 13 May 2009 (UTC) -Leonard J Matusik RN/MSN; BSPharm RPh2FNP@yahoo

Not without a reliable source to back up your personal POV. WhatamIdoing (talk) 00:58, 14 May 2009 (UTC)

NPOV

{{editsemiprotected}}

please add the banner {{globalize/US}}

76.66.203.200 (talk) 11:17, 26 June 2009 (UTC)

Not done: {{edit protected}} is not required for edits to unprotected pages, or pending changes protected pages. I've changed it for you. — Martin (MSGJ · talk) 13:05, 26 June 2009 (UTC)

Midlevel

Where I am from (Denver and Salt Lake City) they are called (by themself and others) mid level providers, to help indicate that they have more training and responsibilities than the RNs and also to denote that they are in between the level of care provided by an RN and a doc. Some patients get confused and don't understand the difference between a doc and their midlevel so it helps if clinics are upfront in telling them who/what they are and what their role is in their care. I'm going to change it to reflect in the article, if anyone else has thoughts please write them here instead of just reverting things.~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 20:22, 21 December 2008 (UTC)

I am a midlevel provider in MN. Other than identifying us as PAs or NPs, this is the common terminnology. —Preceding unsigned comment added by 129.176.151.10 (talk) 17:37, 6 January 2009 (UTC)

RE: "mid-level"

This is a deragatory title bestowed by the AMA and their supporters implying that physcians are comparatively "high-level" (a claim inconsistent with published research on the quality comparison between NPs and physicians) and RNs as "low-level"? —Preceding unsigned comment added by 152.132.9.197 (talk) 01:18, 10 January 2009 (UTC)

If its how the practitioners describe themselves then how is it not appropriate to include in the article? You may believe it is 'deragatory', but I don't believe it is meant to imply anything other than that they are mid, or in between, an RN and a physician. It also emphasizes that they do not provide the same practice care level as a physician, it has nothing to do with "quality", though I doubt you have anything to back that up, but rather with scope of practice which I encourage you to read and educate yourself on. ChillyMD (talk) 01:58, 13 January 2009 (UTC)

Some links from a quick google search showing midlevel used in scholarly discourse both in the US and abroad to define NPs and PAs.

http://who.int/reproductive-health/hrp/policy_briefs/midlevel_hcproviders.pdf

http://www.aafp.org/online/en/home/practicemgt/specialtopics/mlpissues.html

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103623501.html

ChillyMD (talk) 15:04, 13 January 2009 (UTC)

ChillyMD, your statement NPs "do not provide the same practice care level as a physician" is prejudiced, and false. We went to nursing school because we acquiese with nursing philosophies. "Midlevel" as a term does not establish an accurate range of ANY training level, whether a RN or a physician or as you seem to push for your point of view, in between, an RN and a physician. Midlevel" is an outdated, limiting term, and prevents FNPs from relating to patients on THEIR level. What level are the patients ChillyMD - in between an RN or a physician? —Preceding unsigned comment added by 208.191.131.245 (talk) 00:56, 21 January 2009 (UTC)

You clearly missed the point. ChillyMD (talk) 15:54, 18 May 2009 (UTC)

PAs, NPs, CRNAs, are all defined by law as mid level healthcare providers [[1]]. This isn't even an argument. Fuzbaby (talk) 00:28, 16 June 2009 (UTC)

Your claim that "mid-level" is in between an RN and a physician is plainly wrong. A PA is not above an RN and certainly aren't "between" a nurse and physician - they are below a physician just like an MA in the medical hierarchy while an NP is above an RN in the nursing hierarchy. An NP is not below a physician any more than a pharmacist, physical therapist, chiropractor or audiologist is. NPs in many states are independent providers with a different focus on training (prevention and health instead of disease) that provide an identical standard of care to that of a physician in a similar practice environment. You cite physician sources to back your physician biased claim - that's like the Democrats citing Michael Moore to back a claim or the Republicans citing the Heritage Foundation - the source is inherently biased and must be discarded as unreliable. Perhaps you could review the literature instead of citing policy briefs that advocate a position. —Preceding unsigned comment added by 24.117.40.30 (talk) 02:20, 26 October 2009 (UTC)

Reinstatement of edits reverted...

...by Megasloth at 1am 4th Feb 2010

Dear IP user,

I left a note on yout IP talk page, which I note you acknowledged by blanking the page. Please can we enter discussion of these edits? All my reversions were either simple grammatical issues, or issues of Wikipedia guidelines and style. If you believe your changes are warranted, please start a discussion per WP:BRD. Many thanks, --MegaSloth (talk) 01:25, 4 February 2010 (UTC)

this person is a banned sockpuppet who evades bans to vandalize this and a few other articles. they should be reported for vandalism and reverted Theserialcomma (talk) 01:48, 4 February 2010 (UTC)

"44 States"

Some sources say all nurse practitioners can prescribe medication in all 50 states. Is there a link to this anywhere?

Also some sources indicate that nurse practitioners need at least minimal physician supervision in all states Gtadoc 02:19, 18 June 2007 (UTC)

This article also needs to be changed to indicate what the scope of practice is for a NP, it makes it seem as they are same as a physician which is a dangerous and misleading inaccuracy.

No physician supervision is required whatsoever in Washington State where nurse practitioners have complete autonomous practice with regards to legend drugs, controlled substance prescriptions, and even can recommend medical marijuana to their patients. So, I'm not sure the specifics of the other states, but the State of Washington does indeed allow for complete and autonomous NP practice, and there is nothing misleading or dangerous about it. 64.184.170.110 (talk) 08:26, 30 January 2011 (UTC)

Yes, NPs can prescribe in all 50 states. Some states require the name of the collaborating physician (if applicable) on the Rx pad. Most states restrict the prescribing of narcotics to some degree.

source: "US Nurse Practitioner Prescribing Law: A State-by-State Summary" http://www.medscape.com/viewarticle/440315

71.242.234.90 (talk) 21:28, 20 February 2009 (UTC)Denise

Criticism

This article entirely ignores the raging turf battles between physicians and nurse practitioners that is currently going on in the US and that has been going on for quite some time. I have started a criticisms section to shed some light on this topic. There is a lot more information out there regarding this that I hope to add soon. The absence of such a section is a pretty big elephant in the room. Ctoensing (talk) 18:18, 19 March 2009 (UTC)

Its part of the NP agenda to say they can practice independently, yet deliberately leave out what their scope of practice is. I happen to be a licensed pilot, and can fly an aircraft by myself. That doesn't mean I'm certified to fly a 747...but hey, if no one asks...I won't tell!

I do agree though, this article is poor from the standpoint of it being 'informative'. —Preceding unsigned comment added by 129.176.151.10 (talk) 15:42, 18 May 2009 (UTC)

mmm..about dnp programs. they aren't doctor programs, they are geared more like an Ed'D program. i.e. help create better nurse educator. If you don't know what an Ed'D is, think a PhD only without the intense research focus. Cheers. Fuzbaby (talk) 14:18, 21 May 2009 (UTC)

That's not true - DNP is a clinical doctorate, PhD programs are for teachers and researchers. Sapphiremind (talk) 02:54, 27 December 2010 (UTC)

• • last time I checked, the "D" in DNP stood for "doctorate", level of education and not a profession. Claiming that it isn't a "doctor program" is like Coke claiming that Pepsi "isn't a cola because it isn't our brand of cola". Is the DNP a physician program? No (semantics? yes, but then when I was in school words actually had meanings), is a physician program a physical therapy program? No. Is a physical therapy program a nuclear physics program? No. Is a Nuclear physics program an Education Theory program? No. Is an Education theory program an Audiology program? No. See, there's a trend; having a doctoral degree makes you a doctor of whatever you studied. The professional titles are physician and Nurse Practitioner, the education for the DNP, MD, DO, PharmD, DPT, EdD, PsyD, PhD, OD, et al makes them all "doctor". —Preceding unsigned comment added by 24.117.40.30 (talk) 02:06, 26 October 2009 (UTC)

You would be the type of person they market towards. Anything can be called a 'doctorate program' these days as long as you call it such. Doctorate and non doctorate NPs have identical training, that usually lasts about a year and a half, and is at the same level as PA school (master's level). A very small number get doctorates that are education orientated and are true doctorates. I can see how from outside of the education world they could be confused...but in reality "most" DNP programs are simply master programs relabeled so schools can charge more and students there can have bigger egos than at traditional NP schools. 207.229.236.211 (talk) 16:49, 5 April 2010 (UTC)

last time I checked, the "D" in DNP stood for "doctorate", level of education and not a profession. Claiming that it isn't a "doctor program" is like Coke claiming that Pepsi "isn't a cola because it isn't our brand of cola". Is the DNP a physician program? No (semantics? yes, but then when I was in school words actually had meanings), is a physician program a physical therapy program? No. Is a physical therapy program a nuclear physics program? No. Is a Nuclear physics program an Education Theory program? No. Is an Education theory program an Audiology program? No. See, there's a trend; having a doctoral degree makes you a doctor of whatever you studied. The professional titles are physician and Nurse Practitioner, the education for the DNP, MD, DO, PharmD, DPT, EdD, PsyD, PhD, OD, et al. —Preceding unsigned comment added by 149.68.105.221 (talk) 22:41, 8 April 2010 (UTC)

In reality, nursing schools can put a "D" in front of anyting they want. If I offered a program called "doctor of gas station refilling" and had a 1 year course in how to fill up different cars, would that be an equiv degree to other doctoral programs? No? GUESS WHAT??!? IT is the educational content that MATTERS. The sad thing is its patients who lose because of unethical practitioners who try to claim they have the training of physicians, when in reality "DNPs" have no more training than any other NP; and as mid level providers have on average 6-10 year less training than a physician. Its certainly NOT semantics, in fact a DNP (or their equivalent NPs or PAs) claiming to be a physician can lose his/her license and be subject to criminal prosecution. As a PhD, the doctor title has become largely useless, as its used by many schools to describe non rigorous educational programs. 129.176.151.10 (talk) 03:46, 25 April 2010 (UTC)

And yet, thanks to evidence-based practice, study and people scrutinizing NPs, we've discovered they have just as good, if not better outcomes than physicians. That's why they're so popular. Sapphiremind (talk) 09:45, 4 March 2011 (UTC)

To the person inventing the degree of "doctor of gas station refilling" -- you obviously have never gone to graduate school and have no understanding of university structure. No school of anything can just call a program a doctorate degree. Doctorate programs are created and certified under the rules of the graduate school of a University. If a school has managed to put together a new doctorate (such as the DNP) it only can be put into place if it meets the appropriate rigor of such doctorate level graduate education. Certainly, nurses are not given any special favoritism here, indeed since they have often not been part of the "old boys club" nurses and nursing programs often have to prove themselves that they are truly "worthy" of such titles -- and that it seems is the undercurrent of all discussion here ... 64.184.170.110 (talk) 08:46, 30 January 2011 (UTC)

DNP programs exist so that NPs can feel better about themselves and superior to the equally trained Physician Assistants (PAs), and NP schools can charge twice as much tuition for the same amount of time in school.

There has always been talk of academic inflation in any of these fields newly requiring a doctorate (such as physical therapy, nursing, etc), but I will say one thing - whenever I've worked at a hospital with a nurse who had a PhD/DNS/DNP, we never addressed him or her as "Dr (so and so)," nor did they call themselves as such. In a healthcare setting, especially a hospital, to use the term "doctor" will almost always cause the patient to believe you are an MD or DO. We've always addressed them as "Nurse (so and so)," as the word "doctor" carries too much meaning in healthcare to allow its use in the academically correct fashion. Nominally and legally, however, I will recognize them as possessing a "doctorate degree," even though I may NOT be of the opinion that one doctorate degree is as rigorous, difficult, useful, or accessible as another. —Preceding unsigned comment added by 71.61.204.168 (talk) 00:01, 24 May 2010 (UTC)

good page

I liked the page on NPs and found most of the info accurate and concise. I refer prospective students to this page when they ask about what an NP is. In reading some of the comments, I disagree with "gtadoc", nurse practitioners are independent healthcare providers, and many have a scope of practice which is easily equal to that of a given physician. Physicians did not invent healthcare, nurses have been doing it just as long. In fact, we must ask ourselves if nursing, primarily a women's profession, would have progressed a bit faster if there had not been a large gender gap in our culture. Nurse practitioner's practice is expanding all the time, and often there are some physicians who feel threatened. Luckily, there are enough patients for all of us. At any rate, thanks for the page! —Preceding unsigned comment added by Achnp (talk • contribs) 01:36, August 29, 2007 (UTC)

I disagree with the statement that the scope is more or less equal; perhaps to what a first year resident would do but beyond that they are very different. It is different to say that they see similar types of patients and to say that they are capable of doing the same diagnosis/procedures. The first is true for the most part if speaking of a general practitioner (which is a dying breed) and to a lesser extent a family practitioner. It is not at all true for all other types of MDs. The second is defenately not true and will get an NP in trouble if he/she goes beyond their scope of practice and attempts to work as an MD while only being trained as an NP (or PA for that matter). Allgoodnamesalreadytaken 03:06, 13 September 2007 (UTC)

This page had some good infomation but I was really looking for the benefits of being a pediatric nurse and since this was the most closely related topic I settled for it. I was just hoping that someone might have some infomation about the benefits, I would really appreciate.

