Talk:Nurse practitioner

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Er...So where do NPs end and MDs begin?[edit]

Natalie Norem, RN has concerns:

1) there is a big difference between NP's and PA's (PA's are educated under a medical model, NP's educated under a nursing model)
2) NP's have more autonomy than the article gives them
3) NP's are definitely physician extenders, but they compliment physicians care and good looks —Preceding unsigned comment added by 165.20.104.30 (talk) 14:42, 29 January 2009 (UTC) 4) however their education is not uniform. People in the medical community are nervous that NPs feel they are equal to physicians. 5) Physician Assistant's education is more comprehensive and intensive than nurse practitioner's, No weekend, Afternoon, evening courses are available. No working while in school. Sorry all of you NPs who think you are oh so superior get over yourselves. —Preceding unsigned comment added by 76.111.167.251 (talk) 04:31, 7 June 2010 (UTC)


What is up with all of the People who try to make NPs sound as if they have equal training to physicians and PAs? We have great education and training but some people need to get over themselves and the limit to their role. There seems to be many NPs who feel because they have done their learned there job over the several years. The public needs to understand that the nursing "doctorate" is merely an academic degree and they should not be confused with medical doctors. - Susan, phD, aprn


Something the article really doesn't seem to answer (but instead leaves hanging): NPs, it sounds like, can do just about everything an MD can...So where the hell does an NP's scope of practice end and an MD's begin? --Penta 21:45, 25 September 2007 (UTC) THEY CAN NOT!!!

Actually, its more accurate to say that a NP can do everything a RN can do, plus a bit more (very true). The gap between the NP and MD/PA scope of practice is large, about what you would expect as the NP is only 1 year more training from the RN, while a MD does 4 years of medical school and then 3-7 years of residency and for specialists 1-3 years of fellowship. So, the 1 year difference in education between a RN and NP make them more similar than the 6-13 year difference in training between a NP and a MD. Also NP education is no where comparable to PA education. As PA education is full time training with only advanced courses. There is no such thing as counting an undergrad course in pharmacology and counting it as your graduate phamacology course the way some NP schools do it unlike Medical school and PA school. 129.82.217.44 (talk) 19:46, 23 December 2007 (UTC)
NPs and PA have the same scope/level of practice. They are the two "mid levels", only difference is the school track with NPs doing a nursing track and PAs doing a medicine track. —Preceding unsigned comment added by 129.176.151.7 (talk) 16:57, 9 February 2008 (UTC)

NP's and PA's may have the same scope but NP's have years of experience with seeing patients and assessing them before getting their license. An English major, accountant, Sports Information, or geology majors can apply for PA school with absolutely no patient experience. They go through school to end up on the same level as an NP but without the first bit of experience in taking care of patients except in school. NP's have to have been through nursing school and worked as a nurse prior to going back to school. NP's have to have actual knowledge of what happens in the real world with patients. And while a MD may have 6 years of school, a NP has to go through 4 years of nursing school, actually go out and work to get some real life patient experience, and then go back to school for another 2 years to get an NP degree. NP's are the only ones who actually have experience taking care of patient when they get out of school. Actual hands on, no supervision, real life face to face experience taking care of patient before they can get an advanced practice degree. — Preceding unsigned comment added by 2601:3C7:8202:799F:643F:DF50:4E67:BC8B (talk) 02:33, 20 March 2019 (UTC)

I would have to agree and disagree with much of the above.

its more accurate to say that a NP can do everything a RN can do, plus a bit more.

This is a fair statement. However the whole comparison between education of an NP to and MD is misleading. The education for an NP is not 1 year difference between and RN. Many RN's are Associate degree trained, in CA, US well over 50%. Though some are BSN's. A Current NP program requires an RN spend approx 2 years obtaining a masters degree. Then another year or more obtaining the NP certification. To top that, they are pushing the minimum requirement to be a DNP(Doctorate Nurse Practitioner). This will require another 12-18 months of education. The DNP is not designed to change the scope of practice for a NP however.
As for the differences between the scopes of practice of an NP VS MD, there is a large difference. A NP takes on your daily healthcare needs, though severe cases are often passed on to an MD. Also, you seldom see a Surgical NP, though they can be a first assist with proper training. The scope of practice between an PA and NP, though similar, is also different. PA and NP fill a similar notch; however they are governed by different boards. PA's under the AMA, the NP's under nursing boards. PA's must always be under the supervision of an MD, where as NP's has the authority to practice independently in 23 US states, often more rural states. Other states are considering legislation to grant NP's more freedom to practice. Also, the educational training is different for an NP and PA. PA can in some places, still be a diploma certification, though Associate and higher degrees are more the norm. In the US all current NP programs are Masters Degrees. Which means that an NP must also have a Bachelors degree, normally a BSN, though there are some exceptions? NP and PA's are not MD's, though they are more and more taking over the position of an Family practitioner MD, while many MD's go into More profitable specializations. So basically, a NP, is not a PA, is not a MD, but they all work together in their prospective fields to serve health care. —Preceding unsigned comment added by MWJamesLDS (talkcontribs) 17:27, 4 April 2008 (UTC)

In Colorado I have come by very few RNs that did not have a BSN, it would be interesting to see a comparision to the scope of practice from a PA and NP, in our state in common practice they seem to be identical. In regards to PAs, it was my understanding that diploma programs had been discontinued, and that all PA programs where now bachelors degree+2 years PA school, so very similar if not more than the BSN+1-2 year NP? —Preceding unsigned comment added by 67.132.98.55 (talk) 02:21, 24 June 2008 (UTC)

Late to the the conversation, but to answer, NPs are not physicians, so where NPs end and MDs begin is in 4 years of additional medical school education, 3-10 years of additional residency training, and optionally an additional 1-4 years of fellowship training. For people who want to be NPs, go to NP school. If you want to be an MD, go to medical school. Going to one and hoping for another is a recipie for an unhappy healthcare worker. In our practice NPs and PAs are identical, our hospital requires both to be supervised and work in collaboration with their physicians. In practice they do many of the same things that medical students rotating on our service will do, only on a full time basis and they are much more efficient than our students!~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 19:49, 11 December 2008 (UTC) Here's for reading, I see my contribution is somewhat redundant!



1) Hopefully this helps?
Overview of NP Practice in the United States: http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3465
Chart Overview of NP Scopes of Practice in the United States: http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf



2) Also, this statement is simply inaccurate:
"...where NPs end and MDs begin is in 4 years of additional medical school education, 3-10 years of additional residency training, and optionally an additional 1-4 years of fellowship training."


The undergraduate (pre-med) preparation for physicians is not at all clinical, and only about 2 years of medical school are truly clinical. MDs get a ton of basic science, but in undergrad this is mainly a weed-out process. Nursing education doesn't emphasize, for example, understanding the difference between SN1 reactions and SN2 reactions (undergrad organic chem) or being able to calculate the velocity of falling objects, because frankly, it doesn't matter when your patient is going south. Instead, the undergraduate curriculum for nursing students is clinical in nature, with relevant basic science and applied science. And though some RNs only did 2 year programs initially, all NP schools are grad schools and either require the 4 year degree prior to matriculation or they just include the extra education as part of a longer program. But all NP schools grant master's degrees at a minimum.
Most nurses also work for several years before starting grad school (most NP programs require it; even if it doesn't, most students feel they need the experience). On the med school clerkships just get students comfortable in the setting, comfortable with their physical assessment skills, comfortable with handling a code, etc., whereas most nurses have already been doing this stuff for years.
NP programs are specialty specific, e.g. family practice, adult acute care, pediatrics, women's health, oncology. So minimal time is spent on areas unrelated to the intended specialty, e.g. a Pediatric NP student does not spend an inordinate amount of time studying congestive heart failure or dementia. That doesn't mean they get a bad pediatric education, but it does mean that fewer years are required.
Regarding residency, most MDs do not have 9 years of residency and 3 years of fellowship. 3-5 of residency is typical; most do not do fellowships. Longer residencies are for surgeons and specialists; that doesn't make generalists bad or unsafe. Most residents would also tell you that after the first year, they feel that they are being exploited and underpaid, because they don't actually need that much hand-holding. NPs, as nurses who have worked with cohort after cohort of new interns and seasoned residents are aware of this, and while they know that the first year or two on the job will be brutal, they do end up as quite competent providers.71.242.234.90 (talk) 22:30, 20 February 2009 (UTC)Denise
Having read the large amount of talk here...I don't think anyone is arguing about competance of providers. It looks rather that there are 1 or 2 people who are arguing for a political agenda rather than wanting an accurate information page. Having worked as an RN, then an advanced practice nurse, and now in medicine after deciding to become the oldest woman to graduate from my medical school (!! now that sounds depressing!!) I can say that both doctors and nurse practitioners are very competent, but they do very different things and have VASTLY (I was surprised) different knowledge backgrounds. I actually kind of laugh when I think about comparing them, because they aren't the same and have different roles, and your right its not just about time being educated but rather what they are being educated, which is very different. Fuzbaby (talk) 14:15, 21 May 2009 (UTC)
Arguing that basic science education in medical school is pointless highlights your misunderstanding on how MDs and NPs differ. MDs are trained to form ddx from day 1 and you need to be able to have a strong background in the basic sciences (acid/base balance=chemistry, circulatory system=physics, protein structure=sickle cell, etc.) in order to do this. There is also a strong focus on EBM and how to ascertain/synthesize management strategies when clear evidence does not exist (eg prophylactic antibiotics in high risk SBP pts). TO argue that these aspects are worthless because they don't have immediate pertinence in emergency situations is ignoring the vast majority of medicine and how it progresses. If we all just continued to follow algorithms to keep people alive we would still be giving inotropes to people with CHF and resecting gastric adenocarcinomas. — Preceding unsigned comment added by 72.220.185.47 (talk) 06:15, 18 November 2011 (UTC)

Independent[edit]

