Nursing Specialties leading to Nursing Practitioner vs Physician Assistant

szeles23 · Aug 21, 2011

Nursing assistants will not replace Physician's assistants, at least not here in the US. A phys. asst. (PA) functions like a Nurse practitioner here. Nurse assistants are usually nurses aide's (CNA's) etc. The main difference between a PA and an NP is that in many states an NP can have their own practice, whereas, a PA always has to practice under a licensed MD/DO.

Many NP programs require you to have at least 1 year of experience as an RN, some even require more, like 2 years, or require acute care experience. It all depends on the program you are looking at. One note to consider is that by 2015 the ANA theoretically wants NPs to become DNPs, doctor of nursing practice, in order to work independently. According to my school this change will happen in or around 2015, so that might influence your decision as well. Most PA schools are 24-27 months but are highly competitive, like CRNA schools, NP schools etc etc. Hope this helps.

foreverLaur · Aug 23, 2011

NPs are advanced practice nurses and PAs complete something best described quikckly as "mini medical school." One follows the nursing model and one follows the medical model. NPs specialize via education and cannot change to another area without further education. PAs are generalists who can specialize by doing a 1 year residency or by on the job training but can change areas without extra schooling. Both are around 2 years post-bachelors. NP programs require you to be a RN with a BSN and some specialties require specific work experience. PA school may require direct hands-on patient care experience and prerequisites similar to medical school.

In the end, PAs and NPs have different approaches and backgrounds but their job duties and responsibilities are very very similar. Although there are always exceptions, PAs tend to be more hospital based and NPs tend to be more primary care based.

It just depends on what you want to do. Do you want to practice nursing or practice medicine? Do you want to work independently in a primary care setting or do you want to work collaboratively with a healthcare team in the hospital? Even NPs in the hospital setting will work collaboratively with a healthcare team. The one thing that PAs can do that NPs cannot is surgery. A lot of PAs will be first assists in the OR. NPs cannot operate without also becoming RNFAs and, at least in my area, they aren't used.

I would recommend looking up some NP programs and PA programs and looking at the curriculum to see which one looks more appealing to you. I would also look at job postings in the areas you want to work and see what your area seems to favor.

cmw6v8 · Aug 23, 2011

Just want to share my experience w/ NPs and PAs: when I worked on a hospital unit this summer for an externship, the NPs and PAs were equals--they had the exact same job responsibilities as a mid-level provider. That said, an NP would also be suited for advanced nursing roles in a clinic/primary care or another outpatient specialty, whereas I believe PAs are not always utilized in those settings.

ImThatGuy, BSN, RN · Aug 24, 2011

I want to start out in the ER and start working immediately on non-clinical courses for a master's degree. Right now, I'm wanting to focus on being a psych NP. I realize working in a psych area would be beneficial, but I don't want to move to any of the places in my state that have dedicated psych units when I finish school. There's a nearby addictions unit I could work in where the nurses will tell you "we don't do crap," but I think with my background and my sporadic excess of energy that the ER will fit me better.

I see the Canadian flag by your name. I didn't know that PA's were in wide use in Canada. Of the two, I'd rather be a PA if I were just starting out again, but I'm not moving anywhere to go to school for it nor am I willing to go to school to be a PA due to the length or rigor. The master's nurse courses I mentioned above are ALL online through my state's flagship university. Even basic nursing is a career change for me.

nurseprnRN, BSN, RN · Aug 27, 2011

"just want to share my experience w/ nps and pas: when i worked on a hospital unit this summer for an externship, the nps and pas were equals--they had the exact same job responsibilities as a mid-level provider."

as a clarification, do not think that because you observed them to do many of the same tasks that they had the same responsibilities. they are certainly not "equals." a pa is not a "mid-level provider." s/he is a "physician assistant."

most (not all) physician assistant programs require applicants to have previous health care experience and some (maybe) college education. an advanced nurse practitioner has earned a master's degree in nursing and takes extra coursework for prescriptive authority (prescribes medications).

the pa is not licensed to be an independent, autonomous professional and cannot have his/her clinical judgment stand alone; s/he must, must practice under the license of a physician.

the advanced nurse practitioner has a license that grants the right (and in most cases, the obligation) to be personally responsible for his/her own professional judgment and practice.

therefore, the advanced np can practice without physician colleagues in many, many settings. the pa can never do that. that's a huge difference in responsibility right there.

lovescoffee · Sep 7, 2011

On another note, most people I know that did NP were able to do so and work as an RN at the same time; many even full-time. PA however, I believe is a full-time program that highly suggests you not to work at all (though I'm not 100%).

I have worked ER and ICU, and though both are critical care I found them quite different. On a regular basis the ER was much more fast paced with very high turn over. I enjoyed not having the same pts all shift! I didn't do trauma, but we were a STEMI & stroke center so LOTS of those!

After switching to ICU I felt like I knew nothing all over again! I was forced to know many things way more in depth, which I loved! I always preferred the getting the sicker pts/ 1:1 pts, and on slow nights I really missed the ED.

I would see if you can at least shadow in the units you are interested in. That could also help you network for a job later. Warning: try not to be intimidated if you haven't been in a critical care unit before, it can be a bit overwhelming until you get in the swing of things :bugeyes:

GOOD LUCK!!!