My email address is [email protected]

Thank you for your time. Sincerely, Emily. —Preceding unsigned comment added by 216.11.243.60 (talk) 13:40, 14 December 2007 (UTC)

The gap between physician proficiencies and NP proficiencies is huge. Another physician and myself recently hired NPs. We are open minded, and fully expected them to behave professionally: like the physicians we had worked with. We were wrong. All 3 of the NPs that we hired are extremely well and extensively trained. Two have over 10 years of experience in our field of Psychiatry. These were the differences that I see:

1. They are clinically immature. Their critical thinking was at about the level of a First or Second year psychiatric resident, overall. They misdiagnose patients. 2. They are unprofessional. They openly tease, compete with, or criticize the physician who hired each of them in front of patients. They 'show off' in the charts, rather than being protective of the practice. Even though they are independent practitioners, they "call in sick" as if they are employees, and expect someone else to just take up the load for them. 3. They are arrogant, and expect the office to adjust to their "superior way of doing things" rather than trying to fit into the office as it is and has been. 4. They gossip, talk a lot, and don't seem to have to do things like read, study, or think carefully about their cases. 5. They think they know as much as physicians even though they have at best 1/4 of the training of a physician; they think they care more about the patients than physicians do, and they think they are more thorough because it takes them longer to do simple things. 6. They cherry pick the 'good' patients. 7. They abuse the office staff by having them do work for their convenience, like have them "bunch up" patients.

These characteristics occur in 3 out of 3 of our nurse practitioners, ages 30 to 60. This same arrogant attitude is reflected in this article, where it is never acknowledged that NPs are supervised by physicians or that their education is far less. I have never been nervous that NP's are equal to physicians, but having worked with the 'best', now I am nervous about how much they overrate their skills and how low is their level of professional maturity. I sincerely wish I could be more positive, but I cannot.

Debra MD (talk) 23:26, 3 September 2010 (UTC)

I just have to say to that: Anecdotal Evidence ring a bell? Sapphiremind (talk)

As a non-medical editor, this page smacks of NP advocacy -- to wit, cit. 4 to a blog advocating independence for Maryland NPs, etc. But the comments above, while they may be experientially true, are either advocacy (Achnp), are anecdotal and seem to reflect professional jealousy (Debra MD) and do nothing to improve the entry or make it more objective. — Preceding unsigned comment added by Webistrator (talk • contribs) 17:34, 29 July 2012 (UTC)

Comparing

I found this article to be comparing an NP to a Physician Assistant and should really only be compared to a Physician. It was bashing the NP and lifting the PA up above the NP when in reality the NP has more rights and independence than the PA. Don't get me wrong, there are many good PA providers but to consistently say the NP isn't as good as a PA is wrong. — Preceding unsigned comment added by 24.213.249.202 (talk) 20:44, 6 July 2011 (UTC)

This is subject to debate. For one, the term "mid-level provider" is used by many sources, including those outside of the field of medicine, to describe PAs, AAs and ARNPs. Many facilities use NPs and PAs interchangeably. Saying either one is better than the other, framing it as a matter of fact rather an an ongoing debate is misleading. Phltosfo (talk) 20:17, 13 October 2011 (UTC)

NP's are designed to practice autonomously whereas PAs are not. "Mid-level" used as defined as sub-physician is not an appropriate use of the term in relation to APRN's, Dentists or other equivalently trained clinician, and is a term going out of style for all associations outside of MD affiliated ones. Rivard.M (talk) 18:26, 29 August 2012 (UTC)

Image in lead

I removed the image File:Canberra Hospital Walk-in centre staff at work. (5567045104).jpg from the article's lead because it didn't actually do anything to illustrate the concept of a nurse practitioner. The image was since reinstated in this edit (with no explanation), so I'm starting discussion here. — Preceding signed comment added by Cymru.lass (talk • contribs) 04:23, 31 July 2013 (UTC)

Fundamental quality issues

This article seems to be of very low quality. The scope of practice is a non-specific list that is meaningless to the average user. The practice settings section is almost totally irrelevant -- it names nearly every type of facility in which health care of any sort is delivered. The post-nomial credentials section is also irrelevant to the average user. The ones of importance are really APRN,BC and NP-C. Also, it doesn't talk about any of the criticisms of the profession, giving a very one sided view of the profession. Phltosfo (talk) 20:17, 13 October 2011 (UTC)

The Doctorate of Nursing Practice (DNP) is NOT required in 2015. This is only a recommendation by the AACN. The only way for this recommendation to be enforced is for all state BON to require this and/or for all schools to get rid of their MSN programs (of note, two of the most prestigious graduate nursing programs, UCSF and UPenn don't have any plans for this). — Preceding unsigned comment added by 207.96.13.12 (talk) 20:21, 5 January 2013 (UTC)

Substantial growth can be expected in the nurse practitioner field, specifically pertaining to the Affordable Health Care Act in the USA, with the increased emphasis on primary medical care, which many would agree was de-emphasized, to some degree before the passage of this act. Similar growth can be expected in the field of physician assistants and medical schools may move toward more extensive primary physician preparation. Discussion of these matters should be included in this article.

Nurse practitioners (as well as medical professionals in a very parallel role) are often the primary medical functionary in many areas of the world beyond the scope of western medicine's hierarchy and supervision. It would seem highly appropriate to include an overview of this activity from some organization, such as the World Health Organization or other non-governmental agencies in this field. A summation of this activity (as well as any projection of expected changes and improvements) would be a valued inclusion, here. — Preceding unsigned comment added by 68.97.87.243 (talk) 18:39, 5 January 2014 (UTC)

Ann Intern Med

doi:10.7326/M13-2567 - review of nurse management of chronic conditions. JFW | T@lk 12:22, 20 July 2014 (UTC)

Philosophical Orientation of the Article

There is an implicit assumption of a kind of "medicine supremacy" as though in 4000-6000 years of human history it would be impossible that a new discipline emerges that aims for a more holistic examination of the human health and illness experience. One can happily defer to physician colleagues in concerns especially suited to their comprehension of the "matter" of humanity, but this deference does not connote "ownership" in the classic hegemonic sense. The article can acknowledge the the emergence of complexity in human health and disease may require networked models of care with the social and economic benefits that attend. A philosophically and editorially balanced article doesn't view the topic from the standpoint of a discipline specific frame of reference. It is the equivalent of saying that physics is "better" than chemistry. They both use equations. Similarly physicians and nurse practitioners both use aspects of medicine. Physicians extend that to its logical epistemological conclusion; nurse practitioners incorporate some of medicine into a fabric of that discipline's own design. They are aiming for a different conclusion. — Preceding unsigned comment added by 72.95.23.125 (talk) 01:17, 19 October 2014 (UTC)

Rephrase please

The article starts out:

A Nurse Practitioner (NP) is a registered nurse who....

That's a bit ridiculous. Would you say:

A dentist is a college graduate (BA or BS) who....

How about:

A Nurse Practitioner (NP) is a master's degree prepared health care provider. NPs build on their education and experience as a registered nurse (RN) with an advanced nursing education that includes training in the diagnosis and management of common as well as complex medical conditions. They are board certified and licenced to practice by each state. Nurse Practitioners provide a broad range of health care services and can be found in family practice clinics, specialty clinics, emergency departments, hospitals, ICUs, and more.

Nurse Practitioners are considered "mid-level providers" or "physician extenders," by many physicians and hospitals, although this label is controversial, since NPs are completely independent practitioners in many states, and in many settings provide equivalent care to that of physicians.^1,2,3,4,5

1. Brown, S., & Grimes, D. (1993). Nurse practitioners and certified nurse-midwives: A meta-analysis of studies on nurses in primary care roles. Washington, DC: American Nurse Publishing.
2. Burns, M., Moores, P., & Breslin, E. (1996). Outcomes research: Contemporary issues and historical significance for nurse practitioners. American Academy of Nursing Practice, 8(3), 107-112.
3. Crosby, F., Ventura, M. R., & Feldman, J. J. (1987). Future research recommendations for establishing NP effectiveness. Nurse Practitioner, 12, 75- 79.
4. Spitzer, W. O., Sackett, D. L., Sibley, J. C., Roberts, R. S., Gent, M., Kergin, D. J., Hackett, B. C., & Olynich, A. (1974). The Burlington Randomized Trial of the nurse practitioner. The New England Journal of Medicine, 290(5), 251-256.
5. U. S. Congress, Office of Technology Assessment (1986). Nurse practitioners, physician assistants, and certified nurse-midwives: A policy analysis. Washington, DC: U. S. Government Printing Office.

see also: Gwen D Sherwood, Mary Brown, Vaunette Fay, Diane Wardell: Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services. The Internet Journal of Advanced Nursing Practice. 1997. Volume 1 Number 2. Available at: http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml<br />

71.242.234.90 (talk) 23:06, 20 February 2009 (UTC)Denise

I don't agree that you provided an accurate rewrite. I am an RN and work with physicians and NPs. Any NP who claimed to be independant and work as a physician, or who puts themselves forward as a physician or just like one would be rightefully fired from our practice for misrepresentation and likely lose their license with our state. Equivalent care WITHIN their scope of practice, maybe, but an NP doing say a lumbar tap would be just as horrible as a firefighter/emt offering to surgically remove your spleen. Wow, the amount of BS on this talk page is amazing, and as a nurse I'm ashamed to think that some of it my be written by some people who are my collegues (or by others with agendas).

• It is accurate and many NPs are in fact independent - your state maybe not, but in my state they absolutely are. As for an NP doing an LP - absolutely it is within my scope and within my training, as are laceration repairs, I&Ds, biopsies, and many office based or outpatient procedures. Not only that but the NIH definition of an NP includes LPs specifically http://www.nlm.nih.gov/medlineplus/ency/article/001934.htm . Now, if an NP poses as a physician, they are wrong and subject to legal action just as a physician posing as a nurse or NP would be for misrepresentation; claiming to be independent (in my state), providing services that are similar to that of a physician (in most states), and meet the identical standard of care of a physician within their specialty or they are obligated to refer (in all 50 states and the U.S. territories) are all accurate and are not misrepresentations at all. —Preceding unsigned comment added by 24.117.40.30 (talk) 01:57, 26 October 2009 (UTC)

An RN can do an LP if they are specially trained, just like an NP or PA. They CAN't just because they went to NP/PA school. Can they interpret those results and do something about it? Absolutely: its called a physician referral. And an FYI, some paramedic skills are outside of the scope of practice for an NP or PA, so by the same argument you could say paramedics do similar work and at a similar level to an NP/PA. However, anyone who is non biased and with inside understanding of healthcare will know they operate in different roles/levels. 129.176.151.10 (talk) 03:51, 25 April 2010 (UTC)

"Identical standard of care" is not possible, as by definition they are providing a lower level of care (as is any "mid level").129.176.151.10 (talk) 04:39, 28 April 2010 (UTC)

So many people getting butt hurt. It's funny, really. — Preceding unsigned comment added by 24.101.28.2 (talk) 00:38, 27 June 2015 (UTC)

Increased Need in US Section

Putting aside the heavy US focus, this entire section is going too far for what credible sources offer. Some of it reads like a promotional piece for NPs, and statements like " As a result of this extreme need for NPs, they are also expected to receive more autonomy, meaning that nurse practitioners would be able to fill the traditional primary care role like a physician would" are not supported. It seems to be a speculation made by the writer by drawing lines from articles discussing primary care shortages to opinion pieces advocating expanded NP scope of practice. Maybe it can be rewritten well, but I'd say it would be best to cut this whole section. Stick the current practice rights in the US section, and if US job projections are important, find somewhere to put that, but otherwise this section just seems too subjective and speculative. — Preceding unsigned comment added by 107.214.136.181 (talk) 07:03, 21 May 2014 (UTC)

This section is very poorly written, as it stands. It also lacks citations for some claims (beginning with the first sentence). It reads like a poorly produced pamphlet from a MNP program. I recommend removing it altogether. Moreover, the very title of the section suggests a need for NPs that is not fully substantiated. If the section is preserved, I might recommend renaming it to "Role of NPs in addressing increased demand for primary care." Agree with above that it is too speculative. — Preceding unsigned comment added by 216.3.171.22 (talk) 16:53, 7 January 2015 (UTC)

In regards to the two IP editors, both the claim of autonomy and the claim of need for the Nurse Practitioner have occured in the United States. It is specitious to deny changes in licensure, scope of practice etc at the state level. Blanksamurai (talk) 20:07, 17 July 2015 (UTC)

The changes in scope, along with proposals for different changes in different states, seem like they would be appropriately placed in the scope of practice section, which could use more specifics anyway, so that seems beneficial on both ends. The rest of the claims made in the section, though, are what is really specious. — Preceding unsigned comment added by 65.60.186.6 (talk) 05:43, 12 January 2016‎ (UTC)

Photo

Is there any point to the stock photo illustrating this article? It adds nothing of value, as far as I can tell. El Mariachi (talk) 02:08, 25 April 2015 (UTC)

One reason I like it is that it counters the stereotype that men aren't nurses and nurse practitioners. This may seem unnecessary (because "everyone already knows that some nurses and nurse practitioners are men"), but one would be surprised ... even people who know it don't necessarily grok it. "Oh, a male nurse practitioner ... that's nice, I once had a black doctor, too." Some people need help moving past the stage where they feel the need to insert the race/sex adjective. One might think "that's not true anymore" until one meets people that demonstrate otherwise. Seeing a photo like this on an article like this is just one small step that helps people move on. Months or years after seeing it, they won't remember this particular instance ... but their mindset was affected by such instances over time. Quercus solaris (talk) 13:25, 25 April 2015 (UTC)

It's so obviously posed for a publicity photo. How many military nurses work in full uniform like this? Apart from anything else, it's completely impractical and breaches modern hygiene regulations. -- Necrothesp (talk) 14:06, 12 September 2016 (UTC)

Lede

"Medical doctors are healthcare professionals educated and trained to provide health promotion and maintenance through the diagnosis and treatment of acute illness and chronic conditions." - So where's the difference? - 91.10.52.143 (talk) 14:47, 24 January 2018 (UTC)

Please see the lead as it read now and let me know your thoughts. So said The Great Wiki Lord. (talk) 23:57, 4 September 2018 (UTC)

O Great One, I think it would read better to incorporate the APRN bit into the first sentence, assuming the bulleted list under Advanced_practice_registered_nurse#Education,_accreditation,_and_certification is accurate. I was just copy-editing and am not very familiar with the subject matter. I find the current wording of the first three sentences to be a bit awkward: A nurse practitioner is...They are also, as well as the repeated APRN mention. Eric ^talk 12:09, 17 September 2018 (UTC)

Eric, what do you think about the merging APRN and nurse practitioner articles? I have incorporated APRN in the first sentence. Please let me know what are your thoughts.So said The Great Wiki Lord. (talk) 13:04, 23 September 2018 (UTC)

I have no great knowledge of these professions, but the APRN article section Advanced_practice_registered_nurse#Education,_accreditation,_and_certification states that nurse practitioner is one of four types of APRN, each of which has its own article (two of them pretty big), which makes me tend to think they should remain separate articles. But again, I'm well out of area of expertise here.

