Advantages/Disadvantages of NP vs PA

Editorial Team / Admin · Dec 11, 2007

I also hope that there will be a spread of more acurate information on this forum.

allnurses.com has provided some very helpful information regarding the PA. core0 has given input about the PA career that is excellent. He strives to dispell myth and has personally educated me on the role of the PA. Thank you, core0.

And, we thank any PA who wishes to offer more helpful input about the career choice. Informed decision..........a good thing.

core0 · Dec 11, 2007

I think the OP was talking about RN experience, not student training in the nursing program. Gaining RN experience to prepare oneself for an advanced practice role is "generalist training", so to speak.
In my immediate area, the NP is highly sought-after. PA's are not employed here, but further south, they are. It is strictly area dependent.
Again, both careers offer a great service for our patients.

There is actually a pretty good post that sums up a lot of the pros and cons in another thread. I just came out of 10 hours of surgery and have to round but I can find it later.

One issue that has been discussed before in numerous threads is the value of RN experience as an NP. While it is true that RNs are trained in a generalist nursing model there is a divergence of opinion on whether this is necessary:

https://allnurses.com/forums/f34/becoming-np-little-no-nursing-experience-193372.html

Within nursing opinion is also split. There are several specialties that require specific experience while others require none. You can also peruse discussions about the direct entry program. Overall there is no real consensus. This paralells the discussion that we have had in the PA world. Contrary to PA mythology PA programs from the outset accepted PA students without medical experience. There is no good data that it makes any difference in practice.

I would agree with Siri that utilization is very area dependent. I believe I posted this elsewhere but I will put it in again.

PA:

Advantage working in surgery

NP:

Advantage working in OB (although CMN is probably a bigger advantage)

Neonatal: There are a lot of PAs working here but overall probably advantage to NNP.

Specialty medicine - there are more PAs here but this may change as more ACNP programs come online.

Ability to change within areas of medicine - advantage PA.

Not to say that there are not NPs working in surgery, it is just very rare, like PAs in OB.

Other than that it really depends on the area. Knowing your area is key to finding a job.

As BSNDec06 pointed out there are advantages in part time work in going to NP school but this in my opinion is countered by the fact that you get less clinical time and less coverage of didactic material. It also depends on your learning style and what you want to get out of medicine. I personally prefer the PA model because it gives the student exposure all facets of medicine.

As long as I am really tired I will pull out my crystal ball.

There has been a lot of discussion about which NP specialty is better. The FNP has traditionally allowed a lot of NPs a broad range of practice specialties. In my opinion this is coming to an end. This is intended as a primary care specialty and most hospitals and nursing boards are regarding this as insufficent for acute care or specialty care positions. So in addition to getting into NP school you have to make sure the specialty you choose aligns with the nursing boards vision of what the scope is. You also have to anticipate what the nursing boards vision is going to be.

The other issue that has been much debated here is the DNP. The fact that most DNPs are part time for 4 years really eliminates this as an advantage over the PA educational model. There has been a lot of discussion about this in the PA educational forums and some sites reported an increase in RN applicants in areas that are now DNP only. Another issue in the whole advantage disadvantage thing.

Now must have caffiene .....

