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?
Specializes in CCU,MICU,SICU,BICU,ER,MedSurg,Tele.
A Nurse Practitioner can own clinics and can practice independently. Big deal that many states make you have a collaborating physician. SO we gotta have protocols. Doctors have protocols also. I work with many PAs and they do have the advantage of generalist where as a NP is declared a specialist in a particular field. The PA is trained more in medicine which means protocols. THEY will never practice independent. In fact the role is pushed to keep the NP role at bay. I just gave a seminar in which several physicians attended and I am treated as an equal amoung them. Maybe it is the self defeatest attitude and we are no better attitude that holds the NP to the ground. There is nothing wrong with being proud of being a NP.
Correct you are! Don't ever say it...but go ahead and think it, because it is so obviously true. If someone comes to your private practice and you give them a MEDical diagnosis, prescribed MEDicine, and then MEDicare reimbursres you for that service, you, by definition are practicing medicine, regardless if you asked them about their spirituality.
By like she adviced, don't ever say the truth out loud.
1. NP’s can have private independent practices in some state, please refer to the pearsons report which is pub. every year. It contains the entire practice requirement, etc for each and every state. Here in Colorado, I personally know of 4 private practice owned and operated by Np’s. In our state we are required to have a collaborative agreement (see CO scope of practice doc) not and supervisory agreement. Which is completely different! As a result of the collaborative agreement, the Np functions completely independent in all aspect unless a consult deemed necessary by the NP. Both PA and NP’s can only bill 80% of the MD fee in most cases. Further I would like to say that the above mentioned private practices are not planned parenthood, or a women’s clinic, 3 are Fp and 1 is county sponsored first emergent contact clinic (talk about independence).
NP do not make “nursing diagnosis”, we have to function under the allopathic modal just as PA, MD and DO’s. we do incorporate the holistic view point.
there are PA schools which are certificate not just BS, MS. Both professions have moved away from this programs because Medicare require ALL mid-level providers to have MS and National Certs. Further ALL accredited NP program REQUIRE BSN most have a min. of 2 years in “critical care areas” do the math, 3744 hours of previous exp. + 600- 1000hrs in NP rotation + 600-1000hrs in RN rotation = approx 5744 hours.
I’m a ACNP (Acute care) if you did not know thus stating that we ACNP spent our time in just fp, peds, ob/woman health. Apparently your not getting the correct info. We focus on systems, thus we had to do clinical rot in cards, neuro, neph, GI, internal, etc. unlike PA’s – NP come in may different “colors” FNP, ACNP, ANP, ENP, Onco-NP, CRNA, Midwife, etc. These are specialties, and yes some of us are in peds and women’s health.
AS for being on the medical boards, we are not licensed under the board of medicine, why would we be on there board?
There is not clinical difference in functionality of PA and NP other then above mentioned. To assume one is superior to the other is false. I would like to make a final statement as the MD preference. As mentioned above, NP have independent license, thus we can function without direct supervision (collaborator) in 21ish states. This means that unlike PA’s, the MD is not required to be on premises. This further limits liability of the MD because unless consulted he/she had no involvement in the pt. WE ARE INDEPENDENTLY LICENSED sole responsible in most cases.
Specializes in ICU, PICC Nurse, Nursing Supervisor.
On the same note Ill add here that the University of North Texas Health and Science Center in Ft Worth has a well respected PA program, However a student only needs 90 hours of course work for admission and most of those are the same as your nursing pre-classes. So no you do not need a bachelor degree (you may in some state) and you definitly do not have to have any prior certs or degrees. I am not a PA or NP but I have checked into this and know people that have done it...
All midlevels are not required to have a masters for reimbursement.
Not all accredited NP programs require a BSN and 2 years experience.
MDs are not required to be on the premises to supervise PAs. There are more similarities than differences between "collaborative" agreements and "supervisory" agreements. One difference is that PAs are delegated tasks, not given protocols like some states require of NPs.
Good luck in your career, Im sure you're very good with your patients...
1. NP's can have private independent practices in some state, please refer to the pearsons report which is pub. every year. It contains the entire practice requirement, etc for each and every state. Here in Colorado, I personally know of 4 private practice owned and operated by Np's. In our state we are required to have a collaborative agreement (see CO scope of practice doc) not and supervisory agreement. Which is completely different! As a result of the collaborative agreement, the Np functions completely independent in all aspect unless a consult deemed necessary by the NP. Both PA and NP's can only bill 80% of the MD fee in most cases. Further I would like to say that the above mentioned private practices are not planned parenthood, or a women's clinic, 3 are Fp and 1 is county sponsored first emergent contact clinic (talk about independence).
NP do not make "nursing diagnosis", we have to function under the allopathic modal just as PA, MD and DO's. we do incorporate the holistic view point.
there are PA schools which are certificate not just BS, MS. Both professions have moved away from this programs because Medicare require ALL mid-level providers to have MS and National Certs. Further ALL accredited NP program REQUIRE BSN most have a min. of 2 years in "critical care areas" do the math, 3744 hours of previous exp. + 600- 1000hrs in NP rotation + 600-1000hrs in RN rotation = approx 5744 hours.
I'm a ACNP (Acute care) if you did not know thus stating that we ACNP spent our time in just fp, peds, ob/woman health. Apparently your not getting the correct info. We focus on systems, thus we had to do clinical rot in cards, neuro, neph, GI, internal, etc. unlike PA's - NP come in may different "colors" FNP, ACNP, ANP, ENP, Onco-NP, CRNA, Midwife, etc. These are specialties, and yes some of us are in peds and women's health.
AS for being on the medical boards, we are not licensed under the board of medicine, why would we be on there board?
