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"Deadly spin" on nurse practitioner practice.

In the months leading up to the passage of the Patient Protection and Affordable Care Act in March 2010, the American public was inundated by news reports that were as polarized as the political standpoints held by members of Congress. Depending upon the source, facts were buried in words with a tone of opinion and rhetoric, seemingly intended to sway rather than inform. Amidst tense debate, Wendell Potter, a man with longstanding and high-profile ties to the health insurance industry, emerged from a comfortable retirement to shine a spotlight on the subversive tactics used by health insurance companies who placed the demands of stockholders above the needs of individuals to whom they verbalized support and assurances of quality health care. In June 2009, Potter, former communications chief for The CIGNA Corporation, made national headlines when he testified before a Senate panel on healthcare reform, highlighting the ways in which insurers took steps to “confuse their customers and dump the sick” (Yee, 2010). He admitted to his part in crafting the industry’s deception-based public relations strategy on two fronts: (a) a highly visible “charm” offensive spinning an image of insurance companies as advocates for reform, and (b) breeding fear amongst groups in an effort to disseminate misinformation and lies (Potter, 2010). In his book Deadly Spin Potter describes several “Rhetorical Tricks” used in public relations campaigns to skew political debate and spread propaganda. These public relation ploys are described in Table 1. Interestingly, over the past several years, large physician organizations have addressed advanced practice nursing in a similar manner, the difference being that the spotlight illuminating the truth did not come from within their own ranks. Examples of the “tricks” or ploys utilized by these groups are highlighted in Table 2. Advanced practice registered nurses (APRNs) include certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and certified nurse practitioners (NPs). Despite great strides made toward a consensus in the educational preparation, certification, accreditation, and licensing of these professionals (Fulton, Lyon, & Goudreau, 2009), as each state independently determines the APRN scope of practice, there continues to be significant discrepancy in roles and level of practice across the nation (Institute of Medicine [IOM], 2011, p. D6). These discrepancies are largely a result of the efforts of physician organizations that command respect and “charm” policymakers while perpetuating fear among consumers through misstatements. Such statements foster an impression of APRNs as nurses with inconsistent levels of education assuming expanded roles in the healthcare arena while lacking the necessary knowledge and skill. As highlighted in a landmark effort by the IOM and the Robert Wood Johnson Foundation (IOM, 2011), nothing could be further from the truth. While presented as the oldest and largest organization of physicians and medical students, the American Medical Association’s (AMA) membership currently includes only about 12%–13% of the practicing physicians in the United States, with its ranks declining each year (Peck, 2010; Staiger, 2009). Still the AMA intimates that they represent all physicians and hold only the best interests of the public in mind; such statements are reminiscent of the public relations “doublespeak” proffered by Mr. Potter and his colleagues in the insurance industry (Potter, 2010). In 2009, the AMA singled out 10 distinct healthcare professions seeking scope-of-practice expansion that were considered by the AMA to be potentially harmful to the public. They issued a “Scope of Practice Data Series” report for each, with a claimed purpose of “educating policymakers on the qualifications of a particular non-physician health care profession, as well as on the qualifications [that] physicians possess [which] prepare them to accept the responsibility for full, unrestricted licensure to practice medicine in all its branches” (AMA, 2009, p. 4). Two of these reports were directed at APRNs (NPs and CRNAs) and were disseminated to state medical associations and policymakers in an effort to emphasize the AMA’s position that “the health and safety of patients may be threatened as a result of unwarranted scope-ofpractice expansions sought by non-physician health care providers” (AMA, 2009, p. 4; Carlson, 2009). The AMA further incorporated this series into a “truth in advertising” campaign to “create transparency and reduce public confusion,” which was presented in February 2010 as a definitive position on the scope of practice in the United States at the World Health Professions Conference on Regulation in Geneva, Switzerland (Maves, 2010). In reality, this campaign facilitated the dissemination of partial facts and global misrepresentations, further confounding the truth. In the AMA Scope of Practice Data Series: Nurse Practitioners (2009), information is presented regarding the basic education and licensing of registered nurses. While a