Confusion in Professional TitlesAlthough the development and expansion of advanced nursing practice is welcomed with enthusiasm, it does not necessarily measure up to the ethical and political issues surrounding actual practice. The question has been raised whether it is necessary to refer to doctoral-level trained advanced practice nurses (DNPs) as “physicians,” particularly in healthcare settings. Schierhorn (2010) highlights the views expressed by Dr. Yasso, vice president and president of the American Osteopathic Association (AOA) Office of State Government Affairs, that DNPs provide needed care to patients and help reduce the effects of worsening doctor shortage. However, many physicians and other stakeholders have questioned the validity and justification of referring to DNPs as “physicians” in an environment where only physicians are traditionally referred to by that title. Dr. Yasso argues, “If nurses want to become doctors, they should go to medical school to avoid confusion among patients.” However, the literature shows no evidence that such initial patient confusion causes harm as long as patients receive high-quality care (Schierhorn, 2010). Problem of autonomy Traditionally nurses have taken a subordinate role in making decisions regarding patient care. With the increasing emergence of advanced nursing practice, ethical questions arise regarding the independence of practice. After years of legislative debate, some states are trying to fill the shortage of primary care physicians with nurses with advanced degrees in family medicine. There are currently 18 states in America that have allowed DNPs to practice without physician supervision (Vestal, 2013). While many state and federal legislatures express concern for patient health, the focus of the article, erences Fairman, JA (2011). Expand the scope of nursing practice. The New England Journal of Medicine, 193-196.Mundinger, M. O. (2008). American Board of Comprehensive Care Certification (ABCC): too close to medicine. Clinical Scholars Review: JDNP, volume 1(2), 67-68. Palermo, J. (2014, January 13). Doctors and nurses disagree on NP autonomy. Space Coast Daily. Retrieved from http://spacecoastdaily.com/2014/01/phycians-and-nurses-at-odds-over-np-autonomy/Schierhorn, C. (2010, March 19). While NPs push to expand practice rights, physicians oppose. TheDO. Retrieved May 13, 2014, from http://thedo.osteopathic.org/?p=11501&page=2Vestal, C. (2013, July 19). Nurses slowly gain autonomy. Kaiser Health News. Retrieved May 12, 2014, from http://www.kaiserhealthnews.org/stories/2013/july/19/stateline-nurse-practitioners-scope-of-practice.aspx