Nurse Practitioner or Physician's Assistant?

Nurses General Nursing

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Well, I graduated with an associate's degree, and passed my NCLEX in January. I've been working in an LTC since Feburary. I have an opportunity to return to school, and I've already been accepted to a local college to complete a bachelor's in Nursing. This is the quandry I am in. I'm realizing that nurses are not respected or well treated, and I don't like it. I don't know how long I'll be able to put up with it. I have been headed toward Nurse Practitioner. Is physician's assistant a better goal? What are the differences? Is the same amount of schooling from associate degree RN?

Specializes in PACU, presurgical testing.

There is an excellent chart on the web outlining the differences between these two roles. The direct link to the pdf file is www.wapa.org/pdfs/np-pa_chart.pdf.

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Specializes in Family Practice, ICU.

That link isn't working, it just redirects to allnurses.

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Specializes in PACU, presurgical testing.

I'm sorry about that. I have had it downloaded for a long time and didn't check the link. Does anyone know how to attach a PDF file or JPEG image from a local hard drive to a post on this site? I'm happy to share the PA-NP chart if I can figure out how!

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There is an excellent chart on the web outlining the differences between these two roles. The direct link to the pdf file is www.wapa.org/pdfs/np-pa_chart.pdf.

Here is the link. Couple of caveats - its by the Wisconsin PA academy and the rules are specific to Wisconsin (may not be accurate for all states).

http://www.wapa.org/pdfs/np-pa_chart.pdf

David Carpenter, PA-C

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Specializes in PACU, presurgical testing.

Thank you for posting a working link! I'm not sure why my link didn't work, but this is the chart I was trying to offer. I'm sure there are state-by-state regulatory differences as mentioned above, but I thought they did a good job of showing the contrast between the roles, at least as I've observed them in practice.

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Thank you for posting a working link! I'm not sure why my link didn't work, but this is the chart I was trying to offer. I'm sure there are state-by-state regulatory differences as mentioned above, but I thought they did a good job of showing the contrast between the roles, at least as I've observed them in practice.

The link didn't work because there was a period placed at the end of the sentence which became part of the link; making it an incorrect link ;-) Thanks for the comparison!

The only thing I have to add to the thread at this point is that Medicine Sans Frontieres/Doctors without Borders doesn't recruit Physician Assistans (unless it's for a coordinator level position), but it does recruit (at least some types of) advanced practice nurses. Don't read into this at all! Just know that if you wanted to volunteer w/ Doctors w/out Borders at some point you wouldn't really be able to as a PA

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I can understand that. If you go volunteer, you need to be able to work without too much required supervison. I don't think in situations like Haiti it really helps if you cannot. NPs are valued because as other posters have mentioned there is a strong primary care element in experience, even if they have gone on to specialize elsewhere. Remember once out of surgery for these folks it's gonna be long recovery that needs managing as well as ability to do hands on care. Many MDs won't hold out that long, if you think it through, their skillset is limited. In these situations you need people who can function as both architect and carpenter.

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Specializes in Family Practice, ICU.

I think it's funny that all this fuss is made to differentiate them when they basically fulfill the same task. Seems like the bottom line is:

1. They both require some level of physician supervision. NP's do too, they just call it "collaboration" instead.

2. NP's have 1/4th the clinical requirement that PA's do. This makes sense, seeing as nurses have already logged hours and hours of work and clinical experience. Why should they have to do as many as someone with a Bachelor's of English who has worked as a physical therapy aid?

3. PA's are usually trained in surgeries, not always NP's. But there are many NP's that are.

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i think it's funny that all this fuss is made to differentiate them when they basically fulfill the same task. seems like the bottom line is:

1. they both require some level of physician supervision. np's do too, they just call it "collaboration" instead.

there are places where np's are fully independent. no collaboration required.

2. np's have 1/4th the clinical requirement that pa's do. this makes sense, seeing as nurses have already logged hours and hours of work and clinical experience. why should they have to do as many as someone with a bachelor's of english who has worked as a physical therapy aid?

not the same experience imho. hopefully, a np has a strong background; however, many direct entry msn programmes out there.

3. pa's are usually trained in surgeries, not always np's. but there are many np's that are.

agreed.

honestly, i think the biggest point in this whole discussion when considering physicians is the apn push for indi practice.

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I think it's funny that all this fuss is made to differentiate them when they basically fulfill the same task. Seems like the bottom line is:

2. NP's have 1/4th the clinical requirement that PA's do. This makes sense, seeing as nurses have already logged hours and hours of work and clinical experience. Why should they have to do as many as someone with a Bachelor's of English who has worked as a physical therapy aid?