AnxiousRNtobe · Oct 17, 2011

as a clarification, do not think that because you observed them to do many of the same tasks that they had the same responsibilities. they are certainly not "equals." a pa is not a "mid-level provider." s/he is a "physician assistant."

most (not all) physician assistant programs require applicants to have previous health care experience and some (maybe) college education. an advanced nurse practitioner has earned a master's degree in nursing and takes extra coursework for prescriptive authority (prescribes medications).

the pa is not licensed to be an independent, autonomous professional and cannot have his/her clinical judgment stand alone; s/he must, must practice under the license of a physician.

the advanced nurse practitioner has a license that grants the right (and in most cases, the obligation) to be personally responsible for his/her own professional judgment and practice.

therefore, the advanced np can practice without physician colleagues in many, many settings. the pa can never do that. that's a huge difference in responsibility right there.

pas are also mid-level providers and have their own license to practice as a pa. at my old job, the mid level provider label fell over nps, pa, cnm, psych np, all the non-md/do medical providers. in my state (michigan), nurses are licensed as rns and nps have an additional "specialty certificate" to practice as an np. pas just have a license to practice as a pa. neither np nor pa has to have a specific level of oversight, chart co-signature. both professions can prescribe schedule ii-iv (though both are limited to a one week supply of schedule ii). you are correct that pas have not been able to start their own practice, but a few have started around the country, but it is easier for nps to do so.

AnxiousRNtobe · Oct 17, 2011

I should add that PAs can practice in emergency rooms, family practice, surgery, hospitalist, psychiatry, pediatrics, geriatrics, pretty much anywhere except labor & delivery and neonatal where it's really NPs. Nurse practitioners have to pick a specialty before starting school and stay with it or add on another certificate.

nurseprnRN, BSN, RN · Oct 18, 2011

"i should add that pas can practice in emergency rooms, family practice, surgery, hospitalist, psychiatry, pediatrics, geriatrics, pretty much anywhere except labor & delivery and neonatal where it's really nps. nurse practitioners have to pick a specialty before starting school and stay with it or add on another certificate."

that's like saying once nurses pass the nclex they can practice anywhere. true, but so what? any beginner at a low level can do that. pas are lower-level practitioners, not remotely comparable to advanced nurse practitioners. again, do not conflate (or equate) tasks with roles.

aspiring nps pick specialties because at that point in their careers they have developed enough expertise to know their goals for advanced practice. this is in no way a limitation, no more than the unfortunate person who does a pediatric surgery residency cannot get work as a hospitalist. apples and oranges.

AnxiousRNtobe · Oct 18, 2011

that's like saying once nurses pass the nclex they can practice anywhere. true, but so what? any beginner at a low level can do that. pas are lower-level practitioners, not remotely comparable to advanced nurse practitioners. again, do not conflate (or equate) tasks with roles.

aspiring nps pick specialties because at that point in their careers they have developed enough expertise to know their goals for advanced practice. this is in no way a limitation, no more than the unfortunate person who does a pediatric surgery residency cannot get work as a hospitalist. apples and oranges.

i'm not going to get into a pa vs np argument because it's been done to death. in hospitals i've seen, pas and nps have done the same job in most departments. if you need to say that one is "lower level" then the other, that's your lack of awareness of pa training and responsibilities. good luck to op in making your decisions.

foreverLaur · Oct 18, 2011

"i should add that pas can practice in emergency rooms, family practice, surgery, hospitalist, psychiatry, pediatrics, geriatrics, pretty much anywhere except labor & delivery and neonatal where it's really nps. nurse practitioners have to pick a specialty before starting school and stay with it or add on another certificate."
that's like saying once nurses pass the nclex they can practice anywhere. true, but so what? any beginner at a low level can do that. pas are lower-level practitioners, not remotely comparable to advanced nurse practitioners. again, do not conflate (or equate) tasks with roles.

aspiring nps pick specialties because at that point in their careers they have developed enough expertise to know their goals for advanced practice. this is in no way a limitation, no more than the unfortunate person who does a pediatric surgery residency cannot get work as a hospitalist. apples and oranges.

a new grad np and a new grad pa are both mid-level providers. one is not superior to the other. you do realize that nps do not have to have work expeience as a rn, right? you could pull a construction worker off the highway and as long as he has taken some science coursework and has a bachelors in anything, that individual can become a np in 3 straight years and never work in a hospital before that. a bsn grad can go straight into a np program without ever stopping to work first. that obviously isn't true of everyone as some nps worked quite a while as a rn first. the same is true of pas. most pas have previous work experience as a medic, rn, rt, etc.

just because a np specializes in school, that doesn't mean that individual is ready to "fly solo" immediately upon graduation. there is still a big learning curve and a lot of on the job learning and training to be done. a np who decided to become an acute care np usually gets 600 clinical hours in graduate school. a pa has at least 600 "acute care" hours, plus another 1,400 in all the other areas.

you clearly have no idea what you are talking about.

new grad pa = new grad np = both mid-level providers. yes, states are now allowing nps to be independent. however, nurses have been around a lot longer than pas. pas will eventually follow down the same road, i am sure. unless a np opens up his or her own practice, they are working in the same capacity most of the time. just because a pa needs "physician oversight" doesn't mean that the supervising physician follows the pa around all the time. the pa works fairly independently. my acl repair was done by the pa that has been working with my orthopaedic surgeon for 25 years. the surgeon was on-site, but was not in the or.