It might be helpful if Erik ginters were to weigh in here rather than simply edit-warring. Eric ^talk 22:03, 23 September 2018 (UTC)

I agree. I have tried to engage Erik ginters a few times, both here an on his talk page. So said The Great Wiki Lord. (talk) 00:07, 24 September 2018 (UTC)

Eric, Erik ginters seems to be offended by the term Mid-level practitioner. I read some of the discussion above. If you ignore the people who are stating opinion, you can see that Mid-level practitioner is an accepted term, even recognized by CMS. I think it should be included. So said The Great Wiki Lord. (talk) 12:10, 24 September 2018 (UTC)

Oh, I'd never read any of the above, didn't realize it was a bone of contention among others. While I'm not familiar with the daily parlance of medical practitioners, the term doesn't strike me as having a negative connotation, at least not in an encyclopedia article. Eric ^talk 12:30, 24 September 2018 (UTC)

Same here. It is a well referenced term, and I think removing the term would wp:censor Wikipedia. I still want Erik ginters to discuss here and reach consensus. I am still interested in his wp:neutral point of view if he can put his bias aside. So said The Great Wiki Lord. (talk) 13:46, 24 September 2018 (UTC)

Proposed merge with Advanced practice registered nurse

A nurse practitioner is another way of saying an advanced practice registered nurse So said The Great Wiki Lord. (talk) 17:07, 21 September 2018 (UTC) - I have since withdrawn this proposed merger. So said The Great Wiki Lord. (talk) 14:32, 14 November 2018 (UTC)

Er...So where do NPs end and MDs begin?

Natalie Norem, RN has concerns:

1) there is a big difference between NP's and PA's (PA's are educated under a medical model, NP's educated under a nursing model)
2) NP's have more autonomy than the article gives them
3) NP's are definitely physician extenders, but they compliment physicians care and good looks —Preceding unsigned comment added by 165.20.104.30 (talk) 14:42, 29 January 2009 (UTC) 4) however their education is not uniform. People in the medical community are nervous that NPs feel they are equal to physicians. 5) Physician Assistant's education is more comprehensive and intensive than nurse practitioner's, No weekend, Afternoon, evening courses are available. No working while in school. Sorry all of you NPs who think you are oh so superior get over yourselves. —Preceding unsigned comment added by 76.111.167.251 (talk) 04:31, 7 June 2010 (UTC)

What is up with all of the People who try to make NPs sound as if they have equal training to physicians and PAs? We have great education and training but some people need to get over themselves and the limit to their role. There seems to be many NPs who feel because they have done their learned there job over the several years. The public needs to understand that the nursing "doctorate" is merely an academic degree and they should not be confused with medical doctors. - Susan, phD, aprn

Something the article really doesn't seem to answer (but instead leaves hanging): NPs, it sounds like, can do just about everything an MD can...So where the hell does an NP's scope of practice end and an MD's begin? --Penta 21:45, 25 September 2007 (UTC) THEY CAN NOT!!!

Actually, its more accurate to say that a NP can do everything a RN can do, plus a bit more (very true). The gap between the NP and MD/PA scope of practice is large, about what you would expect as the NP is only 1 year more training from the RN, while a MD does 4 years of medical school and then 3-7 years of residency and for specialists 1-3 years of fellowship. So, the 1 year difference in education between a RN and NP make them more similar than the 6-13 year difference in training between a NP and a MD. Also NP education is no where comparable to PA education. As PA education is full time training with only advanced courses. There is no such thing as counting an undergrad course in pharmacology and counting it as your graduate phamacology course the way some NP schools do it unlike Medical school and PA school. 129.82.217.44 (talk) 19:46, 23 December 2007 (UTC)

NPs and PA have the same scope/level of practice. They are the two "mid levels", only difference is the school track with NPs doing a nursing track and PAs doing a medicine track. —Preceding unsigned comment added by 129.176.151.7 (talk) 16:57, 9 February 2008 (UTC)

NP's and PA's may have the same scope but NP's have years of experience with seeing patients and assessing them before getting their license. An English major, accountant, Sports Information, or geology majors can apply for PA school with absolutely no patient experience. They go through school to end up on the same level as an NP but without the first bit of experience in taking care of patients except in school. NP's have to have been through nursing school and worked as a nurse prior to going back to school. NP's have to have actual knowledge of what happens in the real world with patients. And while a MD may have 6 years of school, a NP has to go through 4 years of nursing school, actually go out and work to get some real life patient experience, and then go back to school for another 2 years to get an NP degree. NP's are the only ones who actually have experience taking care of patient when they get out of school. Actual hands on, no supervision, real life face to face experience taking care of patient before they can get an advanced practice degree. — Preceding unsigned comment added by 2601:3C7:8202:799F:643F:DF50:4E67:BC8B (talk) 02:33, 20 March 2019 (UTC)

I would have to agree and disagree with much of the above.

its more accurate to say that a NP can do everything a RN can do, plus a bit more.

This is a fair statement. However the whole comparison between education of an NP to and MD is misleading. The education for an NP is not 1 year difference between and RN. Many RN's are Associate degree trained, in CA, US well over 50%. Though some are BSN's. A Current NP program requires an RN spend approx 2 years obtaining a masters degree. Then another year or more obtaining the NP certification. To top that, they are pushing the minimum requirement to be a DNP(Doctorate Nurse Practitioner). This will require another 12-18 months of education. The DNP is not designed to change the scope of practice for a NP however.
As for the differences between the scopes of practice of an NP VS MD, there is a large difference. A NP takes on your daily healthcare needs, though severe cases are often passed on to an MD. Also, you seldom see a Surgical NP, though they can be a first assist with proper training. The scope of practice between an PA and NP, though similar, is also different. PA and NP fill a similar notch; however they are governed by different boards. PA's under the AMA, the NP's under nursing boards. PA's must always be under the supervision of an MD, where as NP's has the authority to practice independently in 23 US states, often more rural states. Other states are considering legislation to grant NP's more freedom to practice. Also, the educational training is different for an NP and PA. PA can in some places, still be a diploma certification, though Associate and higher degrees are more the norm. In the US all current NP programs are Masters Degrees. Which means that an NP must also have a Bachelors degree, normally a BSN, though there are some exceptions? NP and PA's are not MD's, though they are more and more taking over the position of an Family practitioner MD, while many MD's go into More profitable specializations. So basically, a NP, is not a PA, is not a MD, but they all work together in their prospective fields to serve health care. —Preceding unsigned comment added by MWJamesLDS (talk • contribs) 17:27, 4 April 2008 (UTC)

In Colorado I have come by very few RNs that did not have a BSN, it would be interesting to see a comparision to the scope of practice from a PA and NP, in our state in common practice they seem to be identical. In regards to PAs, it was my understanding that diploma programs had been discontinued, and that all PA programs where now bachelors degree+2 years PA school, so very similar if not more than the BSN+1-2 year NP? —Preceding unsigned comment added by 67.132.98.55 (talk) 02:21, 24 June 2008 (UTC)

Late to the the conversation, but to answer, NPs are not physicians, so where NPs end and MDs begin is in 4 years of additional medical school education, 3-10 years of additional residency training, and optionally an additional 1-4 years of fellowship training. For people who want to be NPs, go to NP school. If you want to be an MD, go to medical school. Going to one and hoping for another is a recipie for an unhappy healthcare worker. In our practice NPs and PAs are identical, our hospital requires both to be supervised and work in collaboration with their physicians. In practice they do many of the same things that medical students rotating on our service will do, only on a full time basis and they are much more efficient than our students!~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 19:49, 11 December 2008 (UTC) Here's for reading, I see my contribution is somewhat redundant!

1) Hopefully this helps?

Overview of NP Practice in the United States: http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3465

Chart Overview of NP Scopes of Practice in the United States: http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

2) Also, this statement is simply inaccurate:

"...where NPs end and MDs begin is in 4 years of additional medical school education, 3-10 years of additional residency training, and optionally an additional 1-4 years of fellowship training."

The undergraduate (pre-med) preparation for physicians is not at all clinical, and only about 2 years of medical school are truly clinical. MDs get a ton of basic science, but in undergrad this is mainly a weed-out process. Nursing education doesn't emphasize, for example, understanding the difference between SN1 reactions and SN2 reactions (undergrad organic chem) or being able to calculate the velocity of falling objects, because frankly, it doesn't matter when your patient is going south. Instead, the undergraduate curriculum for nursing students is clinical in nature, with relevant basic science and applied science. And though some RNs only did 2 year programs initially, all NP schools are grad schools and either require the 4 year degree prior to matriculation or they just include the extra education as part of a longer program. But all NP schools grant master's degrees at a minimum.

Most nurses also work for several years before starting grad school (most NP programs require it; even if it doesn't, most students feel they need the experience). On the med school clerkships just get students comfortable in the setting, comfortable with their physical assessment skills, comfortable with handling a code, etc., whereas most nurses have already been doing this stuff for years.

NP programs are specialty specific, e.g. family practice, adult acute care, pediatrics, women's health, oncology. So minimal time is spent on areas unrelated to the intended specialty, e.g. a Pediatric NP student does not spend an inordinate amount of time studying congestive heart failure or dementia. That doesn't mean they get a bad pediatric education, but it does mean that fewer years are required.

Regarding residency, most MDs do not have 9 years of residency and 3 years of fellowship. 3-5 of residency is typical; most do not do fellowships. Longer residencies are for surgeons and specialists; that doesn't make generalists bad or unsafe. Most residents would also tell you that after the first year, they feel that they are being exploited and underpaid, because they don't actually need that much hand-holding. NPs, as nurses who have worked with cohort after cohort of new interns and seasoned residents are aware of this, and while they know that the first year or two on the job will be brutal, they do end up as quite competent providers.71.242.234.90 (talk) 22:30, 20 February 2009 (UTC)Denise

Having read the large amount of talk here...I don't think anyone is arguing about competance of providers. It looks rather that there are 1 or 2 people who are arguing for a political agenda rather than wanting an accurate information page. Having worked as an RN, then an advanced practice nurse, and now in medicine after deciding to become the oldest woman to graduate from my medical school (!! now that sounds depressing!!) I can say that both doctors and nurse practitioners are very competent, but they do very different things and have VASTLY (I was surprised) different knowledge backgrounds. I actually kind of laugh when I think about comparing them, because they aren't the same and have different roles, and your right its not just about time being educated but rather what they are being educated, which is very different. Fuzbaby (talk) 14:15, 21 May 2009 (UTC)

Arguing that basic science education in medical school is pointless highlights your misunderstanding on how MDs and NPs differ. MDs are trained to form ddx from day 1 and you need to be able to have a strong background in the basic sciences (acid/base balance=chemistry, circulatory system=physics, protein structure=sickle cell, etc.) in order to do this. There is also a strong focus on EBM and how to ascertain/synthesize management strategies when clear evidence does not exist (eg prophylactic antibiotics in high risk SBP pts). TO argue that these aspects are worthless because they don't have immediate pertinence in emergency situations is ignoring the vast majority of medicine and how it progresses. If we all just continued to follow algorithms to keep people alive we would still be giving inotropes to people with CHF and resecting gastric adenocarcinomas. — Preceding unsigned comment added by 72.220.185.47 (talk) 06:15, 18 November 2011 (UTC)

Poor Reflection

There are many inconsistencies and possible erroneous facts in this article, not to mention the writing is of poor quality. For these reasons, it does not reflect well upon NPs. I stumbled upon this article while trying to discern the difference between the scope of practice of physicians and NPs in the United States, and this article fell way short of all of my expectations. For example, early on the article suggests that NPs are licensed through state medical boards, but in the United States section, it says that NPs are licensed through a national board. Is it state, national, or both? Since it seems to vary by state, further research into each state's requirements is necessary to clarify the board certification requirements.

This article seems to suggest that NPs have similar powers and responsibilities as physicians, but have received much less training. Furthermore, the implied inconsistencies in certification requirements give less credibility to the field, as the education, training, and board certification requirements for physicians do not vary by state.

