Stuck in the middle| What it’s really like to be a nurse practitioner

Young female nurse practitioner feeling stressed on a pink background

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Being a nurse practitioner is a rewarding and meaningful profession.  However, there are drawbacks. The most significant is feeling stuck in the middle of the perceived cultural hierarchy at your clinic or institution. Some places still refer to us as “mid-level providers”. This carries the perception that we’re functioning somewhere between a nurse, trainee, and doctor. Even worse patients don’t understand our title or scope of practice.

The term “mid-level provider” may not have been meant to have a bad connotation in the beginning.  But, it definitely diminishes the unique education, licensure, and experience of nurse practitioners.  Another antiquated term is physician extender.  The reality is that many among the healthcare profession not only believe in this terminology, but use it on a daily basis. This means that their behavior towards you is reflected in that belief. How can nurse practitioners and physician assistants break free of this mold and change the culture among their practices?

1. Push towards the “Advanced Practice Provider”

Several years ago there was a push among the legislature and professional organizations to classify nurse practitioners and physician assistants as “advanced practice providers” or APPs.  The term is meant to capture the full scope of practice and authority under your licensure. It also means that you’re operating at the top of your license.  However, many institutions don’t even know the term exists. Patients certainly haven’t heard of it. Educate your patients and colleagues about what it means to be an advanced practice provider.

2. Define your role and delegate tasks

No one wants to feel as if their being that co-worker that pushes work onto their colleagues.  But, what is usually the case for nurse practitioners is that they take on all tasks. This quickly leads to loss of job satisfaction and burnout. It also sends the wrong signal to physicians and colleagues that you’re the person to go to for “x” task completion.  There are whole departments and subcategories of people whose job descriptions encompass running a clinic.  Delegate tasks to the appropriate personnel so that you can focus on taking care of your patients.  For example, scheduling can and should be completed by the scheduler. Of course there are instances where you’re able to help out your colleagues and you should. But, the majority of times it’s not “under” helping that’s the problem.

3. Invest time and effort into expanding your scope of practice

Most state boards define scope of practice as the ability to assess, diagnosis, and treat patients. This includes whatever competencies you obtain during training. For example, a surgery nurse practitioner who has been trained to suture can include suturing in their scope of practice.  Focus on acquiring and honing skills that will elevate your scope of practice. It also carries a lot of weight with patients if you can complete higher level tasks on your own.  It helps patients realize that you’re not a trainee or student. Lastly, honing your skills makes your physician colleagues more productive so that they can focus on other patient needs.

4. Stay current with evidence based practice strategies

Read and adapt evidence based strategies into your practice. The best way to do this is to read peer reviewed articles and attend continuing education conferences. Tag along to clinic with other providers. This will help you find out what strategies they find the most helpful. You can learn so much by going into the exam room with another provider.  Some providers even quote articles that you can jot down and review later. Staying current with evidence based practice improves your skills and scope.  It establishes your expertise and builds confidence among your colleagues and patients.

5. Let your colleagues know how much you enjoy doing tasks that enhance your scope

Whenever you learn a new skill, let your colleagues know how much you appreciate the opportunity to enhance your scope. This will lead to them assigning these higher level tasks to you as opposed to being relegated to scheduling.  For example, if you’ve just learned how to read chest x-rays then that will be a new enhanced level task assigned to you.  This will hopefully let others know that you enjoy practicing at the top of your license.

Being a nurse practitioner can often feel like you’re stuck in the middle of the cultural hierarchy of your clinic.  Break free by defining your role, seeking opportunities to expand your scope of practice, and let others know how much you enjoy working at the top of your licensure.


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