Nurse Practitioner or Physician's Assistant?

ToxicShock · Jul 8, 2009

Maybe I'm an idiot, but I still don't seem to understand the difference between PAs and NPs. Everyone says "they do basically the same thing". What does 'basically' mean in that sentence? Obviously the education is a little different, but can they both prescribe meds? Can they specialize? Can they work independently? What kind of procedures can/can't they do? Etc.

RN4NICU, LPN, LVN · Jul 8, 2009

maybe i'm an idiot, but i still don't seem to understand the difference between pas and nps. everyone says "they do basically the same thing". what does 'basically' mean in that sentence?
the best way i can think of to explain it is that it means that there are more similarities than differences
obviously the education is a little different, but can they both prescribe meds?
yes
can they specialize?
yes
can they work independently?
depends on the state they practice in - particularly for nps. some states require more physician involvement than others.
what kind of procedures can/can't they do? etc.

it depends on what they are trained to do. neither can perform surgery. nps do not deliver babies (only certified nurse midwives), i do not think pas do either, but i don't know. both can work in a hospital setting or in private practice. both can suture, do trigger point injections, order labs, prescribe meds, and do other procedures that they are trained to do as long as it is within the limits of their state's laws.

Murse7 · Jul 9, 2009

In terms of surgery, PA's are found in great numbers in surgery, where they can first assist in the OR. NP's will typically be found outside of the OR.

PA's are trained as generalists, and can move from specialty to specialty. There are a good number of optional residencies available to PA's as well in various specialties.

marilynmom, LPN, NP · Jul 9, 2009

Like others have mentioned it REALLY depends on where you live and what you think you want to do. That is the first thing you should look at and research.

I live in Oklahoma and work as an RN. Here you will see many more PA's in for instance the ER, and in the hospitals. NPs here seem to be mainly in the dr offices and clinics.

I personally think both roles are great!! Good luck and take your time, and do your own research based on where you live or want to live :)

RN4NICU, LPN, LVN · Jul 9, 2009

In terms of surgery, PA's are found in great numbers in surgery, where they can first assist in the OR. NP's will typically be found outside of the OR.
PA's are trained as generalists, and can move from specialty to specialty. There are a good number of optional residencies available to PA's as well in various specialties.

Finding NPs in the OR is not that unusual - at least not more so than finding PAs in the OR. It largely depends on the preferences of the local surgeons. In my area, the cardiovascular surgeons tend to use NPs to first assist whereas the orthopedic surgeons tend to use PAs. Many of the NPs were RNFAs or surgical techs before they became NPs.

Several of my classmates from NP school work as hospitalists or in the ER. A friend of mine from my BSN program, who graduated NP school a year before I did works for an orthopedic surgeon and first assists in the OR. He was a surgical tech before he became a nurse, so that background helps a lot.

core0 · Jul 9, 2009

Maybe I'm an idiot, but I still don't seem to understand the difference between PAs and NPs. Everyone says "they do basically the same thing". What does 'basically' mean in that sentence? Obviously the education is a little different, but can they both prescribe meds? Can they specialize? Can they work independently? What kind of procedures can/can't they do? Etc.

There are essentially three differences between the two professions. The first is in the training. NP education is degree dependent within a nursing specialty. The primary qualification for an NP is an MSN and training in a specific nursing domain. The various certifying agencies specify minimum number of hours for certification and patient exposure to some extent.

PA education is competency based. Every program is required to teach certain items and provide certain clinical experience. Programs may be certificate, associates, bachelors or masters. However, all programs must provide a broad based general medical education accross all settings and age groups. Finally to practice as a PA each student must pass the national certification exam.

The second difference is licensure. PAs are licensed by the Board of Medicine either directly or under a sub board of the BOM. NPs are licensed by the board of nursing. Depending on the state they may also have to register with the board of medicine for practice agreements.

The third difference is scope of practice. NPs for the most part hold independent licenses to practice advanced practice nursing. The scope of practice is determined by their training, certification and state BON. PAs for the most part have dependent licenses to practice medicine. For the most part PAs have their own licenses. The dependent part refers to the scope of practice. In most states the PA may not practice in areas that their supervising is not capable of practicing in. This may apply to populations or it may apply to specific procedures.

In reality the variance in practice is mostly based on how narrowly the BON interprets the scope of practice. Some states interpret it very narrowly (prohibiting FNPs to work in inpatient settings for example) and some choose not to limit the scope at all. You will also see limits when the scope butts up against another advanced practice nursing domain. For examples PAs are allowed to delivery babies in many states. However, NPs are generally not allowed to deliver babies since this is the domain of the CNM.

In primary care the roles are pretty much interchangeable (with the exception of age domains for ANPs and PNPs). In specialties the differences are mostly due to training. PAs are more common in surgery since this is integral to PA training. NPs on the other hand usually are required to have an RNFA which requires additional training. So there are NPs in surgery but they represent around 3-4% of NPs as opposed to more than 35% of PAs.

Both professions have prescriptive authority in all 50 states (and DC). Both groups have can scrip schedule drugs in 47-48 states. Within the limits of their scope both groups can do procedures.

David Carpenter, PA-C

RNburnout · Sep 19, 2009

For the OP the other thing that you should consider is that by the time you get ready to do your NP the majority of the programs may be DNP programs. You can find discussion about this here:
https://allnurses.com/nurse-practitioners-np/doctoral-degree-become-160044-page77.html
Locally it seems to be changing the dynamics of NP vs PA. Both the local PA programs have seen about twice the number of RNs applying as they have historically (although still small N vs NP programs).
David Carpenter, PA-C

David...why do you think the local PA programs in community have seen an increase in RNs applying to their program vs attending an NP program? Do you feel that its the broader range of clinicals areas that PA students experience or RNs avoiding DNP programs at all cost???