David Carpetner, PA-C

Editorial Team / Admin · Dec 11, 2007

There is actually a pretty good post that sums up a lot of the pros and cons in another thread. I just came out of 10 hours of surgery and have to round but I can find it later.
One issue that has been discussed before in numerous threads is the value of RN experience as an NP. While it is true that RNs are trained in a generalist nursing model there is a divergence of opinion on whether this is necessary:
https://allnurses.com/forums/f34/becoming-np-little-no-nursing-experience-193372.html
Within nursing opinion is also split. There are several specialties that require specific experience while others require none. You can also peruse discussions about the direct entry program. Overall there is no real consensus. This paralells the discussion that we have had in the PA world. Contrary to PA mythology PA programs from the outset accepted PA students without medical experience. There is no good data that it makes any difference in practice.
I would agree with Siri that utilization is very area dependent. I believe I posted this elsewhere but I will put it in again.
PA:
Advantage working in surgery
NP:
Advantage working in OB (although CMN is probably a bigger advantage)
Neonatal: There are a lot of PAs working here but overall probably advantage to NNP.
Specialty medicine - there are more PAs here but this may change as more ACNP programs come online.
Ability to change within areas of medicine - advantage PA.
Not to say that there are not NPs working in surgery, it is just very rare, like PAs in OB.
Other than that it really depends on the area. Knowing your area is key to finding a job.
As BSNDec06 pointed out there are advantages in part time work in going to NP school but this in my opinion is countered by the fact that you get less clinical time and less coverage of didactic material. It also depends on your learning style and what you want to get out of medicine. I personally prefer the PA model because it gives the student exposure all facets of medicine.
As long as I am really tired I will pull out my crystal ball.
There has been a lot of discussion about which NP specialty is better. The FNP has traditionally allowed a lot of NPs a broad range of practice specialties. In my opinion this is coming to an end. This is intended as a primary care specialty and most hospitals and nursing boards are regarding this as insufficent for acute care or specialty care positions. So in addition to getting into NP school you have to make sure the specialty you choose aligns with the nursing boards vision of what the scope is. You also have to anticipate what the nursing boards vision is going to be.
The other issue that has been much debated here is the DNP. The fact that most DNPs are part time for 4 years really eliminates this as an advantage over the PA educational model. There has been a lot of discussion about this in the PA educational forums and some sites reported an increase in RN applicants in areas that are now DNP only. Another issue in the whole advantage disadvantage thing.
Now must have caffiene .....
David Carpetner, PA-C

Thank you for your level-headed input, David.

I think everyone knows my opinion on RN experience prior seeking the NP role. But, that is a discussion for another thread (the one you pointed out).

I've seen PAs in other areas of my state and most are in the surgery speecialty area or orthopaedics. Not to say there aren't other areas where they are utilizied. I'm sure they are. I've just not seen this in my own state for I do not have one-on-one contact with them. And, as I said, in my immedicate area, NPs are utilized.

Yes, one needs to evaluate their own area/state and see what the market will bear. I realize many will re-locate and they must research before taking that leap of re-location.

I have to say, I am impressed with the PA model of education.

The other issue that has been much debated here is the DNP.

I highly suspect and am convinced, the DNP will be the entry-into-practice for all APNs.

Again, thank you for your input, David. And, yes, I think you need some java for when you start misspelling your own name, it's obvious you could use the caffiene:

David Carpetner, PA-C

LOL!!!

core0 · Dec 12, 2007

Now that I have some sleep and can actually spell my name I will add a couple of other thoughts. Most of the perceived advantages are in the realm of training specific items. There is some thought that some of the perceived advantages may have been due to the male/female split between NPs and PAs. Now that the distribution among the sexes is similar some of these perceived advantages may disappear.

Several other areas deserve some consideration as as far as advantage.

Minute clinic type of operations in some states may preferentially hire NPs due to supervision requirements.

ER - is another case where there is a potential advantage for PAs. ACNPs have declared that emergency care is part of their domain. However ACNPs cannot see pediatric patients. In larger ERs with pediatric and adult sections this is not a problem. In smaller ERs it may be. PA school also emphasizes skills such as suturing that are beneficial in the ER (although there is no reason that an individual NP cannot learn these).

The ER problem also points out a problem that commonly occurs in private practice. That medical practice frequent spans multiple nursing domains. The problem with adult and pediatric PAs is not isolated to EM. It also occurs in various specialty practices. There is also a question about the use of ACNPs in non acute setting, especially outpatient settings. There are two programs that I am aware of to address this; one a ANP/ACNP program and one a FNP/ACNP program. Neither of these really addresses the ER problem which may be solved at some point with a true ERNP program as has been discussed or a dual PNP/ACNP program (which would also solve problems in some smaller ICUs that take pediatric patients).

