What’s in a name? Everything!

Author(s): Lillee Gelinas, MSN, RN, CPPS, FAAN Editor-in-Chief

Outdated jargon undermines nurse practitioner role.

Nurse practitioners (NPs) expand care delivery to address exploding patient demand, mitigate physician shortages, and enhance the effectiveness of interprofessional teams. However, the words used to describe these healthcare professionals vary and frequently are incorrect. Take, for example, “mid-level.” Why this term? And why has it been used for decades? Words matter. Different words trigger very different responses and can shift how you view an issue. Think about your response when someone says “death tax” instead of “estate tax” or “global warming” instead of “climate change.”

Why do we use slang to describe a licensed advanced practitioner? “Mid-level” is outdated, and it misleads the public into thinking the care provided isn’t “high-level.” Imagine what “mid-level” must sound like to a patient or family member.

I did a literature search to discover the origin of the term, but I didn’t find much other than its frequent use in articles and research. However, I did learn that the U.S. government doesn’t use the term. Payers and regulators have terms known as “identifiers” for NPs and physician assistants (PAs) that are used for billing and monitoring. For example, the U.S. Department of Health and Human Services Medicare program uses “nonphysician practitioner” to describe advanced practice RNs (APRNs) and PAs.

Some physician groups criticize hiring NPs instead of medical doctors, asserting that cost is becoming a priority over patient care and safety. Suggesting that NP care is dangerous and less than the care provided by physicians is unacceptable.

All NPs have advanced clinical training and competency to provide healthcare beyond their initial RN preparation. NPs have graduate education, with master’s or doctoral degrees. The high quality of care they provide, which has been well-documented by research, should be without debate.

The American Nurses Association represents the interests of all APRNs and is a founding member of the Coalition for Patients’ Rights, which was formed to address the American Medical Association’s scope of practice campaign dedicated to limiting the scope of practice for APRNs and other licensed professionals.

What can you do? Support change with two important actions:

  1. Never use the term “mid-level”—spoken or in print—to describe an NP. Correct others “in the moment” by asking them to use the term nurse practitioner.
  2. Request that your organization stop using “mid-level” in reference to NPs.

Nothing about NPs is “mid.” Let’s educate our organizations, our patients, and our communities about that fact. Americans make more than 1.06 billion visits to NPs a year, so let’s ensure that they worry only about their illness, not the competency of those providing care.

– Lillee Gelinas, MSN, RN, CPPS, FAAN, Editor-in-Chief



American Association of Nurse Practitioners. Quality of nurse practitioner practice. 2015. aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice

American Nurses Association. Advanced practice registered nurses (APRN). nursingworld.org/practice-policy/aprn/

U.S. Department of Health and Human Services: Office of Inspector General. Medicare Coverage of Non-physician Practitioner Services. June 2001. oig.hhs.gov/oei/reports/oei-02-00-00290.pdf


Please enter your comment!
Please enter your name here