Response – Strengthening Nurse Practitioner Identity and Scope of Practice

Response – Strengthening Nurse Practitioner Identity and Scope of Practice

Response to Professor’s Post

Thank you for the thoughtful response and for delving into the complexities nurse practitioners (NPs) face regarding the scope of practice and professional identity. The discussion on the varied state regulations and the need for a consensus model resonates deeply with the challenges many NPs encounter in practice. Establishing a standardized approach across states could significantly reduce the disparities in practice authority and enhance patient care, particularly in underserved areas (Martsolf et al., 2020).

The terminology used to describe NPs, such as “mid-level provider” or “non-physician provider,” indeed undermines the expertise and autonomy brought to patient care. The shift towards using more precise titles like “advanced practice provider” is essential in conveying professional identity clearly to both colleagues and patients. Such terms promote clarity and confidence in the care provided, a stance supported by the American Association of Nurse Practitioners (Kleinpell et al., 2023).

Furthermore, the discussion around the various educational paths for NPs—whether through an MSN, DNP, or PhD—highlights a critical issue in the consistency of training and the perception of roles within the healthcare system. While these degrees offer diverse opportunities, the lack of standardization can create confusion among patients and colleagues. The push for requiring a DNP by 2025 is a significant step towards unifying the profession, although its implementation may continue to face challenges (Dobrowolska et al., 2021).

The reflections underscore the ongoing need for advocacy within the profession, not only to clarify roles but also to ensure recognition as essential contributors to the healthcare system. Conclusively, in addressing terminology, educational consistency, and advocacy, NPs can strengthen their identity and influence, ensuring uniformity in practice and recognition as essential healthcare contributors.

References

Dobrowolska, B., Chruściel, P., Pilewska-Kozak, A., Mianowana, V., Monist, M., & Palese, A. (2021). Doctoral programmes in the nursing discipline: A scoping review. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00753-6

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to APRN practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9

Martsolf, G. R., Gigli, K. H., Reynolds, B. R., & McCorkle, M. (2020). Misalignment of speciality nurse practitioners and the consensus model. Nursing Outlook, 68(4). https://doi.org/10.1016/j.outlook.2020.03.001

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Please respond to my professor

Thank you for sharing these thoughts. I loved how you gave examples of different state to state issues we are currently facing. Nurse practitioners (NPs) are in a conundrum. We are battling identity issues on several fronts:

Response – Strengthening Nurse Practitioner Identity and Scope of Practice

State-to-state what the nurse practitioner can do is different. Having a consensus model that is mandated can help to solve this issue (National Council of State Boards of Nursing, 2023).
Several different descriptors are used in the medical world to explain the role of the nurse practitioner. One of those terms is “mid-level provider”. I used to use this term too, until after about two years of becoming a nurse practitioner and saw the confusion for those who I was working alongside of in healthcare, and for patients that I was treating. This is not the only term that I have heard in practice, another term I have heard administration use when booking patients with me or one of the other NPs were terms like “non-physician provider”. These terms imply to the patient that they are not getting adequate care, that their care is “mid-level”. These types of terms have been discouraged by the American Association of Nurse Practitioners due to this confusion of our role. Instead, if administration is wanting to coach schedulers what term to use, terms like “nurse practitioner” or “advance practice provider” convey our role clearer to those on the healthcare team, and they also convey competency to patients we are treating (American Association of Nurse Practitioners, 2022). My practice calls all the nurse practitioners “advance practice providers”, it seems to be received well and has brought continuity within our work community. These thoughts may or may not be new to you guys as NP students, but you will hear more about this in upcoming clinical courses so that you can then educate others within your practice.
Having different exiting degrees for the nurse practitioner role cause confusion on the required education that is needed to provide competency to the NP upon graduation. Currently, NPs can function autonomously within the practice role with either a Masters of Science in Nursing [MSN] with a specialty focus (family, adult gerontology, acute care, pediatric, women’s health, psychiatric mental health) AND/OR a Doctorate of Nursing Science [DNP] (generic nursing practice, education, executive leadership, health policy, public health, nursing administration) AND/OR a Doctor of Philosophy [PHd] (nursing education, leadership, healthcare administration, population/community health, interdisciplinary health). As NPs “we” don’t even know all of these options exist!! Now think about those who are in the healthcare field, and more importantly the patients that we treat!! It is understandable that there may be different types of specialty focuses….we see this with our physician colleagues. Personally, in my opinion, I can see the arguments of having a MSN or DNP in the practice role. But regardless, from my standpoint in the practice world, when we have MSNs and DNPs in practice, it does cause confusion. No doubt about it. Others who perform in individual practice…pharmacists, physical therapist, etc., are now required to have a doctorate degree. The last that I have heard to require NPs to have a exiting DNP degree to create continuity is 2025 (American Association of Colleges of Nursing, 2022). That being said, those who do not have a DNP will be grandfathered in. Also, they may change this date once again. For instance, look at the registered nursing degree with adjusting the standards for all registered to have only a baccalaureate degree.
Sorry for the long post. These are just my observations that I have seen. You have brought up so many great nuggets for us to discuss and marinate in for a minute. It is a reminder to me that advocacy in regulation of these standards, even though they are challenging (and for me bring all types of emotions and opinions) really is needed.