Midlevel? Hi, I’m the Nurse Practitioner

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When you refer to a nurse practitioner or a physician assistant, do you call them the mid-level?

The term “mid-level” has been passed on from generation to generation in the world of healthcare. I often wonder where the term originated?

Even though I am a nurse practitioner, I am still a registered nurse. And I often wonder if bedside nurses consider the term “mid-level”.

If I am called the “mid-level”, then what do we call the registered nurse? Does that make them the “lower level”? Does that make the physician the “upper level”? And if we’re going to talk about “levels”, what about the rest of the healthcare team?

What “level” are our other tertiary services?  What “level” is the physical therapist? What “level” is the respiratory therapist?

The point of this post is to simply start the conversation… Again. I am an advanced practice provider. I am not the physicians subordinate. I am the physicians partner. We work in collaboration.

Do I know what term we should use? Unfortunately no. The term mid-level rolls off the tongs so nicely, doesn’t it?  I’m going to have to find a catchy new term.

Until such time,  the next time you referred to a nurse practitioner or a physician assistant as the “mid-level”… I’m hoping you’ll take pause and maybe think twice. I know the words “nurse practitioner” or “physician assistant” don’t roll off the tongue as well, but I’m hoping you’ll try.

Check out the video below. Click the title, head on over to my Facebook page and leave me a comment.

If you haven’t noticed, comments have been disabled on my blog. I would love to hear your comments, questions and concerns.  So let’s connect. Or drop me a message on snapchat @seanpdent:


I hope to hear from you soon.



The MOST challenging part of transitioning from Nurse to Nurse Practitioner


Entering into the new role of a Nurse Practitioner is difficult. We’ve taken all the course work, fulfilled all the requirements and successfully passed our national certification exam. We now have to learn how to actually ‘do’ the job.

It parallels the same phenomenon we experienced when we graduated basic Nursing school. There’s what they teach and show you in school… and then there’s what happens in real life.

One of the things they don’t ‘teach’ you is how to walk across that imaginary line. The line drawn in the professional sand that separates the RN from the NP (APRN, CRNP, ACNP, etc.) The ‘advanced practice’ line.

This may only apply to the role of an NP caring for the inpatient population, but there comes a moment when you have to actually piss off the bedside nurse.  You have to be the bad guy. You have to be the provider that causes a tad bit of nurse-misery.

The nurse-misery I’m talking about is making the job of the bedside nurse worse than it already could be. You write an order that is going to tax their physical and emotional tolerance as well as test their patience.

Here’s an example:

Yep, wtf are you thinking 😂😂 #nurselife #wannarethinkthat

A post shared by Katie (@diaryofadallasgirl) on

Or ordering Go-Lytely,  Kayexalate or serial enemas…


You get the point.

As a Nurse Practitioner you have the medical rationale to support why you place such an order, but as a former bedside Nurse you know how bad it will sting……

so you feel guilty and horrible.

Regardless of how bad you feel for the bedside nurse you know the order needs to be placed and the intervention needs carried out to provide the care needed for your patient. Whether you’re treating a lethal electrolyte level, prepping for a procedure, or addressing constipation it’s a needed therapy for your patient.

Aaand whether the bedside nurse wants to hear it or not, a patient can become severely septic and (or) develop a medical emergency (colon perforation) if the constipation is left untreated.

But, lets be serious here. When I was the bedside nurse, all I heard from any of those orders was the amount of clean-up I had to endure or how uncomfortable it was going to make my patient (or me).

This is when you have to brush up on your communication skills, because the way you deliver this sort of message matters greatly.

The last thing you want to do as an NP is to be perceived as demeaning, condescending or dictator-like when placing these types of orders.

Because you know better than anyone…..

You do not to piss off the nurses.


What about calling the Nurse Practitioner “Doctor”?


A sensitive and polarized subject lately in the world of nursing and medicine.

It’s a matter of grammar, context and intent.

Here are the facts:


A Nurse Practitioner who attains their doctorate degree is by all intents and purposes a “Doctor” and has earned the title.

Just like the Pharmacist and Physical Therapist


How is the professional using the grammatical term? Are they stating they are a “Doctor” or a “Physician”? (A distinct difference in context)

Just like the Dentist and Chiropractor. Both technically “Doctor’s”, but not physicians.


When the professional uses the term “Doctor” are they representing themselves appropriately and correctly?

Only a licensed physician in a direct patient care clinical scenario should call themselves a “Doctor” with no appended explanation.

If I possessed a doctorate degree and did the same job I do now (inpatient direct care in an ICU), when I introduce myself as “Doctor” I need to clarify with my patient’s that I am NOT a physician.

I hosted another Periscope broadcast discussing this very topic:


I had some connection issues in the beginning due to a severe lake-effect snow storm so bear with the spotty video in the beginning.

What are your thoughts?