Prescriptive Authority for Nurse Practitioners - page 4

by lazer31285 | 35,264 Views | 36 Comments

The passage of the Affordable Care Act (ACA) will provide many more Americans access to health care. The ACA will reduce the cost of receiving health care, while also enabling uninsured Americans access to insurance and more... Read More


  1. 0
    Fair enough, Kalevra. The bottom line is that we disagree, which should not cause either one of us any heartburn. There is, however, something on which we do agree; the development of two separate disciplines for the meeting of similar needs is, I think, very unfortunate. I think that it has added more complexity to an already poorly organized institution. I think that this was a mistake, and I think that I know why it happened, but I am not sure that I am right about that, so I will keep my speculations about cause and effect to myself.

    I do not think that NP and PAs will be fighting for the same jobs; I think it more likely that there will not be enough of either to fill all needed positions, but that is mere speculation on my part. We are all waiting to see how things shake out. As for PAs getting more acceptance, I am not sure what you mean. You acknowledge that the education and capabilities within these professions are both adequate for the job, so how do we decide which one to keep and which one to replace? What, specifically, makes the PA the better choice?
    Last edit by CountyRat on Jan 10, '13 : Reason: Grammar
  2. 0
    Quote from CountyRat
    What, specifically, makes the PA the better choice?
    The reason why I see the PA as having a slight edge between the two is versatility.

    It is my understanding that adding on to the skills an NP is allowed to perform in a setting requires legislation to pass in their scope of practice. I understand that upon entering NP school the student must choose a specialty. Therefore they are locked into that specific role and scope. I found this out while reading through some of the old posts on the site. "NP's are restricted by their specialty, so a pediatric NP couldn't prescribe for adults, etc" http://allnurses.com/general-nursing-discussion/nurse-practitioner-physicians-406029-page6.html

    The PA on the other hand requires the supervising Physician to train and give them the go ahead. No change from the state or BON. The idea of a jack at all trades and master at none. You can easily fit them in any area that has a shortage of PCP.

    For example, in rural areas I expect many children to to go through the usual cuts, scrapes and bruises. Scrapes and bruises are easily remedied by either the PA or NP and there is no need to send them to an MD. Now if the child suffered a laceration that needed stitches, nothing fatal mind you just superficial. It is my understanding that the NP would not be able to place the sutures and would have to send them to a higher level of care. The PA on the other hand would be within their scope to apply sutures. As long as they have been trained and given the ego ahead by the supervising physician.

    Please correct me if I am wrong

    P.S I would be very much interested on your theory as to why both NP and PA were developed simultaneously to meet the PCP shortage.
  3. 0
    Quote from kalevra

    The reason why I see the PA as having a slight edge between the two is versatility.

    It is my understanding that adding on to the skills an NP is allowed to perform in a setting requires legislation to pass in their scope of practice. I understand that upon entering NP school the student must choose a specialty. Therefore they are locked into that specific role and scope. I found this out while reading through some of the old posts on the site. "NP's are restricted by their specialty, so a pediatric NP couldn't prescribe for adults, etc" http://allnurses.com/general-nursing...029-page6.html

    The PA on the other hand requires the supervising Physician to train and give them the go ahead. No change from the state or BON. The idea of a jack at all trades and master at none. You can easily fit them in any area that has a shortage of PCP.

    For example, in rural areas I expect many children to to go through the usual cuts, scrapes and bruises. Scrapes and bruises are easily remedied by either the PA or NP and there is no need to send them to an MD. Now if the child suffered a laceration that needed stitches, nothing fatal mind you just superficial. It is my understanding that the NP would not be able to place the sutures and would have to send them to a higher level of care. The PA on the other hand would be within their scope to apply sutures. As long as they have been trained and given the ego ahead by the supervising physician.

    Please correct me if I am wrong

    P.S I would be very much interested on your theory as to why both NP and PA were developed simultaneously to meet the PCP shortage.
    Idk how it may work in your area, but all of the NPs (FNP: Family Nurse Practitioners) here on my part of NC do their own suturing, I&D, Pap smear, insert IUDs etc... Idk why an NP would have to send a pt to an MD or PA simply to have a "routine" suturing. I am aware that some NP programs might not focus as much on suturing as others, but most, if not all, of the FNPs that are employed at my hospital had suture training in their NP education; and they can do the aforementioned procedures in individuals if all ages, most of the work in the ED. A few of the NPs and PAs have also told me that they got extra training once finishing their programs in order to feel more confident, by taking CEUs in suturing.

    Again maybe it's different where you are. I'm in a rural area so maybe that's just the way schools here prepare their NP students.
  4. 0
    I was trained in suturing, paps, etc. I can practice with any age group. I would never place an IUD unless I did them routinely in a GYN office as the complication rate is high for those that don't do them on a regular basis.

    I think there is a fundamental misconception about NPs and their scope of practice. In many (16) states NPs already practice independently, unlike PAs that do not practice independently in any states (as far as I know).
    Last edit by BostonFNP on Jan 10, '13
  5. 0
    Mandatory collaboration makes it a little harder to practice. It can be difficult finding a collaborator or something can happen to the collaborator and APRN or PA is legally unable to practice. Primary care NP's PA's and MD's do similar jobs. MD's have had a lot more education and training. As a patient I have had satisfactory treatment with all three groups of providers.
  6. 0
    These last few posts have been very informative and I think I have a few more questions now than I did when I first started. Im gonna try to get a first hand view of the situation regarding NP and PA practice, autonomy, economics etc. I have a sit down with a PA in the next few days and see if he can answers some of these questions and shed some light on how the ACA is going to impact their practice. After that Im gonna look for an NP to answer the same set of questions as well.
  7. 0
    I think that both NPs and PAs are moving in a similar direction.

    PAs are:
    1. Moving in a direction which will eventually have post grad fellowships and specialty certification tests. (very early in process)
    2. Are trying to make gains on supervision requiremnts, which will ideally move toward "collaboration" not "supervising". This is more of a word change for many states, where PAs can even practice in different cites than their supervising physician.
    3. Fighting for full prescriptive rights. (C2-5)

    NPs are:
    1. Streamlining certifications
    2. Fighting for "full scope" of practice, and full prescriptive rights. (C2-5)
    3. DNP will not effect scope as much as people may think it will.


    Though none of us can know where we will end up years down the line, I think both will have clear specialty certifications, though the lines will still blur with family practice PAs and FNPs. Both will be more independent, and PAs will get more freedom with billing for medicare/medicaid where NPs have an edge now. Both will be involved in primary care practices, where all patients are seen by NPs/PAs and they are interchangeable. Physician limits on how many PA/NP they can supervise will rise, and one or a few MDs at the top of the food chain take on more of a management role and go over charts as well. Most specialties will not change as much since surgical specialties have limits on scope for NP/PA that probably will not change. Room for growth is likely in Psych, where NP's will most likely begin to take over with MD at the top like in family practice. Of course some new laws will lead to outlier NP's who do manage to open a practice, or something else, but for the most part, life for the average PA/NP will progress in a similar direction.


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