ACNP or PA in the ED

CraigB-RN, MSN, RN · Mar 23, 2009

To answer that question, you have to look at your own local area practices. In a lot of area's you have to be able to see peds also, and the ACNP won't let you do that. The PA is a "generalist" so doesn't have those constraints. The only answer your going to get is to look at job postings were you want to work. Around here the NP's in the ER are FNP's not ACNP's. In other places I've worked the ACNP's are in the ICU and the PA's are in the ER. it's different werever you go.

jer_sd · Mar 23, 2009

Here is a great resource that might workfor you a PA?NP residency in trauma and critical care

http://www.mystlukesonline.org/for-healthcare-professionals/resident-education/trauma-critical-care/index1.aspx

Jeremy

Trauma Columnist · Mar 23, 2009

My area hires APNs in the ER but they have dual certs: ACNP and PNP.

I work part time in an ER (not urgent care) and am an adult health CNS. However,I'm heading back to school in August for a peds/family CNS also.

physasst · Mar 24, 2009

My area hires APNs in the ER but they have dual certs: ACNP and PNP.
I work part time in an ER (not urgent care) and am an adult health CNS. However,I'm heading back to school in August for a peds/family CNS also.

Well, we have ONE ACNP in our ER.....we have six full time PA's, and then several PRN PA's as well. Our NP is having to complete her FNP training as well, as she will have to see peds patients soon, so that seems like a lot of extra work to me.

Our physicians don't really care, they see PA's and NP's as "midlevel" providers, and Mayo as an institution sees us as completely interchangeable.

Trauma Columnist · Mar 24, 2009

In IL, APNs are interchangeable (within the appropriate scope of practice of course), while PAs in my are (central IL) are mostly used in private practice.

physasst · Mar 24, 2009

In IL, APNs are interchangeable (within the appropriate scope of practice of course), while PAs in my are (central IL) are mostly used in private practice.

Well, in Minnesota, PA's and I believe NP's can do the same things, neither of us can be completely independent, and both of us have similar prescriptive authority (II-V).

Mayo has slightly more conservative policies regarding "midlevels" and while they are improving slightly. They are still more conservative than state law. Mayo pays PA's and NP's the same as far as I know, and sees us as interchangeable in our abilities. In fact almost every job posting on the Mayo site, will list "PA or NP wanted".

Mayo was at a time regarded as a "black hole", not my words, but a friends, as pertains to midlevels, and their reputation in the midlevel community here is still recovering. Many departments still use PA's and NP's to see patients prior to a physician seeing them....and yes, like ALL of them, and they rely on the PA's and NP's to answer phone calls, and perform more administrative functions (scheduling, appointments, etc.)

Like I said it is improving, but slowly. In the ED, we have probably the most progressive and aggressive practice agreements in the institution, so we are trying to slowly break down barriers, but Mayo is first and foremost a physician led and physician directed institution, and there is still a mentality here among a lot of the older physicians (you know, the one's in leadership positions with power) that "only a physician can do what a physician does".

Change here occurs at a glacial pace, but count me among those trying to improve it.

Mike

Trauma Columnist · Mar 24, 2009

I must work with some of those Mayo doctors right here in central IL physassist! lol

In my fulltime job, I am very autonomous: examine, order tests, interpret tests, diagnose and treat and even call attendings!

However, in the ER its like I'm back in the stone age - not even allowed to call an attending!

physasst · Mar 24, 2009

I must work with some of those Mayo doctors right here in central IL physassist! lol
In my fulltime job, I am very autonomous: examine, order tests, interpret tests, diagnose and treat and even call attendings!
However, in the ER its like I'm back in the stone age - not even allowed to call an attending!

See, in our ER, I have full admitting, consulting and ordering privileges. I get treated as a colleague, and not a subordinate, however, I have friends in other departments, and I know that it is dramatically different in other areas. Many of my patients are never discussed with an attending. They trust however, that I will consult with them when needed. I haven't called anyone "Doctor" down here in longer than I can remember, the attendings prefer to work on a first name basis, as they view us as colleagues....

In fact, a funny story happened not long ago. One of our junior PA's shared this with me. She was sewing up a rather complex layered lac, and there was some concern about how much contamination might be in the wound, as it was quite dirty. One of the senior residents at the time, went to the attending, and demanded to know why the "PA was doing it" as she "might not clean it thoroughly, and aren't you worried about her abilities".......Hehe, the attending turned to him, and said, "I think you need to remember that the PA's here are staff, and you are just a resident, it would be in your best interest to remember this in the future."

I was like...wow, REALLY????

Some other departments are becoming more progressive as well, but old habits die hard here. The economy is actually helping us with that here, as it might force their hand.

physasst · Mar 25, 2009

I must work with some of those Mayo doctors right here in central IL physassist! lol
In my fulltime job, I am very autonomous: examine, order tests, interpret tests, diagnose and treat and even call attendings!
However, in the ER its like I'm back in the stone age - not even allowed to call an attending!

Nah, in the ED, I am treated as a colleague, NOT a subordinate, which seems to be the case in some of the other departments. I have complete authority to order, admit, consult, whatever. Many, if not most, of my patients only see me, and after so many years, I find that I consult the physicians only occasionally. I still do, even for straightforward patients that are supposed to be staffed according to institutional guidelines. I had a patient I cardioverted recently, and only told the attending, who was up to his shoulders in other patients, AFTER it was done. Another incident that happened a while back involved one of our junior PA's who was treating a patient with a very complicated dirty, layered wound. Well, the senior resident got a little uppity, and said to the attending, "Aren't you worried that she doesn't know what she's doing, what if she doesn't irrigate it well", to which the attending replied, "You would do well to remember that the PA's are staff, and that they are accorded the same respect as the attendings"-or something to that effect.

I was like "wow". I haven't called one of the physicians "doctor" in more years than I can remember, the ED attendings actually prefer to be addressed on a first name basis, as we are thought of as colleagues again, not subordinates.

In many other parts of Mayo, it is quite a different picture.

Trauma Columnist · Mar 25, 2009

Gee - wish I could move!

CraigB-RN, MSN, RN · Mar 25, 2009

There are actually places like that out there. I worked in a hospital were the attending told a resident that when the resident complained about a staff nurse ignoring his orders.