I notice when I go to a clinic, that more and more NPs are doing the work, and there is a MD around to act as a passive supervisor. It will probably get to the point where NPs are the new general practitioners and people with full MDs will all go off to be specialists of some sort. In that case, everyone will probably bump up a notch, so that RNs are acting more like NPs. This may not be a bad thing. Do you really need a doctorate to be an ear, nose and throat man? And, while bed sponges and feeding are important things, they require no formal education, just a good social conscience, and the strength to occasionally flip someone over. As much as people worry about the shortage, I think we might do well to keep everyone performing at or near their maximum training level. This may sound a bit cold, but I don't see a way to warm it up. I just think that, for efficiency, it would be practical to keep degreed personnel busy doing things that they need the degree for, while giving good jobs to non degreed people who can handle the delegated things.