[Ventjock]

Originally Posted by ANPFNPGNP

I've worked with lots of PA's and I've been very impressed with their knowledge of orthopedics. I work PRN in urgent care and one of the PA's saves all the "primary care" questions for me (I fill in for him some evenings). I call him with questions that are ortho related. Also, PA's get far more training in all the "hands on" stuff than we do (suturing, setting fractures, surgery, etc). However, I feel that I can run rings around the PA's in internal medicine.

Regarding the title to your thread, there is no way I would even consider being a PA. That would be considered a step down where I live. PA's can't even open their own practices and the Board of Medicine has their thumb on them. They will never be able to gain 100% independence from doctors. I understand there are some insurance companies that won't even pay for a PA to see a patient without their SP on site. Also, NP's can bill Medicare directly and PA's can't.

On the other side, PA's can work in any field they want without having to get additional education. Another one thing I don't like is the fact that so many PA's don't even have a college education. It just amazes me that PA's can practice with just a certificate, Associate's or Bachelor's degree. I think it's great that NP's are mandated to have a MS degree. If you're out there doing what we do, the more education the better!

PA practice is COMPETENCY based, not degree based.

[core0]

Originally Posted by ANPFNPGNP

Snip

On the other side, PA's can work in any field they want without having to get additional education. Another one thing I don't like is the fact that so many PA's don't even have a college education. It just amazes me that PA's can practice with just a certificate, Associate's or Bachelor's degree. I think it's great that NP's are mandated to have a MS degree. If you're out there doing what we do, the more education the better!

As long as we're piling on. Remember that those 10-12,000 NPs that do not have college degrees are completely without skill or knowledge despite more than 40 years of practice in some cases.

David Carpenter, PA-C

[sirI]

Remember that those 10-12,000 NPs that do not have college degrees are completely without skill or knowledge despite more than 40 years of practice in some cases.

Correct, David. And, I was one of those 10-12,000 who had an ADN and a national certificate after a 4-year full time preceptorship with a physician. I was also one of only 1300 in the U.S. who rec'd national NP certification by doing the preceptorship. I've since rec'd an MSN and post-grad certificate, but had I not, I still would be practicing as an NP w/o a BSN, MSN, or DNP. Still a lot of us out there who practice and have a heck of a lot of experience........

[oldiebutgoodie]

Originally Posted by Joan Z

I would agree that functionally there aren't a lot of differences between NPs and PAs. For myself I think I would have enjoyed school more if it had been modeled along the PA lines--as in specific rotations (peds, ortho, OB, surgery etc) rather than what seemed more like a "catch as catch can" philosophy. I also really missed not getting the hands-on technique stuff; I realize we can pick this up BUT for all the money I would have liked it in the program. This might have been more related to the particular program I was with but talking to other NPs who went through other programs it seems to be fairly common. I did talk to the people running the program with these concerns, haven't gotten any feedback yet!

I agree with you, it seems like PA's get more exposure to more fields, with actual courses and rotations in the different specialties. I would like that better, rather than some of the nonsense we take in the NP courses. Of course, this will now be quoted over at the studentdoctor.net forum, where there are a few NP haters who populate the "Clinicians" subforum (for midlevels, like PAs and NPs).

But PA programs are not very flexible, requiring 2+ years of full time school and are very expensive. NP programs allow more flexiblility, but then, I think they can be too flexible.

Oldiebutgoodie

[westcoastgirl]

I work with several PAs and like them very much as colleagues and one is a mentor of sorts to me.

I do notice they had more suturing and definite rotations in school, I guess I'll pick up some of that on the job.

there are benefits to being both, I think it really depends on your own personal situation. For example, I am not particularly interested in Ortho, if I were I would go the PA route!

Another advantage of PA is they can work in any area they want so long as the doc approves. For example they can move around family practice to psych without needing to go back to school, which many NPs would have to do(to be certified as Psych NP, I know there are a few exceptions out there with FNP serving that role but not in my area).

