PA-C or NP? What would you do?

NJprisonrn · Mar 8, 2012

I am choosing to pursue NP because I already have a nursing license. It just seems like a natural extension of my current education. I like the autonomy that an NP license gives, even though it varies by state. It would be quicker and much less expensive for me to become an NP, which is important at this time in my life since nursing is a second career. I did heavily consider PA because I feel that they get a better clinical education. If I were not concerned about the time it would take to take all the prerequisites and go through the program (which usually requires one to not work) I might have chosen PA instead.

mgholm · Mar 8, 2012

I am an ADN, with many years under my belt in nephrology, ICU, ER, and M/S.
In my current role, I function quite independently/autonomously and I'm quite good at it clinically. One thing this role has taught me, I really, really, reeeeallly enjoy the medical science and application side of things, being able to use my knowledge to make more autonomous decisions, and having a high degree of contact and collaboration with nearly all departments (and docs) in the hospital.
Healthcare politics, business, and trends interest me a great deal, but my primary talent and enjoyment comes from assessing patients and problem-solving.
I am currently in the research phase of deciding between pursuing RN->BSN->ANP or becoming a PA.
>Both roles while similar, have different challenges not just in practice, but on the political scene as well. PA's (at app 85,000 in number) are terribly underrepresented at the State and Fed levels as opposed to RN's (millions strong).
>I like the heavy, medical-model of PA school, yet I like the fact that NP's can function under their own license.
>I dislike the fact that ANP scope of practice varies so wildly from state to state. The barriers to true autonomy are numerous. This issue I realize, is being heavily studied and lobbied.
>I've ruled out CRNA and perfusionist as options (had enough machine-management, thank you :) ).
>I like that PA's are considered "generalists" yet they have so many options in specializing. As one of the docs I work with put it, "you can write your own ticket."
One thought is to just finish my BSN and decide from there, but...PA programs can have different req's...i.e, it's been so long, that I have to take some chemistry, English, and A/P again...sigh.
Any thoughts from those that have faced this conundrum (or otherwise) I'd greatly appreciate it.

I'm a career changer and am trying to decide whether to try for PA or enter an accelerated BSN and then to the ARNP route. If I apply to an accelerated nursing program that says their mission is to "raise the level of professional nursing practice" by preparing baccalaureate graduates and increase the number of BSNs caring for patients in the school's area, and I tell them I want to move on and become a nurse practitioner, am I shooting myself in the foot?

Guttercat, ASN, RN · Mar 8, 2012

I am choosing to pursue NP because I already have a nursing license. It just seems like a natural extension of my current education. I like the autonomy that an NP license gives, even though it varies by state. It would be quicker and much less expensive for me to become an NP, which is important at this time in my life since nursing is a second career. I did heavily consider PA because I feel that they get a better clinical education. If I were not concerned about the time it would take to take all the prerequisites and go through the program (which usually requires one to not work) I might have chosen PA instead.

I think there's a misconception as to the autonomous nature of PA's vs. ANP's in popular thought. It's a wash as far as I can determine, when you factor in all the variables.

A hospitalist PA I work closely with was a BSN, and faced with the same choice. She says she does not regret her choice to pursue the PA-route over the ANP, and would do it again.

Guttercat, ASN, RN · Mar 8, 2012

I'm a career changer and am trying to decide whether to try for PA or enter an accelerated BSN and then to the ARNP route. If I apply to an accelerated nursing program that says their mission is to "raise the level of professional nursing practice" by preparing baccalaureate graduates and increase the number of BSNs caring for patients in the school's area, and I tell them I want to move on and become a nurse practitioner, am I shooting myself in the foot?

I can't see how this would be shooting yourself in the foot.

If your own mission is to "raise your level of professional nursing practice" as well, I can't see how your pursuit of an advanced degree would be anything other than welcome.

But then again, academia is a fickle entity who's rules vary from institution to institution.

zoidberg, BSN, RN · Mar 13, 2012

most of the professors in my absn program are NP's... i bet they would not have minded if they knew i have always wanted to be an NP when i applied.