I strongly suggest that this article be totally revamped by a currently practicing NP.

70.197.69.34 (talk) 06:36, 26 May 2013 (UTC)

Agreed!! This is very inflammatory and inaccurate. Printer987654321 (talk) 22:38, 24 March 2019 (UTC)

Issues ?resolved

The page had WP:POV and WP:Peacock issues throughout. Most of these were uncited. I have done my best to resolve them. Eric, would you please review and comment. Thanks. So said The Great Wiki Lord. (talk) 14:44, 21 March 2019 (UTC)

Hi- I don't have time to read the article in its entirety, but it looks to me like you've done good clean-up and source work on it. It might help to add the article to the "things you can do" section on Portal:Nursing so other interested parties could have a look. Eric ^talk 19:43, 21 March 2019 (UTC)

Thank you for your comments, Very much appreciated. So said The Great Wiki Lord. (talk) 18:03, 25 March 2019 (UTC)

Hi, I am a nurse practitioner, and I recently was made aware of the content of this article/piece on nurse practititoners here on wikipedia. While this piece has a few good citations and some relevant information, there are also some citations/references that are adding information that is a bit skewed. For instance, the study stating how NPs and PAs order more diagnostic imaging and other advanced testing than physicians, while technically true, only showed that NP/PAs do this between 0.1-0.3% more than their physician counterparts. Not exactly a statistically significant finding that I would hang my hat (or argument) on, and yet it is stated in the wikipedia article that NP/PAs are greatly increasing healthcare costs due to this overtesting. Since the actual study cited didn’t show anything statistically significant, this is quite a stretch and is very misleading. There are many other aspects to this piece on nurse practitioners that are also misleading, biased, and/or false. This can lead to a public misperception and damage our credibility. So I would like to ask that this piece be made editable so as to add/correct parts of the information presented. Thank you. Bumashes (talk) 18:43, 25 March 2019 (UTC)

Semi-protected edit request on 25 March 2019

This page is incredibly inaccurate and misleading. It has obviously been tampered with by someone with NO knowledge of NP scope of practice and a real hatred in their heart. Please remove all inaccurate content especially that pertaining to NP practice in Canada. 70.28.20.178 (talk) 20:52, 25 March 2019 (UTC)

 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. - FlightTime (open channel) 20:55, 25 March 2019 (UTC)

Semi-protected edit request on 28 March 2019

Please change, "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner. A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans." to " A Nurse Practitioner is a Registered Nurse who completed a masters or doctoral level advanced degree at a nationally accredited institution and is board certified in their area of specialty as required by individual state law." The opening sentence of this article is purely opinion based. There is no formal designation for "mid-level practitioner", which as the article suggests is considered by many to be a derogatory term. The change suggested more accurately reflects a neutral stance (according to the 5 pillars of wikipedia) and states the facts of what a nurse practitioner is, the training needed to obtain, as well as the requirements for their licensure. https://www.nursinglicensure.org/articles/nurse-practitioner-license.html https://www.nursingworld.org/our-certifications/ 66.177.109.117 (talk) 23:30, 28 March 2019 (UTC)

 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. Please see above where a discussion took place on this and a consensus was established. Mid-level practitioner is a very notable term used by National Institutes of Health, World Health Organization, and also has an article on Wikipedia that meets Wikipedia's guidelines. We do not censor Wikipedia people may consider it derogatory or maybe offended by it. So said The Great Wiki Lord. (talk) 01:39, 29 March 2019 (UTC)

GA Review

This review is transcluded from Talk:Nurse practitioner/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Amanda4187 (talk · contribs) 00:33, 11 April 2019 (UTC)

This article has been significantly altered to paint nurse practitioners as incompetent, manipulative, and unsafe. The article is supposed to be about nurse practitioners who practice advanced practice nursing. Instead the article about a comparison between advanced practice nurses and how they are incompetent to provide care to patients because they are not as good as physicians. In reality, nurse practitioners are not physician's we do not claim to be, we look at patient's completely differently than a physician. Below you find a long list of statements that need to be removed from the article to make it more accurate.

1) "but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions."

2) "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact. The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training.[1] Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals." - Although not completely incorrect, this is debatable. These comments intentionally paint NPs as incompetent and compare NPs to physicians... that is not the point of the article. This is not a comparison article.

3)"Given the quality and quantity of training, experts have questioned the quality of care delivered by nurse practitioners." This is inaccurate and mainly physician groups such as Physician's for Patients feel this to be true. "The studies we reviewed did not demonstrate a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations."

4) "Studies have shown multiple concerns associated with lack of training. Nurse practitioners are more likely to prescribe antibiotics when they are not indicated.[13]" Although yes, there is a known need to increase Antibiotic Stewardship, please view attached table to see the differences in this associated study. Also, the same study states, "The historical studies and recent literature provide little reason to suspect that there is a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations."

5) "It has also been shown that “there is a tremendous need to enhance nurses’ skills."[14] - The study linked to this comment is was "A cross‐sectional descriptive study was conducted that gathered data from an anonymous online survey of practicing nurses throughout the U.S. Measures tapped EBP knowledge, beliefs, culture, mentorship, implementation, and reported competency for each of the 13 EBP competencies for practicing nurses and an additional 11 competencies for advanced practice nurses." - It was an online survey.

6) "Nurse practitioners are also more likely to make unnecessary referrals.[8]" This statistic is related to Nurse Practitioners and Physician Assistants combined. This statistic is misleading.

7) "They are also more likely to order unnecessary tests and procedures such as skin biopsies and imaging studies."[9][15] This statistic is related to Advanced practice clinicians (i.e. Nurse Practitioners and Physician Assistants) This statistic is misleading.

8) Although a few studies have shown that NPs provide similar quality care when compared physicians, these studies were found to have a medium to high potential for bias and had low to insufficient strength of evidence.[16] The study that is referenced does not support the statement. The article does say, "Strong conclusions or policy changes relating to extension of autonomous APRN practice cannot be based solely on the evidence reviewed here. Although no differences in 4 outcome measures (health status, quality of life, mortality, hospitalizations) were detected, the evidence cannot rule out such differences."

I have no knowledge of NPs from other countries.

9) "Overall, to become an NP requires 1.5 to 3 years of post-baccalaureate training, compared to physicians who are required to complete a minimum of 7 years of post-baccalaureate training." A Nurse Practitioner is not a physician, why is this comparison even in this article? This is an inappropriate comparison.

10) A new nurse practitioner has between 500 and 1,500 hours of clinical training <--(This is accurate) "compared with a family physician who would have more 15,000 hours of clinical training by the time certification.[1]" This is another inappropriate comparison, it is an article about Nurse Practitioners. Also, if it is going to compare NPs to physicians, this is unfair to non-American based physicians. If NPs are being compared to MD/DOs shouldn't other countries be represented here?

11) "The quality of education and applicants for NP schools has been cited as a reason to not allow NPs to practice medicine." This is an opinion, no fact. Nurse Practitioners do not practice medicine, we practice Advanced Practice Nursing.

12) "Many schools have 100% acceptance rates, coursework can be 100% online, and clinical experience is limited to shadowing with no hands-on experience.[23][24]" Although this is not completely inaccurate, this is misleading. Clinical experiences are not "no-hands-on" experiences. They do lack significant oversight from the universities but they are hands-on experiences. The purpose for clinical experiences is to have a hands on experience.

These are my recommendations for review, eleminiation. Amanda4187 (talk) 00:33, 11 April 2019 (UTC) — Amanda4187 (talk • contribs) has made few or no other edits outside this topic.

Amanda4187 your comments on review appear to be off topic and suggests a conflict of interest. Please note that Wikipedia is not a battleground. If you disagree with any of the above please try to establish a consensus instead of trying to sabotage a GA Nomination. Normally, I make it a point to make sure I do not bite the newcomers; However given the number of edits saying the same thing from first time users, I am starting to suspect sockpuppetry or meatpuppetry. Please read through the links and the links that I will post on your talk page and we can see how we can make this page even better. So said The Great Wiki Lord. (talk) 13:59, 11 April 2019 (UTC)

Please keep in mind: even Wikipedia's own description of a mid-level provider (https://en.wikipedia.org/wiki/Mid-level_practitioner) includes several references supporting the statement: "The terms "Mid-level provider" or "Mid-level practitioners" have been widely accepted for many years however, they are now seen as derogatory and offensive." Yet this is how the Wikipedia nurse practitioner article starts out. I'll reiterate: nurse practitioners have been providing health care for over half a century. NPs are currently providing care in all 50 U.S. states, the District of Columbia, U.S. territories and in countries around the world. NPs diagnose, treat, prescribe medications and manage patient care. In the U.S., 22 states, the District of Columbia and two territories grant legal permission for NPs to provide care without physician oversight. The remaining states are exploring whether to grant full practice authority. The National Academy of Medicine (formerly the Institute of Medicine), the National Governor's Association, the Federal Trade Commission, the National Conference of State Legislatures, both the Trump and Obama administrations and others have called on states to remove outdated laws and regulations that hinder patient access to NP care as a way to address health care access and reduce health care costs. Raraavis31 (talk) 14:39, 25 May 2019 (UTC)

Yes, I saw that statement in the Mid-level practitioner article, and I doubt that it's appropriately presented. That term is seen by some people, including the marketing departments of some nursing organizations, as derogatory and offensive. It is not necessarily a generally held view. That article should acknowledge both that viewpoint and also the opposite viewpoint, i.e., that none of the MLPs, including NPs, in any country, have ever been legally permitted to perform the most advanced medical treatments, such as pediatric cardiothoracic surgery, and that there's no shame in admitting that NPs have a middle-sized scope of practice. WhatamIdoing (talk) 15:11, 25 May 2019 (UTC)

WhatamIdoing (talk), do otolaryngologists perform pediatric cardiothoracic surgery? Certainly not, because that is not their specialty and it is not within their scope of practice. The nurse practitioner article should describe the care NPs do provide, rather than comparing NPs to some other type of provider and the care they provide to that of other clinicians. Other clinical roles and professions are described on Wikipedia without comparative language, including terms like mid-level practitioner, and the NP article should follow that same pattern. Miraclecln (talk) 15:46, 28 May 2019 (UTC)

Thank you for agreeing that NPs are not licensed to perform such delicate surgeries.

The legal scope of practice for physicians in the US is literally anything and everything medical. In my home state, the law says "The physician's and surgeon's certificate authorizes the holder to use drugs or devices in or upon human beings and to sever or penetrate the tissues of human beings and to use any and all other methods in the treatment of diseases, injuries, deformities, and other physical and mental conditions." That is not true for NPs. An NP isn't permitted to "use any and all other methods in the treatment" of medical conditions. As an example, an NP who wants to add acupuncture to her practice would have to get a separate acupuncture license, but physicians would not. WhatamIdoing (talk) 15:53, 3 June 2019 (UTC)

Not a Good Article

I agree with the points that Amanda4187 laid out. It appears that TheGreatWikiLord has a conflict of interest and should understand that Wikipedia is not a battleground for physicians or nurse practitioners. Instead of denying repeated requests for change, TheGreatWikiLord must try and establish a consensus and include information that describes nurse practitioners in a factual and neutral point of view.

Regarding point #2 above, not only is the information comparative and intentionally designed to disparage nurse practitioners, it is inaccurate for a large percentage of nurse practitioners who are not educated in online programs.

Regarding point #5 above, that study is on registered nurses in the United States, not nurse practitioners.

Additionally, regarding this sentence "Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals.[8][9][10]," none of the studies referenced indicate that NPs increase the cost of care, rather they suggest that it is possible for costs to increase in the future, specifically related to diagnostic imaging.

This sentence has no place in the article, and it certainly should not be mentioned twice (in both the opening paragraph and the controversy section). "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact.[7]"

There are errors in the page like this: "An average family physician has over 15,000 hours of clin[1] to become ..."

The controversy section includes comparisons to physicians that are out of place in a Wikipedia article. The physician assistant page does not contain comparisons to any other health care provider type, as it should be.

If they are going to mention that nurse practitioners are lobbying for independent practice, which is not the optimal term, they should also mention that NPs have full practice authority in 22 states.

Under quality of care, it says, "experts have questioned the quality of care delivered by nurse practitioners," but no sources are cited and no experts are named. This sentence and the entire section should be stricken.

