July 26, 2010, 11:35 am

That Does It……

This is me, laptop firmly attached at the hip!

Okay, I don’t wear white dresses (anymore) and I don’t have a 10 inch waist, either.

But my laptop might as well be surgically implanted; my life is pretty much pixelated!

I make travel decisions based on whether or not wireless is available.

Most people sleep, I “re-boot”.

In response to a funny story this week,  I said “LOL!”. As in the letters, not the words.

But I knew I had gone over the edge when my nursing notes started looking like tweets: “Amb 2 BR s diff; no able 2 p; abd dist; 16F cath 4 lg amt; tol OK; ? more narcs; allerg to tdol & MS; D.did given IM; pt said “OUCH, OMG!”

Addiction, thy name is Apple….


Big news coming soon re: BlogWorld/New Media Expo 2010. Discount codes for medbloggers are coming! I should have a post up with details in the next day or two.


“Physician Extender”.

Sounds like the name of a male-enhancement product.

It’s a phrase often used to describe a nurse practitioner or a physician’s assistant.

I hate it.

It’s insulting.


A nurse practitioner is not an adjunct physician. They do not supplement the care of a physician.

They provide essential advanced practice nursing services, services that include diagnosis and provision of medical care.

While some of these services overlap those of medicine, nurse practitioners are not extensions of another profession, they provide care in their own right, as educated, licensed practitioners.

Sometimes the only care provider for a community is a nurse practitioner.


A few years back, the term “extender” was used to describe nurse’s aides, as in “nurse extender”.

I hated it then, too.

It insulted the aides by implying they were less than individuals, not there to care for the patients, but to do the “lesser work” of the registered nurses.

Referring to nurse practitioners as physician extenders ignores the independent assessment and diagnostic skills possessed by advance practice registered nurses. It  insinuates that they function for the physician’s sake, not the patient’s sake.



I know it’s just a word. But words have power. Words convey attitudes. Words can confuse.

Nurse Practitioner. Educated, licensed, independent professional.

Nurse practitioner. Physician extender.

A rose by any other name…….?


Not this time.


  • Barbara C Phillips, NP

    July 26, 2010 at 12:04 pm


    Thank you for posting this! You are right on. NPs (and several PAs that I’m aware of), find this term disrespectful, oppressive and downright crude . Midlevel is only slightly behind extender.

    As a Nurse Practitioner, I and my colleagues provide primary and specialty HEALTH care. It’s true that sometimes our care overlaps physician care. We refer to physicians when the need of the patient requires it.

    We are Nurse Practitioners. Not midlevels and not extenders.

  • Braden

    July 26, 2010 at 12:41 pm

    MS is not an approved abbreviation. Neither is OMG – it could be confused with FDGB if not written clearly.

  • Andi, On Call RN

    July 26, 2010 at 4:03 pm

    Thank you! I so appreciate people who stand up for nursing as its own profession! When people tell me things like “You should go to Med. School instead of being an NP, you’re so smart!” I get so angry because what a back handed compliment. No thank you, being an NP is what I want because I love nursing!

  • Sean

    July 29, 2010 at 5:19 pm

    Preach it Kim
    Preach it!

  • NPs Save Lives

    July 30, 2010 at 6:57 pm

    The first thing I think of when I hear the word “extender” is that a certain male body part needed enhancement also. I also am offended when commercials say “ask your doctor” when talking about medications. There are so many of us NPs and PAs who are writing life saving prescriptions and are STILL invisible to the system. I make my own educated decisions for my own panel of patients. Yes, I still need advice from other health care providers, not just my collaborating (note not supervising) physician. My patients are offended when they get copies of their reports that are addressed to my collaborating DO rather than me. They want to know why my name is not on the letter? Because we are still not considered the primary care providers that we are. Keep preaching to the choir Kim!

  • Kate

    August 1, 2010 at 4:09 pm

    I just stumbled across your blog. I love it! I’m going to poke around, I promise to put everything back where I found it!

  • Jo Briggs

    August 2, 2010 at 11:05 pm

    Physician extender …. Nurse practitioner. Hmmm. 28 Years nursing, Diploma, Degree, PG Dip, Masters. I don’t provide extended services for any physician. Its all about comprehensive, up to date, patient centred health care thats easily accessible, affordable and collaborative. What an offensive term.

  • Craig B

    August 4, 2010 at 6:44 am

    Some of the fault is ours. When the NP and PA’s were first started, they were a way ato expand the numbers and the area that a group of MS’s could cover. The passage of time snuck up on us, and now decades later and many practice changes, we’re still using the same termonology.

    In some environments the term is accurate though. In the hospital I work at now, the NP’s and PA’s are physician extenders for Ortho, cardiology and athe hospitalists.

    Offennsive, I don’t take as offensive. Accurate? Well nope, and it’s time to educate, in a firm, proffesional, competent way.

  • Dr Dean

    August 4, 2010 at 3:09 pm

    I will tell the PA in our office about being called a male enhancement device. She will LOL!!

    I just found out the PA’s and NP’s are not included as “practitioners” in the new health-care bill that provides assistance for implementing EMRs in the office.

    But we are charged the same for them, by the vendors, as if they were another physician.

    Maybe we need you to lobby for them!!
    Thanks, Dean

  • Barbara C Phillips, NP

    August 4, 2010 at 4:46 pm

    It’s true Dean…we are not included in the Medicare EMR stimulus – makes no sense does it. However, we (PAs and NPs) are included in the Medicaid one.

  • Craig B

    November 15, 2011 at 8:25 am

    Some of the problem is those of us who have been around long enough to be there at the start of the NP/PA career path, That is how the professions were sold to the community and the the medical establishment.

    They were developed to extend the reach of the MD. It was never meant to be a derogatory term. Just the truth.

    As a profession, we’ve never been good and changing the status quo. We always wait till things are beyond recognition before doing anything about it. That and we have thin skin in a lot of cases.

    My view of the term reflects my military back ground. I was a physician extender as an independent duty medical tech. “although later I found I could have challenged the PA board in ’76 after completing the Navy IDMT program”

    Now our issues are clouded by semantic, politics and reimbursement, and the “who’s your doctor” arguments.

    But I don’t see the term as derogatory, in some places it is an accurate description of what is going on. It says nothing about the person not being an individual. Words do have power, but only if we give it to them.

    In my role as a flight nurse, I’m an independent practitioner, but I’m also the eyes and ears of the MD on the other end of the radio. I’m his extension, into that scene. He knows it and depends on my prevention of the patient to be accurate, he depends on my knowledge to be at a level that I can discuss safe treatment options in the aircraft.

    An i a physician extender, Yes, But I”m proud of the term and the role.

    Now does the term accurately portrait the reality of what “here’s another one of those terms” Midlevel Providers do. Nope, not any more.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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