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In my few years of practice as a nurse practitioner, I have determined that much of the public doesn't understand what an NP is or does. The range of understanding and interpretation is wide. Even our colleagues are confused.
Attempts to Define
According to the Internet encyclopedia Wikipedia, a nurse practitioner is "a registered nurse who has completed specific advanced nursing education (generally a master's degree or doctoral degree) and training in the diagnosis and management of common as well as a few complex medical conditions. Nurse practitioners are generally licensed through nursing boards rather than medical boards. Nurse practitioners provide a broad range of healthcare services."
 It reads well, but this definition falls short. For example, in the state of North Carolina, where I practice, NPs are regulated by a joint commission of the medical and nursing boards. So, even the regulatory definition of NP practice varies state by state.
Over the past 35 years, the NP role has expanded. The scope of practice for NPs varies from state to state even as the need for NP services increases. These needs exist in primary care as well as specialty settings. The profession has addressed this need, at least in part, by expanding the training and certification available for NPs. For example, the doctorate of nursing practice degree is an innovative way to prepare NPs to meet the expanding knowledge demands of healthcare.
Clearing the Confusion
The various trainings and certifications for NPs have an unplanned, adverse effect: an increase in the alphabet soup after our names, which confuses patients and colleagues. As the ranks of primary care providers become thinner, NPs must be ready to promote a unified understanding of who we are.
I didn't realize how great this challenge could be until recently. I started putting a greater effort into explaining what my role and title mean. Many patients leave just as confused as when they entered the exam room. In my opinion, a cultural absolute permeates healthcare and creates a barrier to understanding our role. This absolute is the belief that the only person qualified to examine, treat, educate and prescribe for patients must be a doctor. This became clear to me as when Joe came to my office.
After he relocated, Joe transferred from another primary care provider to my care. After introducing myself to Joe, I explained what I do as an NP. Convinced that Joe understood the role of the NP, I began Joe's exam. As I placed my stethoscope on his chest, he smiled at me and exclaimed, "You know, I am so happy you are a nurse practitioner. My last doctor was a nurse practitioner too!"
So there it is, I thought. No matter what I say, the patient will view me as a "doctor." The barrier to gaining patients' understanding seems insurmountable. It occurred to me that our biggest barrier could be a cultural one. Doctors, or physicians, are synonymous with those who diagnose and treat patients.
I decided to join my NP legislative committee, to meet with state representatives, and to seize any opportunity to explain what an NP really is. Anything I can do to validate and promote NPs will create a sense of pride in my personal professional choice and, I hope, advance nurse practitioner practice.
Kristine Diggins is a family and gerontologic nurse practitioner with a doctorate in nursing practice. She practices at Minute Clinic in Charlotte, N.C., and is in the process of establishing a house calls practice for older adults in Waxhaw, N.C.
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