(a scary thought really) Thank you whoever removed the comments about NPs practicing independantly. In our state they practice under the supervision of a physician (like a PA does) and their scope of practice allows them to treat a number of common conditions without really having to do any consultation. This is not, however independant practice the way most people write it. I will look the source up again, but I think it was UCSF's nursing school published that in all 50 states they are required to work in collaboration, supervision, or some other word the state chooses (but not independant) that indicates more or less degrees of freedom, and all states clearly define that said practice is within the scope of their training (just like a PA, they can't go do things they aren't trained to do). ~~ —Preceding unsigned comment added by 129.176.151.10 (talk) 20:27, 21 December 2008 (UTC)


Re: Independent

While many states have mandatory "supervision" or "collaboration" requirements, 14 states have no such restriction for NPs and in those states NPs are in fact independent providers within the State Board of Nursing's stated Scope of Practice for Advanced Practice Nurses. Please link to or fully reference the document from UCSF so that it can be viewed by others. as for PAs, as I understand it they are required to be "supervised" by a physician in all 50 states. Thx. —Preceding unsigned comment added by 152.132.9.197 (talk) 01:16, 10 January 2009 (UTC)

All states describe a scope of practice, which is undebatebly different than that of an MD, and very similar to a PA. I think for the common consumer of healthcare they can think of the NP and the PA being very similar. A quick google search found this:
http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf
My read is that 10 states allow independant practice with somewhat less than that allowing independant prescription writing withing the scope defined by the state. Note: independant does not mean someone can do anything they want, implicit in any practice is working within a defined scope. In every day practice this can be anything between working alone in a minute clinic, to working as a physician extender in a busy multispecialty clinic, to working in a supervisory role above other nurses on a floor. One thing that has always made me recommend the NP/PA career path to students (who often don't think of pathways other than RN or MD) is not the depth of practice (I'm always upfront, if you want to be the final word in patient care, neither PA nor NP are "almost" or "just about like" an MD), but rather the breadth of practice, the shortern training pathways, and the ability to easily change between practice settings. ChillyMD (talk) 02:13, 13 January 2009 (UTC)

I am an NPP, many years of nursing education, and wholeheartedly disagree that we are not "almost" or "just about like" an MD. I dare you to provide AMA references which state NPs practicing in a hospital setting provide substandard care. Until you provide AMA references to back up your narcissistic claim above, these statements do not belong in this article. —Preceding unsigned comment added by FetktNPP (talkcontribs) 19:47, 20 January 2009 (UTC)

This has nothing to do with whether or not the care delivered is substandard; it's an issue of scope of practice. No-one is accusing NPs of providing substandard care. Basie (talk) 21:25, 20 January 2009 (UTC)

The references provided is not a matter of scope of practice issues. These are quality comparisons. Like I asked previously, ChillyMD needs to provide AMA quality comparisons to back up his POV, not scattered about quality comparisons. In outpatient settings I do not tell patients to call me "Midlevel." I am a "Nurse Practitioner." DNPs with full independent practice, owning their own outpatient clinics, aren't telling patients to call them "Midlevel." DNPs refer to themselves as "Nurse Practitioners."FetktNP (talk) 21:42, 20 January 2009 (UTC)

This article is about the level of training and functional role of Nurse Practitioners. We shouldn't make "quality comparisons" here because the quality of care provided depends on the competency of the individual providing it. The term "Mid-level" certainly does apply to training requirements. Maybe we can find some language & references that make it clear. (offtopic, and IMHO: anything which gets a patient more one-on-one facetime with a living, breathing health professional improves the quality of care immensely.) --Versageek 23:54, 20 January 2009 (UTC)

I was going to respond at length here, but I was informed that most of the deliberately provocative posts and problems with this page are from a single disruptive user. As already mentioned, the point I was making was about scope, and not about quality of care, and I'm not sure what the AMA has to do with anything. I am happy to work with both nurse practioners and physician assistants, I have found both to be very valuable in our group (in which they have identical roles). My wife is an academic biochemist (a PhD), and after her many years of schooling and research she is very good at what she does, which I understand very little of; similarly I would not expect her to go into work for me :-) ChillyMD (talk) 19:12, 28 January 2009 (UTC)

Tbere are many references supporting the care of NPs when compared to MDs. Buppert provides an excellent reference list for anyone interested. Selected studies include: - Mundinger, M.O. et. al. Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians. JAMA 283(1), January 5, 2000 - Aigner, M.J., Drew, S. & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only. J Am Med Dir Assoc. 5 (1):16-23 - Lenz, E.R., Mundinger, M., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary Care outcomes in patients treated by nurse practitioners or physicians: two year follow up. Medical Care Research and Review. 61(3): 332-351 - Rudy, E.B., Davidson, L.J., Daly, B., Clochesy, J.M., Sereika, S., Baldisseri, M., Hravnak, M., Ross, T. & Ryan, C. (1998). Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. Am J. Crit Care. 7(4):267-281 - Sox, H.C. (1979). Quality of patient care by nurse practitioners and physician assistants’: a ten year perspective. Ann Intern Med. 91:459-468. - Spitzer, W.O., Sackett, D.L., Sibley J.C., et al. (1974). The Burlington randomized trial of the nurse practitioners. New England J. Med. 290:251-256. - Wardrope, J. & Rothwell, S. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. J Accid Emerg Med. 17(4): 290-291. 204.120.161.4 (talk) 22:25, 26 May 2009 (UTC) proud to be an NP

  • how is any of that relevant to the this topic? Its all talking about NPs working with MDs, AS NPs; which is not what a small minority of NPs in the United States are arguing for. Fuzbaby (talk) 21:33, 27 May 2009 (UTC)
    • NPs work as NPs and provide a quality of care equivalent to that of a physician within their specialty (Ibid - Mundinger et al 2000 and Lenz et al 2004). On top of that, the standard of care rendered by a Nurse Practitioner, Nurse Anesthetist, and Nurse Mid-Wife are identical to that of a Family Practice Physician, Anesthesiologist, and Obstetrician respectively according to the courts. The relevance is related to independence (the title of this section) and the patently false claims by physicians and their minions that NPs do not work independently or that they are "mid-levels" (again a derogatory term employed by the AMA to claim superiority in all things healthcare related) that require "supervision" (in my state this is little more than a farce since there are NP owned and operated practice and there is no physician that sees the patient, reviews the chart, or practices in the office). In contrast, the PA is not independent and requires "supervision" in all 50 states. The claim that the "mid-level" reference is in regard to education is equally absurd since physicians get only two years of instruction followed by two years of clinical rotations and then a protected environment for OJT paid at taxpayer expense (i.e. residency). In contrast NPs have six to eight years of combined didactic and clinical education with no benefit of a protected practice upon graduation. As for the subject matter they study - it is very different and I'm sure that anyone who looks critically at both programs will agree - the education is different and the approach is different, not that one is less than the other, only that they are different with different foci. That doesn't change the reality that in many states NPs can and do practice independently and to claim otherwise is to perpetuate a lie. —Preceding unsigned comment added by 24.117.40.30 (talk) 01:38, 26 October 2009 (UTC)

Again, this shows that lack of training results in ignorance about deficiencies. Reading studies is an art. Those studies quoted above are extremely limited, many of which are written and sponsored by nursing lobbies. Many are low-powered meta-analyses with extreme data heterogeneity that invalidates much of the conclusions. Targeted goals of measurement are only in around 3 guideline-heavy diseases that in these studies follow and artificial algorithm. But you did say it correctly, NP's don't have the "benefit of a protected practice upon graduation" which makes their independent practice push dangerous. The "six to eight years of combines didactic and clinical education" is a joke, much of which is rich in policy studies, lobbying techniques, and administrative studies. Physicians work over 80 hours per week for $45000 on graduation, directly supervised on each and every case by an attending physician. Would you do that as a nurse? And so what if it's taxpayer-subsidized? It's investing in the medical education of the highly-qualified people who have shown dedication and competency in the medical sciences who will take care of you when you are old. They also have >$200,000 in debt from going through that process, and they deserve to have a chance to pay that back. What sacrifices do NP's make? NP education is definitely inferior to a physicians' and the lack of dedication to education should speak volumes.

As the American Association of Nurse Practitioners states in its Use of Terms position paper, “The use of terms such as ‘mid-level provider’ and ‘physician extender’ in reference to nurse practitioners (NPs) individually or to an aggregate inclusive of NPs is inaccurate and misleading.” This implies a hierarchy that is out of place in clinical practice. NPs should be referred to as NPs, and other health care providers should be referred to by their titles, as well. The term midlevel provider is both offensive and inaccurate. [1] Miraclecln (talk) 22:36, 8 May 2019 (UTC)

References

  1. ^ American Association of Nurse Practitioners, "Use of Terms Such as Mid-level Provider and Physician Extender"
I understand that there's some disagreement in the real world about the best term for this classification, but it sounds like there is still agreement about the underlying facts: the scope of practice for NPs is larger than a nurse's and smaller than a physician's. It's that underlying fact that actually matters to this article.
"MLP", for all its flaws, is still the most common term for that group of providers. Wikipedia needs a way to refer to this general category in aggregate, and across national boundaries, because the alternative (listing all the titles that fall into this group) is unworkable in practice.
On a more philosophical level, I see that the advocates for the "APP" label claiming that comparisons and hierarchies are odious, but they are re-creating the comparison with APP. "I'm 'Advanced'" implies "and the rest of you aren't." WhatamIdoing (talk) 18:24, 22 May 2019 (UTC)

Poor Reflection[edit]

There are many inconsistencies and possible erroneous facts in this article, not to mention the writing is of poor quality. For these reasons, it does not reflect well upon NPs. I stumbled upon this article while trying to discern the difference between the scope of practice of physicians and NPs in the United States, and this article fell way short of all of my expectations. For example, early on the article suggests that NPs are licensed through state medical boards, but in the United States section, it says that NPs are licensed through a national board. Is it state, national, or both? Since it seems to vary by state, further research into each state's requirements is necessary to clarify the board certification requirements.

This article seems to suggest that NPs have similar powers and responsibilities as physicians, but have received much less training. Furthermore, the implied inconsistencies in certification requirements give less credibility to the field, as the education, training, and board certification requirements for physicians do not vary by state.

I strongly suggest that this article be totally revamped by a currently practicing NP.