PA schools would love to have you with all of your experience. Knowing your end goal, PA school may be a more direct path and more affordable.

LuxCalidaNP · Mar 16, 2012

All things considered: State regulations and practice acts, academic program reputation, local climate for NPs/PAs, etc, one friend broke it down simply for me: PAs will always need to have a "supervising" MD, as opposed to the trend with NP legislation of having "collaborative" or fully autonomous relationships with MDs, and in his words, "as a PA, I will always be an 'assistant' to the physician on some level, whether in primary care, surgery, etc." (This of course varies based on location). As advanced-practice nursing is being considered more of it's own medical discipline with designated sub-specialties, the model for NPs/CNMs is trending away from being a "second rate provider" to an MD, or "mid-level". This is not always the case with PAs. NPs likely won't ever have as thorough of an education as MDs/DOs, but the overall trend of the last 25 years indicates that NPs are gaining more autonomy than PAs, especially in primary care...just my 2 cents. :)

Guttercat, ASN, RN · Mar 17, 2012

All things considered: State regulations and practice acts, academic program reputation, local climate for NPs/PAs, etc, one friend broke it down simply for me: PAs will always need to have a "supervising" MD, as opposed to the trend with NP legislation of having "collaborative" or fully autonomous relationships with MDs, and in his words, "as a PA, I will always be an 'assistant' to the physician on some level, whether in primary care, surgery, etc." (This of course varies based on location). As advanced-practice nursing is being considered more of it's own medical discipline with designated sub-specialties, the model for NPs/CNMs is trending away from being a "second rate provider" to an MD, or "mid-level". This is not always the case with PAs. NPs likely won't ever have as thorough of an education as MDs/DOs, but the overall trend of the last 25 years indicates that NPs are gaining more autonomy than PAs, especially in primary care...just my 2 cents. :)

Thank you LuxCal, for the input.

Right now ANP's have "limited' practice scope due to a lack of consistency in practice law across state lines, as opposed to PA's...but one thing the nurse contingent has, as opposed to the relatively speaking fragmented PA contingent is...lobbying power. And, sheer numbers (3+ million RN's as opposed to

The Robert Wood Johnson Foundation and the IOM recently undertook a massive study beginning in 2008 regarding the future of RN/ANP practice in light of the ACA (health care reform). It resulted in three books...all of which can be linked to with a little hunting and pecking from these pages (be sure to click on the "Barriers to Nurse Practitioner Practice" link):

http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx?page=1

http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

PA's at this point, enjoy a more uniformed/across-state-line practice scope, but how long will this last?

It's going to boil down to power and money...always follow the money.

nomadcrna, DNP, CRNA, NP · Mar 17, 2012

The states that have restrictive NP practice also have restrictive PA practice. I practice independently in many states. I refuse to go to a state where I do not have independent practice.

reeya · Mar 17, 2012

Both PA/NP have its advantages and disadvantages. At the end of the day they both essentially do the same thing.

ImThatGuy, BSN, RN · Mar 27, 2012

From the outside looking in at both I'd go for PA school if given the chance. If that were a more geographically accomodating option I'd do it. Heck, I'd have already done it, but I chose instead to get a second bachelor's degree (BSN/RN). Now I'm more or less stuck going the APN route because I'm tied down now. I also heavily favor the medical model of healthcare.

Additionally, it's pretty much a given that you can't work and go to PA school although many people work full-time and take an APN role.

sailornurse · Mar 28, 2012

Just thinking the requirements to get into PA school are a bachelors, with your ADN you are closer to completing a BSN.

I once had a student nurse (in a BSN program) that did not understand the differences in PA/NP and she stated to me when I explained that in this state as a NP I have independent practice, she stated that that's why she was going to become a PA is that she DID NOT want the independence. Turns out she became an NP. Looks like she now understands the differences and the issue about independent practice.