My time is limited to post today, but this is just a very brief introduction to why the nurse practitioner page should not be granted good article status and should be revised to describe the NP role in a neutral and factual way. Miraclecln (talk) 17:46, 20 May 2019 (UTC)

Comparisons are a tool that encyclopedia articles use to help people understand some subjects. Thank you for identifying the deficiencies in the Physician assistant article. People who want to understand this subject should know how NPs compare to nurses and physicians (different scope of practice), and also how they compare to PAs and COs (similar scope of practice). WhatamIdoing (talk) 18:30, 22 May 2019 (UTC)

Thanks for the discussion on comparisons, WhatamIdoing (talk), however I do disagree. In addition to the Physician assistant article, we might also consider treatment of the field of dentistry or any other profession on Wikipedia. Comparisons are not used by Wikipedia to help readers understand differences in roles within dentistry or other fields. Rather, each role is described separately. That practice should be continued for nurse practitioners, as well. Miraclecln (talk) 16:45, 23 May 2019 (UTC)

Not quite. Physician assistants should be compared to occupations such as physicians, NPs, and MAs. It's the Dental assistants and Dental hygienists that ought to be compared to dentists. Here's a source with typical comparison lists for NPs and PAs. You haven't presented any reason why we shouldn't do something similar in all articles about all professions (including those outside healthcare), beyond the ones we call WP:IDONTLIKEIT and WP:OTHERSTUFFEXISTS. And, yes, Wikipedia actually does this. You can see one example of comparing and contrasting related professions at Artist#Training and employment, in which we compare and contrast different types of artists in terms of education, income, etc. In the healthcare field, we even have a whole article called Comparison of MD and DO in the United States. WhatamIdoing (talk) 17:13, 23 May 2019 (UTC)

Quick Fail

This article meets the "immediate fail" of a good article criteria due to meeting criteria 4:

It is not stable due to edit warning on the page

This article on Nurse Practitioners has been classified as "semi-protected" for months. NPTruth (talk) 16:05, 23 May 2019 (UTC)

Closing due to issues raised above. Best Wishes, Lee Vilenski ^{(talk • contribs)} 14:41, 3 June 2019 (UTC)

Semi-protected edit request on 17 April 2019

ADD the following: Released in October 2010, the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, is a thorough examination of the nursing workforce. The recommendations offered in the report focus on the critical intersection between the health needs of diverse, changing patient populations across the lifespan and the actions of the nursing workforce. These recommendations are intended to support efforts to improve the health of the U.S. population through the contributions nurses can make to the delivery of care.

The eight recommendations offered in the report are centered on four main issues:

Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and information infrastructure. http://www.academicprogression.org/about/future-of-nursing.shtml

This has helped to decrease the anger felt by doctors that feel threatened by nurse practitioners. In fact collaboration between practitioners has long been stressed as crucial in quality care to improve patient outcomes.

Nurse practitioners have been found to provide comparable primary care to that of family physicians. Their work has reduced costs of health care, increased access to health care and reduced the burden doctors who work in overpopulated ERs, and clinics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/

Some people (particularly MDs think nurse practitioners are competing with physicians, in part because they see patients for basic care at a fraction of the cost. However, Nurse practitioners are trained to provide holistic, patient centered care. Ma030801 (talk) 13:49, 17 April 2019 (UTC) — Ma030801 (talk • contribs) has made few or no other edits outside this topic.

 Partly done: I have added the well cited information. Please read WP:V, WP:NPOV, and WP:RS for more information. So said The Great Wiki Lord. (talk) 14:35, 18 April 2019 (UTC)

Questionable wording

Nurse practitioners are educated clinicians – advanced practice registered nurses with graduate degrees. It surprises me to read the word “flimsy” used to describe the NP education. Even if used to explain what NP opponents believe, this type of derogatory language does not belong in a Wikipedia description of any profession. The Wikipedia Five Pillars are in place to ensure fair and unbiased descriptions – a neutral point of view. I can’t see how respect and civility were practiced using this type of language. Please consider omitting. Raraavis31 (talk) 23:24, 9 May 2019 (UTC) — Raraavis31 (talk • contribs) has made few or no other edits outside this topic.

Remove the emotion, add the facts

The content of this page needs to reflect the current profession of nurse practitioners. There is no debate on the profession: it exists in all 50 U.S. states. If you want to edit an add a section about possibly controversy of the profession, then so be it. But to include opinion and not fact -- despite reference to slanted propaganda from medical associations, is a disservice to anyone reading this page looking for quality information. This is written as if we are still trying to justify the profession, as if we would do that with police officers or teachers. I implore you to consider the changes that so many have recommended but have been denied for poor reasoning.

You failed to respond at any of this first paragraph. Therefore, I am requesting again. Move controversial statements to a "controversial" section if you desire. Its as if you don't believe the role exists and are pandering to organized medicine.

The quote, "In United States, nurse practitioners have been lobbying for independent practice.[6]" references a Forbes article. Nurse practitioners are advocating for "full practice authority." That is, Full Practice State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing. (https://www.aanp.org/advocacy/state/state-practice-environment).

Also, there are states that have granted nurse practitioners "full practice authority" and the inception of the profession in the nurse practice act which defines scope and title. Therefore, it is again incorrect, to insinuate that all NPs are "...lobbying for independent practice."

There is NOTHING in the referenced articles to make the statement, "...but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions." [1][2] NOTHING to make that blanket over-reaching statement. See, that is opinion, not neutral.

Cherry picking low quality studies is a disservice to anyone reading this. The claim of "Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals"

- Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners: This study examined NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS TOGETHER. The data does not seperate nurse practitioners from PAs, therefore this study of 160 patients seen by both NPs and PAs cannot alone be attributed to NP referrals. Also, this study makes NO REFERENCE to cost. It only concludes: "The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation."

- A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office-Based Evaluation and Management Visits: Again this study COMBINED NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS with no analysis of the NP data vs PA data. Its impossible to know the true NP referrals for imaging from this study. They conclude: "Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. Expanding the use of APCs may alleviate PCP shortages. While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level." However the editorial comment by Katz (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939367) states, "In this article, Hughes et al1 find that advanced practice clinicians order modestly more radiologic tests (0.3%) than primary care physicians among Medicare patients. However, this overall percentage difference obscures a more important finding. When the investigators focused on a common problem in primary care, lower back pain, they found that advanced practice clinicians ordered no more imaging tests than physicians, and when the investigators limited the sample to patients with acute respiratory illness, advance practice clinicians actually ordered fewer imaging tests."

- Emergency physician evaluation of PA and NP practice patterns - This low quality study is based on a SURVEY of EMERGENCY ROOM PHYSICIANS " We chose to survey the ACEP council as a representative group of emergency physicians from across the United States with general knowledge and expertise in practice and administrative matters." This is clearly a biased sample who reported, "Just over 51% of the 327 respondents to the audience response system survey reported that they generally regarded PAs and NPs as subordinate in relation to attending physicians." This survey did not study health care costs in any way.

Its time to stop the stone walling on this page and the NP professions and make the appropriate updates.

There are a lot of immature and passive-aggressive "professionals" posting on this page including the editor of the page. Nurse practitioners are not "mid-levels", there is no level between nurse and physicians because they are two different professions! It's a shame this page had to be semi-protected due to vandalism. As it is now, it is riddled with errors and someone's personal viewpoints about nurse practitioners.

Please point out the "poor reasoning," and I will be glad to revisit and re-discuss as I have done before. Thanks. So said The Great Wiki Lord. (talk) 14:10, 16 May 2019 (UTC)

Nurse Practitioner entry

I see many biased and derogatory remarks about nurse practitioners in this entry and I urge you to remove or edit the material to be fact-based. I respect Wikipedia and its many contributors but this is fake and biased information and does not belong on Wikipedia. 104.52.197.251 (talk) 14:31, 16 May 2019 (UTC)

Can you be a little more specific please. So said The Great Wiki Lord. (talk) 14:41, 16 May 2019 (UTC)

Semi-protected edit request on 17 May 2019

This page is being vandalized and protected by a user with malicious intent toward the nurse practitioner profession. It is blatantly slanderous, and professional, accredited nurse practitioners should be able to edit this information and correct the blatant propaganda being spewed here on this page. Juliewiki4 (talk) 17:41, 17 May 2019 (UTC) — Juliewiki4 (talk • contribs) has made few or no other edits outside this topic.

You can propose changes here on the form "Please change X to Y" citing reliable sources. – Þjarkur (talk) 19:30, 17 May 2019 (UTC)

Resistance to edits

There is clear consensus on many of the comments but the admin consistently blocks them. As far as the last edit, you don’t see an issue with having the same text in 2 different sections? Seriously? The whole impetus of the new “controversy” section was to tease out the FACT from OPINION NPTruth (talk) 02:03, 19 May 2019 (UTC)

Information will be rewritten. The summary will remain in the lead and more thorough information will be added to the controversy section. Please read WP:concensus. A number of people encouraging others to write the same thing over and over again is not consensus, please not that Wikipedia is Not a democracy So said The Great Wiki Lord. (talk) 14:35, 19 May 2019 (UTC)

Semi-protected edit request on 20 May 2019

This discussion has been closed. Please do not modify it.
The following discussion has been closed. Please do not modify it.
Can we get a consensus on this? The definition of nurse practitioner needs to be updated on this page. Please see below. A nurse practitioner (NP) is a member of the health delivery system educated and clinically prepared to practice autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NP practice regulations vary by state. NPs are one of four types of advanced practice registered nurses (APRN) – highly valued and an integral part of the health care system. Miraclecln (talk) 16:55, 20 May 2019 (UTC)

Semi-protected edit request 20 May 2019

The edits made by TGWL in the past two days are awful and far beneath Wikipedia's standards. For example, the following needs to be removed immediately, since a discussion board is far from a reliable source, and the person who posted has not even been verified. "Some online NP schools can have very low admission standards." Miraclecln (talk) 19:54, 20 May 2019 (UTC)

References

Agreed that was an oversight. I have removed as requested. So said The Great Wiki Lord. (talk) 20:38, 20 May 2019 (UTC)

Section on nurse practitioners is very politically charged

It's improper to have so much of this article written by an doctors who think using nurse practitioners is a threat to the US health system as per their sources linked. Please update/revise. — Preceding unsigned comment added by Bethany72 (talk • contribs) 01:45, 18 April 2019 (UTC) — Bethany72 (talk • contribs) has made few or no other edits outside this topic.

Comment- The article should define the profession not by controversy but by the actually underlying education and practice. This is very obviously political. APPs do have some controversy regarding recent scope expansion, but this does not define the profession in the US. The vast majority of NPs practice without encountering controversy. The article should read more like the PA article.2600:1700:A5F0:ADE0:154B:A677:993:2CBE (talk) 23:54, 20 April 2019 (UTC)

The controversy is worthy of being included in the article. We cannot remove that part, since we do not censor Wikipedia. The controversy statements are all well sourced and attributed in the article. A lot of the article does deal with history, scope of practice, education, licensing, and board certification. I am trying to expand this article as much as possible. If you think something needs to be included please let me know, and try to be as specific as you can. General statements like "The article should read more like the PA article" or the one made my Bathany72 "It's improper to have so much of this article written by an doctors who think using nurse practitioners is a threat to the US health system as per their sources linked. Please update/revise" are useless. I know the article contains politically charged material, but please understand none of us at Wikipedia attached all the politics to to your profession. We are just including it in the article since it meets inclusion criteria. Please consider getting adopted to learn and contribute constructively. Thanks. So said The Great Wiki Lord. (talk) 19:52, 21 April 2019 (UTC)

Avorn, J., Everitt, D.E. & Baker, M.W. (1991). The neglected medical history and therapeutic choices for abdominal pain. A nationwide study of 799 physicians and nurses. Archives of Internal Medicine, 151(4), 694-698.

A sample of 501 physicians and 298 NPs participated in a study by responding to a hypothetical scenario regarding epigastric pain in a patient with endoscopic findings of diffuse gastritis. They were able to request additional information before recommending treatment. Adequate history-taking resulted in identifying use of aspirin, coffee, cigarettes and alcohol paired with psychosocial stress. Compared to NPs, physicians were more likely to prescribe without seeking relevant history. NPs, in contrast, asked more questions and were less likely to recommend prescription medication.

Bakerjian, D. (2008). Care of nursing home residents by advanced practice nurses: A review of the literature. Research in Gerontological Nursing, 1(3), 177-185. doi: 10.3928/00220124-20091301-01.

Bakerjian conducted an extensive review of the literature, particularly of NP-led care. She found that long-term care patients managed by NPs were less likely to have avoidable geriatric complications such as falls, UTIs, pressure ulcers, etc. They also had improved functional status, as well as better managed chronic conditions.

Borgmeyer, A., Gyr, P.M., Jamerson, P.A. & Henry, L.D. (2008). Evaluation of the role of the pediatric nurse practitioner in an inpatient asthma program. Journal of Pediatric Health Care, 22(5), 273-281.

Administrative and electronic medical record data from July 1, 2009, to June 30, 2010, was retrospectively reviewed from the Children’s Hospital of Colorado’s inpatient medical unit as well as inpatient satellite sites in the Children’s Hospital Network of Care. This study evaluated cost and pediatric patient outcomes between a pediatric NP (PNP) hospitalist team, a combined PNP/MD team and two resident teams without PNPs. Adherence to clinical care guidelines was comparable, and there was no significant difference in length of stay between the PNP, PNP/MD teams or resident teams. The direct cost of the PNP patient care was significantly less than the PNP/MD team and resident teams.

Brown, S.A. & Grimes, D.E. (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research, 44(6), 332-9.

A meta-analysis of 38 studies comparing a total of 33 patient outcomes of NPs with those of physicians demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and resolution of pathological conditions were greatest for NPs. The NP and physician outcomes were equivalent on all other outcomes.

Carter, A., Chochinov, A. (2007). A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. Canadian Journal of Emergency Medicine, 9(4), 286-95.

This systematic review of 36 articles examines if the hiring of NPs in emergency rooms can reduce wait time, improve patient satisfaction and result in the delivery of cost-effective, quality care. Results showed that hiring NPs can result in reduced wait times, leading to higher patient satisfaction. NPs were found to be equally as competent as physicians at interpreting X-rays and more competent at following up with patients by phone, conducting physical examinations and issuing appropriate referrals.

Congressional Budget Office. (1979). Physician extenders: Their current and future role in medical care delivery. Washington, D.C.: US Government Printing Office.

As early as 1979, the Congressional Budget Office reviewed findings of the numerous studies of NP performance in a variety of settings and concluded that NPs performed as well as physicians with respect to patient outcomes, proper diagnosis, management of specified medical conditions and frequency of patient satisfaction.

