NP VS PA

[TicTok411]

I have been asked why one over the other. I even had an early class assignment related to what makes an NP different or unique in the health care setting. I admit I struggled to really "get it".

In this last year I have worked with a lot more PAs and never really had much exposure to them prior in my career. A few have been really good but overall I just never felt that any of them "got it" or related well in the hospital setting when compared to the NPs I worked with..

Then, this week it hit me what the difference is. I had a patient driving me crazy and not to go into all the details - I had an NP make orders to help out without me even asking and she said "I know how it really is, I was an ICU nurse too".

So obvious and I never could see it! What makes an NP really different is our experience as a bedside nurse. Spending 12 or more hours in the rooms with the crazy patient or family. It seasons us to think differently than a PA ever could. The perspective changes how you approach something when you 12 hours fighting rather than just poke your head in for a minute or two. That is why the NP rounding is not looking her nose down at the bedside RN where the PA often comes across condescending.

I am not saying one is better than the other even though I would prefer an NP over a PA most days of the week. However, I finally understand in my little brain why one sees the patient different than the other. It also helped me feel really good about my decision to become an NP.

[Dranger]

It comes down to the individual. I have met some awesome PAs and NPs and some downright terrible ones. I have had condescending PAs who thought they knew more than they did and a new grad FNP who had 0 business rounding on progressive care patients but pretended like she did. Which is worse?

Empirically, PA education is on a whole stronger. There really is no denying that.

Everyone will have different anecdotes.

[Goldenfox]

When you become a practitioner, you're going to find that the only things that matter to your employer are the appropriateness of your clinical decision making skills and your productivity. Most of them won't care whether you are PA or an NP, as long as you know what you are doing. You're also going to find that, for the most part, you really don't see patient's all that differently from the way that PA's do: it's always a person with some patho going on, and you need a relevant and effective plan for an intervention.

Being successful as an NP means knowing how to handle yourself as a clinician without getting into the little patient/family-member dramas often associated with bedside nursing. I know exactly what you are talking about, but as an NP, and especially in acute care, you have to be aware that your role as a clinician is different from what you did as an RN. Its important to have good bedside manners and all that, but you have to stay on point with your assessments and explaining your plan of care, address their concerns, then move on. The RNs who are assigned to take care of the patients at the bedside are professionals; they can offer supplemental information that the patient or family members want. I let them do their jobs. If they need additional orders they will call. If you stay there and get involved in stuff and long conversations you're going to fall behind, and your other patients who are waiting on you won't be happy---and you're not going to be happy with yourself at the end of the day when you've got a whole bunch of charts to review and sign off and a lot more documentation to do, and don't forget that if you're working in an acute care hospital people will constantly be calling you about one thing or another.

I've worked with many PA's, and I assure you that they can smile and do all the touchy-feely, nicey, chatty stuff too. But one can only go so far with these things before they begin to distract and detract. This isn't about being condescending, it's about being objective and professional. You have to balance it.

[anh06005, MSN, APRN, NP]

I agree with Dranger that it is very individual but I also agree that NP's with a decent amount of bedside experience have a different take on patient issues.

I am FNP and if my nurses are busy taking care of phone calls and checking patients in I will do my own strep or flu swab. Do my own UA. I want to keep things going smoothly and I know they are busy also. I'm not sure if my MD or PA coworkers would do this. Some, maybe. Other, no. I have seen joint injections done and the MD left saying the nurse would come back to wipe the betadine off the knee. I was amazed.

I do sometimes wish I'd done PA for the "mini Med school" experience rather than nursing theory and research but at the time I started school that wasn't an option. I'm happy where I'm at. Once we graduate and get in a clinic we are pretty well equal in my state. I make good money and only have one small loan from school. At least as FNP I do have the possibility of independent practice if legislation in my state changed.

[cayenne06, MSN, CNM]

I work with PAs, NPs, other CNMs, and MDs. Of course there are widely differing personalities, with some of us more touchy feely and others not so much, but I don't think you could pick out any "type" of clinician based on their patient interactions. We all try our best, and care a lot about our patients. Sometimes our thought processes and priorities are different, maybe based off our educations and work experiences. I definitely practice in a way that reflects my long background in family-centered maternity care, but I do not consider myself more "caring" or patient-focused than anyone else.

Maybe I've been lucky, but the physicians I have worked with never hesitate to grab a cup of water for a patient, or take their own vitals or whatever. I LOVE my docs. I can call them for anything, and they never hesitate to offer me cheerful guidance or advice. And never treat me as anything less than a full colleague.

[guest939210]

Goldenfox, I would like to be your best friend! Very wise words and truth. Does anyone ever do an offshoot of this forum for more specific support for APN's.....hint hint Goldenfox.

[elijahvegas, ASN, RN, EMT-P]

a major difference between nurse practitioners and physicians assistant is the model by which they are trained. np's are trained in a nursing model, so it is taught to treat the patient as a whole, which includes their mental health and well being as well as their ailments. PAs on the other hand are taught under the medical model like MDs. They are heavily trained in procedural treatment, medical, labs, etc. They treat symptoms, and don't look at the patient the way a nurse would.

Of course in practice, it comes down to the type of practitioner you want to be. Not all PAs are the same, and not all healthcare professionals are created equal. But i've noticed the subtle difference between their approaches before long.

[AllIcanbe]

.. And I am very sure of one thing.. This thread aint leading no where.. Deadhorse; cpr unsuccesful!

[ritit123]

.. And I am very sure of one thing.. This thread aint leading no where.. Deadhorse; cpr unsuccesful!

I think its really important to discuss different roles within the heath care setting. As a bedside nurse I often find my self feeling resentful toward PA/NP who would come strolling in with their differential diagnosis, etc. Then, when I became an NP student, everything changed. The benefit of MD's, PA's, NP's and RN's/LPN's as well an nursing assistant/ techs having a different education model is evident in the success of a multi- disciplinary team. To be able to focus in on a pertinent diagnosis all the while maintaining the integrity of your field i.e holistic care approach of nursing, the 1:1 time spend with pt. by CNA's is crucial in effective practice.