However, I like the security of knowing I will always have my RN license, so that if for some reason I had to work as a RN I can. Imagine many years down the line when I am near retired and the DNP is now required, well I dont' feel like going back to school for a DNP at near retirement age just want some part time work for personal fulfillment then I can still work as a RN.

I don't know about your area but around here it seems many administrative positions in clinics and hospitals are filled by RNs and NPs, and I am interested in eventually moving to that area.

To each their own, I think most of the time we're pretty interchangeable to the masses and the docs, it only matters if you have some specific goals in mind that might really sway your decision towards one path.

[DaisyRN, ACNP]

Well, I am going to throw in another perspective...

I just got back from the AANP conference, and while there, I was reminded of some of the biggest disadvantages regarding the NP profession:

1. Lack of collegiality among our own profession
There were several conversations which revolved around which specialty was better... INSTEAD of viewing each as complementary to another. If we cannot get along, how do we expect other professionals to respect us?

2. Lack of consistency in our individual NP programs - ACNP vs. FNP vs. DNP
Not only do we not have a single educational route (like the PA curriculum), we do not have consistency among the same degree plans. For example, not all ACNP/FNP/DNP programs train you the same... therefore, the scope of practice issues resurface. It's so frustrating...

If I were an employer, I know NPs/PAs offer varying advantages, but for sake of avoiding scope of practice conflict because I wouldn't want to have to keep up with all the variations of NP education... I would probably just go with hiring a PA. For this disappointment, sometimes I do wish I had done the PA route. It just seems "easier," with less confusion...

Please keep in mind: I am happy (now) with my job and my role as an ACNP... but if I had to do it all over again, I would do medical school... but between the NP/PA... I would pick PA, even if I already were an RN. Maybe I am just bitter about the conflict I witnessed at the conference... but to me, that just goes to show how much the NP profession needs to change.

[core0]

Originally Posted by DaisyRN, ACNP

Well, I am going to throw in another perspective...

I just got back from the AANP conference, and while there, I was reminded of some of the biggest disadvantages regarding the NP profession:

1. Lack of collegiality among our own profession
There were several conversations which revolved around which specialty was better... INSTEAD of viewing each as complementary to another. If we cannot get along, how do we expect other professionals to respect us?

2. Lack of consistency in our individual NP programs - ACNP vs. FNP vs. DNP
Not only do we not have a single educational route (like the PA curriculum), we do not have consistency among the same degree plans. For example, not all ACNP/FNP/DNP programs train you the same... therefore, the scope of practice issues resurface. It's so frustrating...

If I were an employer, I know NPs/PAs offer varying advantages, but for sake of avoiding scope of practice conflict because I wouldn't want to have to keep up with all the variations of NP education... I would probably just go with hiring a PA. For this disappointment, sometimes I do wish I had done the PA route. It just seems "easier," with less confusion...

Please keep in mind: I am happy (now) with my job and my role as an ACNP... but if I had to do it all over again, I would do medical school... but between the NP/PA... I would pick PA, even if I already were an RN. Maybe I am just bitter about the conflict I witnessed at the conference... but to me, that just goes to show how much the NP profession needs to change.

This was just put out by the NCSBN:
https://www.ncsbn.org/Joint_Dialogue_Report_6_18_08.pdf
Interesting but its actually more confusing about the scope.

"The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. At this point in time the acute care and primary care CNP delineation applies only to the pediatric and adult-gerontology CNP population foci. Scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs."

I'm not sure what this means. It really doesn't make any sense. Part of the problem of course is the whole acute care issue. Acute is more a state than a thing. For example if I have a stable diabetic waiting for a nursing home bed in the hospital there is really nothing acute. On the other hand someone in a primary care office with crushing 10/10 chest pain is having an acute issue. If you read the CCRN definition they view acute as inpatient, critical care and specialty care (ie everything that isn't primary care). Of course then you get into the whole definition of what is primary care (always wanted to use that).

