Jason, don’t want to derail the topic here, and feel free to move this thread to another place, if necessary, but I’m not sure you’re getting what I’m saying regarding the NP role. Lumping PA’s and NP’s together as “mid-levels” reflects the old way of thinking about NP’s. NP’s are moving in a different direction, attempting to be autonomous like pshysicians, but not equivalent to them. We’re a different sort of animal altogether. Our scope is limited to our area of education (unlike a PA), but (in this state) we have no requirement to be affiliated with a physician in any way. No one, I’d argue, would say that a Certified Nurse Midwife should work under an obstetrician – He or she is not an “obsteric PA”, but a different sort of obstetric provider altogether. Same with most NP specialties – the NP’s offer a unique, nursing-oriented type of approach, and an alternative to physician-led care.
You brought up (in a roundabout sort of way) one important point about NP’s, though: The clinical experience requirement. The ideal situation is that a nurse has several years experience as an RN, and then goes back to school to earn an DNP and initiate practice as an NP. The years of residency our physician friends put in are made up for by years of real-world nursing experience on the floor. I do think it’s a terrible idea to send people “straight through” a BSN/DNP program in 7 years, and then turn them loose on the world as licensed providers with no experience. This was never the way it was supposed to be.