Dena, RN, BSN

core0 · Sep 19, 2009

David...why do you think the local PA programs in community have seen an increase in RNs applying to their program vs attending an NP program? Do you feel that its the broader range of clinicals areas that PA students experience or RNs avoiding DNP programs at all cost???
Dena, RN, BSN

I think that its a combination of things. The DNP isn't really a factor around here, but at least one of the RNs was worried about it being required in the future. The primary draws in interviews seem to be the broad medical model and the ability to work in surgery. Also some of them had less than stellar experiences with nursing administration during nursing school. Like I said its a small n vs the number going to NP school but I would be interested to see if the trend repeats nationally, especially in areas where the DNP is more established.

David Carpenter, PA-C

nurseman78, BSN, RN, NP · Sep 24, 2009

I think the ability of a nurse/NP to actually deliver a baby depends on the facility and situation. One of the instructors in my RN program isn't a NP or a CNM, just an OB nurse, but she was trained to deliver babies when the doctor wasn't available to do so.

jess818 · Oct 10, 2009

David, I was hoping to get your opinion because I read this forum quite frequently and I see that you answer a lot the questions leading me to feel you have a real opinion on the matter. I ultimately want to practice as an NP but I am not yet an RN and would have to attend an accelerated BSN program. I could however start a PA program a year and a half from now and then be done in 27 months. I am nervous that going into PA school with virtually no patient care experience would be unfair to potential patients but I have been told that the school will prepare me. I also want to primarily work in primary care which seems to be more of an NP dominated area (at least to me) where PAs do a lot of ER and acute care. I know I can go be an RN and then go back to PA school but I just don't want to make any horrible decisions. Also, I live in Ohio which is HORRIBLE for PAs. Thanks for any advice

From where you are you could do either. There are bachelors, associates and certificate programs out there so potentially you could apply directly. Most likely you will need additional coursework to apply for any PA program. A bachelors will also allow you to apply for masters PA programs which account for 80% of the seats out there. For NP you will need a BSN. For PA programs with a BSN you will also probably need additional coursework such as A&P, chemistry and possibly biochem and ochem depending on the program. The other difference is that most NPs programs will allow you to work some while you are in school while most PA programs will not.
From a practice issue you have to look around and decide what you want to do and if there is an advantage for a particular provider. Every area is different depending on local practice patterns and BON rules. From a PA standpoint we have our own licenses for the most part. The scope of practice is determined by the supervising physician. For NPs the scope of practice is determined by their certification, training and state BON. For example where I moonlight the practice won't hire NPs because of scope issues in the ER. On the other hand several large ERs in town are pretty much all NP. There are certain areas such as surgery where PAs tend to be more common.
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.
David Carpenter, PA-C

core0 · Oct 11, 2009

David, I was hoping to get your opinion because I read this forum quite frequently and I see that you answer a lot the questions leading me to feel you have a real opinion on the matter. I ultimately want to practice as an NP but I am not yet an RN and would have to attend an accelerated BSN program. I could however start a PA program a year and a half from now and then be done in 27 months. I am nervous that going into PA school with virtually no patient care experience would be unfair to potential patients but I have been told that the school will prepare me. I also want to primarily work in primary care which seems to be more of an NP dominated area (at least to me) where PAs do a lot of ER and acute care. I know I can go be an RN and then go back to PA school but I just don't want to make any horrible decisions. Also, I live in Ohio which is HORRIBLE for PAs. Thanks for any advice

In the end its going to come down to your comfort level. I have a different view of non-hce PAs than most because of where I trained. The program I went to takes half the class as freshman. If you keep a B average do some volunteer time and do well in core classes you enter into the PA program after your junior year. The class I was in had around 40% of the class that started. The rest of the class is made up of people with HCE and a bachelors (my part of the class). So I have the experience of watching non-hce students up close and seeing how they do. We also get together from time to time and I've been able to keep track of a fair number.

From an academic perspective, this has been examined a couple of times. There is no measurable difference in graduation rates, passing the PANCE or entry into practice between students with or without HCE. The student with HCE may have an advantage in some parts of the clinicals but it probably is a wash given the non-HCE students more recent academic experience (and youth).

Also what a lot of people forget is that non-HCE programs are on the average longer and have more clinical training (slightly more didactic training). Essentially they substitute program time for medical experience. The statistics say they are doing this successfully.

The key in my mind is early exposure to the medical environment. My program had us doing H&Ps in the hospital on real patients from the fourth week. We also to shadow PAs in various specialties which helped focus us on why we were there. Programs that follow the older medical school model of didactics without patient interaction tend to be the ones where the students have problems (regardless of HCE).

As far as primary care, remember that one third of PAs work in primary care. It may look like its NP dominated but there are quite a few Ohio PAs working in primary care. The main issue is once you get used to the specialty money its hard to go back:D. Interestingly non-HCE graduates are more likely to go into primary care than those with HCE. No one knows exactly why but the primary theory is that someone with HCE will gravitate back to the areas where they had HCE (OR, ER etc). On the other hand non-HCE students rely on their training which in most cases is weighted toward primary care. And don't worry Ohio is slowly joining the rest of the nation. PAs can even scrip there now.

Ultimately you have to decide what you want to do. I looked at nursing initially but PA school more closely fit what I wanted to do. Your the only one that can answer that.

David Carpenter, PA-C

jess818 · Oct 11, 2009

Wow, thank you SO much for such an informative and timely reply. I am def. going to go out and try to shadow a few PAs now to make sure that it is the right fit for me. At least your reply has comforted my concerns!