Hello. I am considering NP and PA school. I have a few years of experience as an ED Tech in a Level 3 Trauma Center in California (busy, but not too intense). Our ED is staffed with PA's no NP's.
I have a few questions about clinical differences between NP's and PA's. I know that PA's seem to have a great ability to work in surgery specialties like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interprets tests, and prescribe meds (at least in 47-49 states). Are there any NP's on this forum who do this? Are there any in California who can comment?
Second. I know that most PA schools have a much longer clinical component than do NP schools. I have been told it is because NP's already have so much clinical experience as nurses. But can you really compare the two? In our ED, the nurses are not making differential diagnoses, determining etiology of disease, etc. etc., they are monitoring the pt's overall state and response to the treatment ordered by the Physician (or sometimes PA). Therefore, does this experience compare to the rigorous training PA's get in diagnosing?
Part of my interest in medicine is the actual procedures themselves. I want to do chest tubes, central lines, suturing, first assistant surgery, etc. etc. Are there any NP's out there who are doing this?
Finally, I know some people (including some nurses) who deride the "nursing diagnosis" concept. Can anyone offer up a brief rationale for how nursing diagnoses are of value to an NP in clinical practice?
Heh i just have something to contribute, this whole discussion about NP or PA, in Australia is mute as we don't have PA's. When studying for your NP (Masters) you choose between two electives, one in medical the other in surgical.
huh, didn't know that about Australia. Right now, PAs are being initiated in England. Many PAs have gone over there to help things get started; I've a friend, who has gone over for a few months.
Too bad about NPs in Aussie only being "initiators" in getting tests going; it sounds like a pretty restrictive place for a NP to be.
Physician assistants (PAs) provide health care services with supervision by physicians. They should not be confused with medical assistants, who perform routine clinical and clerical tasks. PAs are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine patients, order and interpret laboratory tests and x- rays, and make diagnoses. They also treat minor injuries by suturing, splinting, and casting. PAs record progress notes, instruct and counsel patients, and order or carry out therapy. In 46 States and the District of Columbia, physician assistants may prescribe medications. PAs may also have managerial duties. Some order medical and laboratory supplies and equipment and may supervise technicians and assistants.
Physician assistants always work with the supervision of a physician. However, PAs may provide care in rural or inner city clinics where a physician is present for only 1 or 2 days each week, conferring with the supervising physician and other medical professionals as needed or required by law. PAs may also make house calls or go to hospitals and nursing homes to check on patients and report back to the physician.
The duties of physician assistants are determined by the supervising physician and by State law. Aspiring PAs should investigate the laws and regulations in the States where they wish to practice.
Many PAs work in primary care areas such as general internal medicine, pediatrics, and family medicine. Others work in specialty areas, such as general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide pre- and post-operative care and may work as first or second assistants during major surgery.
All States require that new PAs complete an accredited, formal education program. As of July 1999, there were 116 accredited or provisionally accredited educational programs for physician assistants; 64 of these programs offered a bachelor's degree or a degree option. The rest offered either a certificate, an associate degree, or a master's degree. Most PA graduates have at least a bachelor's degree.
Here's a point of contention: The above sentance is quite true. It is, however, often misinturpreted and misunderstood. Many seem to think that having a supervising physician, (SP), means that every thing must be okay'd, run past, approved by, checked, and/or singed off, by the SP. This is often not the case. It does depend upon what state one is in, however. A lot of the times, as it is in my case, PAs work autonomously and collaborate with a SP, whenever questions arise, or as needed. It actually takes good judgement skills to do this because most SPs don't want everything brought to them.
In my practice, my SP has expressed confidence in my skills and his attitude is that I will work autonomously and when I have a question, I'll ask. He instills that confidence to patients as well, which goes a long way. I'm also in a surgical subspecialty and sometimes need to ask the surgeon to come in to meet my patient, whom I've worked up and surgery looks like a next viable option.
For the record: In my state, no charts need to be co-signed. In NH, where I am, the NH Board of Medicine (of which I'm licensed to practice), lets the SP & PA relationship come up with their own plan of how supervising works. In a lot of cases (and mine) the SP is fine with the natural dynamic of how things work becuase there's a regular dialog with at least 1 patient a day and a dialog of all in-house patients I've rounded on, which keeps the SP pretty well-aware of things.
Personally, I wish the term supervising physician was not chosen because it is often misunderstood. I am enveous of the term collaborative physician, that NPs have because the word much-better describes what is taking place. That is an excellent choice in terminology in practice dynamics.
That was written in a government agency..I believe it has truth to it thou..Unless you want to challenge the government on what they write..But in reality, dont you think a PA, I maean they cannot be independent all the time because they dont have the amount of education that the MD has..
That was written in a government agency..I believe it has truth to it thou..Unless you want to challenge the government on what they write..But in reality, dont you think a PA, I maean they cannot be independent all the time because they dont have the amount of education that the MD has..
Where did I say that a PA can be independent all the time? I did not. In my last post, I think I made it pretty clear on the proper and real dynamics--at least in my state. Please don't misunderstand my post b/c I am not--repeat--not interested in the old "Independence" battle. There is some level of independence with a PA, for sure, but my last post pretty much spells that out and it does, in fact, vary from job-to-job and state-to-state.
Oh, and, by the way, the government has mis-spoken about this topic before so, don't be too naive--although this one is pretty much on the money, with the exception that a lot of PAs, nowadays, are getting Master's degrees.
