United Advanced Practice Registered Nurses of Georgia

"Just Say No!"

Posted about 5 years ago by James F. Lawrence


As we embark upon our first month into the New Year, I want all of UAPRN members and even those non-UAPRN members who are advanced practice registered nurses to join with me and agree in unison about one specific area. This week, I have been in communication via email or telephonically with three national organizations that I have had to politely interrupt them and correct them on their use of the term "mid-level provider" and "physician extender".

For the record, UAPRN of Georgia and AANP adamantly oppose the use of these terms. I find them offensive, demeaning, and pejorative. All that was required for me to "see the light" in using these terms was during my three hours of oral comprehensive defense during my Ph.D. program. One member of my committee "took a strip out of me" when I innocently used these terms. But, then she explained the symbolic meanings behind these terms and their use and I finally understood the complete picture. Thus, I would like to share them with you all. APRNs in this state are licensed, independent clinicians who require no other identity or provider to exist.

Terms such as "mid-level provider" and "physician extender" originated in bureaucracies and medical organizations. They suggest that the quality of care provided by APRNs is "diluted", "watered down" or less than some other higher standard. The literature over the past 50 years is quite clear in that the standard of care for patients being treated by APRNs is the same as that provided by our physician colleagues or other health care providers in the same type of setting. Furthermore, we are independently licensed clinicians who are able to give high quality, cost-effective care equivalent to that of our physician peers.

The less known term,"physician extender," send sharp pains up my spine and across my temple when I hear it as the term originated in medicine and suggests that the APRN role evolved to only serve as a extension of physicians' care or "hand-maiden" to physicians' care. Well, brothers and sisters, I am no hand maiden or extension of any physician!!

Since the mid 1960's we have shown again and again that with advanced education and training, the APRN is fully competent and capable of providing primary care and significantly enhancing  access to high quality and cost-effective health care. The data supports this.

In closing, the next time you are addressed as this or hear these terms used to describe you or your professional colleagues, stop what you are doing, take a deep breath, and politely explain to the person or the organization that this is a inappropriate, prejudice use of terminology that you find quite offensive. Then, kindly explain that as an APRN, you in no way provide "mid quality care" to your patients. Instead, you provide the same high quality of care that your physician colleague does. Then ask the person or organization directly- "Would you want me to provide anything less?"

Would we tolerate a racial, sexist, ageist term to be used in our presence? Of course not, then why should we lower our high standards with such prejudice terms as these ?

James F. Lawrence, Ph.D. APRN BC CHPN FAANP CPS

State UAPRN President