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North Central Florida Advanced Practice Nurses

Position on Term Midlevel Provider

Posted over 5 years ago


During my term a AANP President the organization created a position statement on the term MLP. One of the most frustrating issues I encountered was APRNs being referred to as MLPs at national think tanks, legislative summits and especially with the media. I worked diligently at our VA to change the culture. I spoke to our nurse executive, (Shella Stovall) in 2010 and she has been very supportive and instrumental in using the correct terminology and correcting others who do not. It is sad to say by many APRNs are fine with the title and our RN colleagues are some the biggest offenders. We must continue to educate our colleagues, MDs and others.

Best Regards,
Penny Kaye Jensen, DNP, APRN, FNP-C, FAANP
Liaison for National APRN Policy
Office of Nursing Services (10A1)
810 Vermont Ave. N.W.
Washington, DC 20420
Office: (202) 461-6700
Mobile: (801) 560-7069

Use of Terms such as Midlevel Provider (MLP) & Physician Extender

The American Association of Nurse Practitioners (AANP) opposes use of terms such as "mid-level provider" & "physician extender" in reference to nurse practitioners (NPs)individually or to an aggregate inclusive of NPs. NPs are licensed independent practitioners. AANP encourages employers, policy-makers, healthcare professionals, and other parties to refer to NPs by their title. When referring to groups that include NPs, examples of appropriate terms include: independently licensed providers, primary care providers, healthcare professionals, and clinicians.

Terms such as "midlevel provider" & "physician extender" are inappropriate references to NPs. These terms originated in bureaucracies and/or medical organizations; they are not interchangeable with use of the NP title. They call into question the legitimacy of NPs to function as independently licensed practitioners, according to their established scopes of practice. These terms further confuse the healthcare consumers and the general public, as they are vague and are inaccurately used to refer to a wide range of professions.

The term "midlevel provider" (mid-level provider, mid level provider, MLP) implies that he care rendered by NPs is "less than" some other (unstated) higher standard. In fact, the standard of care for patients treated by an NP is the same as that provided by a physician or other healthcare provider, in the same type of setting. NPs are independently licensed practitioners who provide high quality and cost-effective care equivalent to that of physicians.1,2 The role was not developed and has not been demonstrated to provide only "mid-level" care.

The term "physician extender" (physician-extender) originated in medicine and implies that the NP role evolved to serve an extension of physicians' care. Instead, the NP role evolved in the mid-1960's in response to the recognition that nurses with advanced education and training were fully capable of providing primary care and significantly enhancing access to high quality and cost-effective health care. While primary care remains the main focus of NP practice, the role has evolved over almost 45 years to include specialty and acute-care NP functions. NPs are independently licensed and their scope of practice is not designed to be dependent on or an extension of care rendered by a physician.

In addition to the terms cited above, other terms that should be avoided in reference to NPs include "limited license providers", "non-physician providers", and "allied health providers". These terms are all vague and are not descriptive of NPs. The term "limited license provider" lacks meaning, in that all independently licensed providers practice within the scope of practice defined by their regulatory bodies. "Non physician provider" is a term that lacks any specificity by aggregately including all healthcare providers who are not licensed as an MD or DO; this term could refer to nursing assistants, physical therapy aides, and any member of the healthcare team other than a physician. The term "allied health provider" refers to a category that excludes both medicine and nursing and, therefore, is not relevant to the NP role.