Change is often a slow process, even within a profession. There is still work to be done in how we communicate our self-views. As professionals, we are in a position to effect change with simple awareness of the words that we use.
One example of that awareness relates to use of the term “mid-level provider.” Whereas many of our colleagues recognize the negative connotations of the term and choose not to use it, many more appear to be quite comfortable with it. The largest professional organization for nurse practitioners (NPs), the American Association of Nurse Practitioners, “opposes use of terms such as mid-level provider in reference to NPs individually or to an aggregate inclusive of NPs.” The organization encourages employers, policy makers, healthcare professionals, and other parties to refer to NPs by their title. The term calls into question the legitimacy of NPs to function as independently licensed.
And if the designation of being “mid-level” is not concerning enough, consider the standard of being last in lists. As an example, one phenomenon related to this professional view of self can be observed quite frequently in the literature when nurse authors include nurses in lists with other providers. Regularly, providers are ordered in lists as “physicians, physician assistants, NPs, and nurses,” with nursing consistently being mentioned last.
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From a professional perspective, placing nursing last prompts questions of why we as nurse authors list nursing roles last, especially because “n” comes before “p” in the alphabet. If we do not see ourselves first, why should anyone else?
There is also confusion about use of the word “doctor.” Doctor has long been a popular synonym for physician in the United States. Unfortunately, despite the fact that many other scholars and professionals earn doctoral degrees, this synonym has been difficult to change. When many different types of healthcare professionals are working to provide the highest quality of care, this unclear use of the word “doctor” brings more confusion to the roles of healthcare team members. It is very simple and clear to refer to people by their role (eg, NP, physical therapist, physician, etc) in our language and our written words.
In discussing the value of accurate phrasing, Summers [Am Nurse. 2015;47(2):10] highlights the nuances of the words “independent,” “collaboration,” supervision,” and “accountability.” The author indicates that the word “independent” is not defined by place of employment, business model of practice, or reimbursement mechanisms and is most prone to misinterpretation to mean “in a vacuum” or “alone.” Collaboration is vital to all health care; however, it becomes a barrier when laws, regulations, or institutional guidelines require formal agreements in a biased manner for individual groups of providers. Supervision in NP practice is a misnomer, and the notion that NPs require supervision by physicians or any group of providers is archaic. NPs alone are legally responsible for the care they deliver, and that responsibility cannot be delegated to others.
To effect change, we first must change. It will take all of us (and likely our friends and colleagues) working to change how we communicate about our profession of nursing. The words that we use and how we use them ultimately reflect what we think of ourselves.
Kahlil Demonbreun, DNP, WHNP-BC, ANP-BC, is the women’s health medical director at William Jennings Bryant Dom VA Medical Center in Columbia, S.C. Julee B. Waldrop, DNP, FAANP, is a professor in the School of Nursing at the University of North Carolina at Chapel Hill.
