Nurse Practitioner or Physician's Assistant? Nurse Practitioner or Physician's Assistant? - pg.7 | allnurses

Nurse Practitioner or Physician's Assistant? - page 7

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... Read More

  1. Visit  CuriousMe profile page
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    Quote from bajasauce07
    [<snip>
    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.
    I'm in the second year of a three year BS nursing program. If I ever answered my Prof's question of, "What is meterprolol?" with, "it's a blood pressure pill"...I can only imagine I'd be writing a paper describing the mechanism of action of all the different classes of anti-hypertensives.

    Although my answer wouldn't have been as long as yours. What I learned is that it's cardio selective because it's acting preferentially on the Beta 1 receptor, so I wouldn't have said both.

    So, I can't speak for any other nursing program.....but I know that we're responsible for knowing the mechanism of action on any drug we administer. Not knowing in clinicals will get you sent to find it before administration at the least and if it's a pattern, sent home (if you're sent home more than once....you've failed out of the program).
  2. Visit  bajasauce07 profile page
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    Really? All the nursing associations are gathering the data? And it's all awesome? I had no idea! Studies on noninferiority when dealing with proteinuria are excellent. But lets have a study on how many of these protenuria patients were actually patients with various hypergabbaglobulinemias or vasculities, or HIV nephropathies. Did the NP group recognize the early presentation of Multiple myeloma? or Multiple Gammopathy of Unkown Significance? or Waldenstoms macroglobulimemia? Or did they just put those patients on an ACE-I and remeasure a few months later? If you didn't know those disorders existed that would be the route to take. This would lead to delayed diagnosis, and treatment and early death/morbidity.
    As far as getting sued? the patient would have no idea that the diagnosis could have been made earlier. No one would sue. Patients see a provider based on how nice they are, not how skillfull, and you know it.
    To CURIOUS ME:
    I know you are all taught the basics of pharmacology. And you should make sure to remember those things as you graduate and continue to practice. The thing is you don't REALLY need to know the pharmacology to be a mediocre nurse. Just take the orders of the chart and do what the doctor says and you'll keep your job. A good nurse would keep up with his/her pharm and be able to recognize and point out potential mistakes in therapy. Go ahead and ask a nurse with 5 years of hospital experience what any drug does, you'll be surprised how many have let their skills slip.
    My point when I said that was simply that nursing school should not be used as an excuse for a less intense practitioner training, it doesn't provide much in the way of preparation. All of an NP's medical training will occur in NP school. Prior nursing experience does not prepare to be a practitioner of medicine.
  3. Visit  EquuszRN profile page
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    Bajasauce: Nurse practitioners know of all those disorders. If you're going to do a study on whether they were caught or not, better start with the physicians who miss them, because there's a HELL of a lot more physician lawsuits for missed diagnoses than nurse practitioner lawsuits!

