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?

I have a Biology degree and have applied to nursing school so that I can become a NP in the future. Then I realized that the amount of schoolong for a NP seems to be alot more than a PA. If you look up certified PA programs in California, half of them are associates, bachelor's, or certificate programs. To finish my NP certification, I will have to do 2 more years of nursing, plus 3 years for the NP, not including all of the extra classes I had to take to get into the nursing program. Which is weird considering I had 3 years of chemistry, etc. but was told I needed to take human physiology, that my upper division mammalian physiology didn't count.

With the lower pay and higher education requirements, why does anyone become a nurse practitioner if they both have similar roles?

Most NPs are already RNs before starting the NP route. So for them the route is much shorter. Consider that for PA they would need to take several semesters of prerequisites to get into a PA program. Also the ability to work during NP programs as opposed to the general lack of this option in PA programs cannot be discounted.

Given the difficulty getting into nursing school you are right without an RN its probably a faster route to PA school, although if you look closely at the California programs they all pretty much require a significant amount of health care experience which also changes the equation.

Finally depending on the state there are differences in scope, practice and utilization between NPs and PAs. That may play a role. Also consider that many programs are moving to the DNP which will add additional time for the NP.

David Carpenter, PA-C

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Thanks David,

I was looking at the California programs again. Is there any benefit to getting your master's degree as a PA-C versus an associates or certificate? It seems as though the masters programs are usually quite expensive. I got into nursing school for the fall, to one ADN program and one private BSN program. I think I will probably go to the ADN program, and see what the requirements are for the FNP program when I get out. If it is a doctorate, I will probably try to get into a PA program.

It seems that although nursing school will take longer, it can be significantly cheaper, if you go to a public school. The public PA programs in California do want you to have about two years of experience as a paid healthcare worker. I have had trouble getting work in healthcare because I don't have a technical healthcare degree.

I am not stuck on staying in California, are there any public PA programs elsewhere?

As to the idea that most NPs are RNs before they start their NP route, I don't know if that is true, at least in my area. I have several people in my o-chem class (which I had to take again because its over 5 years old) who are RNs who got their ADN after a non-nursing bachelor's degree. They are all trying to get their NP. I also know of several people who are trying to get into accelerated second bachelor BSN programs because they want to be NPs. I think people here don't really know about PA's because the majority of primary care practices here use NP's. I believe PA's are present in Southern California more in specialty practices and in-patient hospital care.

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Thanks David,

I was looking at the California programs again. Is there any benefit to getting your master's degree as a PA-C versus an associates or certificate? It seems as though the masters programs are usually quite expensive. I got into nursing school for the fall, to one ADN program and one private BSN program. I think I will probably go to the ADN program, and see what the requirements are for the FNP program when I get out. If it is a doctorate, I will probably try to get into a PA program.

It seems that although nursing school will take longer, it can be significantly cheaper, if you go to a public school. The public PA programs in California do want you to have about two years of experience as a paid healthcare worker. I have had trouble getting work in healthcare because I don't have a technical healthcare degree.

I am not stuck on staying in California, are there any public PA programs elsewhere?

There is no real advantage to having a masters. A for that matter the CC programs are considered among the best in the nation. RCC is probably the best PA program out there. If you are applying for a position at an academic institution then a masters is helpful. If you already have a bachelors most of the cert/cc programs have affiliation agreements that allow you to get your masters along with your associates. If not then there are number of post graduate masters programs that are pretty easy to do.

As for other programs there are 149 programs and another 9-12 being added in the next few years. This is discussed extensively on the PA forum but there are a number of programs that don't require prior HCE (mostly in the NE). That being said most students due have HCE so you will be at a disadvantage if you don't have any. If you are already in a nursing program then I would continue with that. Then when you are done and have some experience you can see what still interests you (hopefully the job market will be better in a couple of years). Also California has a weird divide North >NP

David Carpenter, PA-C

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Not to beat a dead horse or anything (I just came upon this thread while researching) but it's kinda crazy to see PA's coming on here telling nurses that they will need classes like chemistry, A&P, biochem, etc... to go to PA school. Do people seriously believe that nurses do not have to take these classes? I mean, looking at most of the programs now for BSN, they are want you to take math, chemistry, biology, A&P, etc. not to mention the requirements for the school in general like history, literature, etc. With the failing grade being 76 and below around here, having a high GPA in nursing is one of the most well-rounded programs you can come out of imo.

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Specializes in Family Practice, ICU.

No kidding, great post, Sugarmagnolia. Nurses DO have to take all those classes. Obviously these PA's aren't aware of what a nurse education entails.

The PA vs. NP debate will continue, but ultimately it doesn't matter, both are good professions. Almost every job I see is for a "PA or NP", even the specialty stuff like orthopedic surgery and ENT.

You can go back and forth about who is better prepared, but they ultimately have to each get their footing once they start practicing regardless.