Cooper, M.A., Lindsay, G.M., Kinn, S., Swann, I.J. (2002). Evaluating emergency nurse practitioner services: A randomized controlled trial. Journal of Advanced Nursing, 40(6), 771-730.

A study of 199 patients randomly assigned to emergency NP-led care or physician-led care in the U.K. demonstrated the highest level of satisfaction and clinical documentation for NP care. The outcomes of recovery time, symptom level, missed work, unplanned follow up and missed injuries were comparable between the two groups.

Ettner, S.L., Kotlerman, J., Abdelmonem, A., Vazirani, S., Hays, R.D., Shapiro, M., et al. (2006). An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model. Medical Decision Making, 26, 9-17.

A total of 1,207 patients were randomized to a standard treatment group or to a physician-NP treatment model in an academic medical center. The physician-NP team achieved significant cost savings during the initial inpatient stay and during post-discharge compared to the control group while the outcomes between the treatment and control group were comparable.

Gracias, V. H., Sicoutris, C. P., Stawicki, S.P., Meredith, D. M., Horan, A. D., Gupta, R., Schwab, C.W. (2008). Critical care nurse practitioners improve compliance with clinical practice guidelines in “semiclosed” surgical intensive care unit. Journal of Nursing Care Quality, 23(4), 338-344. doi:10.1097/01.NCQ.0000323286.56397.8c.

This study examined adherence to clinical practice guidelines in a critical care setting by an NP team and a non-NP team. Critical care patients were prospectively assigned to a NP or non-NP team, and findings indicate that clinical practice guideline adherence was significantly higher among patients belonging to the NP team.

Horrocks, S., Anderson, E., Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819-823.

A systematic review of 11 randomized clinical trials and 23 observational studies identified data on outcomes of patient satisfaction, health status, cost and/or process of care. Patient satisfaction was highest for patients seen by NPs. Comparisons of the results showed comparable outcomes between NPs and physicians. NPs spent more time with their patients, offered more advice/information, had more complete documentation and had better communication skills than physicians. No differences were detected in health status, prescriptions, return visits or referrals. Equivalency in appropriateness of diagnostic studies ordered and interpretations of X-rays were identified.

Kuo, Y., Chen, N., Baillargeon, J., Raji, M. A. & Goodwin, J. S. (2015). Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians. Medical Care, 53(9), 776-783. doi:10.1097/MLR.0000000000000406.

Potentially preventable hospitalizations of Medicare beneficiaries with a diagnosis of diabetes were analyzed between patients of physicians and NPs. Several statistical methods demonstrated that receipt of care from NPs decreased the risk of potentially preventable hospitalizations. These findings suggest that NPs are exceptionally effective at treating diabetic patients.

Laurant, M., Reeves, D., Hermens, R., Braspenning, J., Grol, R. & Sibbald, B. (2006). Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews. 2006, Issue 1. CD001271.

This meta-analysis included 25 articles relating to 16 studies comparing outcomes of primary care nurses (nurses, NPs, clinical nurse specialists or other advanced practice registered nurses [APRNs]) and physicians. The quality of care provided by nurses was as high as that of the physicians. Overall, health outcomes and outcomes such as resource utilization and cost were equivalent for nurses and physicians. The satisfaction level was higher for nurses. Studies included a range of care delivery models, with nurses providing first contact, ongoing care and urgent care for many of the patient cohorts.

Lenz, E.R., Mundinger, M.O., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review 61(3), 332-351.

The outcomes of care in a prior study described by Mundinger, et al., in 2000 are further described in this report, including two years of follow-up data, confirming continued comparable outcomes for the two groups of patients: one seen by NPs and one seen by physicians. No differences were identified in health status, physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Patients assigned to physicians had more primary care visits than those assigned to NPs.

Lin, S.X., Hooker, R.S., Lens, E.R., Hopkins, S.C. (2002). Nurse practitioners and physician assistants in hospital outpatient departments, 1997-1999. Nursing Economics, 20(4), 174-179.

Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was used to identify patterns of NP and physician assistant (PA) practice styles. NPs were more likely to see patients alone and to be involved in routine examinations, as well as care directed towards wellness, health promotion, disease prevention and health education than PAs, regardless of the setting type. In contrast, PAs were more likely to provide acute problem management and to involve another person, such as a support staff person or a physician.

Martsolf, G., Auerbach, D., Arifkhanova, A. The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practitioners in Ohio. Santa Monica, CA: Rand Corporation, 2015.

The researchers identified three high-quality studies addressing the impact that more favorable NP practice environment laws could have on health care access, quality and costs. Informed by this review of literature, the authors describe the potential effect of removing state practice law restrictions for APRNs in the state of Ohio. Their review of the literature and effect estimates demonstrate that granting APRNs full practice authority would likely increase access to health care services for Ohioans, with possible increases in quality and no clear increase in costs.

Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., Cleary, P.D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283(1), 59-68.

The outcomes of care were measured in a study where patients were randomly assigned either to a physician or to an NP for primary care between 1995 and 1997, using patient interviews and health services utilization data. Comparable outcomes were identified, with a total of 1,316 patients. After six months of care, health status was equivalent for both patient groups, although patients treated for hypertension by NPs had lower diastolic values, indicating positive trends in blood pressure for NP patients. Health service utilization was equivalent at both six and 12 months, and patient satisfaction was equivalent following the initial visit.

Naylor, M.D. and Kurtzman, E.T. (2010). The Role of Nurse Practitioners in Reinventing Primary Care. Health Affairs, (5), 893-99.

This meta-analysis of studies comparing the quality of primary care services of physicians and NPs demonstrates the role NPs play in reinventing how primary care is delivered. The authors found that comparable outcomes are obtained by both providers, with NPs performing better in terms of time spent consulting with the patient, patient follow ups and patient satisfaction.

Newhouse, R. et al (2011). Advanced practice nurse outcomes 1999-2008: A systematic review. Nursing Economics, 29(5), 1-22.

The outcomes of NP care were examined through a systematic review of 37 published studies, most of which compared NP outcomes with those of physicians. Outcomes included measures such as patient satisfaction, patient perceived health status, functional status, hospitalizations, emergency department visits and bio-markers such as blood glucose, serum lipids and blood pressure. The authors conclude that NP patient outcomes are comparable to those of physicians.

Office of Technology Assessment. (1986). Nurse practitioners, physician assistants, and certified nurse midwives: A policy analysis. Washington D.C.: US Government Printing Office.

The Office of Technology Assessment reviewed studies comparing NP and physician practice, concluding that, “NPs appear to have better communication, counseling and interviewing skills than physicians have,” and that malpractice premiums and rates supported patient satisfaction with NP care, pointing out that successful malpractice rates against NPs remained extremely rare.

Ohman-Strickland, P.A., Orzano, A.J., Hudson, S.V., Solberg, L.I., DiCiccio-Bloom, B., O’Malley, D., et al. (2008). Quality of diabetes care in family medicine practices: Influence of nurse-practitioners and physician’s assistants. Annals of Family Medicine, 6(1), 14-22. doi:10.1370/afm.758.

The authors conducted a cross-sectional study of 46 practices, measuring adherence to American Diabetes Association clinical guidelines. They reported that practices with NPs were more likely to perform better on quality measures, including appropriate measurement of glycosylated hemoglobin, lipids and microalbumin levels and were more likely to be at target for lipid levels.

Oliver, G. M., Pennington, L., Revelle, S. & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447. doi:10.1016/j.outlook.2014.07.004.

The relationship between NP practice environment and state-level health outcome measures was analyzed. The authors gathered findings from existing publications on potentially avoidable hospitalizations, hospital readmissions and nursing home resident hospitalization of Medicare and Medicaid patients. Significant differences existed for all three state-level outcome measures between states with and without full practice authority. Results showed that states with full practice authority have decreased hospitalizations and better overall health outcomes. There were no significant differences in the state-level outcome measures between reduced and restricted states, which suggests that any limit on NP practice may negatively impact patient outcomes.

Prescott, P.A. & Driscoll, L. (1980). Evaluating nurse practitioner performance. Nurse Practitioner, 5(4), 28-32.

The authors reviewed 26 studies comparing NP and physician care, concluding that NPs scored higher in many areas. These included the amount/depth of discussion regarding child health care, preventative health and wellness; amount of advice, therapeutic listening and support offered to patients; completeness of history and follow up on history findings; completeness of physical examination and interviewing skills; and patient knowledge of the management plan given to them by the provider.

Ritsema, T. S., Bingenheimer, J. B., Scholting, P. & Cawley, J. F. (2014). Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009. Preventing Chronic Disease, 11E33. doi:10.5888/pcd11.130175.

This original Centers for Disease Control and Prevention (CDC) research paper utilizes a large sample of more than 136,000 adult patients with select chronic conditions drawn from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Across all conditions, the study finds NPs provide health education to patients more frequently than physicians.

Roblin, D.W., Becker, R., Adams, E.K., Howard, D. H. & Roberts, M.H. (2004). Patient satisfaction with primary care: Does type of practitioner matter? Medical Care, 42(6), 606-623.

A retrospective observational study of 41,209 patient satisfaction surveys randomly sampled between 1997 and 2000 for visits by pediatric and medicine departments identified higher satisfaction with NP and/or PA interactions than those with physicians, for the overall sample and by specific conditions.

Sacket, D.L., Spitzer, W. O., Gent, M. & Roberts, M. (1974). The Burlington randomized trial of the nurse practitioner: Health outcomes of patients. Annals of Internal Medicine, 80(2), 137-142.

A sample of 1,598 families were randomly allocated, so that two-thirds continued to receive primary care from a family physician and one-third received care from a NP. The outcomes included: mortality, physical function, emotional function and social function. Results demonstrated comparable outcomes for patients, whether assigned to physician or to NP care.

Safriet, B. J. (1992). Health care dollars and regulatory sense: The role of advanced practice nursing. Yale Journal on Regulation, 9(2).

The full summer 1992 issue of this journal was devoted to the topic of advanced practice nursing (APN), including documenting the cost-effective and high-quality care provided, and to call for eliminating regulatory restrictions on their care. Safriet summarized the U.S. Office of Technology Administration study concluding that NP care was equivalent to that of physicians and pointed out that 12 of the 14 studies reviewed in this report which showed differences in quality reported higher quality for NP care. Reviewing a range of data on NP productivity, patient satisfaction and prescribing, Safriet concludes “APNs are proven providers, and removing the many barriers to their practice will only increase their ability to respond to the pressing need for basic health care in our country.”

Spitzer, W.O., Sackett, D.L., Sibley, J.C., Roberts, M., Gent, M., Kergin, D.J., Hacket, B.D. & Olynich, A. (1974). The Burlington randomized trial of the nurse practitioner. New England Journal of Medicine, 290(3), 252-256.

This report provides further details of the Burlington trial, also described by Sackett, et al. This study involved 2,796 patients being randomly assigned to either one of two physicians or to an NP, so that one-third were assigned to NP care, from July 1971 to July 1972. At the end of the period, physical status and satisfaction were comparable between the two groups. Clinical activities were evaluated, and it was determined that 69 percent of NP management was adequate compared to 66 percent for the physicians. The conclusion was that an NP can, “provide first-contact primary clinical care as safely and effectively as a family physician.”

Stanik-Hutt, J., Newhouse, R., (2013). The quality and effectiveness of care provided by Nurse Practitioners. The Journal for Nurse Practitioners, 9(8). doi:10.1016/j.nurpra.2013.07.004.

Evidence regarding the impact of NPs compared to physicians (MDs) on health care quality, safety and effectiveness was systematically reviewed. Data from 37 of 27,993 articles published from 1990-2009 were summarized into 11 aggregated outcomes. Outcomes for NPs compared to MDs are comparable or better for all 11 outcomes reviewed. A high level of evidence indicated better serum lipid levels in patients cared for by NPs in primary care settings. A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure and mortality are similar for NPs and MDs.

Traczyski, J., Udalova, V. (2013). Nurse Practitioner independence, health care utilization and health outcomes. Retrieved from http://www.lafollette.wisc.edu/research/health_economics/Traczynski.pdf.

The authors examined how state practice laws impact health care utilization and patient outcomes. In states that have fewer unnecessary practice restrictions on NPs, the frequency of routine checkups and preventive health exams increases. More favorable practice environments also were associated with higher patient-reported health status and fewer emergency room visits by patients with ambulatory sensitive conditions.

Virani, S. S., Maddox, T. M., Chan, P. S., Tang, F., Akeroyd, J. M., Risch, S. A. & ... Petersen, L. A. (2015). Provider Type and Quality of Outpatient Cardiovascular Disease Care: Insights From the NCDR PINNACLE Registry. Journal of the American College of Cardiology, 66(16), 1803-1812. doi:10.1016/j.jacc.2015.08.017.

The quality of coronary artery disease (CAD), heart failure and atrial fibrillation care was compared for care delivered by physicians versus NPs or physicians assistants (PAs) for outpatient visits during a one-month period. Quality measures were comparable among both groups, and smoking cessation screening intervention was higher among the NP/PA group for CAD patients.

Wright, W.L., Romboli, J.E., DiTulio, M.A., Wogen, J., and Belletti, D.A. (2011). Hypertension treatment and control within an independent nurse practitioner setting. American Journal of Managed Care, 17(1), 58-65.