    You are out of control with your agenda. I think you've made your opinion clear and need to go away now. No one here is going to agree with you, and the studies and research back us up. Not just nursing board, but state medical boards and those who govern scope of practice both at the state and federal levels. YOU ARE WRONG. And as you continue to refuse to state your background, I believe I'm safe in my assumption that you are NOT A NURSE. Therefore go wave your flags for doctors over on the medical students' and PAs' forums and stop bothering us with it.
    shel_wny likes this.
  4. Visit  jlcole45 profile page
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    Quote from bajasauce07
    . We all have a place in healthcare, but if you want to be the boss, be the MD. .
    Actually I would argue that you are wrong.
    If someone wants to be the boss then go into administration.
    shel_wny likes this.
  5. Visit  eddoc profile page
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    Not sure how I stumbled on to this discussion but it has been a fascinating stroll. Can you spell "cognitive dissonance?" It is patently clear that but for a few discussants, having made your career choice you are, like reformed smokers, intolerant of other's choices. As it happens, I have taught in both NP and PA programs and there is little similarity between the content or the approach. By the same token, it is equally clear that the concept of supervision/dependent practitioner and collaboration/independent practioner is poorly understood by most on this board. In this day and age of litigation, it is the foolish doc/NP or PA who doesn't collaborate with his or her colleagues and seek advice from those with greater experience or training. In fact, I would posit that you have a moral imperative to do so, regardless of your legal requirements.
    shel_wny and braithiar like this.
  6. Visit  bajasauce07 profile page
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    quite agreed. How are PA and NP schools different?
  7. Visit  eddoc profile page
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    I can only use my limited experience to reply. My content area was afforded ~ 45 hours in the PA program and 8 in the FNP program. The FNP program approached the "medical" issues from a bio/psycho/social perspective. They clearly had a great deal of experience on which to draw, but did not seem to have the underlying science. The PA students generally speaking had less experience but a much better grasp of the underlying pathophysiology. So the bottom line seemed to be IMHO, that the NP students had a framework that allowed them to apply what was taught but with a less thorough understanding of the "why." The PA students understood the "why" and the "how" but lacked perspective on prevalence and application.
  8. Visit  tothct profile page
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    A Physician Assistant completes around 3000 hours for didactic and clinical education (1000+2000). A Nurse Practitioner completes about 1000 hours total or a little over (500+700). Also, a PA is trained in the medical model (just like physicians) and as such are general practitioners. NPs are trained in the nursing model (biopsychosocial) and they must specialize, which greatly limits their job opportunities. I have found that PAs are paid more in general. As for a PA and NP practicing in the same specialty, their duties are relatively similar.

    I do want to comment specifically on how NPs claim they can practice independantly of a physician. This is misleading. It doesn't broaden their scope of practice whatsoever. Sure they can open their own clinic but they are still limited in what they can do. Collaboration vs supervision is a myth. Both PAs and NPs are under physicians.
  9. Visit  EquuszRN profile page
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    tothct:

    You're wrong. Do your research.

    NP's are not "under" physicians in many states. In my state, they practice independently and can/should refer to a specialist directly if there is a patient outside their capabilities. A FNP in Oregon does not have to refer to a family practice MD that they are "under". They can refer directly to a specialist, same as the MD would.

    Everyone here is now talking in circles. You can keep saying that NP's have less training and that makes them less safe. Then you can look at the percentage of patients who sue their NP's vs. those who sue their docs. And you can look at what the state legislatures authorize NPs to do. Just because an NP has to specialize doesn't mean they're less capable. They simply choose a field and focus on their clinical hours on that field, whereas a PA is diluting their clinical hours with many different areas of medicine. That's why they have more hours. You may think that makes the PA better, but I don't, especially not within a specialty. There has to be a reason that PAs have to have a supervising physician in every state, whereas in many states NPs do not. What do you think that reason is? Why would a nursing model practitioner with less hours have more autonomy? Do you think it's a big conspiracy or the power of the nursing boards? I doubt it. States look to their bottom line and that bottom line is nurse practitioners, in their view, can handle full autonomy with less liability than PAs can. They must have some basis for that decision, as its becoming more and more the norm.
  10. Visit  tothct profile page
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    That's funny, because when I graduated from The University of Pittsburgh with a BSN and from Yale as an Adult Care Nurse Practitioner, I thought I had the schooling and job specifications down pretty straight...

    Trust me. The fact that we are licensed by the nursing boards and not the medical boards really means nothing. Yes they can't legislate anything in regards to our capabilities, but it in no way means we are on equal footing with a doctor. Working apart from them doesn't open new worlds of possibilities and make us better than PAs. And looking back on it I wish I could have had a more general education instead of specializing. I think it broadens your scope of practice and better allows you to extend the services of physicians... hey! Isn't that what a mid-level practitioner was created for?
  11. Visit  EquuszRN profile page
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    Would you like me to send you the FNP scopes for Oregon and Washington? Perhaps they're less restrictive than where you practice.

    No one on this thread has said that an NP is on an equal footing with an MD. That would be ludicrous. What is being said is that an NP is on an equal footing with (and somewhat more autonomous than) a PA, and the debate is whether an NP is less safe or less capable because he/she has less clinical hours than a PA. Is that what you, as a nurse practitioner, also believe?

