Nurse Practitioner or Physician's Assistant?

Opinion on a public forum such as SDN or even this website must be taken rather critically. You have allot of whining, complaining, and venting on both sides; therefore, be critical of what is said. Yes, some doctors prefer PA's. However, some like NP's and I suspect some really do not care.

I look at people who consistently post a particular concept or point of view as having some weight. IMHO, I would be more inclined to consider the opinions of Core0 and others who are able to see these debates from both sides with a rather objective eye.

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:
http://allnurses.com/nurse-practitio...44-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

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.

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.

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.

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

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.

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

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