Nurse Practitioners Are Not ‘Physician Extenders’

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“Physician extender.” It’s way past time to kill that term.

A study published in the October issue of Surgery found that adding an NP to the surgical team decreased the number of unnecessary ED visits by 50% and increased the use of visiting nurse, physical therapy, and occupational therapy services. A Medscape article (registration required) on the study explained the importance of the findings in this way: “According to the researchers, physician ‘extenders,’ such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week. . . .”

Sure enough, the stated purpose of the study was to determine if “integrating this physician extender into the surgery team” would improve outcomes and resource allocation. Ouch.

Experts in our own right. Nurse practitioners are not physician extenders. We are highly skilled and educated nurses who provide evidence-based care grounded in the nursing model. We are not “extensions” of anyone. We are colleagues and collaborators, independent clinicians and experts in our own right. Our purpose is to provide comprehensive care, promote health, educate, and advocate. It is not to relieve interns, supplement physician education, or be the low-cost alternative when physicians have to “do more with less,” as Medscape quoted one of the study authors. Yes, we should be integrated into health care teams, surgical and otherwise—because nurses provide a distinctive aspect of care that research has repeatedly shown to be essential to good patient outcomes.

The results of this study are certainly more good news about the effectiveness of NPs, though not surprising. As the authors noted, “Patients are no longer being discharged without support.” This is what nurses do and what distinguishes us from other health care providers: we look past curing the disease to see what optimal wellness means to each patient and do what needs to be done to help the patient get there. The positive results in this study didn’t come about because someone “extended” the physician’s role; it came about because a nurse was doing what a nurse does best.

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. […] Nurse Practitioners Are Not ‘Physician Extenders’ […]

  2. […] week, we posted here a piece by AJN’s clinical managing editor Karen Roush, decrying the use of the term “physician […]

  3. dlm13 November 15, 2011 at 1:49 pm

    Hell, I did discharge teaching/support/coordination of pt care, etc when I was an RN, BSN. It doesn’t take an advanced degree to provide that type of care.
    but when I decided I wanted to play doctor, I went to Medical school.

  4. jm November 15, 2011 at 1:15 pm

    I think the last comment missed the point. No one is equating NPs and MDs. They have different areas of expertise and knowledge. It’s best to actually read an article before commenting, rather than starting with free-floating anger and a conviction of the correctness of your assumptions.

  5. dlm13 November 15, 2011 at 1:05 pm

    Give me a break. Its called you don’t know what you don’t know. As a result you think you know just as much as a physician whose education is more intense and much longer. You can not get an MD online like you can your NP or DNP.

  6. Lois Roelofs November 12, 2011 at 4:09 pm

    Amen. Well stated.

  7. Dr.T November 11, 2011 at 5:30 pm

    Clearly stated!!!! There are a lot of physicians immigrating from South America and Cuba to the US becoming nurses by joining intensive online programs. They are later admitted to NP programs w/o any nursing experience whatsoever. Their believe is that they are going to “do the same” they were doing when they “were physicians”…… Very troubling though!!!!

  8. Meredith November 11, 2011 at 11:06 am

    Thank you! I’m going to quote you on that whenever anyone asks me how I feel about being a “physician extender”.

Comments are moderated before approval, but always welcome.

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