LuxCalidaNP 5,202 Views
Joined Feb 22, '09.
Posts: 229 (43% Liked)
I work on a Cardiac Tele floor in California, and while it is technically also a Med Surg floor, we are a progressive-care/step-down floor for the ICU. Our patients are much more sick/unstable than our other med-surg floors, and thus we have smaller ratios (that are union-protected, mind you) of 1:4. I like to describe our floor as ICU minus ventilators and titrated drips (we still have some vasoactive and antiarrhythmic drips). Most night on our floor, 3 patients feels insane.
We often have the unstable ACS patients come to us before cath lab, 3rd degree heart blocks before they get their device, CHF and COPD exacerbation patients, and of course heart surgery patients, post-op.
Most tele units are med-surg, but depending on the facility, may be more acute.
All things considered: State regulations and practice acts, academic program reputation, local climate for NPs/PAs, etc, one friend broke it down simply for me: PAs will always need to have a "supervising" MD, as opposed to the trend with NP legislation of having "collaborative" or fully autonomous relationships with MDs, and in his words, "as a PA, I will always be an 'assistant' to the physician on some level, whether in primary care, surgery, etc." (This of course varies based on location). As advanced-practice nursing is being considered more of it's own medical discipline with designated sub-specialties, the model for NPs/CNMs is trending away from being a "second rate provider" to an MD, or "mid-level". This is not always the case with PAs. NPs likely won't ever have as thorough of an education as MDs/DOs, but the overall trend of the last 25 years indicates that NPs are gaining more autonomy than PAs, especially in primary care...just my 2 cents.
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