Advanced Practitioners Are Not Mid-Level Providers

W hile I was completing my nurse practitioner program, I interviewed for a PRN position at a large private oncology practice. The oncolo-gist with whom I spoke was aware that I was continuing my graduate nursing education; she spoke of how they might consider me for employment as an oncology nurse practitioner upon my graduation. As she talked about her current staff, she used a descriptor I had never heard before: mid-level. I truly did not know what she meant, or even who she was speaking about. However, I soon realized she was talking about the nurse practitioners (NPs) and physician assistants (PAs) who were part of her staff. I was puzzled. Was the term " mid-level " a way of quantifying the amount of care the NPs and PAs provided? Was it a way of qualifying the type of care they provided? I felt confused and belittled. I was in the midst of graduate level (advanced) education and as such would be practicing at an advanced level of nursing. The scope of practice within my home state allowed me to practice medicine under the supervision of a collaborating physician. I was dismayed at the term " mid-level " and what it must sound like to a patient, a family member , or another health-care professional. I did not seek employment at that practice upon graduation. The term " mid-level practitioner " is used by the US Department of Justice's Drug Enforcement Administration (DEA) to identify a group of health-care individuals for the purpose of monitoring controlled substances. According to the website of the DEA, Office of Diversion Control, " Pursuant to Title 21, Code of Federal Regulations , Section 1300.01(b28), the term mid-level practitioner means