70.197.69.34 (talk) 06:36, 26 May 2013 (UTC)

Agreed!! This is very inflammatory and inaccurate. Printer987654321 (talk) 22:38, 24 March 2019 (UTC)

Issues ?resolved[edit]

The page had WP:POV and WP:Peacock issues throughout. Most of these were uncited. I have done my best to resolve them. Eric, would you please review and comment. Thanks. So said The Great Wiki Lord. (talk) 14:44, 21 March 2019 (UTC)

Hi- I don't have time to read the article in its entirety, but it looks to me like you've done good clean-up and source work on it. It might help to add the article to the "things you can do" section on Portal:Nursing so other interested parties could have a look. Eric talk 19:43, 21 March 2019 (UTC)
Thank you for your comments, Very much appreciated. So said The Great Wiki Lord. (talk) 18:03, 25 March 2019 (UTC)

Hi, I am a nurse practitioner, and I recently was made aware of the content of this article/piece on nurse practititoners here on wikipedia. While this piece has a few good citations and some relevant information, there are also some citations/references that are adding information that is a bit skewed. For instance, the study stating how NPs and PAs order more diagnostic imaging and other advanced testing than physicians, while technically true, only showed that NP/PAs do this between 0.1-0.3% more than their physician counterparts. Not exactly a statistically significant finding that I would hang my hat (or argument) on, and yet it is stated in the wikipedia article that NP/PAs are greatly increasing healthcare costs due to this overtesting. Since the actual study cited didn’t show anything statistically significant, this is quite a stretch and is very misleading. There are many other aspects to this piece on nurse practitioners that are also misleading, biased, and/or false. This can lead to a public misperception and damage our credibility. So I would like to ask that this piece be made editable so as to add/correct parts of the information presented. Thank you. Bumashes (talk) 18:43, 25 March 2019 (UTC)

Semi-protected edit request on 25 March 2019[edit]

This page is incredibly inaccurate and misleading. It has obviously been tampered with by someone with NO knowledge of NP scope of practice and a real hatred in their heart. Please remove all inaccurate content especially that pertaining to NP practice in Canada. 70.28.20.178 (talk) 20:52, 25 March 2019 (UTC)

 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. - FlightTime (open channel) 20:55, 25 March 2019 (UTC)

Semi-protected edit request on 28 March 2019[edit]

Please change, "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner. A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans." to " A Nurse Practitioner is a Registered Nurse who completed a masters or doctoral level advanced degree at a nationally accredited institution and is board certified in their area of specialty as required by individual state law." The opening sentence of this article is purely opinion based. There is no formal designation for "mid-level practitioner", which as the article suggests is considered by many to be a derogatory term. The change suggested more accurately reflects a neutral stance (according to the 5 pillars of wikipedia) and states the facts of what a nurse practitioner is, the training needed to obtain, as well as the requirements for their licensure. https://www.nursinglicensure.org/articles/nurse-practitioner-license.html https://www.nursingworld.org/our-certifications/ 66.177.109.117 (talk) 23:30, 28 March 2019 (UTC)

 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. Please see above where a discussion took place on this and a consensus was established. Mid-level practitioner is a very notable term used by National Institutes of Health, World Health Organization, and also has an article on Wikipedia that meets Wikipedia's guidelines. We do not censor Wikipedia people may consider it derogatory or maybe offended by it. So said The Great Wiki Lord. (talk) 01:39, 29 March 2019 (UTC)

GA Review[edit]

This review is transcluded from Talk:Nurse practitioner/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Amanda4187 (talk · contribs) 00:33, 11 April 2019 (UTC)


This article has been significantly altered to paint nurse practitioners as incompetent, manipulative, and unsafe. The article is supposed to be about nurse practitioners who practice advanced practice nursing. Instead the article about a comparison between advanced practice nurses and how they are incompetent to provide care to patients because they are not as good as physicians. In reality, nurse practitioners are not physician's we do not claim to be, we look at patient's completely differently than a physician. Below you find a long list of statements that need to be removed from the article to make it more accurate.


1) "but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions."

2) "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact. The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training.[1] Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals." - Although not completely incorrect, this is debatable. These comments intentionally paint NPs as incompetent and compare NPs to physicians... that is not the point of the article. This is not a comparison article.

3)"Given the quality and quantity of training, experts have questioned the quality of care delivered by nurse practitioners." This is inaccurate and mainly physician groups such as Physician's for Patients feel this to be true. [1] "The studies we reviewed did not demonstrate a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations."

4) "Studies have shown multiple concerns associated with lack of training. Nurse practitioners are more likely to prescribe antibiotics when they are not indicated.[13]" Although yes, there is a known need to increase Antibiotic Stewardship, please view attached table to see the differences in this associated study. [2] Also, the same study states, "The historical studies and recent literature provide little reason to suspect that there is a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations."

5) "It has also been shown that “there is a tremendous need to enhance nurses’ skills."[14] - The study linked to this comment is was "A cross‐sectional descriptive study was conducted that gathered data from an anonymous online survey of practicing nurses throughout the U.S. Measures tapped EBP knowledge, beliefs, culture, mentorship, implementation, and reported competency for each of the 13 EBP competencies for practicing nurses and an additional 11 competencies for advanced practice nurses." - It was an online survey.

6) "Nurse practitioners are also more likely to make unnecessary referrals.[8]" This statistic is related to Nurse Practitioners and Physician Assistants combined. This statistic is misleading.

7) "They are also more likely to order unnecessary tests and procedures such as skin biopsies and imaging studies."[9][15] This statistic is related to Advanced practice clinicians (i.e. Nurse Practitioners and Physician Assistants) This statistic is misleading.

8) Although a few studies have shown that NPs provide similar quality care when compared physicians, these studies were found to have a medium to high potential for bias and had low to insufficient strength of evidence.[16] The study that is referenced does not support the statement. The article does say, "Strong conclusions or policy changes relating to extension of autonomous APRN practice cannot be based solely on the evidence reviewed here. Although no differences in 4 outcome measures (health status, quality of life, mortality, hospitalizations) were detected, the evidence cannot rule out such differences."


I have no knowledge of NPs from other countries.

9) "Overall, to become an NP requires 1.5 to 3 years of post-baccalaureate training, compared to physicians who are required to complete a minimum of 7 years of post-baccalaureate training." A Nurse Practitioner is not a physician, why is this comparison even in this article? This is an inappropriate comparison.

10) A new nurse practitioner has between 500 and 1,500 hours of clinical training <--(This is accurate) "compared with a family physician who would have more 15,000 hours of clinical training by the time certification.[1]" This is another inappropriate comparison, it is an article about Nurse Practitioners. Also, if it is going to compare NPs to physicians, this is unfair to non-American based physicians. If NPs are being compared to MD/DOs shouldn't other countries be represented here?

11) "The quality of education and applicants for NP schools has been cited as a reason to not allow NPs to practice medicine." This is an opinion, no fact. Nurse Practitioners do not practice medicine, we practice Advanced Practice Nursing.

12) "Many schools have 100% acceptance rates, coursework can be 100% online, and clinical experience is limited to shadowing with no hands-on experience.[23][24]" Although this is not completely inaccurate, this is misleading. Clinical experiences are not "no-hands-on" experiences. They do lack significant oversight from the universities but they are hands-on experiences. The purpose for clinical experiences is to have a hands on experience.


These are my recommendations for review, eleminiation. Amanda4187 (talk) 00:33, 11 April 2019 (UTC) Amanda4187 (talkcontribs) has made few or no other edits outside this topic.

Amanda4187 your comments on review appear to be off topic and suggests a conflict of interest. Please note that Wikipedia is not a battleground. If you disagree with any of the above please try to establish a consensus instead of trying to sabotage a GA Nomination. Normally, I make it a point to make sure I do not bite the newcomers; However given the number of edits saying the same thing from first time users, I am starting to suspect sockpuppetry or meatpuppetry. Please read through the links and the links that I will post on your talk page and we can see how we can make this page even better. So said The Great Wiki Lord. (talk) 13:59, 11 April 2019 (UTC)

Not a Good Article[edit]

I agree with the points that Amanda4187 laid out. It appears that TheGreatWikiLord has a conflict of interest and should understand that Wikipedia is not a battleground for physicians or nurse practitioners. Instead of denying repeated requests for change, TheGreatWikiLord must try and establish a consensus and include information that describes nurse practitioners in a factual and neutral point of view.

Regarding point #2 above, not only is the information comparative and intentionally designed to disparage nurse practitioners, it is inaccurate for a large percentage of nurse practitioners who are not educated in online programs.

Regarding point #5 above, that study is on registered nurses in the United States, not nurse practitioners.

Additionally, regarding this sentence "Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals.[8][9][10]," none of the studies referenced indicate that NPs increase the cost of care, rather they suggest that it is possible for costs to increase in the future, specifically related to diagnostic imaging.

This sentence has no place in the article, and it certainly should not be mentioned twice (in both the opening paragraph and the controversy section). "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact.[7]"

There are errors in the page like this: "An average family physician has over 15,000 hours of clin[1] to become ..."

The controversy section includes comparisons to physicians that are out of place in a Wikipedia article. The physician assistant page does not contain comparisons to any other health care provider type, as it should be.

If they are going to mention that nurse practitioners are lobbying for independent practice, which is not the optimal term, they should also mention that NPs have full practice authority in 22 states.

Under quality of care, it says, "experts have questioned the quality of care delivered by nurse practitioners," but no sources are cited and no experts are named. This sentence and the entire section should be stricken.

My time is limited to post today, but this is just a very brief introduction to why the nurse practitioner page should not be granted good article status and should be revised to describe the NP role in a neutral and factual way. Miraclecln (talk) 17:46, 20 May 2019 (UTC)

Comparisons are a tool that encyclopedia articles use to help people understand some subjects. Thank you for identifying the deficiencies in the Physician assistant article. People who want to understand this subject should know how NPs compare to nurses and physicians (different scope of practice), and also how they compare to PAs and COs (similar scope of practice). WhatamIdoing (talk) 18:30, 22 May 2019 (UTC)

Semi-protected edit request on 17 April 2019[edit]

ADD the following: Released in October 2010, the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, is a thorough examination of the nursing workforce. The recommendations offered in the report focus on the critical intersection between the health needs of diverse, changing patient populations across the lifespan and the actions of the nursing workforce. These recommendations are intended to support efforts to improve the health of the U.S. population through the contributions nurses can make to the delivery of care.