    Everyone agrees that if something is out of your scope or knowledge base then you should refer to higher level of care. This is common sense. It's just that in the PA's case, everything he/she does is somehow reviewed by a higher level of care, whereas in the NP's, in many states it's left to his/her discretion. The NP scope in Oregon simply says, when considering whether or not something is in your scope, you consider whether it falls within your specialty and is something the NP would reasonably do. That leaves a lot up to the NP's own decision-making instead of regulation, and so far I have not heard of many cases where it's being abused enough to become a problem. I haven't seen a lot of NPs with "god complexes" is what I mean. When they need to refer, they refer, and yes, that's what being a mid-level is all about.
  12. Visit  core0 profile page
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    Quote from Equusz
    Would you like me to send you the FNP scopes for Oregon and Washington? Perhaps they're less restrictive than where you practice.

    No one on this thread has said that an NP is on an equal footing with an MD. That would be ludicrous. What is being said is that an NP is on an equal footing with (and somewhat more autonomous than) a PA, and the debate is whether an NP is less safe or less capable because he/she has less clinical hours than a PA. Is that what you, as a nurse practitioner, also believe?

    Everyone agrees that if something is out of your scope or knowledge base then you should refer to higher level of care. This is common sense. It's just that in the PA's case, everything he/she does is somehow reviewed by a higher level of care, whereas in the NP's, in many states it's left to his/her discretion. The NP scope in Oregon simply says, when considering whether or not something is in your scope, you consider whether it falls within your specialty and is something the NP would reasonably do. That leaves a lot up to the NP's own decision-making instead of regulation, and so far I have not heard of many cases where it's being abused enough to become a problem. I haven't seen a lot of NPs with "god complexes" is what I mean. When they need to refer, they refer, and yes, that's what being a mid-level is all about.
    As far as PA review, the requirement for review is entirely state dependent. To use Oregon for example. There is no requirement for any review of a PAs actions. Instead the requirement for supervision is determined by the PA and physician in accordance with a board approved practice description. The autonomy is earned.

    What is codified is that the requirements for general supervision must be met. This means that at any time a physician must be available (either in person, telephonically, by radio or TV (yes thats what the statute says)). What this codifies who and how a PA must contact the physician when something exceeds their scope or experience. For NPs (in Oregon) there is no requirement for supervision or collaboration. The difference is that in the event that something exceeds the scope or experience of the NP or PA in the PAs case there is a clearly defined chain of communication and responsibility for the patient.

    Medicare on the other hand requires collaboration. For states with no requirement the practice can maintain the agreement. There is also no requirement that the physician agree. So for example the agreement could say in the case of a problem exceeding scope of practice the patient will be referred to Dr. X. On the other hand Dr. X could legally refuse the consult which would mean that for practical purposes there is no collaboration agreement. Its one of the items that Medicare chooses not to deal with.

    For PAs the other place that supervision comes into play is in scope. In general a PA cannot do anything that the supervising physician is not trained to do. So the supervising physician will define the scope of practice for the PA. NPs on the other hand are defined by a combination of training, certification and experience (in conjunction with the BONs interpretation of this). In theory even in a state with a collaboration agreement an NP could do something that the collaborating physician is not trained to do. Whether they would be willing to accept the liability is another thing.

    Autonomy is earned. 98% of PAs and NPs will work for a medical practice. The physicians of the medical practice will incur liability either in a corporate manner or through medical directorship for both providers. Therefore any autonomy will be based on demonstrated competence (or benign neglect in the case of the lazy). For the vast majority of PAs and NPs there is no difference in the job. The differences usually revolve around the administrativa (which can be different from state to state between NPs and PAs) and the scope of practice which state to state can be less or more restrictive for NPs).

    David Carpenter, PA-C
  13. Visit  EquuszRN profile page
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    Thanks, David. I think you've got it nailed down quite accurately there.

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