Further thoughts

David Carpenter, PA-C

allnurses Guide · Dec 12, 2007

Now that I have some sleep and can actually spell my name I will add a couple of other thoughts. Most of the perceived advantages are in the realm of training specific items. There is some thought that some of the perceived advantages may have been due to the male/female split between NPs and PAs. Now that the distribution among the sexes is similar some of these perceived advantages may disappear.
Several other areas deserve some consideration as as far as advantage.
Minute clinic type of operations in some states may preferentially hire NPs due to supervision requirements.
ER - is another case where there is a potential advantage for PAs. ACNPs have declared that emergency care is part of their domain. However ACNPs cannot see pediatric patients. In larger ERs with pediatric and adult sections this is not a problem. In smaller ERs it may be. PA school also emphasizes skills such as suturing that are beneficial in the ER (although there is no reason that an individual NP cannot learn these).
The ER problem also points out a problem that commonly occurs in private practice. That medical practice frequent spans multiple nursing domains. The problem with adult and pediatric PAs is not isolated to EM. It also occurs in various specialty practices. There is also a question about the use of ACNPs in non acute setting, especially outpatient settings. There are two programs that I am aware of to address this; one a ANP/ACNP program and one a FNP/ACNP program. Neither of these really addresses the ER problem which may be solved at some point with a true ERNP program as has been discussed or a dual PNP/ACNP program (which would also solve problems in some smaller ICUs that take pediatric patients).
Further thoughts
David Carpenter, PA-C

Sorry to disappoint, but there is an actually a speciality for NPs in emergency care http://www.uta.edu/nursing/grad/enp. You get your certification as ENP and are able to see all age groups.

I don't see any big advantages over Np vs. PA. NPs can work in certain places that allow total independence, and PAs are able to do surgery, if one of these things is your biggest goal then follow that route.

I would recommend to anyone that is already a nurse to get their NP, and anyone that wasn't already a nurse interested in being NP/PA to go the PA route (which I have counseled my med techs to do many times.)

core0 · Dec 12, 2007

Sorry to disappoint, but there is an actually a speciality for NPs in emergency care http://www.uta.edu/nursing/grad/enp. You get your certification as ENP and are able to see all age groups.
I don't see any big advantages over Np vs. PA. NPs can work in certain places that allow total independence, and PAs are able to do surgery, if one of these things is your biggest goal then follow that route.
I would recommend to anyone that is already a nurse to get their NP, and anyone that wasn't already a nurse interested in being NP/PA to go the PA route (which I have counseled my med techs to do many times.)

I bolded the important part:

The Emergency Nurse Practitioner (ENP) Program prepares advanced practice nurses with the knowledge and skills needed to provide emergency and urgent health care services to individuals of all ages. Emphasis is on the management of acute illnesses, trauma, and/ or chronic unstable illnesses requiring immediate attention, stabilizing the individual's condition, and determining appropriate referral and follow-up care. ENPs provide care in ambulatory, urgent care, and emergency department settings. Graduates are prepared to be recognized as advanced practice nurses by the Board of Nurse Examiners and to take the Family Nurse Practitioner National Certification Examination through the American Nurses Credentialing Center or the Academy of Nurse Practitioners.

The problem is that this is still a FNP certification and the competency for FNPs still clearly states that it is a primary care certification. It doesn't matter if you add extra hours to a primary certification, it is still that certification. If there was not a specialty certification it would matter less but ACNP competencies clearly state that emergency nursing is in their domain and FNP competencies clearly state they are primary care. I would think that a program in Texas would be especially aware of this, from the Texas BON:

Q: I am authorized to practice in a particular specialty area. I want to expand my scope of practice to include a second specialty area. (Examples of this situation include but are not limited to: adult health expanding to include pediatrics, family practice expanding to include care of patients with complex psychiatric pathologies, and primary care expanding to include acute/critical care). Can I do this by completing continuing education activities specific to the specialty and working with another advanced practice nurse authorized in that specialty or a physician?

