i think that if someone wants more responsibility he needs to earn it. if NPs want responsibility beyond the scope of a PA, they need to sit for medical exams not nursing exams. in no way am i saying that this could replace medical school and residency.
here is the beauty in this: with this new higher (highest possible) tier of nursing, the role that the NPs have been fighting for is now available. they will no longer be able to say that they are blocked from providing primary care. however, how many could actually pass the family medicine boards, not to mention the step one exam? very few could!!!
the kind of people that can pass medical licensing exams are the kind of people that go to medical school, not nursing school. lets just go ahead and prove that. and if a few geniuses become NPs and are able to learn the knowledge and skills of a family medicine doctor well...my guess is that number would be insignificantly small.
in the end, the huge failure rate of nurses taking medical boards would be on the news.