There are many differently credentialed medical providers in healthcare. Often it’s not clear from the name badge or uniform what the person does or is supposed to do. This post will shed some light on the subject.
Let me first begin with the common initial behind a medical provider’s name, 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.
An LPN (licensed practical nurse) or LVN (licensed vocational nurse) is another type of 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. RNs supervise LPNs or LVNs who cannot modify treatment plans without consulting an RN or other licensed medical provider.
Another kind of licensed medical provider is the NP (Nurse Practitioner). An NP first starts as an RN and then does additional graduate work to earn a Master of Science (MS) or doctorate of nursing practice (DNP) degree with a specialty in something. Nurse Practitioners are just one kind of APRN (Advanced Practice Registered Nurse). APRNs have all started as RNs and then depending on the degree they get come to a more specific designation. Some designations are ANP (adult nurse practitioner), who care for people 18 years and older, and PNP (Pediatric Nurse Practitioner) who care for people 21 years and younger. There is also an FNP (family nurse practitioner) who cares for infants through geriatrics.
An NNP (neonatal nurse practitioner) cares primarily for high-risk newborn infants in a neonatal intensive care unit. There is an ACNP (acute care nurse practitioner) who typically cares for hospitalized patients 18 years and older, some can do children. The ACNP may function in the role termed a hospitalist. Other NPs work in hospitals too, as they have been trained after graduation for this role. There is also a PMHNP (psychiatric mental health nurse practitioner). They care for patients with mental health problems. They can do many of the same things a psychiatrist would do (some states allow for involuntary commitment).
Nurse medical providers
CRNA (certified registered nurse anesthetist) is another APRN. The CRNA functions in a role similar to an anesthesiologist. CRNAs administer over 60% of anesthesia in the US. In the military, that number is much higher. CNMs (certified nurse midwives) attend births and provide comprehensive women’s health care from prenatal through post-partum care. They can do well-baby visits for up to 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 differ from state to state. In all 50 states, NPs have prescriptive privileges. The Pearson Report gives more specific details for each state regarding the scope of practice of NPs.
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 Master’s degree, but some rare exceptions allow for practice with a Bachelor’s degree. To my knowledge, all of the associate degree PA programs are no more, but there are some very experienced PAs who are grandfathered into current practice.
Board Certified and more
As if those were not enough initials you may also see the C or BC designation after the above for example NP-C, PA-C, or RNC (the C stands for certified or board certified). This means that the professional with the certified designation after their primary licensing initials has done a specialty certification and has passed a national board exam. (The C and the BC are due to the 2 different national certifying associations.) 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.
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 replaced 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). Also, PCA, PCT, and CNAs are known as nurse’s aides. They must be under the supervision of someone with an RN license. Typically they can do things like help bathe 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.
The licensed medical provider is known as 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- bachelor’s degree in medicine. The osteopaths have additional training in osteopathic manipulative therapy. Both of these doctors can perform surgery if trained in residency. Also, they can prescribe medications and treatments.
Don’t confuse a DO with an OD (Doctor of Optometry). ODs typically practice vision care, but in some states are trained in more advanced eye care. They differ from ophthalmologists in that they are not MDs, and ophthalmologists are considered surgeons of the eye.
Physical therapist, Speech Therapist, etc.
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, and occupational therapy (DOT).
I hope this article clarified the various medical providers.
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Dr. Raymond Zakhari is board certified as a family nurse practitioner and Adult- Adolescent & Child psychiatric nurse practitioner, he can diagnose and treat medical and psychiatric conditions, and prescribe medications including suboxone, and all therapeutic services and referrals to specialists. All services are provided in the form of medical house calls in Manhattan. The visit begins with a comprehensive history and physical exam, and necessary diagnostic tests to evaluate risk. Medical House Calls and Psychiatric House Calls are available in Manhattan with evening and weekend appointment times. Out of network for all insurance, opted out of Medicare allowing for maximum discretion.