A cross-sectional, retrospective study of 1,284 propensity score-matched patients with hypertension, one-half of whom were treated by NPs and the other half by physicians, found comparable controlled blood pressure rates among the comparison groups. — Preceding unsigned comment added by Bethany72 (talk • contribs) 08:06, 22 April 2019 (UTC)

Noted with thanks. Some of these studies have already been addressed as being of poor quality, for example either 6 month or 1-year follow-up for chronic conditions. I will continue to look through these and add what is found to be notable as I have done before. So said The Great Wiki Lord. (talk) 00:41, 23 April 2019 (UTC)

Every study has limitations. Just because the study author published their limitations, does not mean the study is poor quality. On the contrary, most of these studies are randomized trials, and a few are systematic reviews of RCTs, which are the highes level of evidence. — Preceding unsigned comment added by Bethany72 (talk • contribs) 01:14, 25 April 2019 (UTC) — Bethany72 (talk • contribs) has made few or no other edits outside this topic.

Comment - I agree with Bethany72 that the information on this Wikipedia page does not accurately reflect the role of nurse practitioners. The content contains citations of material that does not pertain to or support said content. For example, the depth of expertise comment in the second sentence contains an inaccurate citation of comments that the President of AANP made in testimony before Congress. Valid resources have been discounted without sufficient reason, and comparisons to physicians have been allowed to remain. Why compare one health care role to another? Let the role stand on its own merits. The five pillars of Wikipedia state that content will be written from a neutral point of view. This section should state the facts, without comparisons subjective, negative and inflammatory value judgments. Miraclecln (talk) 22:46, 8 May 2019 (UTC)

It is from a neutral point of view. Everything is a fact that is well sourced. Please point out one this that is not fact. The lobbying for unsupervised practice is very notable and well cited and so is the opposition to that. NPs are comparing themselves to physician and studies are being done to compare too. so that comparison is notable and worth of inclusion.So said The Great Wiki Lord. (talk) 15:29, 10 May 2019 (UTC)

MiracleIn, I just had another look at the article, there percentage of article that compares MDs to NP is very small and well sourced and attributed to maintain and hence appropriate for inclusion. Please see WP:Content disclaimer. So said The Great Wiki Lord. (talk) 15:00, 11 May 2019 (UTC)

The information Bethany72 and Miraclecln provided above is accurate. So said The Great Wiki Lord should be open to the facts and a consensus. The facts are: nurse practitioners have been providing health care for over half a century. NPs are currently providing care in all 50 U.S. states, the District of Columbia, U.S. territories and in countries around the world. NPs diagnose, treat, prescribe medications and manage patient care. In the U.S., 22 states, the District of Columbia and two territories grant legal permission for NPs to provide care without physician oversight. The remaining states are exploring whether to grant full practice authority. The National Academy of Medicine (formerly the Institute of Medicine), the National Governor's Association, the Federal Trade Commission, the National Conference of State Legislatures, both the Trump and Obama administrations and others have called on states to remove outdated laws and regulations that hinder patient access to NP care as a way to address health care access and reduce health care costs. This background on the current U.S. legislative process, however, has little to do with a professional Wikipedia description of a health care provider type -- which is what this Wikipedia page is about: a profession description. It should be providing a neutral description of the nurse practitioner role. The NP page/article as currently stated is inaccurate, including some references. For example, reference #14 isn't even about nurse practitioners and shouldn't be included as a references. It relates to registered nurses. Another inaccuracy: reference #8 was used to support the line that NP-provided services increases cost of care, yet the reference/study actually referred to a possibility of cost increases sometime in the future. Plus, it was specific to diagnostic imaging. This article needs to be revised and many have requested similar revisions in discussions on this talk page. To support Wikipedia's pillar of neutrality, this page needs to be revised to remove comparisons and bias, which are out of place on any Wikipedia page. Raraavis31 (talk) 12:26, 22 May 2019 (UTC)

Independent

(a scary thought really) Thank you whoever removed the comments about NPs practicing independantly. In our state they practice under the supervision of a physician (like a PA does) and their scope of practice allows them to treat a number of common conditions without really having to do any consultation. This is not, however independant practice the way most people write it. I will look the source up again, but I think it was UCSF's nursing school published that in all 50 states they are required to work in collaboration, supervision, or some other word the state chooses (but not independant) that indicates more or less degrees of freedom, and all states clearly define that said practice is within the scope of their training (just like a PA, they can't go do things they aren't trained to do). ~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 20:27, 21 December 2008 (UTC)

Re: Independent

While many states have mandatory "supervision" or "collaboration" requirements, 14 states have no such restriction for NPs and in those states NPs are in fact independent providers within the State Board of Nursing's stated Scope of Practice for Advanced Practice Nurses. Please link to or fully reference the document from UCSF so that it can be viewed by others. as for PAs, as I understand it they are required to be "supervised" by a physician in all 50 states. Thx. —Preceding unsigned comment added by 152.132.9.197 (talk) 01:16, 10 January 2009 (UTC)

All states describe a scope of practice, which is undebatebly different than that of an MD, and very similar to a PA. I think for the common consumer of healthcare they can think of the NP and the PA being very similar. A quick google search found this:

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

My read is that 10 states allow independant practice with somewhat less than that allowing independant prescription writing withing the scope defined by the state. Note: independant does not mean someone can do anything they want, implicit in any practice is working within a defined scope. In every day practice this can be anything between working alone in a minute clinic, to working as a physician extender in a busy multispecialty clinic, to working in a supervisory role above other nurses on a floor. One thing that has always made me recommend the NP/PA career path to students (who often don't think of pathways other than RN or MD) is not the depth of practice (I'm always upfront, if you want to be the final word in patient care, neither PA nor NP are "almost" or "just about like" an MD), but rather the breadth of practice, the shortern training pathways, and the ability to easily change between practice settings. ChillyMD (talk) 02:13, 13 January 2009 (UTC)

I am an NPP, many years of nursing education, and wholeheartedly disagree that we are not "almost" or "just about like" an MD. I dare you to provide AMA references which state NPs practicing in a hospital setting provide substandard care. Until you provide AMA references to back up your narcissistic claim above, these statements do not belong in this article. —Preceding unsigned comment added by FetktNPP (talk • contribs) 19:47, 20 January 2009 (UTC)

This has nothing to do with whether or not the care delivered is substandard; it's an issue of scope of practice. No-one is accusing NPs of providing substandard care. Basie (talk) 21:25, 20 January 2009 (UTC)

The references provided is not a matter of scope of practice issues. These are quality comparisons. Like I asked previously, ChillyMD needs to provide AMA quality comparisons to back up his POV, not scattered about quality comparisons. In outpatient settings I do not tell patients to call me "Midlevel." I am a "Nurse Practitioner." DNPs with full independent practice, owning their own outpatient clinics, aren't telling patients to call them "Midlevel." DNPs refer to themselves as "Nurse Practitioners."FetktNP (talk) 21:42, 20 January 2009 (UTC)

This article is about the level of training and functional role of Nurse Practitioners. We shouldn't make "quality comparisons" here because the quality of care provided depends on the competency of the individual providing it. The term "Mid-level" certainly does apply to training requirements. Maybe we can find some language & references that make it clear. (offtopic, and IMHO: anything which gets a patient more one-on-one facetime with a living, breathing health professional improves the quality of care immensely.) --Versageek 23:54, 20 January 2009 (UTC)

I was going to respond at length here, but I was informed that most of the deliberately provocative posts and problems with this page are from a single disruptive user. As already mentioned, the point I was making was about scope, and not about quality of care, and I'm not sure what the AMA has to do with anything. I am happy to work with both nurse practioners and physician assistants, I have found both to be very valuable in our group (in which they have identical roles). My wife is an academic biochemist (a PhD), and after her many years of schooling and research she is very good at what she does, which I understand very little of; similarly I would not expect her to go into work for me :-) ChillyMD (talk) 19:12, 28 January 2009 (UTC)

Tbere are many references supporting the care of NPs when compared to MDs. Buppert provides an excellent reference list for anyone interested. Selected studies include: - Mundinger, M.O. et. al. Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians. JAMA 283(1), January 5, 2000 - Aigner, M.J., Drew, S. & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only. J Am Med Dir Assoc. 5 (1):16-23 - Lenz, E.R., Mundinger, M., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary Care outcomes in patients treated by nurse practitioners or physicians: two year follow up. Medical Care Research and Review. 61(3): 332-351 - Rudy, E.B., Davidson, L.J., Daly, B., Clochesy, J.M., Sereika, S., Baldisseri, M., Hravnak, M., Ross, T. & Ryan, C. (1998). Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. Am J. Crit Care. 7(4):267-281 - Sox, H.C. (1979). Quality of patient care by nurse practitioners and physician assistants’: a ten year perspective. Ann Intern Med. 91:459-468. - Spitzer, W.O., Sackett, D.L., Sibley J.C., et al. (1974). The Burlington randomized trial of the nurse practitioners. New England J. Med. 290:251-256. - Wardrope, J. & Rothwell, S. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. J Accid Emerg Med. 17(4): 290-291. 204.120.161.4 (talk) 22:25, 26 May 2009 (UTC) proud to be an NP

• how is any of that relevant to the this topic? Its all talking about NPs working with MDs, AS NPs; which is not what a small minority of NPs in the United States are arguing for. Fuzbaby (talk) 21:33, 27 May 2009 (UTC)
  • NPs work as NPs and provide a quality of care equivalent to that of a physician within their specialty (Ibid - Mundinger et al 2000 and Lenz et al 2004). On top of that, the standard of care rendered by a Nurse Practitioner, Nurse Anesthetist, and Nurse Mid-Wife are identical to that of a Family Practice Physician, Anesthesiologist, and Obstetrician respectively according to the courts. The relevance is related to independence (the title of this section) and the patently false claims by physicians and their minions that NPs do not work independently or that they are "mid-levels" (again a derogatory term employed by the AMA to claim superiority in all things healthcare related) that require "supervision" (in my state this is little more than a farce since there are NP owned and operated practice and there is no physician that sees the patient, reviews the chart, or practices in the office). In contrast, the PA is not independent and requires "supervision" in all 50 states. The claim that the "mid-level" reference is in regard to education is equally absurd since physicians get only two years of instruction followed by two years of clinical rotations and then a protected environment for OJT paid at taxpayer expense (i.e. residency). In contrast NPs have six to eight years of combined didactic and clinical education with no benefit of a protected practice upon graduation. As for the subject matter they study - it is very different and I'm sure that anyone who looks critically at both programs will agree - the education is different and the approach is different, not that one is less than the other, only that they are different with different foci. That doesn't change the reality that in many states NPs can and do practice independently and to claim otherwise is to perpetuate a lie. —Preceding unsigned comment added by 24.117.40.30 (talk) 01:38, 26 October 2009 (UTC)

Again, this shows that lack of training results in ignorance about deficiencies. Reading studies is an art. Those studies quoted above are extremely limited, many of which are written and sponsored by nursing lobbies. Many are low-powered meta-analyses with extreme data heterogeneity that invalidates much of the conclusions. Targeted goals of measurement are only in around 3 guideline-heavy diseases that in these studies follow and artificial algorithm. But you did say it correctly, NP's don't have the "benefit of a protected practice upon graduation" which makes their independent practice push dangerous. The "six to eight years of combines didactic and clinical education" is a joke, much of which is rich in policy studies, lobbying techniques, and administrative studies. Physicians work over 80 hours per week for $45000 on graduation, directly supervised on each and every case by an attending physician. Would you do that as a nurse? And so what if it's taxpayer-subsidized? It's investing in the medical education of the highly-qualified people who have shown dedication and competency in the medical sciences who will take care of you when you are old. They also have >$200,000 in debt from going through that process, and they deserve to have a chance to pay that back. What sacrifices do NP's make? NP education is definitely inferior to a physicians' and the lack of dedication to education should speak volumes.

As the American Association of Nurse Practitioners states in its Use of Terms position paper, “The use of terms such as ‘mid-level provider’ and ‘physician extender’ in reference to nurse practitioners (NPs) individually or to an aggregate inclusive of NPs is inaccurate and misleading.” This implies a hierarchy that is out of place in clinical practice. NPs should be referred to as NPs, and other health care providers should be referred to by their titles, as well. The term midlevel provider is both offensive and inaccurate. Miraclecln (talk) 22:36, 8 May 2019 (UTC)

References

I understand that there's some disagreement in the real world about the best term for this classification, but it sounds like there is still agreement about the underlying facts: the scope of practice for NPs is larger than a nurse's and smaller than a physician's. It's that underlying fact that actually matters to this article.

"MLP", for all its flaws, is still the most common term for that group of providers. Wikipedia needs a way to refer to this general category in aggregate, and across national boundaries, because the alternative (listing all the titles that fall into this group) is unworkable in practice.

On a more philosophical level, I see that the advocates for the "APP" label claiming that comparisons and hierarchies are odious, but they are re-creating the comparison with APP. "I'm 'Advanced'" implies "and the rest of you aren't." WhatamIdoing (talk) 18:24, 22 May 2019 (UTC)

Please remove the section that is misleading and derogatory

Please remove the section that describes Advanced Practice Nurse Practitioners (APNPs) as "midlevel" and "flimsy." This is a non-fact-based, emotionally-charged, and derogatory description of the profession. It should be replaced by a more accurate description provided by solid resources like the Center for Disease Control (CDC).

