Advantages/Disadvantages of NP vs PA - page 4

What are advantages and disadvantages of PA vs. NP? It's hard to pick which way to go. Combined degree may be too far away. thanks, J... Read More

  1. by   core0
    Now that I have some sleep and can actually spell my name I will add a couple of other thoughts. Most of the perceived advantages are in the realm of training specific items. There is some thought that some of the perceived advantages may have been due to the male/female split between NPs and PAs. Now that the distribution among the sexes is similar some of these perceived advantages may disappear.

    Several other areas deserve some consideration as as far as advantage.

    Minute clinic type of operations in some states may preferentially hire NPs due to supervision requirements.

    ER - is another case where there is a potential advantage for PAs. ACNPs have declared that emergency care is part of their domain. However ACNPs cannot see pediatric patients. In larger ERs with pediatric and adult sections this is not a problem. In smaller ERs it may be. PA school also emphasizes skills such as suturing that are beneficial in the ER (although there is no reason that an individual NP cannot learn these).

    The ER problem also points out a problem that commonly occurs in private practice. That medical practice frequent spans multiple nursing domains. The problem with adult and pediatric PAs is not isolated to EM. It also occurs in various specialty practices. There is also a question about the use of ACNPs in non acute setting, especially outpatient settings. There are two programs that I am aware of to address this; one a ANP/ACNP program and one a FNP/ACNP program. Neither of these really addresses the ER problem which may be solved at some point with a true ERNP program as has been discussed or a dual PNP/ACNP program (which would also solve problems in some smaller ICUs that take pediatric patients).

    Further thoughts

    David Carpenter, PA-C
  2. by   wtbcrna
    Quote from core0
    Now that I have some sleep and can actually spell my name I will add a couple of other thoughts. Most of the perceived advantages are in the realm of training specific items. There is some thought that some of the perceived advantages may have been due to the male/female split between NPs and PAs. Now that the distribution among the sexes is similar some of these perceived advantages may disappear.

    Several other areas deserve some consideration as as far as advantage.

    Minute clinic type of operations in some states may preferentially hire NPs due to supervision requirements.

    ER - is another case where there is a potential advantage for PAs. ACNPs have declared that emergency care is part of their domain. However ACNPs cannot see pediatric patients. In larger ERs with pediatric and adult sections this is not a problem. In smaller ERs it may be. PA school also emphasizes skills such as suturing that are beneficial in the ER (although there is no reason that an individual NP cannot learn these).

    The ER problem also points out a problem that commonly occurs in private practice. That medical practice frequent spans multiple nursing domains. The problem with adult and pediatric PAs is not isolated to EM. It also occurs in various specialty practices. There is also a question about the use of ACNPs in non acute setting, especially outpatient settings. There are two programs that I am aware of to address this; one a ANP/ACNP program and one a FNP/ACNP program. Neither of these really addresses the ER problem which may be solved at some point with a true ERNP program as has been discussed or a dual PNP/ACNP program (which would also solve problems in some smaller ICUs that take pediatric patients).

    Further thoughts

    David Carpenter, PA-C
    Sorry to disappoint, but there is an actually a speciality for NPs in emergency care http://www.uta.edu/nursing/grad/enp. You get your certification as ENP and are able to see all age groups.

    I don't see any big advantages over Np vs. PA. NPs can work in certain places that allow total independence, and PAs are able to do surgery, if one of these things is your biggest goal then follow that route.

    I would recommend to anyone that is already a nurse to get their NP, and anyone that wasn't already a nurse interested in being NP/PA to go the PA route (which I have counseled my med techs to do many times.)
  3. by   core0
    Quote from wtbcrna
    Sorry to disappoint, but there is an actually a speciality for NPs in emergency care http://www.uta.edu/nursing/grad/enp. You get your certification as ENP and are able to see all age groups.

    I don't see any big advantages over Np vs. PA. NPs can work in certain places that allow total independence, and PAs are able to do surgery, if one of these things is your biggest goal then follow that route.

    I would recommend to anyone that is already a nurse to get their NP, and anyone that wasn't already a nurse interested in being NP/PA to go the PA route (which I have counseled my med techs to do many times.)
    I bolded the important part:
    The Emergency Nurse Practitioner (ENP) Program prepares advanced practice nurses with the knowledge and skills needed to provide emergency and urgent health care services to individuals of all ages. Emphasis is on the management of acute illnesses, trauma, and/ or chronic unstable illnesses requiring immediate attention, stabilizing the individual's condition, and determining appropriate referral and follow-up care. ENPs provide care in ambulatory, urgent care, and emergency department settings. Graduates are prepared to be recognized as advanced practice nurses by the Board of Nurse Examiners and to take the Family Nurse Practitioner National Certification Examination through the American Nurses Credentialing Center or the Academy of Nurse Practitioners.