A: There are finite limits to expanding one's scope of practice without completing additional formal education and obtaining the requisite authorization to practice in the additional role and/or specialty from the BON. When incorporating a new patient care activity or procedure into one's individual scope of practice, the board expects the advanced practice nurse to verify that the activity or procedure is consistent with the professional scope of practice for the authorized role and specialty and permitted by laws and regulations in effect at the time. For example, a women's health nurse practitioner or nurse-midwife who wishes to incorporate performance of colposcopies in his/her practice may do so without obtaining an additional authorization to practice from the BON because this activity is consistent with the professional scope of practice for those roles.

There are a number of programs similar to this. I am continuously amazed that nursing schools allow programs to exist that have the potential to put there students at considerable legal risk. APN is truly caveat emptor in these cases.

David Carpenter, PA-C

ILoveIceCream · Dec 12, 2007

Now that I have some sleep and can actually spell my name I will add a couple of other thoughts. Most of the perceived advantages are in the realm of training specific items. There is some thought that some of the perceived advantages may have been due to the male/female split between NPs and PAs. Now that the distribution among the sexes is similar some of these perceived advantages may disappear.
Several other areas deserve some consideration as as far as advantage.
Minute clinic type of operations in some states may preferentially hire NPs due to supervision requirements.
ER - is another case where there is a potential advantage for PAs. ACNPs have declared that emergency care is part of their domain. However ACNPs cannot see pediatric patients. In larger ERs with pediatric and adult sections this is not a problem. In smaller ERs it may be. PA school also emphasizes skills such as suturing that are beneficial in the ER (although there is no reason that an individual NP cannot learn these).
The ER problem also points out a problem that commonly occurs in private practice. That medical practice frequent spans multiple nursing domains. The problem with adult and pediatric PAs is not isolated to EM. It also occurs in various specialty practices. There is also a question about the use of ACNPs in non acute setting, especially outpatient settings. There are two programs that I am aware of to address this; one a ANP/ACNP program and one a FNP/ACNP program. Neither of these really addresses the ER problem which may be solved at some point with a true ERNP program as has been discussed or a dual PNP/ACNP program (which would also solve problems in some smaller ICUs that take pediatric patients).
Further thoughts
David Carpenter, PA-C

In Psychiatry, also, it seems that NPs (and CNSs with prescriptive privileges) may have an advantage over PAs.

CraigB-RN, MSN, RN · Dec 12, 2007

I would recommend to anyone that is already a nurse to get their NP, and anyone that wasn't already a nurse interested in being NP/PA to go the PA route (which I have counseled my med techs to do many times.)

That dogmatic approach may not be doing anyone of hte of the techs a favor. The skills, personality, education base all play into the decision as to NP vs PA. It's an education choice based on all the factors that have been stated here.

I send people to both programs. Personlly right now I'm carefull about advising on NP programs due to the potential changes in the proffesion. BON's are looking at scope of practice issues and I personally don't want to get cought in the middle. MY FNP/ACNP will hopefully cover me for a few years, but I'm pretty far along. New people/Young people, I'm not so sure, the PA preffesion is pretty stable in it's scope of practice. THen again I may just stop and get a PhD in underwater basket weaving.

Like any prof it's a choice and needs to be made with open eyes and as much data as possible.

amzyRN · Dec 20, 2007

That dogmatic approach may not be doing anyone of hte of the techs a favor. The skills, personality, education base all play into the decision as to NP vs PA. It's an education choice based on all the factors that have been stated here.
I send people to both programs. Personlly right now I'm carefull about advising on NP programs due to the potential changes in the proffesion. BON's are looking at scope of practice issues and I personally don't want to get cought in the middle. MY FNP/ACNP will hopefully cover me for a few years, but I'm pretty far along. New people/Young people, I'm not so sure, the PA preffesion is pretty stable in it's scope of practice. THen again I may just stop and get a PhD in underwater basket weaving.
Like any prof it's a choice and needs to be made with open eyes and as much data as possible.