There is not clinical difference in functionality of PA and NP other then above mentioned. To assume one is superior to the other is false. I would like to make a final statement as the MD preference. As mentioned above, NP have independent license, thus we can function without direct supervision (collaborator) in 21ish states. This means that unlike PA's, the MD is not required to be on premises. This further limits liability of the MD because unless consulted he/she had no involvement in the pt. WE ARE INDEPENDENTLY LICENSED sole responsible in most cases.
From my experience, the vast majority of nursing programs do not require 2 years of chemistry, including inorganic/general, organic, and biochem, or immunology and genetics. Also remember, most med schools only "require" 90 semester credits. These are the MINIMUM requirements to get it. They do this because there are some very good nurses who have every right to become a PA and it doesn't matter if they had a 3.0 and didnt do that great in organic chem... if they have the experience to make up for it, the PA programs keep the MINIMUMS low to allow some discretion and ability to assess the candidate as a whole package.. not just someone who "has 90 semester credits."
On the same note Ill add here that the University of North Texas Health and Science Center in Ft Worth has a well respected PA program, However a student only needs 90 hours of course work for admission and most of those are the same as your nursing pre-classes. So no you do not need a bachelor degree (you may in some state) and you definitly do not have to have any prior certs or degrees. I am not a PA or NP but I have checked into this and know people that have done it...
All midlevels are not required to have a masters for reimbursement.
Not all accredited NP programs require a BSN and 2 years experience.
MDs are not required to be on the premises to supervise PAs. There are more similarities than differences between "collaborative" agreements and "supervisory" agreements. One difference is that PAs are delegated tasks, not given protocols like some states require of NPs.
Good luck in your career, Im sure you're very good with your patients.
If you don't think there's a difference between a NP and PA, then you need to get on physicianassistantforum.com and read the thread, "When I grow up I want to be a NP." On that thread, several PA's are lamenting the fact that they don't have the respect that NP's enjoy. One PA in Kentucky is complaining that NP's can write Schedule II meds now, although he can't. He also states that he has gone to several drug programs and has overheard physicians state that they would rather hire a NP over a PA, because of their independence. If a NP can practice independently in a state and is involved in a lawsuit, it's doubtful the physician will be included in that suit. Any time a PA gets sued, the doctor is automatically included. You will see more and more physicians hiring NP's in those states, it's happening right here in Texas. My boss was planning on hiring a PA until he spoke with some of his physician friends and found out he was less likely to be included in a malpractice lawsuit if he employeed NP's. Well, guess what, HE HAS 2 NP'S AND HE'S LOOKING FOR A THIRD!
Yes, sometimes docs will prefer to hire NPs and much of the time docs will prefer to hire PAs. Every statement you just made can be mirrored for NPs. For example, how many NPs were upset about the differences in practice in GA between PAs and NPs. Its about the person, not the profession. The laws are very similar in most states. Some states offer more clinical decision making autonomy to PAs by not requiring protocols etc. Some offer more prescriptive authority to PAs by giving them sch 2 where NPs dont have it. Some offer more autonomy to NPs in that way, like Kentucky. BUT, in the end, there is way more IN COMMON than difference.
Yes, sometimes docs will prefer to hire NPs and much of the time docs will prefer to hire PAs. Every statement you just made can be mirrored for NPs. For example, how many NPs were upset about the differences in practice in GA between PAs and NPs. Its about the person, not the profession. The laws are very similar in most states. Some states offer more clinical decision making autonomy to PAs by not requiring protocols etc. Some offer more prescriptive authority to PAs by giving them sch 2 where NPs dont have it. Some offer more autonomy to NPs in that way, like Kentucky. BUT, in the end, there is way more IN COMMON than difference.
Please tell me where I can find similar postings by NP's. I have yet to see a thread written by a NP entitled, "When I grow up I want to be a PA." Docs are going to continue to prefer NP's because of the lowered risk of liability. The ones who haven't already done it, don't know about it. My boss used to hire PA's, but not since he found out he was 100% liable for everything they did. Actually a lawyer was the one to inform my boss about this issue and he'll never hire another PA for this very reason. The NP associations need to get this news to the physicians ASAP.
I will simply say.... Show me the proof. If you have no proof, then I consider YOUR statement to be "inflammatory" and a "personal attack" on ALL PAs.
p.s. look around some more on that forum and find the NP who states he/she wishes they were a PA. This is a ridiculous argument. Thats all I have been trying to point out. If ANYTHING is inflammatory its the factless, baseless attacks on PAs I see on this forum every day.
Please tell me where I can find similar postings by NP's. I have yet to see a thread written by a NP entitled, "When I grow up I want to be a PA." Docs are going to continue to prefer NP's because of the lowered risk of liability. The ones who haven't already done it, don't know about it. My boss used to hire PA's, but not since he found out he was 100% liable for everything they did. Actually a lawyer was the one to inform my boss about this issue and he'll never hire another PA for this very reason. The NP associations need to get this news to the physicians ASAP.
Specializes in Education, FP, LNC, Forensics, ED, OB.
please do not make this thread personal. we are all professionals and should be able to discuss the np and pa similarities/differences and get along as we do so.
would hate to see this thread go by the wayside should personalizations continue in a negative light.
wellnessNP
6 Posts
A Nurse Practitioner can own clinics and can practice independently. Big deal that many states make you have a collaborating physician. SO we gotta have protocols. Doctors have protocols also. I work with many PAs and they do have the advantage of generalist where as a NP is declared a specialist in a particular field. The PA is trained more in medicine which means protocols. THEY will never practice independent. In fact the role is pushed to keep the NP role at bay. I just gave a seminar in which several physicians attended and I am treated as an equal amoung them. Maybe it is the self defeatest attitude and we are no better attitude that holds the NP to the ground. There is nothing wrong with being proud of being a NP.