The eight recommendations offered in the report are centered on four main issues:

Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and information infrastructure. http://www.academicprogression.org/about/future-of-nursing.shtml

This has helped to decrease the anger felt by doctors that feel threatened by nurse practitioners. In fact collaboration between practitioners has long been stressed as crucial in quality care to improve patient outcomes.

Nurse practitioners have been found to provide comparable primary care to that of family physicians. Their work has reduced costs of health care, increased access to health care and reduced the burden doctors who work in overpopulated ERs, and clinics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/

Some people (particularly MDs think nurse practitioners are competing with physicians, in part because they see patients for basic care at a fraction of the cost. However, Nurse practitioners are trained to provide holistic, patient centered care. Ma030801 (talk) 13:49, 17 April 2019 (UTC) Ma030801 (talkcontribs) has made few or no other edits outside this topic.

 Partly done: I have added the well cited information. Please read WP:V, WP:NPOV, and WP:RS for more information. So said The Great Wiki Lord. (talk) 14:35, 18 April 2019 (UTC)

Section on nurse practitioners is very politically charged[edit]

It's improper to have so much of this article written by an doctors who think using nurse practitioners is a threat to the US health system as per their sources linked. Please update/revise. — Preceding unsigned comment added by Bethany72 (talkcontribs) 01:45, 18 April 2019 (UTC) Bethany72 (talkcontribs) has made few or no other edits outside this topic.

Comment- The article should define the profession not by controversy but by the actually underlying education and practice. This is very obviously political. APPs do have some controversy regarding recent scope expansion, but this does not define the profession in the US. The vast majority of NPs practice without encountering controversy. The article should read more like the PA article.2600:1700:A5F0:ADE0:154B:A677:993:2CBE (talk) 23:54, 20 April 2019 (UTC)
The controversy is worthy of being included in the article. We cannot remove that part, since we do not censor Wikipedia. The controversy statements are all well sourced and attributed in the article. A lot of the article does deal with history, scope of practice, education, licensing, and board certification. I am trying to expand this article as much as possible. If you think something needs to be included please let me know, and try to be as specific as you can. General statements like "The article should read more like the PA article" or the one made my Bathany72 "It's improper to have so much of this article written by an doctors who think using nurse practitioners is a threat to the US health system as per their sources linked. Please update/revise" are useless. I know the article contains politically charged material, but please understand none of us at Wikipedia attached all the politics to to your profession. We are just including it in the article since it meets inclusion criteria. Please consider getting adopted to learn and contribute constructively. Thanks. So said The Great Wiki Lord. (talk) 19:52, 21 April 2019 (UTC)

Avorn, J., Everitt, D.E. & Baker, M.W. (1991). The neglected medical history and therapeutic choices for abdominal pain. A nationwide study of 799 physicians and nurses. Archives of Internal Medicine, 151(4), 694-698.

A sample of 501 physicians and 298 NPs participated in a study by responding to a hypothetical scenario regarding epigastric pain in a patient with endoscopic findings of diffuse gastritis. They were able to request additional information before recommending treatment. Adequate history-taking resulted in identifying use of aspirin, coffee, cigarettes and alcohol paired with psychosocial stress. Compared to NPs, physicians were more likely to prescribe without seeking relevant history. NPs, in contrast, asked more questions and were less likely to recommend prescription medication.

Bakerjian, D. (2008). Care of nursing home residents by advanced practice nurses: A review of the literature. Research in Gerontological Nursing, 1(3), 177-185. doi: 10.3928/00220124-20091301-01.

Bakerjian conducted an extensive review of the literature, particularly of NP-led care. She found that long-term care patients managed by NPs were less likely to have avoidable geriatric complications such as falls, UTIs, pressure ulcers, etc. They also had improved functional status, as well as better managed chronic conditions.

Borgmeyer, A., Gyr, P.M., Jamerson, P.A. & Henry, L.D. (2008). Evaluation of the role of the pediatric nurse practitioner in an inpatient asthma program. Journal of Pediatric Health Care, 22(5), 273-281.

Administrative and electronic medical record data from July 1, 2009, to June 30, 2010, was retrospectively reviewed from the Children’s Hospital of Colorado’s inpatient medical unit as well as inpatient satellite sites in the Children’s Hospital Network of Care. This study evaluated cost and pediatric patient outcomes between a pediatric NP (PNP) hospitalist team, a combined PNP/MD team and two resident teams without PNPs. Adherence to clinical care guidelines was comparable, and there was no significant difference in length of stay between the PNP, PNP/MD teams or resident teams. The direct cost of the PNP patient care was significantly less than the PNP/MD team and resident teams.

Brown, S.A. & Grimes, D.E. (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research, 44(6), 332-9.

A meta-analysis of 38 studies comparing a total of 33 patient outcomes of NPs with those of physicians demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and resolution of pathological conditions were greatest for NPs. The NP and physician outcomes were equivalent on all other outcomes.

Carter, A., Chochinov, A. (2007). A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. Canadian Journal of Emergency Medicine, 9(4), 286-95.

This systematic review of 36 articles examines if the hiring of NPs in emergency rooms can reduce wait time, improve patient satisfaction and result in the delivery of cost-effective, quality care. Results showed that hiring NPs can result in reduced wait times, leading to higher patient satisfaction. NPs were found to be equally as competent as physicians at interpreting X-rays and more competent at following up with patients by phone, conducting physical examinations and issuing appropriate referrals.

Congressional Budget Office. (1979). Physician extenders: Their current and future role in medical care delivery. Washington, D.C.: US Government Printing Office.

As early as 1979, the Congressional Budget Office reviewed findings of the numerous studies of NP performance in a variety of settings and concluded that NPs performed as well as physicians with respect to patient outcomes, proper diagnosis, management of specified medical conditions and frequency of patient satisfaction.

Cooper, M.A., Lindsay, G.M., Kinn, S., Swann, I.J. (2002). Evaluating emergency nurse practitioner services: A randomized controlled trial. Journal of Advanced Nursing, 40(6), 771-730.

A study of 199 patients randomly assigned to emergency NP-led care or physician-led care in the U.K. demonstrated the highest level of satisfaction and clinical documentation for NP care. The outcomes of recovery time, symptom level, missed work, unplanned follow up and missed injuries were comparable between the two groups.

Ettner, S.L., Kotlerman, J., Abdelmonem, A., Vazirani, S., Hays, R.D., Shapiro, M., et al. (2006). An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model. Medical Decision Making, 26, 9-17.

A total of 1,207 patients were randomized to a standard treatment group or to a physician-NP treatment model in an academic medical center. The physician-NP team achieved significant cost savings during the initial inpatient stay and during post-discharge compared to the control group while the outcomes between the treatment and control group were comparable.

Gracias, V. H., Sicoutris, C. P., Stawicki, S.P., Meredith, D. M., Horan, A. D., Gupta, R., Schwab, C.W. (2008). Critical care nurse practitioners improve compliance with clinical practice guidelines in “semiclosed” surgical intensive care unit. Journal of Nursing Care Quality, 23(4), 338-344. doi:10.1097/01.NCQ.0000323286.56397.8c.

This study examined adherence to clinical practice guidelines in a critical care setting by an NP team and a non-NP team. Critical care patients were prospectively assigned to a NP or non-NP team, and findings indicate that clinical practice guideline adherence was significantly higher among patients belonging to the NP team.

Horrocks, S., Anderson, E., Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819-823.

A systematic review of 11 randomized clinical trials and 23 observational studies identified data on outcomes of patient satisfaction, health status, cost and/or process of care. Patient satisfaction was highest for patients seen by NPs. Comparisons of the results showed comparable outcomes between NPs and physicians. NPs spent more time with their patients, offered more advice/information, had more complete documentation and had better communication skills than physicians. No differences were detected in health status, prescriptions, return visits or referrals. Equivalency in appropriateness of diagnostic studies ordered and interpretations of X-rays were identified.

Kuo, Y., Chen, N., Baillargeon, J., Raji, M. A. & Goodwin, J. S. (2015). Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians. Medical Care, 53(9), 776-783. doi:10.1097/MLR.0000000000000406.

Potentially preventable hospitalizations of Medicare beneficiaries with a diagnosis of diabetes were analyzed between patients of physicians and NPs. Several statistical methods demonstrated that receipt of care from NPs decreased the risk of potentially preventable hospitalizations. These findings suggest that NPs are exceptionally effective at treating diabetic patients.

Laurant, M., Reeves, D., Hermens, R., Braspenning, J., Grol, R. & Sibbald, B. (2006). Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews. 2006, Issue 1. CD001271.

This meta-analysis included 25 articles relating to 16 studies comparing outcomes of primary care nurses (nurses, NPs, clinical nurse specialists or other advanced practice registered nurses [APRNs]) and physicians. The quality of care provided by nurses was as high as that of the physicians. Overall, health outcomes and outcomes such as resource utilization and cost were equivalent for nurses and physicians. The satisfaction level was higher for nurses. Studies included a range of care delivery models, with nurses providing first contact, ongoing care and urgent care for many of the patient cohorts.

Lenz, E.R., Mundinger, M.O., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review 61(3), 332-351.

The outcomes of care in a prior study described by Mundinger, et al., in 2000 are further described in this report, including two years of follow-up data, confirming continued comparable outcomes for the two groups of patients: one seen by NPs and one seen by physicians. No differences were identified in health status, physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Patients assigned to physicians had more primary care visits than those assigned to NPs.

Lin, S.X., Hooker, R.S., Lens, E.R., Hopkins, S.C. (2002). Nurse practitioners and physician assistants in hospital outpatient departments, 1997-1999. Nursing Economics, 20(4), 174-179.

Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was used to identify patterns of NP and physician assistant (PA) practice styles. NPs were more likely to see patients alone and to be involved in routine examinations, as well as care directed towards wellness, health promotion, disease prevention and health education than PAs, regardless of the setting type. In contrast, PAs were more likely to provide acute problem management and to involve another person, such as a support staff person or a physician.

