Confusion in Professional Credentialing Although the development and expansion of advanced nursing practice is welcomed with enthusiasm, it does not necessarily fall short of ethical and policy issues surrounding actual practice. Questions have been raised about the appropriateness of referring to advanced doctoral-prepared nurse practitioners (DNPs) as “physicians,” particularly in the health care field. Schierhorn (2010) highlights the sentiments expressed by Dr. Yasso, Vice President and Chairman of the Office of Governmental Affairs of the American Osteopathic Association (AOA), that DNPs provide necessary care to patients and help reduce the effects of the worsening shortage of doctors. However, many physicians and other interested parties have questioned the validity and justification of referring to DNPs as "physicians" in an environment that only physicians traditionally refer to by that title. Dr. Yasso says that "if nurses want to become doctors, they should attend medical school to avoid confusion among patients." Nevertheless, the literature shows no evidence that such initial patient confusion causes harm as long as patients receive high-quality care (Schierhorn, 2010). Issue of Autonomy Traditionally, nurses have played a subordinate role in making decisions about patient care. With the increasing emergence of advanced nursing practice, ethical questions related to the independence of practice arise. After years of legislative debate, some states are trying to fill the primary care physician shortage with nurses with advanced degrees in family medicine. There are currently 18 U.S. states that allow DNPs to practice without physician supervision (Vestal, 2013). While many state and federal legislations raise concerns about the middle of paper...... references 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. (January 13, 2014). Doctors and nurses disagree on NP autonomy. Space Coast Daily. Retrieved from http://spacecoastdaily.com/2014/01/physicians-and-nurses-at-odds-over-np-autonomy/Schierhorn, C. (2010, March 19). While NPs demand expanded practice rights, doctors resist. The D.O. Retrieved May 13, 2014 from http://thedo.osteopathic.org/?p=11501&page=2Vestal, C. (July 19, 2013). Nurse practitioners are slowly gaining autonomy. Kaiser Health News. Accessed May 12, 2014, from http://www.kaiserhealthnews.org/stories/2013/july/19/stateline-nurse-practitioners-scope-of-practice.aspx