1. Introduction
The Patient Protection and Affordable Care Act (PPACA) was
passed by the U.S. Congress and signed into law in 2010 by President
Nurse practitioners (NPs) and physician assistants (PAs)
provide primary patient care across the United States (U.S.)
working both independently or under physician guidance. Today
there are over 100,000 NPs and PAs practicing in the U.S.
(American Academy of Physician Assistants, 2013; U.S. Department
of Health & Human Services, 2010) meeting the primary,
preventative, and chronic health care needs of American citizens,
often in medically underserved geographical regions. However,
very few studies address the roles of primary care NPs and PAs in
the U.S. and the ethical challenges this role brings to patient care
delivery. In fact, disagreement remains between NPs and physicians
on the role of advanced nurse practitioners and their scope of
practice within the healthcare arena. For instance, in a recent
national survey NPs believe that they provide safe, efficient, and
quality care while two-thirds of MDs (66.1%) report that physicians
provide a higher-quality examination and consultation than NPs
alone (Donelan, DesRoches, Dittus, & Buerhaus, 2013). Moreover,
physicians are less likely to believe that NPs should have hospital