Martsolf, G., Auerbach, D., Arifkhanova, A. The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practitioners in Ohio. Santa Monica, CA: Rand Corporation, 2015.

The researchers identified three high-quality studies addressing the impact that more favorable NP practice environment laws could have on health care access, quality and costs. Informed by this review of literature, the authors describe the potential effect of removing state practice law restrictions for APRNs in the state of Ohio. Their review of the literature and effect estimates demonstrate that granting APRNs full practice authority would likely increase access to health care services for Ohioans, with possible increases in quality and no clear increase in costs.

Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., Cleary, P.D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283(1), 59-68.

The outcomes of care were measured in a study where patients were randomly assigned either to a physician or to an NP for primary care between 1995 and 1997, using patient interviews and health services utilization data. Comparable outcomes were identified, with a total of 1,316 patients. After six months of care, health status was equivalent for both patient groups, although patients treated for hypertension by NPs had lower diastolic values, indicating positive trends in blood pressure for NP patients. Health service utilization was equivalent at both six and 12 months, and patient satisfaction was equivalent following the initial visit.

Naylor, M.D. and Kurtzman, E.T. (2010). The Role of Nurse Practitioners in Reinventing Primary Care. Health Affairs, (5), 893-99.

This meta-analysis of studies comparing the quality of primary care services of physicians and NPs demonstrates the role NPs play in reinventing how primary care is delivered. The authors found that comparable outcomes are obtained by both providers, with NPs performing better in terms of time spent consulting with the patient, patient follow ups and patient satisfaction.

Newhouse, R. et al (2011). Advanced practice nurse outcomes 1999-2008: A systematic review. Nursing Economics, 29(5), 1-22.

The outcomes of NP care were examined through a systematic review of 37 published studies, most of which compared NP outcomes with those of physicians. Outcomes included measures such as patient satisfaction, patient perceived health status, functional status, hospitalizations, emergency department visits and bio-markers such as blood glucose, serum lipids and blood pressure. The authors conclude that NP patient outcomes are comparable to those of physicians.

Office of Technology Assessment. (1986). Nurse practitioners, physician assistants, and certified nurse midwives: A policy analysis. Washington D.C.: US Government Printing Office.

The Office of Technology Assessment reviewed studies comparing NP and physician practice, concluding that, “NPs appear to have better communication, counseling and interviewing skills than physicians have,” and that malpractice premiums and rates supported patient satisfaction with NP care, pointing out that successful malpractice rates against NPs remained extremely rare.

Ohman-Strickland, P.A., Orzano, A.J., Hudson, S.V., Solberg, L.I., DiCiccio-Bloom, B., O’Malley, D., et al. (2008). Quality of diabetes care in family medicine practices: Influence of nurse-practitioners and physician’s assistants. Annals of Family Medicine, 6(1), 14-22. doi:10.1370/afm.758.

The authors conducted a cross-sectional study of 46 practices, measuring adherence to American Diabetes Association clinical guidelines. They reported that practices with NPs were more likely to perform better on quality measures, including appropriate measurement of glycosylated hemoglobin, lipids and microalbumin levels and were more likely to be at target for lipid levels.

Oliver, G. M., Pennington, L., Revelle, S. & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447. doi:10.1016/j.outlook.2014.07.004.

The relationship between NP practice environment and state-level health outcome measures was analyzed. The authors gathered findings from existing publications on potentially avoidable hospitalizations, hospital readmissions and nursing home resident hospitalization of Medicare and Medicaid patients. Significant differences existed for all three state-level outcome measures between states with and without full practice authority. Results showed that states with full practice authority have decreased hospitalizations and better overall health outcomes. There were no significant differences in the state-level outcome measures between reduced and restricted states, which suggests that any limit on NP practice may negatively impact patient outcomes.

Prescott, P.A. & Driscoll, L. (1980). Evaluating nurse practitioner performance. Nurse Practitioner, 5(4), 28-32.

The authors reviewed 26 studies comparing NP and physician care, concluding that NPs scored higher in many areas. These included the amount/depth of discussion regarding child health care, preventative health and wellness; amount of advice, therapeutic listening and support offered to patients; completeness of history and follow up on history findings; completeness of physical examination and interviewing skills; and patient knowledge of the management plan given to them by the provider.

Ritsema, T. S., Bingenheimer, J. B., Scholting, P. & Cawley, J. F. (2014). Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009. Preventing Chronic Disease, 11E33. doi:10.5888/pcd11.130175.

This original Centers for Disease Control and Prevention (CDC) research paper utilizes a large sample of more than 136,000 adult patients with select chronic conditions drawn from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Across all conditions, the study finds NPs provide health education to patients more frequently than physicians.

Roblin, D.W., Becker, R., Adams, E.K., Howard, D. H. & Roberts, M.H. (2004). Patient satisfaction with primary care: Does type of practitioner matter? Medical Care, 42(6), 606-623.

A retrospective observational study of 41,209 patient satisfaction surveys randomly sampled between 1997 and 2000 for visits by pediatric and medicine departments identified higher satisfaction with NP and/or PA interactions than those with physicians, for the overall sample and by specific conditions.

Sacket, D.L., Spitzer, W. O., Gent, M. & Roberts, M. (1974). The Burlington randomized trial of the nurse practitioner: Health outcomes of patients. Annals of Internal Medicine, 80(2), 137-142.

A sample of 1,598 families were randomly allocated, so that two-thirds continued to receive primary care from a family physician and one-third received care from a NP. The outcomes included: mortality, physical function, emotional function and social function. Results demonstrated comparable outcomes for patients, whether assigned to physician or to NP care.

Safriet, B. J. (1992). Health care dollars and regulatory sense: The role of advanced practice nursing. Yale Journal on Regulation, 9(2).

The full summer 1992 issue of this journal was devoted to the topic of advanced practice nursing (APN), including documenting the cost-effective and high-quality care provided, and to call for eliminating regulatory restrictions on their care. Safriet summarized the U.S. Office of Technology Administration study concluding that NP care was equivalent to that of physicians and pointed out that 12 of the 14 studies reviewed in this report which showed differences in quality reported higher quality for NP care. Reviewing a range of data on NP productivity, patient satisfaction and prescribing, Safriet concludes “APNs are proven providers, and removing the many barriers to their practice will only increase their ability to respond to the pressing need for basic health care in our country.”

Spitzer, W.O., Sackett, D.L., Sibley, J.C., Roberts, M., Gent, M., Kergin, D.J., Hacket, B.D. & Olynich, A. (1974). The Burlington randomized trial of the nurse practitioner. New England Journal of Medicine, 290(3), 252-256.

This report provides further details of the Burlington trial, also described by Sackett, et al. This study involved 2,796 patients being randomly assigned to either one of two physicians or to an NP, so that one-third were assigned to NP care, from July 1971 to July 1972. At the end of the period, physical status and satisfaction were comparable between the two groups. Clinical activities were evaluated, and it was determined that 69 percent of NP management was adequate compared to 66 percent for the physicians. The conclusion was that an NP can, “provide first-contact primary clinical care as safely and effectively as a family physician.”

Stanik-Hutt, J., Newhouse, R., (2013). The quality and effectiveness of care provided by Nurse Practitioners. The Journal for Nurse Practitioners, 9(8). doi:10.1016/j.nurpra.2013.07.004.

Evidence regarding the impact of NPs compared to physicians (MDs) on health care quality, safety and effectiveness was systematically reviewed. Data from 37 of 27,993 articles published from 1990-2009 were summarized into 11 aggregated outcomes. Outcomes for NPs compared to MDs are comparable or better for all 11 outcomes reviewed. A high level of evidence indicated better serum lipid levels in patients cared for by NPs in primary care settings. A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure and mortality are similar for NPs and MDs.

Traczyski, J., Udalova, V. (2013). Nurse Practitioner independence, health care utilization and health outcomes. Retrieved from http://www.lafollette.wisc.edu/research/health_economics/Traczynski.pdf.

The authors examined how state practice laws impact health care utilization and patient outcomes. In states that have fewer unnecessary practice restrictions on NPs, the frequency of routine checkups and preventive health exams increases. More favorable practice environments also were associated with higher patient-reported health status and fewer emergency room visits by patients with ambulatory sensitive conditions.

Virani, S. S., Maddox, T. M., Chan, P. S., Tang, F., Akeroyd, J. M., Risch, S. A. & ... Petersen, L. A. (2015). Provider Type and Quality of Outpatient Cardiovascular Disease Care: Insights From the NCDR PINNACLE Registry. Journal of the American College of Cardiology, 66(16), 1803-1812. doi:10.1016/j.jacc.2015.08.017.

The quality of coronary artery disease (CAD), heart failure and atrial fibrillation care was compared for care delivered by physicians versus NPs or physicians assistants (PAs) for outpatient visits during a one-month period. Quality measures were comparable among both groups, and smoking cessation screening intervention was higher among the NP/PA group for CAD patients.

Wright, W.L., Romboli, J.E., DiTulio, M.A., Wogen, J., and Belletti, D.A. (2011). Hypertension treatment and control within an independent nurse practitioner setting. American Journal of Managed Care, 17(1), 58-65.

A cross-sectional, retrospective study of 1,284 propensity score-matched patients with hypertension, one-half of whom were treated by NPs and the other half by physicians, found comparable controlled blood pressure rates among the comparison groups. — Preceding unsigned comment added by Bethany72 (talkcontribs) 08:06, 22 April 2019 (UTC)

Noted with thanks. Some of these studies have already been addressed as being of poor quality, for example either 6 month or 1-year follow-up for chronic conditions. I will continue to look through these and add what is found to be notable as I have done before. So said The Great Wiki Lord. (talk) 00:41, 23 April 2019 (UTC)

Every study has limitations. Just because the study author published their limitations, does not mean the study is poor quality. On the contrary, most of these studies are randomized trials, and a few are systematic reviews of RCTs, which are the highes level of evidence. — Preceding unsigned comment added by Bethany72 (talkcontribs) 01:14, 25 April 2019 (UTC) Bethany72 (talkcontribs) has made few or no other edits outside this topic.