    The problem is that this is still a FNP certification and the competency for FNPs still clearly states that it is a primary care certification. It doesn't matter if you add extra hours to a primary certification, it is still that certification. If there was not a specialty certification it would matter less but ACNP competencies clearly state that emergency nursing is in their domain and FNP competencies clearly state they are primary care. I would think that a program in Texas would be especially aware of this, from the Texas BON:

    Q: I am authorized to practice in a particular specialty area. I want to expand my scope of practice to include a second specialty area. (Examples of this situation include but are not limited to: adult health expanding to include pediatrics, family practice expanding to include care of patients with complex psychiatric pathologies, and primary care expanding to include acute/critical care). Can I do this by completing continuing education activities specific to the specialty and working with another advanced practice nurse authorized in that specialty or a physician?
    A: There are finite limits to expanding one's scope of practice without completing additional formal education and obtaining the requisite authorization to practice in the additional role and/or specialty from the BON. When incorporating a new patient care activity or procedure into one's individual scope of practice, the board expects the advanced practice nurse to verify that the activity or procedure is consistent with the professional scope of practice for the authorized role and specialty and permitted by laws and regulations in effect at the time. For example, a women's health nurse practitioner or nurse-midwife who wishes to incorporate performance of colposcopies in his/her practice may do so without obtaining an additional authorization to practice from the BON because this activity is consistent with the professional scope of practice for those roles.



    There are a number of programs similar to this. I am continuously amazed that nursing schools allow programs to exist that have the potential to put there students at considerable legal risk. APN is truly caveat emptor in these cases.




    David Carpenter, PA-C
  4. by   ILoveIceCream
    Quote from core0
    Now that I have some sleep and can actually spell my name I will add a couple of other thoughts. Most of the perceived advantages are in the realm of training specific items. There is some thought that some of the perceived advantages may have been due to the male/female split between NPs and PAs. Now that the distribution among the sexes is similar some of these perceived advantages may disappear.

    Several other areas deserve some consideration as as far as advantage.

    Minute clinic type of operations in some states may preferentially hire NPs due to supervision requirements.

    ER - is another case where there is a potential advantage for PAs. ACNPs have declared that emergency care is part of their domain. However ACNPs cannot see pediatric patients. In larger ERs with pediatric and adult sections this is not a problem. In smaller ERs it may be. PA school also emphasizes skills such as suturing that are beneficial in the ER (although there is no reason that an individual NP cannot learn these).

    The ER problem also points out a problem that commonly occurs in private practice. That medical practice frequent spans multiple nursing domains. The problem with adult and pediatric PAs is not isolated to EM. It also occurs in various specialty practices. There is also a question about the use of ACNPs in non acute setting, especially outpatient settings. There are two programs that I am aware of to address this; one a ANP/ACNP program and one a FNP/ACNP program. Neither of these really addresses the ER problem which may be solved at some point with a true ERNP program as has been discussed or a dual PNP/ACNP program (which would also solve problems in some smaller ICUs that take pediatric patients).

    Further thoughts

    David Carpenter, PA-C
    In Psychiatry, also, it seems that NPs (and CNSs with prescriptive privileges) may have an advantage over PAs.
  5. by   CraigB-RN
    Quote from wtbcrna

    I would recommend to anyone that is already a nurse to get their NP, and anyone that wasn't already a nurse interested in being NP/PA to go the PA route (which I have counseled my med techs to do many times.)
    That dogmatic approach may not be doing anyone of hte of the techs a favor. The skills, personality, education base all play into the decision as to NP vs PA. It's an education choice based on all the factors that have been stated here.

    I send people to both programs. Personlly right now I'm carefull about advising on NP programs due to the potential changes in the proffesion. BON's are looking at scope of practice issues and I personally don't want to get cought in the middle. MY FNP/ACNP will hopefully cover me for a few years, but I'm pretty far along. New people/Young people, I'm not so sure, the PA preffesion is pretty stable in it's scope of practice. THen again I may just stop and get a PhD in underwater basket weaving.

    Like any prof it's a choice and needs to be made with open eyes and as much data as possible.
  6. by   amzyRN
    Quote from CraigB-RN
    That dogmatic approach may not be doing anyone of hte of the techs a favor. The skills, personality, education base all play into the decision as to NP vs PA. It's an education choice based on all the factors that have been stated here.