A more accurate, fact-based definition worthy of an online encyclopedia would read "NPs are nurses who have completed a master’s or doctoral degree program and have advanced clinical training beyond their initial professional registered nurse preparation. NPs are licensed in all 50 states and the District of Columbia and practice care based on the rules and regulations of the state in which they are licensed," (https://www.cdc.gov/dhdsp/pubs/toolkits/np-resources.htm, retrieved 05/16/2019). — Preceding unsigned comment added by HEALTH IS-A TEAM SPORT (talk • contribs) 16:34, 16 May 2019 (UTC) — HEALTH IS-A TEAM SPORT (talk • contribs) has made few or no other edits outside this topic.

I am sorry this offend you, but "mid-level" is well sources from WHO and NIH. "flimsy" is in quotes appropriately attributed to those who oppose along with a reference. "based on the rules and regulations of the state in which they are licensed" removes information regarding the level of supervision and scope and essentially censors the article. So said The Great Wiki Lord. (talk) 19:59, 16 May 2019 (UTC)

Why do you resist the calls for correction? Mid-level is not a term used by an official United States agency - You mention WHO and NIH. Where does it officially "classify" nurse practitioners as "mid-level practitioner"(s)? They don't.

Let me give you 2 examples:

• | Page 8 of this document by WHO
• | first page of this document by DEA So said The Great Wiki Lord. (talk) 12:38, 17 May 2019 (UTC)

Respectfully, both of those links are broken. Again, “mid-level” is not an official term nor designation for NPs. — Preceding unsigned comment added by NPTruth (talk • contribs) — NPTruth (talk • contribs) has made few or no other edits outside this topic.

Corrected. So said The Great Wiki Lord. (talk) 20:48, 17 May 2019 (UTC)

@NPTruth: It seems you are completely incorrect in claiming that "mid-level is not an official term nor designation for NPs." The World Health Organisation states:

Towards a working definition of mid-level providers

Many countries’ health care services are provided by cadres not trained as physicians, but capable of performing many diagnostic and clinical functions. Collectively these are variously referred to as “substitute health workers”, “auxiliaries”, “non-physician clinicians”, or “mid-level health providers”, and include cadres such as clinical officers, medical assistants, physician assistants, nurse practitioners, etc. There isn’t an official definition of mid-level providers that represents a direct match with any of the professional categories, such as paramedical practitioners, recognized in the International Standard Classification of Occupations. The use of these terms is fairly broad, ranging from internationally recognized groups, including nurses and midwives to whom specific diagnostic and clinical skills have been delegated (nurse practitioners), to cadres that have been trained to meet specific country needs – e.g. técnicos de cirurgia (surgical technicians) in Mozambique and clinical officers in East African countries.

The DEA in its document Mid-Level Practitioners Authorization by State states:

Pursuant to Title 21, Code of Federal Regulations, Section 1300.01(b28), the term mid-level practitioner means an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice. Examples of mid-level practitioners include, but are not limited to, health care providers such as nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists and physician assistants who are authorized to dispense controlled substances by the state in which they practice.

It seems very clear to me that both national and international bodies closely associated with health care define NPs as mid-level providers. I can understand nurse practitioners wanting to be seen as equivalent to MDs, since they may perform many of the same functions and may operate equally autonomously in some jurisdictions. However, they are not identical, and clearly undertake a far more limited training to achieve their qualification.

I strongly suggest you accept that this article is going to use definitions from independent reliable sources, and not from organisations' own aspirational self-descriptions. The WHO, DEA and similar organisations' statements are regarded among the highest level of evidence by WP:MEDDEF. I would urge you to read WP:MEDRS in full; it gives excellent guidance to the way Wikipedia uses sources related to medicine.

If you are going to help make improvements to this article, you are going to have to concentrate on areas where you can seek consensus within our guidelines to make changes. For example, I'm sure you have a valid case to get the section comparing the training of NPs with MDs rewritten. There is a point made below that the number of hours of patient contact in training NPs could range from 3% up to 10% of that undertaken by MDs in training. The sources are factual and the summary would be sensible. Why not turn your attention to what you are likely to find consensus over? --RexxS (talk) 19:38, 22 May 2019 (UTC)

Thank you for your response RexxS and I do appreciate your suggestion. I am not minimizing the credibility of the WHO or the DEA. But within the WHO definition, it states,

"There isn’t an official definition of mid-level providers that represents a direct match with any of the professional categories, such as paramedical practitioners, recognized in the International Standard Classification of Occupations. The use of these terms is fairly broad..."

I also point out that Medicare states,

"Nurse practitioners, clinical nurse specialists, and physician assistants are health care providers who practice either in collaboration with or under the supervision of a physician. We refer to them as non-physician practitioners. States are responsible for licensing and for setting the scopes of practice for all three specialties. Services provided by them can be reimbursed by Medicare Part B.

This is not about trying to make an equivalency to physicians. It is about correcting the entry. Again, to claim, "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner," is not a globally accepted classification, so why state it all? While we are at it, we can also say that nurse practitioners are classified as advanced practice clinicians or advanced practice providers or non-physician practitioners as per Medicare. Or it can just read, "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) - a registered nurse with advanced education and preparation, and holds either a master's or doctoral degree. Nurse practitioners are licensed and authorized in all states to diagnose, treat, and prescribe. NPs deliver primary and specialty health care to all populations across the lifespan." This would be a factual definition with indisputable facts. Again, I am learning what is consensus on Wikipedia but it would definitely appear that there is NO consenus on the term "mid-level practitioner." Respectfully,NPTruth (talk) 20:16, 22 May 2019 (UTC)

@NPTruth: Per MOS:BEGIN, the article has to have an introduction to the term "Nurse Practitioner", and part of that will inevitably be the classification applied by the WHO. I am clear that the WHO classifies NPs as mid-level providers, and I don't think anything you've written contradicts that. Our policy at WP:YESPOV requires us to represent significant perspectives published in reliable sources, but the view of the NPs' professional association can't really be given the same prominence as that of the WHO and the DEA, certainly not in the lead. If you think that there is a place in the body of the article where we could explore the views of those who find the term "mid-level provider" derogatory, then perhaps we can try to seek some consensus here for a form of words, but I think you're going to find it difficult to get agreement for more than a brief mention for something that is very likely a small minority viewpoint.

I think your intent here is to raise the profile of NPs and I don't blame you for trying. Regardless of intent, we are still going to have to go by what the highest quality sources tell us, and I see no way of "correcting the entry" without the high quality sources to counterpoise the classification that the WHO makes. Of course the WHO is as globally accepted as a source can be; if there are fringe groups that don't accept the WHO's statements, that does not invalidate their use on Wikipedia. Your definition is completely US-centric. The American Medical Association, the American Society of Clinical Oncology and Medicare have a lot of useful things to say about practices in the USA, but that's not the world, and the USA represents only a minority of the readership of the English Wikipedia. Many NPs in other parts of the world do not have postgraduate qualifications, which is an example of a glaring mistake in your suggestion.

Once more I'm going to have to point you to our policy on WP:NPOV. How the WHO classifies NPs is not a matter of consensus here, it is a matter of fact, and that fact is verified by the source. No matter how much you dislike that fact, you haven't produced a single policy-based reason why our article should not make prominent use of it. Cheers --RexxS (talk) 20:57, 22 May 2019 (UTC)

@RexxS Ok, this will be my last comment on mid-level practitioner https://en.wikipedia.org/wiki/Mid-level_practitioner. Is it not significant that the Nurse Practitioner profession was founded and created in the United States ? The WHO is not the authority on healthcare nomenclature and I don't believe that is a "fringe" opinion. They, understandably are attempting to fit a square peg in a round hole. It doesn't seem congruent to me that the U.S. with the most number of NPs by far, editors should use a classification that is from the WHO. Usually, it is American NPs and universities who are helping with the NP role development in other countries. So, because Wikipedia readership is global, we are stuck with a classification that has to be the same? Ok, if you say so.

This is not about "raising the profile of NPs" as I have mentioned before. It is conveying an accurate description to the readers of Wikipedia about a profession that is indisputable. NPTruth (talk) 21:49, 22 May 2019 (UTC)

@NPTruth: No, as far as the classification of NPs is concerned, I don't see that the fact that they were first introduced over 50 years ago in the USA is at all relevant. Are you implying that one country should somehow have a greater say in how NPs are classified than a pan-national organisation? In any case, the DEA is a USA organisation and they classify NPs as mid-level providers as well. In fact, I'm having difficulty in finding any source independent of NPs that takes a contrary stance. Can you provide a reliable independent source that does so?

To find sources on classification nomenclature, we don't have to find "the authority on healthcare nomenclature" (what is that, by the way?); we can be satisfied with a high-quality source that isn't contradicted by an equally high-quality source. I'm pretty sure the WHO fits that bill.

A fringe opinion is defined on Wikipedia as "an idea that departs significantly from the prevailing views or mainstream views in its particular field." I think you're wrong. I believe that the claim that NPs are not classified as mid-level providers is indeed a fringe opinion, as I can find what the WHO and DEA say – I call that 'mainstream' – but I can't find anybody apart from the American Association of Nurse Practitioners who dissent from that view.

I don't agree that the WHO is attempting to fit a square peg into a round hole. It is merely reflecting the wide variance in standards of education and training afforded to medical practitioners of all kinds between those available to first-world countries and those that third-world countries have to make do with. What is indisputable is that in every setting, there is a case to be made for practitioners who can be fast-tracked into service with less cost than a fully trained physician. These are mid-level providers, by definition, and NPs are preeminent among them. Our article must reflect the global situation, not just that of the most developed country on Earth, whose standards would appear impossibly high to someone from the third world. Do you really believe that NPs in Mozambique have Masters degrees or higher? As much respect as I have for the AANP, I still don't think we can give way to their campaign to raise the profile of NPs without introducing serious errors in our coverage of the prominent sources available to us. Those sources confine what we present as an accurate description of the classification of NPs, and no matter how much the AANP finds it distasteful, we are duty-bound to report what the highest-quality sources say on the matter. That is as close to "indisputable" as we can get on Wikipedia. --RexxS (talk) 22:43, 22 May 2019 (UTC)

@RexxS, can you share the algorithm you are using to arbitrarily choose one credible reference source over another? You seem to put more credence into the DEA's use of mid-level provider than what the Centers for Medicare and Medicaid Services use of non-physician practitioner (as I already mentioned above and you ignored.) Or is it more of a two (WHO & DEA) against one (CMS) deal? See how silly it is to pick and choose facts based on your biases? And yes, I do think the country originating the role reasonably holds substantive weight as to how the profession is classified. There are no Nurse Practitioners in Mozambique (though likely mid-level providers) and their physician education probably differs from that of U.S. schools too, wouldn't you think? Finally, I don't know what your repeated references to AANP has to do with me. You have given me a lot to consider. I am heading into the Wikipedia-world to edit all entries to be country-neutral as this model entry is. But don't worry, I will be back. NPTruth (talk) 01:01, 23 May 2019 (UTC)

NPTruth, I'm glad to hear that you are interested in reducing the Wikipedia:Systemic bias problems on Wikipedia, as many articles are overly focused on the US (and, to a lesser extent, other English-speaking countries). I am just a little worried, given the contentious context, that you might end up blocked over the rule that says Wikipedia:Do not disrupt Wikipedia to illustrate a point. Please keep in mind that I'd really rather see you editing productively than getting blocked. :-) We really, really, really need people to pitch in and help out with this problem.

The answer to your question above is that we favor independent sources for questions like this. So, for example, government agencies or a newspaper style guide matter more than professional advocacy groups. That isn't to say that we should omit any mention of the controversy or differences of opinion; it is verifiably true that American Association of Nurse Practitioners opposes both the WHO's use of the term mid-level practitioner and CMS's uses of the term non-physician provider. This doesn't change the fact that nurse practitioners actually meet the usual definitions for those terms, but we can certainly acknowledge somehow that they don't appreciate anyone comparing their profession to that of physicians. WhatamIdoing (talk) 03:17, 23 May 2019 (UTC)

This article is does not meet the wikipedia standard of non-biased articles. The bias against nurse practitioner practice, scope, and education is clear. I think it would be more appropriate to make a sub-section titled "Controversy/Criticism" to include critiques of NPs. — Preceding unsigned comment added by 163.40.114.82 (talk) 03:17, 17 May 2019 (UTC)

I think that is a very reasonable suggestion, We can most certainly include that section put the quality of care and limitation in education in that section. I will get started on it shortly. So said The Great Wiki Lord. (talk) 12:38, 17 May 2019 (UTC)

References

Definition of Nurse Practitioner Request for Change

This discussion has been closed. Please do not modify it.
The following discussion has been closed. Please do not modify it.
The definition of nurse practitioner needs to be updated on this page. Please see below. A nurse practitioner (NP) is a member of the health delivery system and practices autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NPs are one of four types of advanced practice registered nurses (APRN) – highly valued and an integral part of the health care system. Miraclecln (talk) 22:05, 8 May 2019 (UTC) MiraclecIn, NPs do no always practice autonomously that why the most accurate way to describe them it to say "scope of practice for a nurse practitioner is defined by jurisdiction." So said The Great Wiki Lord. (talk) 19:35, 16 May 2019 (UTC) Can we get a consensus on this? A nurse practitioner (NP) is a member of the health delivery system who is educated and clinically prepared to practice autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NP practice regulations vary by state. NPs are one of four types of advanced practice registered nurses (APRN) – highly valued and an integral part of the health care system. Miraclecln (talk) 16:54, 20 May 2019 (UTC)

Please don't fragment the debate. See below. --RexxS (talk) 17:43, 23 May 2019 (UTC)