Comment - I agree with Bethany72 that the information on this Wikipedia page does not accurately reflect the role of nurse practitioners. The content contains citations of material that does not pertain to or support said content. For example, the depth of expertise comment in the second sentence contains an inaccurate citation of comments that the President of AANP made in testimony before Congress. Valid resources have been discounted without sufficient reason, and comparisons to physicians have been allowed to remain. Why compare one health care role to another? Let the role stand on its own merits. The five pillars of Wikipedia state that content will be written from a neutral point of view. This section should state the facts, without comparisons subjective, negative and inflammatory value judgments. Miraclecln (talk) 22:46, 8 May 2019 (UTC)
It is from a neutral point of view. Everything is a fact that is well sourced. Please point out one this that is not fact. The lobbying for unsupervised practice is very notable and well cited and so is the opposition to that. NPs are comparing themselves to physician and studies are being done to compare too. so that comparison is notable and worth of inclusion.So said The Great Wiki Lord. (talk) 15:29, 10 May 2019 (UTC)
MiracleIn, I just had another look at the article, there percentage of article that compares MDs to NP is very small and well sourced and attributed to maintain and hence appropriate for inclusion. Please see WP:Content disclaimer. So said The Great Wiki Lord. (talk) 15:00, 11 May 2019 (UTC)

The information Bethany72 and Miraclecln provided above is accurate. So said The Great Wiki Lord should be open to the facts and a consensus. The facts are: nurse practitioners have been providing health care for over half a century. NPs are currently providing care in all 50 U.S. states, the District of Columbia, U.S. territories and in countries around the world. NPs diagnose, treat, prescribe medications and manage patient care. In the U.S., 22 states, the District of Columbia and two territories grant legal permission for NPs to provide care without physician oversight. The remaining states are exploring whether to grant full practice authority. The National Academy of Medicine (formerly the Institute of Medicine), the National Governor's Association, the Federal Trade Commission, the National Conference of State Legislatures, both the Trump and Obama administrations and others have called on states to remove outdated laws and regulations that hinder patient access to NP care as a way to address health care access and reduce health care costs. This background on the current U.S. legislative process, however, has little to do with a professional Wikipedia description of a health care provider type -- which is what this Wikipedia page is about: a profession description. It should be providing a neutral description of the nurse practitioner role. The NP page/article as currently stated is inaccurate, including some references. For example, reference #14 isn't even about nurse practitioners and shouldn't be included as a references. It relates to registered nurses. Another inaccuracy: reference #8 was used to support the line that NP-provided services increases cost of care, yet the reference/study actually referred to a possibility of cost increases sometime in the future. Plus, it was specific to diagnostic imaging. This article needs to be revised and many have requested similar revisions in discussions on this talk page. To support Wikipedia's pillar of neutrality, this page needs to be revised to remove comparisons and bias, which are out of place on any Wikipedia page. Raraavis31 (talk) 12:26, 22 May 2019 (UTC)

References[edit]

All major organizations EXCEPT physicians have come out saying the term mid level is derogatory. I don't come to Wiki to be insulted. NP care is not judged medically or legally different from physicians. We practice according to the same standards. I've included the official paper from the AANP. Please change it and stop with the insulting terminology.

https://www.aanp.org/advocacy/advocacy-resource/position-statements/use-of-terms-such-as-mid-level-provider-and-physician-extender "Use of Terms Such as Mid-level Provider and Physician Extender The use of terms such as “mid-level provider” and “physician extender” in reference to nurse practitioners (NPs) individually or to an aggregate inclusive of NPs is inaccurate and misleading. The American Association of Nurse Practitioners® (AANP) opposes the use of these terms and calls on employers, policymakers, health care professionals and other parties to refer to NPs by their title. In 2010, the Institute of Medicine (IOM) developed a blueprint for the future of nursing. A key recommendation of this report is that NPs should be full partners with physicians and other health care professionals.i Achieving this recommendation requires the use of clear and accurate nomenclature of the nursing profession.

NPs are licensed, independent practitioners. NPs work throughout the entirety of health care, from health promotion and disease prevention to diagnosis that prevents and limits disability.ii These inaccurate terms originated decades ago in bureaucracies and/or organized medicine; they are not interchangeable with use of the NP title. The terms fail to recognize the established national scope of practice for the NP role and authority of NPs to practice according to the full extent of their education. Further, these terms confuse health care consumers and the general public due to their vague nature and are not a true reflection of the role of the NP.

The term “mid-level provider” implies an inaccurate hierarchy within clinical practice. NPs practice at the highest level of professional nursing practice. It is well established that patient outcomes for NPs are comparable or better than that of physicians.iii NPs provide high-quality and cost-effective care."

"


Definition of Nurse Practitioner Request for Change[edit]

The definition of nurse practitioner needs to be updated on this page. Please see below.

A nurse practitioner (NP) is a member of the health delivery system and practices autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NPs are one of four types of advanced practice registered nurses (APRN) – highly valued and an integral part of the health care system. [1]

Miraclecln (talk) 22:05, 8 May 2019 (UTC)

MiraclecIn, NPs do no always practice autonomously that why the most accurate way to describe them it to say "scope of practice for a nurse practitioner is defined by jurisdiction." So said The Great Wiki Lord. (talk) 19:35, 16 May 2019 (UTC)

Can we get a consensus on this? A nurse practitioner (NP) is a member of the health delivery system who is educated and clinically prepared to practice autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NP practice regulations vary by state. NPs are one of four types of advanced practice registered nurses (APRN) – highly valued and an integral part of the health care system. [2] Miraclecln (talk) 16:54, 20 May 2019 (UTC)

Semi-protected edit request on 20 May 2019[edit]

Can we get a consensus on this? The definition of nurse practitioner needs to be updated on this page. Please see below.

A nurse practitioner (NP) is a member of the health delivery system educated and clinically prepared to practice autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NP practice regulations vary by state. NPs are one of four types of advanced practice registered nurses (APRN) – highly valued and an integral part of the health care system. [3] Miraclecln (talk) 16:55, 20 May 2019 (UTC)

Semi-protected edit request on 9 May 2019[edit]

Please change "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner. A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans." to "A nurse practitioner (NP) is a member of the health delivery system and practices autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics and women’s health care. NPs are one of four types of advanced practice registered nurses(APRN) – highly valued and an integral part of the health care system." [4] Miraclecln (talk) 20:31, 9 May 2019 (UTC)

 Not done: "practices autonomously" turns a complete blind eye to the current lobbying for legislation for unsupervised practice going on. Even though you may dislike and want to remove the term Mid level practitioner, it is very well cited term used by WHO and NIH, as the consensus on top was developed. No amount of objection or "position statements" from professional organization is going to change that is very well accepted term. Wikipedia is not censored because a person or a group dislikes a term or a fact. So said The Great Wiki Lord. (talk) 15:24, 10 May 2019 (UTC)

The request made at Third Opinion has been removed (i.e. declined). Like all other moderated content dispute resolution venues at Wikipedia, Third Opinion requires thorough talk page discussion before seeking assistance. If an editor will not discuss, consider the recommendations which are made here. — TransporterMan (TALK) 20:47, 15 May 2019 (UTC)

I agree. NPs are allowed to practice autonomously in some places, and not in others. We can't mislead the readers by saying that they do, as if it was the same everywhere. WhatamIdoing (talk) 17:47, 22 May 2019 (UTC)

References

  1. ^ APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education"
  2. ^ APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education"
  3. ^ APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education"
  4. ^ APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/APRNReport.pdf "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education"

Questionable wording[edit]

Nurse practitioners are educated clinicians – advanced practice registered nurses with graduate degrees. It surprises me to read the word “flimsy” used to describe the NP education. Even if used to explain what NP opponents believe, this type of derogatory language does not belong in a Wikipedia description of any profession. The Wikipedia Five Pillars are in place to ensure fair and unbiased descriptions – a neutral point of view. I can’t see how respect and civility were practiced using this type of language. Please consider omitting. Raraavis31 (talk) 23:24, 9 May 2019 (UTC) Raraavis31 (talkcontribs) has made few or no other edits outside this topic.

Remove the emotion, add the facts[edit]

The content of this page needs to reflect the current profession of nurse practitioners. There is no debate on the profession: it exists in all 50 U.S. states. If you want to edit an add a section about possibly controversy of the profession, then so be it. But to include opinion and not fact -- despite reference to slanted propaganda from medical associations, is a disservice to anyone reading this page looking for quality information. This is written as if we are still trying to justify the profession, as if we would do that with police officers or teachers. I implore you to consider the changes that so many have recommended but have been denied for poor reasoning.

You failed to respond at any of this first paragraph. Therefore, I am requesting again. Move controversial statements to a "controversial" section if you desire. Its as if you don't believe the role exists and are pandering to organized medicine.

The quote, "In United States, nurse practitioners have been lobbying for independent practice.[6]" references a Forbes article. Nurse practitioners are advocating for "full practice authority." That is, Full Practice State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing. (https://www.aanp.org/advocacy/state/state-practice-environment).

Also, there are states that have granted nurse practitioners "full practice authority" and the inception of the profession in the nurse practice act which defines scope and title. Therefore, it is again incorrect, to insinuate that all NPs are "...lobbying for independent practice."

There is NOTHING in the referenced articles to make the statement, "...but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions." [1][2] NOTHING to make that blanket over-reaching statement. See, that is opinion, not neutral.

Cherry picking low quality studies is a disservice to anyone reading this. The claim of "Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals"

- Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners: This study examined NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS TOGETHER. The data does not seperate nurse practitioners from PAs, therefore this study of 160 patients seen by both NPs and PAs cannot alone be attributed to NP referrals. Also, this study makes NO REFERENCE to cost. It only concludes: "The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation."

- A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office-Based Evaluation and Management Visits: Again this study COMBINED NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS with no analysis of the NP data vs PA data. Its impossible to know the true NP referrals for imaging from this study. They conclude: "Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. Expanding the use of APCs may alleviate PCP shortages. While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level." However the editorial comment by Katz (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939367) states, "In this article, Hughes et al1 find that advanced practice clinicians order modestly more radiologic tests (0.3%) than primary care physicians among Medicare patients. However, this overall percentage difference obscures a more important finding. When the investigators focused on a common problem in primary care, lower back pain, they found that advanced practice clinicians ordered no more imaging tests than physicians, and when the investigators limited the sample to patients with acute respiratory illness, advance practice clinicians actually ordered fewer imaging tests."