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David, I have now been in RN school for 1 semester (starting my second) and I HATE it! The nursing part is fine, but the schooling is awful. We had a one unit pharm course and have to look up our meds otherwise. Then they offered these optional online pharm courses which consisted of a once a week chat room that the professor was absent from 50% of the time.And we have some comprehensive pharm exam that we have to pass before we graduate which doesn't make any sense whatsoever. I am still trying to find a pharm course at another school that I can take. We also don't have pathophysiology. I am sure some nursing programs are better. I also don't like how the faculty treat the students. I will either try to transfer or finish this thing and then work and look into PA school.

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Specializes in Family Practice, ICU.

Melowbeans,

I know your comment was directed to David, but I thought I'd just throw my 2 cents in and say that your experience is very atypical for a good nursing program. I am an LPN and recent RN grad (taking boards tomorrow), and our pharmacology training was very hands-on with lots of classroom time.

It's hard to make the call. I say get into a different program, unless you're a fantastic self-teacher. In nursing school, you need good faculty to whom you can ask questions. From what I've seen, the quality of the school and the school's curriculum really makes a difference in the ability of the students to pass boards, too.

If you are close to a Bachelor's degree in something, the PA route would be good. Here in Utah, it seems that the most competitive candidates are those who have 2-3 years of health care experience. I hear that PA school is more competitive than NP school, mainly because in PA school you're competing with non-nurse applicants as well as nurses.

Anyway, I've overstayed my welcome by butting into your conversation. Good luck!

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Hey Sam?

I know I am not in a good program. I already have a Biology degree, but here in California, because of the budget cuts, I couldnt apply to the CSU's or UC's for a BSN (because I already have a bachelor's degree in something). Our cirriculum is terrible, but it is approved by the BRN. I am looking to transfer, but schools everywhere are so impacted, and because our cirriculum is so weird, I don't know that I can transfer. My GPA is going down too, because my school has a weird higher grading scale, and the faculty doesnt let us take our graded tests back, and it doesn't seem to matter what the textbook says, the right answer is whatever the teacher says it is.

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Specializes in Family Practice, ICU.

That would be hard. I wish you the best of luck. You're always welcome here in Utah!

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I saw this was orginally posted back in 2009. I am in a similiar situation. I love to go to PA school but I heard they don't like RNs. Also the ones where I live are super competitive ( accepting only 19 percent of applicants!) Going for my nurse practioner would be ideal because I heard most school offer classes online and you can work while going to school. I am interested in working an in ER however and I think ERS are more likely to hire PAs. If someone could enlighten me why pa school don't like nurses that might sway me one way or another.

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"realistically within a practice nps and pas will do the same job. the pay is very similar and the opportunities for practice ownership are basically the same."

not true. or, should i say, only true if you think that a pa without a nursing license can practice to an aprn standard of care, which s/he cannot.

an aprn can hang out a shingle in many states without being under the md's license. a pa cannot.

an aprn can legally diagnose human response to illness and injury (as well as have prescriptive authority under the aprn license)and make a plan of care without md sign-off. a pa cannot.

many nurses are familiar with the "i can do anything a nurse can do, i just don't have the credential" mindset that pervades the lpn and cna ranks (until they get better educated). so too do many pas believe about aprns.

you're a nurse. be a nurse.

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"realistically within a practice nps and pas will do the same job. the pay is very similar and the opportunities for practice ownership are basically the same."

not true. or, should i say, only true if you think that a pa without a nursing license can practice to an aprn standard of care, which s/he cannot.

an aprn can hang out a shingle in many states without being under the md's license. a pa cannot.

an aprn can legally diagnose human response to illness and injury (as well as have prescriptive authority under the aprn license)and make a plan of care without md sign-off. a pa cannot.

many nurses are familiar with the "i can do anything a nurse can do, i just don't have the credential" mindset that pervades the lpn and cna ranks (until they get better educated). so too do many pas believe about aprns.

you're a nurse. be a nurse.

this was answered two pages back (although without green text). functionally everywhere i've worked nps and pas doing the same job do the same work. i can diagnose medical conditions, formulate a plan and enact it without anyone signing off. the only thing that is the physician is required to sign is my discharge summaries (just like the nps). technically you are correct i do not practice to an aprn standard of care. i practice to a physician standard of care for the specialty that i am working in. i really don't know or care what the aprn standard of care for my specialty is (although if my fellow aprns practice to less than the physician standard of care they would certainly hear about it). functionally and legally in my organization, the only difference between what i do and the aprns that work with me do is that i can see patients under 18 and they can't. ymmv.

for the poster above you and for others if you want to go to pa school take a look. its not for everyone and there are real advantages to np school for an rn that i elucidated several pages back. nationwide around 5% of pa students are rns, if you include nps and lpns that number goes up. anectodally it seems to be growing for a number of reasons. the medical experience that an rn has is valued and while pa school remains competitive, depending on the program an rn might give someone an advantage.

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