Is It Time to Retire the Term ‘Midlevel Practitioner’?

Rachel_Scherzer_photo_and_calloutWhat are the implications of calling advanced practice nurses “midlevel practitioners”? According to Rachel Scherzer, a nurse educator and critical care nurse, such a term pigeonholes APNs in an implied (and disproven) hierarchy of value and quality of care rather than in relation to specific competencies and expertise.

In the Viewpoint essay in the July issue of AJN, Scherzer describes some of the reasons why such terms aren’t just inaccurate, they damage the standing of the profession:

Policymakers use the term while developing health care policy, health care economists use it when reporting data and performing cost analyses, and other health care providers use it in the clinical setting. . . . This term is both diminutive and inaccurate, implying that these professionals cannot provide the same level of care as other members of the interprofessional care team. Referring to APNs as “midlevel” practitioners contributes to a general misunderstanding of their role and of the services they provide.

APNs play an important and unique role in the U.S. health care system, says Scherzer:

“They are particularly valued for their ability to shift roles in response to the changing needs of the public, filling critical gaps in the country’s health care system and helping to significantly improve patient outcomes.”

In other words, we need “midlevel practitioners” now more than ever as we expand access to health care coverage, seek ways to provide coordinated and effective care to the millions with one or more chronic illnesses, try out new models of care, and try to address the needs of an aging population.

Scherzer says the public needs to be given a clearer sense of each of the various professional groups (nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists, and others) encompassed by this umbrella term—and of what each actually does. The term itself, she hopes, will one day die a painless death.—Jacob Molyneux, senior editor

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

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