[jstuben]

Hello. I am considering NP and PA school. I have a few years of experience as an ED Tech in a Level 3 Trauma Center in California (busy, but not too intense). Our ED is staffed with PA's no NP's.

I have a few questions about clinical differences between NP's and PA's. I know that PA's seem to have a great ability to work in surgery specialites like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interpret tests, and prescibe meds (at least in 47-49 states). Are there any NP's on this forum who do this? Are there any in California who can comment?

Second. I know that most PA schools have a much longer clinical component than do NP schools. I have been told it is because NP's already have so much clinical experience as nurses. But can you really compare the two? In our ED, the nurses are not making differential diagnoses, determining etiology of disease, etc. etc., they are monitering the pt's overall state and response to the treatment ordered by the Physician (or sometimes PA). Therefore, does this experience compare to the rigorous training PA's get in diagnosing?

Part of my interest in medicine is the actual procedures themselves. I want to do chest tubes, central lines, suturing, first assistant surgery, etc. etc. Are there any NP's out there who are doing this?

Finally, I know some people (including some nurses) who deride the "nursing diagnosis" concept. Can anyone offer up a brief rationale for how nursing diagnoses are of value to an NP in clinical practice?

Thank you very much!

[naggytabby]

Actually it's Physician Assistant, not Physician's Assistant. If you want more info on Physician Assistants see: aapa.org

[lalaxton]

NP's can and do do many of the procedures you have seen PA's do in the ER. I do agree that clinical components of training are probably less in NP school than in PA school as NP's in general have time in the clinical setting albeit not diagnosis and prescribing etc, this is where the NP training focuses as well as advanced nursing practice concepts.
Hope this helps! Good luck!

[zenman]

This will give you some info on NPs in the ED. http://sonser4.nur.uth.tmc.edu/ecnps/

[msmith]

Don't worry about not having any experience for PA school. Some schools don't consider medical experience at all. I applied to a fairly well known school with a ton of healthcare experience, about 10 years worth and they totally did not consider that. The thing they look for more than anything else is your GPA. It's kind of like trying to get into med school only not as cut throat competitive. Some of the people that interviewed with me at this one PA school had NO experience. One girl was 21 and still in college and had no healthcare background at all.

I did not get accepted to the school I applied to but I was interviewed there. I am glad I did not go that route because the facilities weren't that great and the people were quite unfriendly. Even my interviewers "toasted" me.

NPs and PAs are very similar in alot of ways. I think you just have to decide what type of education works better for you and where you would be the most marketable. I actually looked into PA jobs near where I live and the job market is horribly saturated. There are virtually no PA jobs in my neck of the woods. But, there are plenty of NP jobs. All the hospitals where I live hire NPs, no PAs. I thought that was kind of strange, but it might because nurses have their base training in hospitals whereas PAs do most of their training in clinics.

I would say it would be good to pursue either career and go with what you think is best for you!

Best wishes.

[xy/RN 2006]

Originally Posted by kristinwiz

Again, another uneducated comment regarding PAs. I don't know when and where this dumb idea began, but it is time to put it to an end. Here goes.

Originally, PAs were called Physician Associates. In fact, Duke University still confers their PA degrees with this title, to this day. This name was in use for many years. Some docs got testy with the term "associate", and so, the PA profession offered to change the title (because they didn't really CARE what they were called...) to Physician Assistant. Now, of course, everyone and their brother is called an associate today - sales associate, etc. Because "assistant" is closely associated with "medical assistant", there is some discussion in the PA world today about changing this title back to Physician Associate. Reclaiming their original title or gaining a new one is probably on the horizon over the next 10 years, I believe.

Secondly, NPs are not truly independent, no matter what they claim. Even so, they must be independent NURSES!! Independence = a medical degree. Period. You don't see any NPs running their own medical practice. Women's clinics like Planned Parenthood, sure, but not actual private offices. You won't see a group of NPs joining together to open a pediatric office. It's not legal. There will always be a physician with whom they allign themselves They must have a supervising physician as well - even if the doctor is off-site. NPs still have docs countersign charts. NPs have limits on prescription privileges, just as PAs. Why would NPs WANT to assume independent status with all of the legal headaches it brings....without the corresponding increase in pay? Go to medical school if you want independence. Stop trying to backdoor your way into it. Too many MidLevels think that they are mini-docs. We are not doctors, but we ARE Primary Care Providers. There is a difference!

Advanced nursing is advanced nursing.
PAs, however, practice MEDICINE.
Both professions are supposed to be doing so in conjunction with a physician. A NP will always be a nurse. Don't get offended by this - you chose this profession, and if you feel put-down by being called a nurse, you must not take much pride in your work or your collegues. Accept it and be proud!

Advanced or not, they practice nursing theory and nursing diagnoses. PAs are taught to think and make decisions similar to physicians. That is the comparison in a nutshell. Otherwise, they are pretty much the same and we would be wise to try and get the two professions to work together, instead of tearing them both apart.