- Emergency physician evaluation of PA and NP practice patterns - This low quality study is based on a SURVEY of EMERGENCY ROOM PHYSICIANS " We chose to survey the ACEP council as a representative group of emergency physicians from across the United States with general knowledge and expertise in practice and administrative matters." This is clearly a biased sample who reported, "Just over 51% of the 327 respondents to the audience response system survey reported that they generally regarded PAs and NPs as subordinate in relation to attending physicians." This survey did not study health care costs in any way.

Its time to stop the stone walling on this page and the NP professions and make the appropriate updates.

There are a lot of immature and passive-aggressive "professionals" posting on this page including the editor of the page. Nurse practitioners are not "mid-levels", there is no level between nurse and physicians because they are two different professions! It's a shame this page had to be semi-protected due to vandalism. As it is now, it is riddled with errors and someone's personal viewpoints about nurse practitioners.

Please point out the "poor reasoning," and I will be glad to revisit and re-discuss as I have done before. Thanks. So said The Great Wiki Lord. (talk) 14:10, 16 May 2019 (UTC)

Nurse Practitioner entry[edit]

I see many biased and derogatory remarks about nurse practitioners in this entry and I urge you to remove or edit the material to be fact-based. I respect Wikipedia and its many contributors but this is fake and biased information and does not belong on Wikipedia. 104.52.197.251 (talk) 14:31, 16 May 2019 (UTC)

Can you be a little more specific please. So said The Great Wiki Lord. (talk) 14:41, 16 May 2019 (UTC)

Please remove the section that is misleading and derogatory[edit]

Please remove the section that describes Advanced Practice Nurse Practitioners (APNPs) as "midlevel" and "flimsy." This is a non-fact-based, emotionally-charged, and derogatory description of the profession. It should be replaced by a more accurate description provided by solid resources like the Center for Disease Control (CDC).

A more accurate, fact-based definition worthy of an online encyclopedia would read "NPs are nurses who have completed a master’s or doctoral degree program and have advanced clinical training beyond their initial professional registered nurse preparation. NPs are licensed in all 50 states and the District of Columbia and practice care based on the rules and regulations of the state in which they are licensed," (https://www.cdc.gov/dhdsp/pubs/toolkits/np-resources.htm, retrieved 05/16/2019). — Preceding unsigned comment added by HEALTH IS-A TEAM SPORT (talkcontribs) 16:34, 16 May 2019 (UTC) HEALTH IS-A TEAM SPORT (talkcontribs) has made few or no other edits outside this topic.

I am sorry this offend you, but "mid-level" is well sources from WHO and NIH. "flimsy" is in quotes appropriately attributed to those who oppose along with a reference. "based on the rules and regulations of the state in which they are licensed" removes information regarding the level of supervision and scope and essentially censors the article. So said The Great Wiki Lord. (talk) 19:59, 16 May 2019 (UTC)

Why do you resist the calls for correction? Mid-level is not a term used by an official United States agency - You mention WHO and NIH. Where does it officially "classify" nurse practitioners as "mid-level practitioner"(s)? They don't.

Let me give you 2 examples:

Respectfully, both of those links are broken. Again, “mid-level” is not an official term nor designation for NPs. — Preceding unsigned comment added by NPTruth (talkcontribs) NPTruth (talkcontribs) has made few or no other edits outside this topic.

Corrected. So said The Great Wiki Lord. (talk) 20:48, 17 May 2019 (UTC)
@NPTruth: It seems you are completely incorrect in claiming that "mid-level is not an official term nor designation for NPs." The World Health Organisation states:

Towards a working definition of mid-level providers

Many countries’ health care services are provided by cadres not trained as physicians, but capable of performing many diagnostic and clinical functions. Collectively these are variously referred to as “substitute health workers”, “auxiliaries”, “non-physician clinicians”, or “mid-level health providers”, and include cadres such as clinical officers, medical assistants, physician assistants, nurse practitioners, etc. There isn’t an official definition of mid-level providers that represents a direct match with any of the professional categories, such as paramedical practitioners, recognized in the International Standard Classification of Occupations. The use of these terms is fairly broad, ranging from internationally recognized groups, including nurses and midwives to whom specific diagnostic and clinical skills have been delegated (nurse practitioners), to cadres that have been trained to meet specific country needs – e.g. técnicos de cirurgia (surgical technicians) in Mozambique and clinical officers in East African countries.

The DEA in its document Mid-Level Practitioners Authorization by State states:

Pursuant to Title 21, Code of Federal Regulations, Section 1300.01(b28), the term mid-level practitioner means an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice. Examples of mid-level practitioners include, but are not limited to, health care providers such as nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists and physician assistants who are authorized to dispense controlled substances by the state in which they practice.

It seems very clear to me that both national and international bodies closely associated with health care define NPs as mid-level providers. I can understand nurse practitioners wanting to be seen as equivalent to MDs, since they may perform many of the same functions and may operate equally autonomously in some jurisdictions. However, they are not identical, and clearly undertake a far more limited training to achieve their qualification.
I strongly suggest you accept that this article is going to use definitions from independent reliable sources, and not from organisations' own aspirational self-descriptions. The WHO, DEA and similar organisations' statements are regarded among the highest level of evidence by WP:MEDDEF. I would urge you to read WP:MEDRS in full; it gives excellent guidance to the way Wikipedia uses sources related to medicine.
If you are going to help make improvements to this article, you are going to have to concentrate on areas where you can seek consensus within our guidelines to make changes. For example, I'm sure you have a valid case to get the section comparing the training of NPs with MDs rewritten. There is a point made below that the number of hours of patient contact in training NPs could range from 3% up to 10% of that undertaken by MDs in training. The sources are factual and the summary would be sensible. Why not turn your attention to what you are likely to find consensus over? --RexxS (talk) 19:38, 22 May 2019 (UTC)
Thank you for your response RexxS and I do appreciate your suggestion. I am not minimizing the credibility of the WHO or the DEA. But within the WHO definition, it states,

"There isn’t an official definition of mid-level providers that represents a direct match with any of the professional categories, such as paramedical practitioners, recognized in the International Standard Classification of Occupations. The use of these terms is fairly broad..."

I also point out that Medicare states,

"Nurse practitioners, clinical nurse specialists, and physician assistants are health care providers who practice either in collaboration with or under the supervision of a physician. We refer to them as non-physician practitioners. States are responsible for licensing and for setting the scopes of practice for all three specialties. Services provided by them can be reimbursed by Medicare Part B.

