1. Booth, Misty BSN

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After reading "'Midlevel' Practitioner" (Viewpoint, July), I admit that I have a different perspective from that of the author. Having worked as a director in a home health setting, I'm aware of the restrictions placed on midlevel practitioners by the Centers for Medicare and Medicaid Services (CMS). There is a difference in the roles physicians and NPs play within the home health care realm.


The CMS states that NPs can provide the face-to-face requirement prior to home care admission, but they cannot sign the plan of care.1 Maybe once the Home Health Care Planning Improvement Act of 2015 is passed and more authority is awarded to these practitioners, advanced practice nurses (APRNs) will not focus on the use of the term "midlevel provider," but rather see the bigger picture-that they are amazing professionals who provide quality care.


Although the American Association of Nurse Practitioners disagrees with the use of this term,2 when looked at from a hierarchical perspective it makes sense. Advanced NPs have more education and authority than BSN-prepared nurses but not more than physicians. Although they work alongside physicians, and in some cases provide higher quality care than physicians,2 they are not equal to MDs.


As future innovations and leadership roles emerge, I believe these midlevel practitioners will become the primary providers, which may pave the way for a change in this naming convention. I don't feel that the use of "midlevel practitioner" is demeaning to this group of highly educated health care professionals; instead it accurately describes their role from an education- and current authority-based perspective. There are still many differences in the level of authority between physicians and APRNs, but not in the quality of care they provide.


Misty Booth, BSN


Waco, TX




1. American Nurses Association. Home health: Home Health Care Planning Improvement Act 2015 (S. 578, H.R.1342). 2016. [Context Link]


2. American Association of Nurse Practitioners. Use of terms such as mid-level provider and physician extender. Austin, TX; 2015. Position statements; [Context Link]