    I send people to both programs. Personlly right now I'm carefull about advising on NP programs due to the potential changes in the proffesion. BON's are looking at scope of practice issues and I personally don't want to get cought in the middle. MY FNP/ACNP will hopefully cover me for a few years, but I'm pretty far along. New people/Young people, I'm not so sure, the PA preffesion is pretty stable in it's scope of practice. THen again I may just stop and get a PhD in underwater basket weaving.

    Like any prof it's a choice and needs to be made with open eyes and as much data as possible.
    You mentioned the stability of scope of practice of PAs. Do you think that NPs scope of practice will change in light of the DNP thing? I don't want to bring up that topic, but am curious as to what you mentioned about scope of practice. Thanks so much for the info and insight, I really appreciate it,
    J
  7. by   CraigB-RN
    I wasn't as clear as I should have been in my earlier comment. By the stability I was talking about how Boards of Nursing are looking at scope of practice issues for the different specialty area's. I figure some of that will settle out over the next couple of years. You also have specialty areas like the ACNP who as they develop as a specialty that are taking over some of the responsibilities that the FNP's had, ie, inpatient medicine. People who go into a specialty area with certain expectations just need to be more aware of how the specialty area is developing, or thy are opening themselves up to some disapointment.

    The transition to the DNP which is in my opinion pretty much a done deal, unlike things like the ND which had pretty much disapeared, is something else to be aware of. There may or may not be any backlash from the medical community for this.

    Like the old world curse goes "may you live in interesting times" this is one of those for the proffesion. All these things need to be considered when someone is making a career desicion.
  8. by   amzyRN
    Quote from CraigB-RN
    I wasn't as clear as I should have been in my earlier comment. By the stability I was talking about how Boards of Nursing are looking at scope of practice issues for the different specialty area's. I figure some of that will settle out over the next couple of years. You also have specialty areas like the ACNP who as they develop as a specialty that are taking over some of the responsibilities that the FNP's had, ie, inpatient medicine. People who go into a specialty area with certain expectations just need to be more aware of how the specialty area is developing, or thy are opening themselves up to some disapointment.

    The transition to the DNP which is in my opinion pretty much a done deal, unlike things like the ND which had pretty much disapeared, is something else to be aware of. There may or may not be any backlash from the medical community for this.

    Like the old world curse goes "may you live in interesting times" this is one of those for the proffesion. All these things need to be considered when someone is making a career desicion.
    So do you think that b/c AP nursing is so specialized the scope of practices would vary among specialties where as PAs being generalists would have a broader scope. And is the DNP supposed to equalize the scope of practice among NPs? I really appreciate your input, thanks much,
    J
  9. by   CraigB-RN
    Not a broader scope, just a more sable one at THIS time. And I emphasise, at this time. From my perspective, it's all just part of the picture when making career desicians. If your only goal is to work in a rural health clinic or family practice clinic, then it realy doesn't matter much. On the other hand if your planning on having LOTS of options, then the generalist aproach may be the best bet. As far as Clinical practice goes, neither is better than the other. One of the things that I'm always concerned about, is that it's the BON that regualates the APRN practice. Now remember that the BON isn't there to make your life easy,it's there to protect the residents and visitors of the state your in. But just think back on all the seemingly strange things taht have come out of BON's over the years.

    As to the DNP making a difference, I really don't hink it's going to make a difference in the whole scheme of things. Unless someone can break the reimbursment bottle neck, not much is going to change. No more money, at least not measureable, No more recognition, no increase in the scope of practice. Education is a good thing, and I know that I"ll be doing the Doctorate thing sometime in the future, but I'm still out on what it will be in. I'm actually ready all the DNP stuff now, and not just using what I read here. The origional idea/concept is actually pretty good. But like everything in nursing, the reality is open to interpretation someway.

    I'm not making a statement one way or another which is better. I can't or my wife PA would slap me silly. :spin: But I've been a nurse for way to long to be blind to the problems that are inherant to the proffesion. The arguments about holistic care, and such, don't realy seem to stand up much in my opinion. A primary care provider is a primary care provider. They can all fall into the $$$ mode were you make more money buy seeing more patients, when that happens, holistic/whole body treatment goes out the window. I laugh when I say that one of the best NP's I know is a PA.