Additionally, the dumb myth that NPs like to propegate is that their clinical rotation requirements are less than 1/4 that of PAs is because "they have so much more clinical experience prior to beginning the NP program." Actually, the NP requirement for clinical experience prior to the program is a minimum of 1 year experience, isn't it? The PA requirement is some huge number like 6000 + hours. You do the math. PA students ALWAYS have some kind of professional certification prior to becoming PAs. Some are nurses, resp therapists, dentists, chiropractors, paramedics, foreign medical doctors, physical therapists, imaging techs, etc. Name ONE NP program that requires that its students were "something else" before admission. You can't - because they don't! PA schools have stricter admission and graduation requirements all-around. This myth that NP students had "greater clinical experience, and that's why their clinical rotations are shorter" is a huge LIE propegated to make NPs feel better. It is simply NOT true.

What is the NP clinical rotation requirement across the country? Around here, they need 600 hours of rotations to graduate. And what areas are these rotations in? FP, women's, peds...certainly NOT surgery, ED, neurosurgery, cardiothoracic surgery, dermatology, rheumatology, coroner's office, occupational medicine, etc. as PAs do. The bottom line is that PAs have more admission requirements and more graduation hours, not to mention more classes in how to practice medicine!

Most PA students also have about 6-10 + years of healthcare experience in their former professions prior to even applying to the program. Now you tell me....who has more overall medical experience? A BSN is NOT always required to get into a NP program. Plenty of 2 yr RNs go on to NP school as well. Most PA programs require a BA/BS before admission, and many students already have a masters degree before admission to the PA program.

PA programs require 40 wks of clinicals because they believe that hands-on experience is the best route to competency. You can memorize all the nursing theory that you want, but it's not going to help you perform a subcuticular suture on a kid's face. In fact, there are VERY few NPs who work in ERs at all. Mostly PAs. Even the webpage listed above for ERNPs has NO job openings listed, and only 2 educational programs in the whole country. Wonder why? What does this say about doctors preferences? For treating critical ED patients, PAs are the clear winner because of their experience. For women's care and for family practice and pediatrics, NPs have been the dominant force by tradition. Just things to consider when making your decision.

The physican does not have ownership of the PA - thus, it is Physician Assistant, not Physician's Asst. Would it matter if they were called Clinician Practitioners (a name currently being discussed to replace PA)? Would that make you respect them more? Stop being shallow and assuming that assistant = idiot and that APN = "advanced". How advanced can nursing be? Any more advanced, and you would be practicing medicine, which is exactly what nurses claim to NOT practice - which is why they answer only to their nursing medical boards and not to the physicians state med board. BTW, do any NPs sit on ANY State Medical Board? I would be shocked if this were true. In many states, PAs sit on the state board. In one, a PA is the HEAD of the state medical board, and physicians serve on the board under his direction...Hmmmmm..

this non-sense may fly in a PA forum but not here .....kristinwiz you may want to post this in the PA forum where it is spouted out how superior PA's are to NP's and all that is over there is a bunch of PA's stroking there own ego....in fact there are actual quotes of PA's comparing themselves to MD's ...don't bring that PA vs NP nonsense over here ,you will just be shot down by the facts......The fact is NP/PA's are both equal. The only time you have someone that will argue that fact is when they fill threatened by the other. You can try and compare the education all you want to....the whole "well PA's have more clinical time than NP's"....but for every argument a PA has an NP has two....lest we forget that there are actually PA's running around out there treating patients with just an associates degree....scary huh....not that I have anything against an associates degree but if someone is going to diagnose me they better have a little more education than a two year community college degree.....see what I mean we can go back and forth all day but in the end the true NP/PA's are out there busting there tails, making there money, and not caught up in these online debates.
Good luck to all those pursuing an NP career I wish you the best of luck....
The market for NP's is on the rise and so is the nursing field...you can't hold a good nurse down!!!

[susanna]

Originally Posted by zenman

I hope NPs stay as far as possible away from the antiquated reductionist medical model that harms so many people!

What do you mean antiquated medical model? Do you mean the nursing model?

[xy/RN 2006]

no....I think he ment exactly what he said......medical model. It wasn't a typo.

[xy/RN 2006]

Excellent post mango-lo-maniac.........by far the best unbiast post I have ever seen. I agree with your post 110%. Good luck with PA school.
Mid-level providers are the best!!!

[chip193]

Originally Posted by xy/RN 2006

not that I have anything against an associates degree but if someone is going to diagnose me they better have a little more education than a two year community college degree

I know quite a few of these A.S. PAs as, until recently, the local PA program was held a local Community College in conjunction with the local medical school. Most are quite good. Most also had a BA/BS in something in order to get in as the competition for the seats was quite high.

The program is now at the medical college as a MS level program. Actually, I don't think that they changed much - just the level of degree.

There is a PA program offered by the U. North Dakota (or is it So. Dakota?) which requires a BSN for admission. It has only 16 weeks on campus with the rest of the two years in a PCP office near your home.

Chip