David Carpenter, PA-C

[JDCitizen]

Originally Posted by core0

This was just put out by the NCSBN:
https://www.ncsbn.org/Joint_Dialogue_Report_6_18_08.pdf
Interesting but its actually more confusing about the scope.

"The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. At this point in time the acute care and primary care CNP delineation applies only to the pediatric and adult-gerontology CNP population foci. Scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs."

I'm not sure what this means. It really doesn't make any sense. Part of the problem of course is the whole acute care issue. Acute is more a state than a thing. For example if I have a stable diabetic waiting for a nursing home bed in the hospital there is really nothing acute. On the other hand someone in a primary care office with crushing 10/10 chest pain is having an acute issue. If you read the CCRN definition they view acute as inpatient, critical care and specialty care (ie everything that isn't primary care). Of course then you get into the whole definition of what is primary care (always wanted to use that).

David Carpenter, PA-C

Any nurse knows that acute patients are on the floor and non-acute are in the ICU at any given time for many, many reasons. Delineating patient care by acuity can be trick... But for now I am off to read 40 pages... By the way were do you get this stuff...

[core0]

Originally Posted by JDCitizen

Any nurse knows that acute patients are on the floor and non-acute are in the ICU at any given time for many, many reasons. Delineating patient care by acuity can be trick... But for now I am off to read 40 pages... By the way were do you get this stuff...

I guess I use a different definition. Mostly something with a rapid onset and increasing severity of symptoms. You could have an acute gastroenteritis on the floor or a chronic CHF PT with acute exacerbation. You could also have a chronic heart patient with poor flow in the unit. Acuity is more about how sick the patient is whether the issue is acute or chronic.

Talking to a couple of the NPs that were at the meeting the issue seems to revolve around training and role. There is one group that wants very well defined roles by location (ie inpatient or outpatient). There is another group that does not want restrictions on role. Hence the language that you see.

The other issue that I didn't discuss goes to the issue that Daisy talked about. The NCSBN is getting really sick of dealing with the lack of commonality among NP programs. The mess in Texas with FNPs really brought it home. They seem to looking at not only mandating a seperate credentialling agency for programs but also a single certifying organization for NPs. Of course there was a lot of blowback from those agencies that provide these services (ie make a lot of money of them).

As far as where I get it, I have an RSS feed that looks at certain web sites and notifies me when they change. The draft of this has been out since April but the NCSBN didn't really advertise when they released it. There was a message on the main page of the ANA website Thursday.

David Carpenter, PA-C

[djc1981]

Originally Posted by DaisyRN, ACNP

Well, I am going to throw in another perspective...

I just got back from the AANP conference, and while there, I was reminded of some of the biggest disadvantages regarding the NP profession:

1. Lack of collegiality among our own profession
There were several conversations which revolved around which specialty was better... INSTEAD of viewing each as complementary to another. If we cannot get along, how do we expect other professionals to respect us?

2. Lack of consistency in our individual NP programs - ACNP vs. FNP vs. DNP
Not only do we not have a single educational route (like the PA curriculum), we do not have consistency among the same degree plans. For example, not all ACNP/FNP/DNP programs train you the same... therefore, the scope of practice issues resurface. It's so frustrating...

If I were an employer, I know NPs/PAs offer varying advantages, but for sake of avoiding scope of practice conflict because I wouldn't want to have to keep up with all the variations of NP education... I would probably just go with hiring a PA. For this disappointment, sometimes I do wish I had done the PA route. It just seems "easier," with less confusion...

Please keep in mind: I am happy (now) with my job and my role as an ACNP... but if I had to do it all over again, I would do medical school... but between the NP/PA... I would pick PA, even if I already were an RN. Maybe I am just bitter about the conflict I witnessed at the conference... but to me, that just goes to show how much the NP profession needs to change.

Wow, Daisy. You're usually pretty upbeat about the NP profession. Must have been a REALLY sucky conference!! Hope you're feeling happier soon!