    All I know for sure is that I can't type or spell.
  10. by   prairienp
    Quote from craigb-rn
    as to the dnp making a difference, i really don't hink it's going to make a difference in the whole scheme of things. unless someone can break the reimbursment bottle neck, not much is going to change. no more money, at least not measureable, no more recognition, no increase in the scope of practice. education is a good thing, and i know that i"ll be doing the doctorate thing sometime in the future, but i'm still out on what it will be in. i'm actually ready all the dnp stuff now, and not just using what i read here. the origional idea/concept is actually pretty good. but like everything in nursing, the reality is open to interpretation someway.
    the more i think about this the more i feel this is the way to proceed. with more education in policy dnps may make that difference. with the dnp we are already getting a lot of attention, at least more people have heard of the dnp who never heard of the np before. i have always felt good things happen to good people, i really think nps are good people with good intentions, thus maybe we will have a good outcome.
    all i know for sure is that i can't type or spell.
    i have to agree with you on this point!
  11. by   ANPFNPGNP
    I can tell you that the scope of practice for NP's is very limited in Texas. I just completed a post-Master's FNP program at UT (I was already a NP), and my professors told us that the TX BON is really coming down on NP's who are practicing outside their specialty. For instance, we were informed that 17 FNP's had been practicing at Texas Children's Hospital, but they were all fired when the TX BON found out about it. We were specifically told that we were NOT allowed to work in the hospital setting, although we could work in the ER fast-track area.

    I checked with the TX BON about this and I was told that I could work in the hospital as an Adult NP, since my program contained an "Acute Care" component that required us to train in the hospital setting. However, I was told that I couldn't work in the ICU. The person I spoke with told me that FNP's were specifically trained to work in primary care and that's it. Another area the TX BON is concerned about is psych. It appears that several FNP's are working for psychiatrists, yet this is outside their scope as well. Supposedly, the BON has had so many complaints/questions about this issue, they are sending a letter to all the APN's in TX within the next few months.

    p.s. the scary part is that if there's a malpractice suit filed against a NP practicing outside their scope, their insurance company won't pay the claim! The collaborating physician will then get nailed BIG TIME! BE AFRAID...BE VERY AFRAID!
  12. by   djc1981
    as i see it, the entry level dnp couldn't hurt the profession at all. we'd be on the same educational level that pharmacists and physical therapists are on. sure, the money and scope probably won't change all that much, but i do think there will be more respect there. and we will be dr. (so and so), np. the pa's will be scrambling to come up with a dpa program (if they haven't already started)....its going to drive many of them crazy that we will have higher degrees! they'll be upper midlevels and lower midlevels (jk!) isn't it funny how the entire medical community is like a microcosm of society and class structure?! :chuckle
  13. by   core0
    Quote from djc1981
    as i see it, the entry level dnp couldn't hurt the profession at all. we'd be on the same educational level that pharmacists and physical therapists are on. sure, the money and scope probably won't change all that much, but i do think there will be more respect there. and we will be dr. (so and so), np. the pa's will be scrambling to come up with a dpa program (if they haven't already started)....its going to drive many of them crazy that we will have higher degrees! they'll be upper midlevels and lower midlevels (jk!) isn't it funny how the entire medical community is like a microcosm of society and class structure?! :chuckle
    yes this just drives the pas crazy. what ever will we do. oh yeah we'll just have to fall back on 40 years of proven clinical competency regardless of the degree given. this is one of the basic differences between the professions. one is based upon clinical competency in relation to a shared academic environment regardless of the degree. the other is based on academic achievement with little shared academic achievements.

    for your information there is already a dpas program. it is a post graduate program. the entry requirements are fairly simple. you have to be a member of the us army, you have to have served between 6-10 years with excellent fitness reports, you have to have served one combat tour (currently) and you have to be selected for one of four slots out of 100 applicants. this enables the pa to attend a full time (40-50 hours per week) clinical and didactic course in emergency medicine. original research and publication is expected.

    given the number of nps that were disenfranchised by the move to the masters, i'm not sure why you would consider this a good thing. the pa profession has looked at this extensively and found that in the pa world the move to a masters is associated with higher gpa but less prior health care experience. this is also associated with less willingness for the pa to work in rural or underserved areas and decreased ability to provide instruction in rural areas. all of these concerns are increased with a movement to a doctorate.

    finally if you want to consider yourself an "upper midlevel" go ahead. i have been a provider for seven years. i have never been midlevel at anything. a patient that sees me can expect the same level of care and competency as any other provider. i have never been "mid" at anything that i do.

    david carpenter, pa-c

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