Why NP and not PA?

Specialties NP

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I'd appreciate all your input! I've been a research nurse for 5 years and have always had an interested in midlevel work and am ready to pursue. I'm having a hard time deciding which route to go. I've talked to both NPS and PAs. Many of the PAs from my clinic were nurses. I hear more negatives about the job from NPs than I do PAs. The floor was not a good fit for me. It's hard to explain, but I'd say I didn't like the technical aspects at all (hanging blood, fluids, giving meds etc). I liked the monitoring and assessments and teaching. I also like it when my coworkers come to me and report labs out of range, or what they should do in certain situations that are not always clear. I like to direct the care and I feel I'm more confident in that than I was hanging blood. I think it's the equipment that makes me nervous, to be honest!! Since I have limited hands on experience, do many of you NPs out there think the PA route would be better for me? I've already read the threads about PAs and RNs going to NP school without experience. Appreciate your time to read this. Many thanks....

Specializes in Pulmonology/Critical Care, Internal Med.

Thanks Jeremy,

Didn't know that either. Lots of things I'm learning here. Are you by chance a NP? If so what type, and do you do surgery?

one thing to keep in mind is that most if not all states have rules or advisory concerning the practice RNFAs. It is possible to be a NP and function as a RNFA in an area outside of your NP cert, as long as you meet the requirements for RNFA practice. So an adult NP could hypothetically first assist peds surgery. It is the preop and postop care that will use the NP license. But if you look at AORN guidelines they allow RNFAs to participate in the preop and post op care (so rx might be the only sticky point). Acute NPs are still a new creature in the midlevel arena compared to other NPs or PAs. If I wanted to work ortho I would consider the np residency in ortho to facilitate this.............Jeremy
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Thanks Jeremy,

Didn't know that either. Lots of things I'm learning here. Are you by chance a NP? If so what type, and do you do surgery?

I am a NP, I started off as a RNFA then finished up my NP education. I work as a NP for a radiology group where I do some first assisting, some procedures solo, and see patients in clinic/hospital.

A RNFA is limited in the employment choices, with the inability to bill medicare. NPs and CNS can bill medicare for first assisting, but this is missing in the vast majority educational programs. One hospital I practice out of has credentialing for NP, NP first assisting only, RNFA, or full NP scope with first assisting added (must complete a RNFA program). My other hospital includes first assisting with standard credentialing for NPs and PAs.

Take a look at the states you are wanting to work in... see how they define the practice of RNFAs and NPs. In one state I am licensed in I can only practice within national guidlines, the other two allow me to do what I am trained in (can show competency and didactic/clinical experience). Depending on the state you might be better with a ACNP or FNP... There are not FNP/RNFA combined programs so if you are really interested in that take a look at the state laws, regulations, and the diffrent educaition programs.

Jeremy

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Do any of you folks know who has greater job satisfaction - PAs or NPs? Do PAs and NPs tend to have choice in scheduling (e.g., 8/10/12). I also wonder if PAs and NPs working for a medical practice might have greater access to training vs. those working directly for a hospital.

I recently read an article that said the need for PAs and NPs in medical practices are increasing as doctors abandon the field because of medical malpractice suits, etc. Makes me wonder who will bear the ultimate responsibility for an error. I guess it would be case by case?

Based on what I have seen as a nurse assistant, I think I would rather be a PA. I would rather bypass working as an RN on the way to NP. I think NPs have phenomenal experience to draw upon. But I think that when you work as an RN in the hospital - especially at entry level - you are underpaid. I have seen too many stressed out RNs in the hospital. I think hospitals could be great places to learn in. But I don't think so when you are working with too many high-acuity patients and too little staff. --In a nutshell, I am really leaning toward becoming a PA rather than an RN and then an NP. I still have more research to do. Thank you to all of you, esp. the OP.

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do any of you folks know who has greater job satisfaction - pas or nps? do pas and nps tend to have choice in scheduling (e.g., 8/10/12). i also wonder if pas and nps working for a medical practice might have greater access to training vs. those working directly for a hospital.

i think it completely depends on the market. where i was, pas almost always worked for private practice and there wasn't shift work. we could do some nice schedules (4 10s with three day weekends twice a month for example), but the schedule had to be covered. a lot of the nps worked either part time or shift work for hospitals. the university system there which is almost completely pas has a lot of shift work.

from a training standpoint, there is more incentive in private practice to quickly get you up to a competent level. on the other hand once you reach that level there is little reason to do other training unless you can show it brings in more $$$. in university settings there is not the emphasis on initial training, but there may be more opportunities in other areas. for example most of the np/pas doing endoscopy are doing it in a va or university setting.

i recently read an article that said the need for pas and nps in medical practices are increasing as doctors abandon the field because of medical malpractice suits, etc. makes me wonder who will bear the ultimate responsibility for an error. i guess it would be case by case?

