Interesting Physician Perspective On NPs

Specialties NP

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I am not an NP. I am a full time rapid response nurse at a teaching hospital. This morning I stopped in to residents office to update the night residents on what had happened with their patients and what I had done. They were in the middel of sign out to the day team including several interns, residents, the chief resident and the attending. After I was done an intern speaks up and says "PMFB you should become a PA!". This was met with a rousing round of "NOooos" & "no way!" from the residents and attending. The intern looked confused. The chief resident leans over to her and says "PAs are at the bottom of the medical word. PMFB should become and NP, they are at the top of the nursing world".

The attending and other residents all readily agreed. I thought it was an interesting insight into physician thoughts about mid levels.

On the other hand I'm not sure NPs and PAs should be lumped together.

How come ?

Specializes in FNP, ONP.

FWIW, I don't live in the NE.

As my family's finances are secure and retirement assured irrespective of our present and future income, we are no longer motivated by salary or cost of living issues, per se. We would never choose to live in any state that didn't allow NPs full independent practice and legally provide parity to my physician colleagues. I would never opt to work alongside colleagues that did not treat me as an equal in every way.

I do not use the term "midlevel." I always take the extra millisecond to say "nurse practitioners and PAs" when I want to make a statement intended to be inclusive of both professions. That said, I certainly do not object to NPs and PAs being "lumped together." I do feel somewhat badly for PAs; I think it is unfortunate for the group that they are precluded from practicing to the full extend of their education and training. I hope that changes in the future, and I think if there is anyway NPs can help PAs obtain any measure of autonomy we ought to do so. However, we have not yet even been able to free our own members from the chains in states in (ahem) certain parts of the country that I guess it is politically incorrect to specify, lol. Until we can get our own profession straightened out, we are in no position to assist out PA brethren!

Specializes in Psychiatric Nursing.

I think there are only 13 states where a APRN can practice independently. So we are like PA's in most states regarding mandatory physician involvement. I bet the more restrictive states for NP's are also more restrictive for PA's...

How come ?
For one, IMHO, NPs have more of a leg to stand on regarding Independent practice. NPs are advanced practice nurses whereas PA's are by design assistants. Beyond that and dispite the interchangeable roles (in most instances), I think there is some value in keeping NPs a separate breed.
I think there are only 13 states where a APRN can practice independently. So we are like PA's in most states regarding mandatory physician involvement. I bet the more restrictive states for NP's are also more restrictive for PA's...

It really depends on the state. Even in one of the states that isn't part of the 13 that grant complete independence, the NP rules can still be pretty darn loose (especially compared to PAs)... a significant number only require a "collaborative agreement" (whatever that is) between NPs and docs. It isn't independent practice completely, but it certainly is a lot freer than what many PAs must put up with.

That's a good point. In some states a collaborative agreement just means that the Physician will answer the NPs call if he/she has a question.

Specializes in Psychiatric Nursing.

Besides the states, the scope of practice of NP,s/PA's is likely also influenced by politics and the employer. I worked for a while as a staff nurse on a busy detox floor in a NY hospital. The hospital did not employ NP,s, only PA's.. On my unit, the PA,s wrote all the orders. They worked from detox protocols which they modified and they also treated concurrent medical conditions. There was an attending. He would come to the unit and sit in the nurses station for brief periods of time, one /day during the week and on weekends there was a moonlighter who did the same thing..I think the PA's called the attending sometimes... There was a range of competence with the PA's..the good ones were excellent...the not so good ones listened to the nurses!! The attending had three units.. He may have signed charts but I don't think he ever saw patients..

This is a little off topic for where the thread has gone most recently, but back to the original idea, there is a pecking order for MDs/DOs too (actually don't all MDs pretty much think they are better than all DOs?) and between specialties, I have heard many a FP physician lament the lack of respect/pay they receive.

I think this NP vs PA thing is ridiculous. My husband is a PA, and wonderful at his job. I am amazed at the breadth of his knowledge and his comfort working in a rural ER without a physician readily at hand (only available by telephone). Although I am supposed to be more independent, I wouldn't feel comfortable in his role, although there are probably plenty of NPs that would. My state gives NPs and PAs equally limited rights to practice and in fact the NP role is not legislatively defined and some physician advocacy groups in the state have suggested that NPs are practicing completely illegally even when bound up with all the regulations, collaborative practice agreements, etc.