I have been reading up on both the PA and the NP fields for about a year or more. From what I understand, The NP teaches you to think like a nurse and the PA is tought to think and act just like a doctor. The NP leads to a specialty and PA program is patterned after the medical school curriculum (. Also, according to one PA commision, the AMA watches the PA program and the accrediting body very closely. As the nursing shortage gets worse and the health insurance companies get leaner, the PA will become more and more popular. I am applying for both programs for next year but, would prefer the graduate PA program.
In Maryland you have to have a Bachelors Degree and then you can apply to a PA school. It is a 2 year program and is not done in conjunction with your previous Bachelors degree, it is a separate program.
I work in a level 1 trauma center. I primarily work in ambulatory but also do some shifts in critical care, ob/gyn, medical, etc pods. I am not required to run anything by my SP. I tend to get some really sick people in ambulatory (bad triage system) and do my own central lines, LP, arthrocentesis, etc. I don't have to talk to the physician for anything if I chose not to. Even on the critical side, there are no requirements to run anything by my SP or any of the docs. But I do when I have a complicated case. And the reason? Look at a medical lawsuit against a midlevel and one of the biggest thing they will hang you with is "so let me understand this, you are not a doctor, you had this patient presenting with (fill in the blank) and the patient ended up going home and dying the following week and you didn't feel the need to run the case by someone with more medical knowledge and experience!" Yes, I know all of the arguments of how there are lots of bad doctors out there but the bottom line is we (PA/NP) are not doctors, and the public's perception of this is just that. They don't care that for 10 years you have done well in your practice.
I am graduating from an adult NP program in June. There is not anyone in my progam who has not been practicing less than 3 years and most have been practicing 10 years or more. Everyone has a BSN as a requirement for admission. This is a traditional graduate program, not the GEP (graduate entry pathway) which does not require you to be an RN prior to entering the program. That is an entirely different program. We, in the traditional master's program have 540 hrs of clinical in adult primary care and for a subspecialty, such as geri, 180 hrs additional, for a total of 720 hrs. which is 24 hrs of clinical for 36 weeks. Why anyone would make a generalization that NP programs do not have stringest admission requirements as well as a hefty clinical component is beyond me.
Congratulations on your graduation. I went to a program similar to yours, I'm certified in both Adult and Geriatric health. I had worked as a BSN for 10 years before applying to graduate school. I was shocked to find that the majority of students in my program had never even worked as a nurse. They had bachelor's degrees in something else, then were rushed through a 1 year RN program and then went directly into the NP program. I'm strongly opposed to these programs. I noticed that the ANCC is now requiring neonatal NP's to have a minimum of 2 years experience as a neonatal nurse before even applying to a NNP program. The majority of NNP's at my school had never even worked as a nurse! I have a strong feeling that these "direct entry" programs are going to cease to exist.
Listen to this one...one of the instructors at our school, who had gone through the direct entry program and never worked as a nurse, was talking about giving an IM injection with an 18 gauge needle! Unbelievably STUPID! Also, the direct entry students were met with a lot of disrespect by RNs/LVNs when they started their clinical rotations.
Depending upon which state you work- PA's practice under the physician's license & NP's practice under their own license. PAs may have either an Associate's or Masters in PA studies and may have an educational background preferably in health sciences, etc. NPs have a background in nursing. NPs (esp. Adult NPs who specialize in particular areas) do perform procedures (e.g. d/c'ing CT, suturing, casting, etc...)Most NPs primarily work in primary care. But I do know that PAs can work as a 1st or 2nd assist in surgery...if that interests you. NPs will not normally do that. If you have a background as an ED tech, it may just be a faster route to go through a PA program. But here is of course my biased opinion, if you want to be a primary care provider who integrates holistic approaches, cost effective treatments, and attains more autonomy-->go for the NP degree! Plus, the settings in which you can work (e.g. internal med, family practice, community health, visiting nurse services, hospice, LTC, hospitals) is much more broad. But then again if you are in a rural area, there are perks to working as a PA. I hope this helps. Good luck!
I work in a level 1 trauma center. I primarily work in ambulatory but also do some shifts in critical care, ob/gyn, medical, etc pods. I am not required to run anything by my SP. I tend to get some really sick people in ambulatory (bad triage system) and do my own central lines, LP, arthrocentesis, etc. I don't have to talk to the physician for anything if I chose not to. Even on the critical side, there are no requirements to run anything by my SP or any of the docs. But I do when I have a complicated case. And the reason? Look at a medical lawsuit against a midlevel and one of the biggest thing they will hang you with is "so let me understand this, you are not a doctor, you had this patient presenting with (fill in the blank) and the patient ended up going home and dying the following week and you didn't feel the need to run the case by someone with more medical knowledge and experience!" Yes, I know all of the arguments of how there are lots of bad doctors out there but the bottom line is we (PA/NP) are not doctors, and the public's perception of this is just that. They don't care that for 10 years you have done well in your practice.
I agree. We don't have very specific guidelines in my ED on what we need to involve the docs in, but I always try to for the same reasons that you mentioned. We are not physicians and it would not look good in a lawsuit that we were taking care of critical patients without involving our MD's.
freakyaye
15 Posts
also, regarding the post above mine, in Australia NPs can order medical tests, but thats it. Just 'initiate' them.