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 Emergency, Occupational, Primary.

Well Bajasauce, you may think it's irresponsible, and you're entitled to your opinion, but there are a whole lot of PhD's and experts in the field, along with studies, licensing agencies, and state governments that don't agree with you. The trend is for more independent practice, and if it were truly irresponsible (ie, people were being harmed because of it), the trend would be going the opposite way. The consensus among those who make the licensing and practice standards and regulations is that mid-levels should be practicing independently, especially with the severe shortage of primary care MD's. But, as I said, you're entitled to your opinion.

--Equusz

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Unfortunately you have a very bad environment in which you work.

My colleagues, ESPECIALLY PHYSICIANS, give me the utmost respect. They value my input and often give a sigh of relief when they have the sickest of the sick passed off to me. Often they ask for ME to take over instead of another nurse, and that has to do with my background, experience , and intelligentsia.

I'm sorry you're not being valued.

But please don't make the assumption that ALL NURSES are disrespected -

You are very, very wrong.

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so has anyone done both? I would be intersted in hearing from that person- that has been on both sides of this "camp" although I am doubting this as I am saying but it seems like there is abit of tem vs us disscussion in this forum

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On what do these agencies make these recommendations? Either way, we shall see.

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Specializes in Emergency, Occupational, Primary.

Are you kidding me? How about myriad and ongoing studies, quality control, and research? The state boards of nursing, ANA, NLN and other regulatory agencies are constantly gathering data on that which they regulate. It works. How many nurse practitioner lawsuits do you hear of? How much is nurse practitioner compared to MD?

What is your background anyway, Bajasauce? Are you even a nurse? I don't know of many RN's who think that NP's should have less independence.

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Medicine has EVERYTHING to do with how knowledgeable you are and NOTHING to do with how nice you are. It's just good to be nice as well. As far as the comment above about NP vs PA? You can come out of training as either an NP, PA, or MD and be a moron. It's all up to the individual. I have not touted PA's as masters of diagnosis, I do think the training is different and I prefer the methods of the PA way, but my argument has been, and will likely always be, that midlevels should not practice independently.

Of course, as someone pointed out, NP's do practice "independently," depending on how you define that. But it's irresponsible. We all have a place in healthcare, but if you want to be the boss, be the MD. You don't learn construction and then try to practice as an engineer.

most of the complaints a person gets- be a nurse, NP, PA or MD, etc. is more on the 'soft skills' then it is on the techinal aspect.of course if there is a problem with techinal skills or knowledge then typically the person has a malpractice against them. but if there is a issue with an attuide then less people go to that provider. that carries over into every aspect of life

how many time would any one of us keep going back to the same resturant, car repair etc if we did not like the way we were treated- bad or no service, rude service, bad prices- only for the good food or a good repair? we wouldn't. that person is labeled as 'in it for the money'

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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).

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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.

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Specializes in Emergency, Occupational, Primary.

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.

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Specializes in ER, ICU, Education.
. 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.

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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.

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quite agreed. How are PA and NP schools different?

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