I have a big problem with this. Many NP's will claim the very thing you just stated. The problem with this fact is that while many nurses have "work experience" their work experience does nothing to help their ability to practice clinical medicine. I have worked at a large number of medical facilities and I have yet to meet a nurse who has any understanding of even basic pathology or physiology. Many nursing programs require biologies and perhaps pharmacology in their prerequisites. However, since actual nursing care requires none of this knowledge it is quickly forgotten, if it was ever even learned well (there are no certification tests for undergraduate pharmacology electives). Nurses are not trained to make clinical decisions, prescribe, understand labs or treatments.

How in the world can anyone claim this as the basis for not needing clinical hours in their MEDICAL training? "oh, but I'm trained in the nursing model, it's not medical." that's BS (not bachelor's degree) The work that NP's do IS medical, they are under trained for it and try to coat this with their previous "nursing experience"

This is not to say that there are not extremely good and knowledgeable NP's out there, but usually they have 10 years experience AS NP's!!! not as nurses. Seriously, quiz any nurse more than one year out of school on the pathophysiology of any but the most basic diseases, or differential diagnosis, or pharmacologic action of any med any you will receive blank stares of uncomprehension. (yes, i made that word up).

What is metorprolol? "what?" what is lopressor? "OH! that's a blood pressure pill" well duh, but what does it do... "um... lower blood pressure?" no, it is a cardio selective beta blocker acting preferentially on Beta 1 receptors decreasing myocardial contractility and chronotropy.

Unfortunately I'm afraid some NP's might give the same response if asked less than one year out of school

What you don't know in this field can kill someone.

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Specializes in Family Practice, ICU.
However, since actual nursing care requires none of this knowledge it is quickly forgotten, if it was ever even learned well (there are no certification tests for undergraduate pharmacology electives). Nurses are not trained to make clinical decisions, prescribe, understand labs or treatments.

An ADN nurse has 1 and 1/2 years of pharmacology training, including mechanisms, side effects and reasons why different meds are prescribed. So technically, they have more formal education on medication than an entry-level PA. Whether they remember it all depends on the nurse. Some are slackers and do the bare minimum, like the ones you mentioned. Others do remember. It seems that the nurses that are most interested in being an NP are those that care to remember them. As far as who is better prepared out of school, I think it also depends on the individual. I've heard heresay about "such and such PA had to have the nurses all remind him of blah blah blah" and I've heard PA's say the same thing about NP's.

And I agree with you, they both practice medicine. They really ought to just call it that. It's just the semantics are so voraciously guarded by the medical and nursing camps. Really stupid. What layperson will honestly know what it means to practice "advanced practice nursing"? But you can't say, "I'm an nurse who practices medicine", because the medical world will be up in arms. Pretty dumb if you ask me.

The bottom line is: PA's and NP's are both mid-level care providers. They do basically the same thing. If either one sucks, they're going to learn fast or get reamed for not knowing what they ought to know.

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Too true, I agree that the quality of the provider is highly individual. I don't think I can argue that point. Maybe I'm wrong, I think though that even so, the nursing experience does not prepare one to make clinical decisions of the magnitude that midlevel providers are supposed to make. the time spent in clinical rotation probably should not be shortened in light of the fact that the NP has nursing experience prior to his/her training. By the time a doc gets out of school they have around 10000 hours of practice making life and death decisions. PA's will have around 2500-3000 hours of clinical rotations without any of the residencies that are available, while an NP will have as little as 300 (not true of all, but not many pass the 1000 hr mark) 2500 hrs barely qualifies the PA. The big problem I have is that the goal of the NP lobby is to make themselves independent providers when they do not have the qualifications to do so. If one wants to practice INDEPENDENTLY become a doctor (medical one, not an online doctorate in nursing studies). Otherwise accept that all midlevels should practice in collaboration with an MD.

Also, not sure about all nursing programs, but my close friend is a nurse, I've looked over the material and I have been told by her and others that they don't need to know mechanism of action specifically, only the effect on the body (x is a steroid, x is a blood pressure drug, etc). Mechanism is incredibly important when understanding side effects, interactions, and treatment. Also, pathophysiology as I understand it is not taught to the extent necessary to diagnose complex/rare disease processes. I hope that NP's are not simply ok with diagnosing thousands of colds and missing the odd presentation of sarcoidosis or Churg-Strauss syndrome etc. If one doesn't know it exists one can't diagnose it! these types of diseases are not covered in ANY nursing curriculum (Speaking of churg-strauss, not sarcoid, I'm sure that is common enough to be mentioned somewhere.)

I agree with your comment about PA's. Unfortunately there are quite a few I'm sure who don't know as much as they need to, but the material is covered in their school.

Thoughts?

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