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Advanced Practice Nurses stuck in the “Middle”

blogimageI’ve been in a couple of situations recently where people have used the term “mid-level” to describe nurse practitioners (NP’s) or advanced practice nurses (APN’s). They likely didn’t mean to be derogatory, but that’s how it feels to this NP.  Think about it: mid-level implies that APN’s are of a lower stature or quality than physicians, which is not the case. We are different in training and perspective, but the evidence shows our outcomes are comparable and sometimes better (


It would be handy to have a term specifically denoting “non-physician licensed independent healthcare providers” but “mid-level” is not it. So, the next time you want to describe such providers consider that “APN’s” is the same number of syllables and “APNs/PA’s” only a few more and both are more collegial.


And, while I’m on the topic of APNs, the Federal Trade Commission (FTC) just issued a policy paper warning those states considering restrictions of APN practice that such restrictions could be interpreted as potential restraint of trade since they impede competition and restrict access to providers who are effective and safe ( . This is a follow up to the 2011 IOM Future of Nursing report which advocated allowing nurses to practice to the full scope of their education and training .


We will all be needed as providers given our aging population and healthcare reform. Palliative care could lead the way since we are an interdisciplinary specialty that has strongly embraced APN’s. Onward!


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  • Marian Grant

    Thanks for your comments. I think it gets complicated in situations that hire NPs and PAs and what do you call that group since they’re not all APNs. Still, APN/PA isn’t so hard to say and better than mid-level!

  • Illaria-Boise AGNP

    Agree wholeheartedly! AND…if we are referred to as “mid-level”, doesn’t that imply that nurses are “low-level”? I have an issue with implying that we as APRNs as well as our RN colleagues are on a lower place in the healthcare delivery hierarchy. Thanks for your post.

  • Terri M. Hannah

    I agree fully. I don’t like to be referred to as a mid-level provider. I’m an APN. It would be great to get a consensus on this. The term APN includes all advance practice nurses. How can we change this language?

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