both pas and np are being named in more lawsuits. this is a nationwide phenomenon. there are some theories it is because of greater numbers, others believe it is tied to the pain and suffering restrictions.

based on what i have seen as a nurse assistant, i think i would rather be a pa. i would rather bypass working as an rn on the way to np. i think nps have phenomenal experience to draw upon. but i think that when you work as an rn in the hospital - especially at entry level - you are underpaid. i have seen too many stressed out rns in the hospital. i think hospitals could be great places to learn in. but i don't think so when you are working with too many high-acuity patients and too little staff. --in a nutshell, i am really leaning toward becoming a pa rather than an rn and then an np. i still have more research to do. thank you to all of you, esp. the op.

the decision should be multi factorial. there are advantages to both. you have to look at the area that you want to work in and what the community you want to work in uses. i will say that on a bang for the buck basis the adn from a community college is one of the best values in healthcare.

as far as who has the greater job satisfaction, most surveys show good satisfaction in both. i will say that approx 2/3 of those trained as nps are working as nps while 85% of all pas ever trained are working as pas. the reality probably has more to do with relationship between rn and np pay than job satisfaction.

david carpenter, pa-c

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"i will say that approx 2/3 of those trained as nps are working as nps while 85% of all pas ever trained are working as pas. the reality probably has more to do with relationship between rn and np pay than job satisfaction."

do you think that this (2/3 of nps working as nps) also has to do with job availibility and salary? it is my understanding that in some places (northern cali particularly) it is easier to find an rn position than an np position. it also seems that many rns are getting paid better. is this common in many other places throughout the country?

rns around here, new grads included, are starting off with higher salaries than a lot of np listings i have seen. ... actually, i don't see that many np listings, and have read on these boards that our market is saturated with them. it seems that the np listings are often times for low income, or nonprofit, clinics, and the starting salarys are low. i can see the temptation in finding an rn position, where as the pa does not have that option, unless he/she is an rn.

this is of concern to me as i am starting a de msn fnp program. the fact that i will have the rn (job security) is the main reason that i chose the fnp program over a pa program, even though i have completed the prereqs for both programs.

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"i will say that approx 2/3 of those trained as nps are working as nps while 85% of all pas ever trained are working as pas. the reality probably has more to do with relationship between rn and np pay than job satisfaction."

do you think that this (2/3 of nps working as nps) also has to do with job availibility and salary? it is my understanding that in some places (northern cali particularly) it is easier to find an rn position than an np position. it also seems that many rns are getting paid better. is this common in many other places throughout the country?

rns around here, new grads included, are starting off with higher salaries than a lot of np listings i have seen. ... actually, i don't see that many np listings, and have read on these boards that our market is saturated with them. it seems that the np listings are often times for low income, or nonprofit, clinics, and the starting salarys are low. i can see the temptation in finding an rn position, where as the pa does not have that option, unless he/she is an rn.

this is of concern to me as i am starting a de msn fnp program. the fact that i will have the rn (job security) is the main reason that i chose the fnp program over a pa program, even though i have completed the prereqs for both programs.

i think that there are a lot of factors at work. the first being that in a lot of markets, starting np salaries are less than experience rn salaries. also specialty practice pays better than primary care and fnps at least anecdotally are being shut out of that track. last, depending on the market rn salaries are pretty close to np salaries even with experience. i have seen a few nps take jobs and come back to nursing after discovering that there is a lot more responsibilities with no increase in pay with the np.

you also touch on another difference between pa and np. nps can fall back on the rn license for a job. in the medical field there is nothing for a pa to fall back on. it pretty much requires the pa to find a pa job. good or bad is up to you to decide.

like the pa field, there are jobs out there for nps. the issue is are you willing to relocate or take a less than perfect job to get experience.

david carpenter, pa-c

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Specializes in Infection Preventionist/ Occ Health.

Thanks to everyone for the helpful information. I am learning a lot from this thread.

In my area, most job postings are for a PA or NP, and midlevels are considered interchangable by most health care organizations. The main exception is in surgical services, where you predominantly find PAs. Having no interest in surgery, I considered both options. It came down to the fact that the PA program in my area required full-time attendance and had very high tuition rates. By comparison, I have completed (or will complete) most of my RN and NP education on a part-time basis at a public institution. I also like the fact that nursing offers doctoral degrees and opportunities for independent research, two things that I may be interested in down the road.

On the flip side, the PA program in my city has a nearly 100% placement rate, while I know quite a few NPs who are working in other positions (nurse educator, unit-based APN, nursing instructor, etc.) Whether this is because the NPs are struggling to find suitable positions or simply prefer to work in other areas is questionable.

Thanks again to David and Jeremy!

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