Who’s who in health care

14Aug09

There are many differently credentialed individuals that work in health care. Often times it is not clear by the name badge or the uniform what the person actually does or is supposed to do. This post will hopefully shed some light on the subject.

Let me first begin with the 2 most common initials behind a health care provider’s name. The first is RN (registered nurse). This is a licensed health care professional who can render professional nursing services to people. They can do health assessments, and teach about any health topic.  They can also do some medical interventions under the authority of a licensed medical provider.

The licensed medical provider traditionally is an MD (Medical Doctor traditionally Allopathic) but can also be a DO (Doctor of Osteopathy). Both of these doctors can practice medicine. They both do an undergraduate degree in something and then complete 4 year post- bachelors degree in medicine. The osteopaths have additional training in osteopathic manipulative therapy. Both of these doctors can perform surgery if trained in residency. They both can prescribe medications, and therapeutic treatments.

The DO should not be confused with the OD (doctor of optometry). ODs typically do vision care, but in some states can do some more advance eye medicine work. They differ from ophthalmologists in that they are not MDs, and ophthalmologists are considered surgeons of the eye.

Another kind of licensed medical provider is the NP (Nurse Practitioner). An NP first starts out as an RN, and then does additional graduate work to earn a master of science degree with an specialty in something. NPs are just one kind of APRN (Advanced Practice Registered Nurse). APRNS have all started out as RNs and then depending on the Master’s degree they get comes the more specific designation. Some designations are ANP (adult nurse practitioner), they care for people 18 years and older, PNP (Pediatric Nurse Practitioner) they care for people 18 years and younger. There is also an FNP (family nurse practitioner) they care for infants through geriatrics. There is also a NNP (neonatal nurse practitioner) they care primarily for high risk new born infants in a neonatal intensive care unit. There is an ACNP (acute care nurse practitioner) they typically care for hospitalized patients 18 years and older, some can do children. The ACNP may function in the role termed a hospitalist. There is also a PMHNP (psychiatric mental health nurse practitioner). They care for either patients with mental health problems. They can do many of the same things a psychiatrist would do. There is another APRN called a CRNA (certified registered nurse anesthetist). The CRNA functions in the role of an anesthesiologist. In fact more than 60% of anesthesia in the US is given by CRNAs. In the military that number is much higher. CNMs (certified nurse midwife) attend births and provide comprehensive women’s health care from the pre-natal through post-partum care. They can do well baby visits for upto 1 year as well.  Nurse Practitioners can do many of the same things as their physician colleagues. To my knowledge none are doing independent surgical procedures. The restrictions on what they can’t do differs from state to state. In all 50 states NPs have prescriptive privileges. The Pearson Report gives more specific details for each state regarding scope of practice of NPs. For the most part they work in collaboration with an MD or a DO, in some states they have to work under the supervision of an MD or DO, and in 15 states they work completely independent of physicians. They can have their own private practice as well but the states have differing rules regarding this.

Another type of licensed medical provider is the PA (physician assistant) there is a movement underway to rename the profession (physician associate), but for now the protected title is the former.  PAs can do all of the same things a physician can do including surgery. PAs must work under the supervision of a licensed MD or DO. Their scope of practice becomes limited by the scope of practice of the supervising physician.  Some states define supervision very differently and in essence can sometimes look like the NP equivalent of collaboration. To my knowledge in no state can a PA work completely independently of an MD or DO. They can however have private practices depending on the rules of the individual states.  PA education is typically a Masters degree, but there are some rare exceptions that allow for practice with a Bachelors degree. To my knowledge all of the associate degree PA programs are no more.

As if those were not enough initials you may also see the C designation after the above  for example NP-C, of PA-C, or RNC (the C stands for certified). This means that the professional with the C after their primary licensing initials has done a specialty certification and has passed a national board exam. Specialties can range from women’s health (WHNP), cardiology, oncology, dermatology, telemetry, pediatrics, critical care (CCRN) of adults, pediatrics or neonates. NPs can get further education to get a clinical doctorate in nursing practice. This is becoming a popular trend the initials are DNP.

Even more initials. Aside from the initials that come with academic preparation there are those contrived by corporations and hospitals. Some of those include CNM (but in this case it means clinical nurse manager) or PCA (patient care associate or assistant) which seems to have replaces the CNA (certified nursing assistant). There is also a move toward and away from at the same time depending on the state PCT (patient care technician). Generically the PCA, PCT and CNA are referred to as nurses aides. They must be under the supervision of someone with an RN licenses. They typically can do things like help bath and feed and reposition patients. They can help them walk. Some can also do finger stick blood sugars, check vital signs, perform EKGs, draw blood, insert urinary catheters and connect feeding tubes, and take out peripheral IV catheters. The tasks are specific to the institution that hires them.

Another type of nurse is the LPN (licensed practical nurse) or LVN (licensed vocational nurse). These are nurses that have done an intensive 12-18 month training program that allows them to sit for a state exam. They can do many of the same things that RNs can do, but traditionally care for stable patients that have predictable outcomes. They are supervised by RNs, and they cannot make modifications to a treatment plan without consulting an RN or a licensed medical provider.

Allow me to confuse or enlighten you further. PT (physical therapy) many programs are going to doctoral preparation for this so the initials you may see will be DPT. Following suit are the ST (speech therapists) soon to be DST, OT, occupational therapy (DOT).

As health care reform continues to be discussed let this help clarify who is caring for you.

Raymond Zakhari, MS, ANP-C

If there are some initials you’ve seen in health care that have not been addressed here please let me know and I will try to shed some light.



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