[1]
This is not about trying to make an equivalency to physicians. It is about correcting the entry. Again, to claim, "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner," is not a globally accepted classification, so why state it all? While we are at it, we can also say that nurse practitioners are classified as advanced practice clinicians [2] or advanced practice providers [3] or non-physician practitioners as per Medicare. Or it can just read, "A nurse practitioner (NP) is an advanced practice registered nurse (APRN) - a registered nurse with advanced education and preparation, and holds either a master's or doctoral degree. Nurse practitioners are licensed and authorized in all states to diagnose, treat, and prescribe. NPs deliver primary and specialty health care to all populations across the lifespan." This would be a factual definition with indisputable facts. Again, I am learning what is consensus on Wikipedia but it would definitely appear that there is NO consenus on the term "mid-level practitioner." Respectfully,NPTruth (talk) 20:16, 22 May 2019 (UTC)
@NPTruth: Per MOS:BEGIN, the article has to have an introduction to the term "Nurse Practitioner", and part of that will inevitably be the classification applied by the WHO. I am clear that the WHO classifies NPs as mid-level providers, and I don't think anything you've written contradicts that. Our policy at WP:YESPOV requires us to represent significant perspectives published in reliable sources, but the view of the NPs' professional association can't really be given the same prominence as that of the WHO and the DEA, certainly not in the lead. If you think that there is a place in the body of the article where we could explore the views of those who find the term "mid-level provider" derogatory, then perhaps we can try to seek some consensus here for a form of words, but I think you're going to find it difficult to get agreement for more than a brief mention for something that is very likely a small minority viewpoint.
I think your intent here is to raise the profile of NPs and I don't blame you for trying. Regardless of intent, we are still going to have to go by what the highest quality sources tell us, and I see no way of "correcting the entry" without the high quality sources to counterpoise the classification that the WHO makes. Of course the WHO is as globally accepted as a source can be; if there are fringe groups that don't accept the WHO's statements, that does not invalidate their use on Wikipedia. Your definition is completely US-centric. The American Medical Association, the American Society of Clinical Oncology and Medicare have a lot of useful things to say about practices in the USA, but that's not the world, and the USA represents only a minority of the readership of the English Wikipedia. Many NPs in other parts of the world do not have postgraduate qualifications, which is an example of a glaring mistake in your suggestion.
Once more I'm going to have to point you to our policy on WP:NPOV. How the WHO classifies NPs is not a matter of consensus here, it is a matter of fact, and that fact is verified by the source. No matter how much you dislike that fact, you haven't produced a single policy-based reason why our article should not make prominent use of it. Cheers --RexxS (talk) 20:57, 22 May 2019 (UTC)
@RexxS Ok, this will be my last comment on mid-level practitioner https://en.wikipedia.org/wiki/Mid-level_practitioner. Is it not significant that the Nurse Practitioner profession was founded and created in the United States [4]? The WHO is not the authority on healthcare nomenclature and I don't believe that is a "fringe" opinion. They, understandably are attempting to fit a square peg in a round hole. It doesn't seem congruent to me that the U.S. with the most number of NPs by far, editors should use a classification that is from the WHO. Usually, it is American NPs and universities who are helping with the NP role development in other countries. So, because Wikipedia readership is global, we are stuck with a classification that has to be the same? Ok, if you say so.
This is not about "raising the profile of NPs" as I have mentioned before. It is conveying an accurate description to the readers of Wikipedia about a profession that is indisputable. NPTruth (talk) 21:49, 22 May 2019 (UTC)
@NPTruth: No, as far as the classification of NPs is concerned, I don't see that the fact that they were first introduced over 50 years ago in the USA is at all relevant. Are you implying that one country should somehow have a greater say in how NPs are classified than a pan-national organisation? In any case, the DEA is a USA organisation and they classify NPs as mid-level providers as well. In fact, I'm having difficulty in finding any source independent of NPs that takes a contrary stance. Can you provide a reliable independent source that does so?
To find sources on classification nomenclature, we don't have to find "the authority on healthcare nomenclature" (what is that, by the way?); we can be satisfied with a high-quality source that isn't contradicted by an equally high-quality source. I'm pretty sure the WHO fits that bill.
A fringe opinion is defined on Wikipedia as "an idea that departs significantly from the prevailing views or mainstream views in its particular field." I think you're wrong. I believe that the claim that NPs are not classified as mid-level providers is indeed a fringe opinion, as I can find what the WHO and DEA say – I call that 'mainstream' – but I can't find anybody apart from the American Association of Nurse Practitioners who dissent from that view.
I don't agree that the WHO is attempting to fit a square peg into a round hole. It is merely reflecting the wide variance in standards of education and training afforded to medical practitioners of all kinds between those available to first-world countries and those that third-world countries have to make do with. What is indisputable is that in every setting, there is a case to be made for practitioners who can be fast-tracked into service with less cost than a fully trained physician. These are mid-level providers, by definition, and NPs are preeminent among them. Our article must reflect the global situation, not just that of the most developed country on Earth, whose standards would appear impossibly high to someone from the third world. Do you really believe that NPs in Mozambique have Masters degrees or higher? As much respect as I have for the AANP, I still don't think we can give way to their campaign to raise the profile of NPs without introducing serious errors in our coverage of the prominent sources available to us. Those sources confine what we present as an accurate description of the classification of NPs, and no matter how much the AANP finds it distasteful, we are duty-bound to report what the highest-quality sources say on the matter. That is as close to "indisputable" as we can get on Wikipedia. --RexxS (talk) 22:43, 22 May 2019 (UTC)
@RexxS, can you share the algorithm you are using to arbitrarily choose one credible reference source over another? You seem to put more credence into the DEA's use of mid-level provider than what the Centers for Medicare and Medicaid Services use of non-physician practitioner (as I already mentioned above and you ignored.) Or is it more of a two (WHO & DEA) against one (CMS) deal? See how silly it is to pick and choose facts based on your biases? And yes, I do think the country originating the role reasonably holds substantive weight as to how the profession is classified. There are no Nurse Practitioners in Mozambique (though likely mid-level providers) and their physician education probably differs from that of U.S. schools too, wouldn't you think? Finally, I don't know what your repeated references to AANP has to do with me. You have given me a lot to consider. I am heading into the Wikipedia-world to edit all entries to be country-neutral as this model entry is. But don't worry, I will be back. NPTruth (talk) 01:01, 23 May 2019 (UTC)
NPTruth, I'm glad to hear that you are interested in reducing the Wikipedia:Systemic bias problems on Wikipedia, as many articles are overly focused on the US (and, to a lesser extent, other English-speaking countries). I am just a little worried, given the contentious context, that you might end up blocked over the rule that says Wikipedia:Do not disrupt Wikipedia to illustrate a point. Please keep in mind that I'd really rather see you editing productively than getting blocked. :-) We really, really, really need people to pitch in and help out with this problem.
The answer to your question above is that we favor independent sources for questions like this. So, for example, government agencies or a newspaper style guide matter more than professional advocacy groups. That isn't to say that we should omit any mention of the controversy or differences of opinion; it is verifiably true that American Association of Nurse Practitioners opposes both the WHO's use of the term mid-level practitioner and CMS's uses of the term non-physician provider. This doesn't change the fact that nurse practitioners actually meet the usual definitions for those terms, but we can certainly acknowledge somehow that they don't appreciate anyone comparing their profession to that of physicians. WhatamIdoing (talk) 03:17, 23 May 2019 (UTC)

This article is does not meet the wikipedia standard of non-biased articles. The bias against nurse practitioner practice, scope, and education is clear. I think it would be more appropriate to make a sub-section titled "Controversy/Criticism" to include critiques of NPs. — Preceding unsigned comment added by 163.40.114.82 (talk) 03:17, 17 May 2019 (UTC)

I think that is a very reasonable suggestion, We can most certainly include that section put the quality of care and limitation in education in that section. I will get started on it shortly. So said The Great Wiki Lord. (talk) 12:38, 17 May 2019 (UTC)

References

Semi-protected edit request on 17 May 2019[edit]

This page is being vandalized and protected by a user with malicious intent toward the nurse practitioner profession. It is blatantly slanderous, and professional, accredited nurse practitioners should be able to edit this information and correct the blatant propaganda being spewed here on this page. Juliewiki4 (talk) 17:41, 17 May 2019 (UTC) Juliewiki4 (talkcontribs) has made few or no other edits outside this topic.

You can propose changes here on the form "Please change X to Y" citing reliable sources. – Þjarkur (talk) 19:30, 17 May 2019 (UTC)

Semi-protected edit request on 18 May 2019[edit]

Delete the following sentences, since they now appear in the new "Controversy" section: "The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact.[7] The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training.[1] Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals.[8][9][10]" NPTruth (talk) 14:52, 18 May 2019 (UTC) NPTruth (talkcontribs) has made few or no other edits outside this topic.

 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. The summary of findings belongs in the lead. Controversy section will be expanded further. So said The Great Wiki Lord. (talk) 22:09, 18 May 2019 (UTC)

I agree with NPTruth and the request to make this change. With all the voices on this page requesting this change, we seem to have a consensus that this is not neutral language and is out of place on Wikipedia. Miraclecln (talk) 16:45, 20 May 2019 (UTC)

 Not done: A parade of brand new single purpose accounts does not demonstrate a consensus. You're going to have to work with your opposition to find some compromise, not attempt to bludgeon them with repeated edit requests. - MrOllie (talk) 16:52, 20 May 2019 (UTC)

This is not a new account MrOllie, and it is clear that the NP page is not written from a neutral perspective as per the Wikipedia pillar of neutrality. Miraclecln (talk) 17:07, 20 May 2019 (UTC)

I've attempted to tease out a little more of what the source https://www.managedcaremag.com/archives/2018/9/nurse-practitioners-docs-lawmakers-give-us-our-independence says. It seems to present a reasonably balanced overview of the opposing positions, although it does not contain the word "flimsy", which I've consequently removed. If anyone is unhappy with my expansion, or has other reliable sources that belong in that section, please let me know and I'll do my best to try to find some common ground here. --RexxS (talk) 20:12, 22 May 2019 (UTC)

Resistance to edits[edit]

There is clear consensus on many of the comments but the admin consistently blocks them. As far as the last edit, you don’t see an issue with having the same text in 2 different sections? Seriously? The whole impetus of the new “controversy” section was to tease out the FACT from OPINION NPTruth (talk) 02:03, 19 May 2019 (UTC)

Information will be rewritten. The summary will remain in the lead and more thorough information will be added to the controversy section. Please read WP:concensus. A number of people encouraging others to write the same thing over and over again is not consensus, please not that Wikipedia is Not a democracy So said The Great Wiki Lord. (talk) 14:35, 19 May 2019 (UTC)

Semi-protected edit request 20 May 2019[edit]

The edits made by TGWL in the past two days are awful and far beneath Wikipedia's standards. For example, the following needs to be removed immediately, since a discussion board is far from a reliable source, and the person who posted has not even been verified. "Some online NP schools can have very low admission standards.[1]" Miraclecln (talk) 19:54, 20 May 2019 (UTC)

References

  1. ^ "For-Profit NP admissions... I thought they were joking!".
Agreed that was an oversight. I have removed as requested. So said The Great Wiki Lord. (talk) 20:38, 20 May 2019 (UTC)

Inappropriate sources[edit]

As of the current revision, the article cites quite a few unreliable and/or misrepreseted sources. In particular:

  • Reference 1 is basically a press release by an advocacy organization. That's clearly not a reliable source. It also doesn't support the statemet it's cited for in the lead, "The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training." - assuming that's referring to clinical hours, then the numbers given by the source are 500-1500 vs. 15,000-16,000, which amounts to 3.1%-10%, definitely not "less than or equal to 3%".
  • Reference 8 groups NPs with physician assistants and, as far as I can tell, makes no statement about only NPs, and it also doesn't seem to say anything about cost.
  • Reference 9 also groups NPs with PAs, with no meaningful statement about only NPs.
  • Reference 10, conversely, compares NPs and PAs. It does not say anything about the cost impact of an increased role of NPs.
  • Reference 13 is an opinion piece, not a reliable source for statements of fact. It's pseudonymous, too, and comes with an explicit disclaimer.
  • Reference 14 is misrepresented. I assume it's meant to support the statement that "Many schools have 100% acceptance rates" - except it shows that only eight schools out of 228 had a 100% acceptance rate, and it further qualifies the result by noting that those are generally schools with small applicant pools. I don't think 8/228 is "many", and the source certainly doesn't say so.
  • Reference 16 is used misleadingly; the quote refers to nurses in general, not nurse practitioners. "Younger nurses and those with higher levels of education [presumably including NPs] reported higher EBP competency (p < .001)."
  • "NPs are also more likely to order unnecessary tests and procedures such as skin biopsies and imaging studies." - reference 9 (already mentioned above) explicitly does not comment on whether the additional images ordered by NPs (and PAs) are unnecessary or whether the physicians they're compared with order too few images.
  • Reference 19 is an editorial, not a peer-reviewed study.

I don't know whether the above list is exhaustive (at some point I grew tired of checking sources), but it's big, and it's systematic. It needs fixing, and that likely means getting rid of much of the "controversy" section when there are no reliable secondary sources for the content. Huon (talk) 03:04, 21 May 2019 (UTC)

Thank you for pointing these out Huon. Others and myself have mad similar suggestions in the past with rationale as well. Looking forward to having these substantive edits made to clean up this entry with acceptable standards. NPTruth (talk) 15:17, 22 May 2019 (UTC)