You mentioned the stability of scope of practice of PAs. Do you think that NPs scope of practice will change in light of the DNP thing? I don't want to bring up that topic, but am curious as to what you mentioned about scope of practice. Thanks so much for the info and insight, I really appreciate it,

J

CraigB-RN, MSN, RN · Dec 20, 2007

I wasn't as clear as I should have been in my earlier comment. By the stability I was talking about how Boards of Nursing are looking at scope of practice issues for the different specialty area's. I figure some of that will settle out over the next couple of years. You also have specialty areas like the ACNP who as they develop as a specialty that are taking over some of the responsibilities that the FNP's had, ie, inpatient medicine. People who go into a specialty area with certain expectations just need to be more aware of how the specialty area is developing, or thy are opening themselves up to some disapointment.

The transition to the DNP which is in my opinion pretty much a done deal, unlike things like the ND which had pretty much disapeared, is something else to be aware of. There may or may not be any backlash from the medical community for this.

Like the old world curse goes "may you live in interesting times" this is one of those for the proffesion. All these things need to be considered when someone is making a career desicion.

amzyRN · Dec 20, 2007

I wasn't as clear as I should have been in my earlier comment. By the stability I was talking about how Boards of Nursing are looking at scope of practice issues for the different specialty area's. I figure some of that will settle out over the next couple of years. You also have specialty areas like the ACNP who as they develop as a specialty that are taking over some of the responsibilities that the FNP's had, ie, inpatient medicine. People who go into a specialty area with certain expectations just need to be more aware of how the specialty area is developing, or thy are opening themselves up to some disapointment.
The transition to the DNP which is in my opinion pretty much a done deal, unlike things like the ND which had pretty much disapeared, is something else to be aware of. There may or may not be any backlash from the medical community for this.
Like the old world curse goes "may you live in interesting times" this is one of those for the proffesion. All these things need to be considered when someone is making a career desicion.

So do you think that b/c AP nursing is so specialized the scope of practices would vary among specialties where as PAs being generalists would have a broader scope. And is the DNP supposed to equalize the scope of practice among NPs? I really appreciate your input, thanks much,

J

CraigB-RN, MSN, RN · Dec 20, 2007

Not a broader scope, just a more sable one at THIS time. And I emphasise, at this time. From my perspective, it's all just part of the picture when making career desicians. If your only goal is to work in a rural health clinic or family practice clinic, then it realy doesn't matter much. On the other hand if your planning on having LOTS of options, then the generalist aproach may be the best bet. As far as Clinical practice goes, neither is better than the other. One of the things that I'm always concerned about, is that it's the BON that regualates the APRN practice. Now remember that the BON isn't there to make your life easy,it's there to protect the residents and visitors of the state your in. But just think back on all the seemingly strange things taht have come out of BON's over the years.

As to the DNP making a difference, I really don't hink it's going to make a difference in the whole scheme of things. Unless someone can break the reimbursment bottle neck, not much is going to change. No more money, at least not measureable, No more recognition, no increase in the scope of practice. Education is a good thing, and I know that I"ll be doing the Doctorate thing sometime in the future, but I'm still out on what it will be in. I'm actually ready all the DNP stuff now, and not just using what I read here. The origional idea/concept is actually pretty good. But like everything in nursing, the reality is open to interpretation someway.

I'm not making a statement one way or another which is better. I can't or my wife PA would slap me silly. But I've been a nurse for way to long to be blind to the problems that are inherant to the proffesion. The arguments about holistic care, and such, don't realy seem to stand up much in my opinion. A primary care provider is a primary care provider. They can all fall into the $$$ mode were you make more money buy seeing more patients, when that happens, holistic/whole body treatment goes out the window. I laugh when I say that one of the best NP's I know is a PA.

All I know for sure is that I can't type or spell.