As others said earlier on this thread, I don't think tearing down and belittling the PA profession builds us up in any way.

And to the previous poster who disseminated false information earlier, the Army PA program is a Masters program and has been for at least 6 years.

Specializes in Peds Med/Surg; Peds Skilled Nursing.
Not accurate, in 2 ways:

1) NPs do not need a doctorate, nor is there any timeframe which says they will need one. I'm quite surprised regarding the misunderstanding RNs and others here have regarding this topic. It was recommended that by 2015 Master's training programs start to offer DNP. But there is absolutely no requirement. Amazing how people are continually confused by this

2) True, you can enter PA school with any degree, but most enter with a science degree. And here's why. The prerequisite list is very heavy! Heavier than medical school in many cases. Keep in mind, you can also enter medical school with any degree. Here is the prereq list from my PA school:

[TABLE]

[TR]

[TD]Human anatomy*[/TD]

[TD]4[/TD]

[TD=width: 324]Biochemistry[/TD]

[/TR]

[TR]

[TD=width: 188]Human physiology*[/TD]

[TD=width: 120]4[/TD]

[TD=width: 324]Cellular biology[/TD]

[/TR]

[TR]

[TD=width: 188]Genetics[/TD]

[TD=width: 120]3[/TD]

[TD=width: 324]Human sexuality[/TD]

[/TR]

[TR]

[TD=width: 188]Psychology[/TD]

[TD=width: 120]3[/TD]

[TD=width: 324]Immunology[/TD]

[/TR]

[TR]

[TD=width: 188]General chemistry*[/TD]

[TD=width: 120]8[/TD]

[TD=width: 324]Medical terminology[/TD]

[/TR]

[TR]

[TD=width: 188]Organic chemistry*[/TD]

[TD=width: 120]4[/TD]

[TD=width: 324]Pharmacology[/TD]

[/TR]

[TR]

[TD=width: 188]Microbiology*[/TD]

[TD=width: 120]4[/TD]

[TD=width: 324]Spanish[/TD]

[/TR]

[TR]

[TD=width: 188]College algebra or higher[/TD]

[TD=width: 120]3[/TD]

[TD=width: 324]Statistics[/TD]

[/TR]

[/TABLE]

Let us strive for accuracy when making comments. We would only expect the same when taking care of patients.

I took all these classes for my BSN (except immunology) and they were required before applying for my NP program. So the education is similar.

Specializes in Internal Medicine.

It's incredible how anecdotal this whole thread is, with opinions on all sides by lots of folks that aren't NP's or PA's.

Anyone that has had a few years of nursing under their belt will tell you stories about great NP's and PA's that they've worked with who loved their jobs, and they will also tell you about NP's or PA's that weren't that good or they hated their job.

The fact is, outside of a quarter of the states in this country, where NP's essentially operate like General Practice physicians, PA's and NP's work in a very similar roll, and any professional advancement done on a state level by either group needs to be with the help of the other. While many of us might understand the differences between the two professions, a huge chunk of politicians don't and group us together when drafting laws. It's up to all of us to advocate for each other as we all do important work in the field.

Specializes in ICU hopeful!.

I know this thread is a little dead but I wanted to add a coment re: the South, cost of living, and low salaries.

AZ and NM are both indy practice states with equally low, if not lower (esp. AZ) cost of living than the SE. Also high salaries.

Sad, because I love the south and would love to live there but as a future PMHNP hopeful, I've just completely crossed it off my radar.

Specializes in med-surg, psych, ER, school nurse-CRNP.
I know this thread is a little dead but I wanted to add a coment re: the South, cost of living, and low salaries.

AZ and NM are both indy practice states with equally low, if not lower (esp. AZ) cost of living than the SE. Also high salaries.

Sad, because I love the south and would love to live there but as a future PMHNP hopeful, I've just completely crossed it off my radar.

That's a shame...we're looking to expand my practice, and if Alabama was to your taste, that might have been a great fit!

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