1. Kaplan, Louise PhD, ARNP, FNP-BC, FAANP

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Many people think advocacy means engaging in the legislative or regulatory process. A great deal of advocacy, however, occurs in the day-to-day practice of nurse practitioners (NPs). Providing high-quality care is a strategy to help gain acceptance and recognition. What happens, however, when an NP encounters derision manifested by statements of ridicule or scorn? How should the NP respond?


Find a "real doctor"

An NP-owned practice in Washington state encountered a problem with derision when a patient needed care in an area ED. The patient told her NP that the ED physician seemed "put out" at having to care for her. When asked who her primary care provider was, she named the NP practice. The physician asked who was the supervising physician and was informed that NPs in Washington state practice independently. When her visit was over, the physician rudely told her to get herself a "real doctor."


What would you do? Would you consider the physician misinformed and not worth the time and energy to educate, or would you advocate for yourself, your colleagues, and the profession? In this case, the NP wrote a letter to the physician and copied the ED director, chief of the medical staff, and the hospital's Board of Directors. Here is a condensed version of the letter with identifiers removed:


Our clinic was one of the first NP-run clinics in Washington. We have been diligently serving patients in this community for 30 years. Our clinic provides services to many patients who are underserved and can only get insurance from Medicaid or have no insurance. Our practice and the hospital have had a respectful, collegial relationship all of these years, referring patients back and forth. We need the hospital when emergencies arise, and we have, on many occasions, accepted difficult and complex patients who were discharged by your hospitalists because none of the "real doctors" would take their insurance. We do not mind this at all. In fact, we consider it a compliment and enjoy the challenge.


Your public remarks cast a cloud on our reputation, which may in turn hamper our right to conduct lawful business in this community. That is illegal. We ask that you cease and desist from making such comments to any other patients in your care or to any other practitioners. Along with this letter, we are enclosing some articles so you can better understand and accept the role that NPs provide in communities all across Washington and beyond.


We are also copying this letter to your superiors for their information and to reassure them that we understand that your behavior does not represent the hospital's attitude toward NPs. We collaborate with many NPs and other professional colleagues who work at the hospital. We expect to continue the collegial relationships, referrals, and patient sharing that has benefitted all of us for the past 30 years.


Removing barriers

This act of advocacy is to be applauded, admired, and replicated. Although the NP role was developed nearly 50 years ago, there is much work to be done to remove practice barriers in thought as well as law. Derisive comments create a hostile environment as restrictive as the archaic laws and regulations that prevent NPs from practicing to the full extent of their education.


If you would like to share your act of advocacy, please contact me at Every act of advocacy is a step toward universal unrestricted practice.