Can We Change Culture through Full Practice Authority?

We have been focusing our attention on restrictive laws and practice agreements, but they are only one method the establishment uses to hold us back. Many of us who practice in states that have enacted full practice authority have come to realize that repealing outdated laws didn’t solve all our issues. It’s a great beginning but much more needs to be done if we want to see real progress.

During the messy business of passing full practice authority, we were acutely tuned in to what the opposition was saying about our profession. I think you are all familiar with the old, tired arguments, so I won’t repeat them here. In a show of solidarity, nurse practitioners all united and spoke out loudly and shot down the barrage of misleading comments and stories about nurse practitioners. It’s fairly easy to defend when the threat is blatant. But how do we fight against silence?

The culture has proven much harder to change than the laws. Despite our growing numbers and accomplishments, we are in danger of becoming the silent majority if we don’t start speaking up. Let me give you an example from a national conference,  which I recently attended, of my specialty organization. This is an organization that focuses on a medical sub-specialty and this particular subspecialty is multi-disciplinary, but if you attended the presentations you would have come away with the impression that it was only physicians who were engaged in delivering direct care. Over and over I heard, “The physician in your clinic, the physician who is prescribing, the physician blah blah blah.”

When I thought about it more, I also began to notice that when I attend many provider workgroups that include NPs as equal members the default is still “the physician.” And if it isn’t “physician,” it’s that good old generic “advanced practice clinicians/providers.” While that term is lightyears ahead of “mid-level,” it still does not acknowledge us as a separate and distinct profession. Now, I love my PA colleagues, but the truth is that both our professions ought to insist we be called by our proper names. I am an NP, the care I provide falls into the nursing model. A physician assistant does many of the same things I do but they don’t practice nursing. I have to think that my PA friends also get a little tired of the assumption that they are no different from NPs and would like the PA profession to be appreciated and applauded for it’s unique history. Lumping us into what amounts to an “other” category does nothing to advance (no pun intended) either of our professions.

Well, I have finally had it, and I decided I need to speak up. In my conference evaluation, I will be noting my disappointment in the exclusionary language my particular organization continues to use, and I encourage you to do the same. As NPs and PAs we provide important contributions and make up larger and larger numbers in various organizations (and we pay dues to those organizations!). It’s time to speak up and stop the marginalization of our roles. If we stay silent we will continue to be an “invisible” class of providers.

About The Author