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?
Siri, I'm pretty sure that I read something earlier this year that Georgia FINALLY got it together and began allowing NPs prescriptive authority- Yeah! (I live in Georgia).
For everyone else, this is definitely an interesting debate. As I read, I find myself swinging back and forth on which way to go. I have not done extensive research on these subjects as many of you all have, as I am still working on becoming "seasoned" as an RN. But I know that this site is a great place to start - gaining insight from those who have already been down this road.
I will make this comment though: My boyfriend is a Gastroenterologist and he has encouraged me to get enrolled in an NP program. In the more distant past, I think we had this NP/PA discussion and do you know what he said (PLEASE DON'T SHOOT THE MESSENGER!!!)? He advised me not to go the PA route because he said I will get more respect as an NP (from the doctors I assume?) because they have more education under their belt. Now mind you, in fairness to the PAs, I'm not sure that he is aware that PAs now have master's level training.
Now again, PAs, please don't get mad at me for the above comment, as I have really considered taking this path and certainly have not ruled it out yet. I can say that at the hospital where I work, most of the PAs are excellent - very professional and just really cool people. But, I'll say this too, there are also 2 or 3 that come to mind that seem to have this superior attitude towards nurses...almost like those stuffy docs who don't mind abruptly interrupting nurse/pt interactions as though their time is so much more important than the nurses'. Or when they walk away expecting you to follow them while you are trying to convey important pt information to them. That is so rude and unprofessional from anyone - MD or PA. Those individuals I spoke of really need to check themselves and realize that they are NOT DOCTORS and lose the attitude. On a nice ending note...my hat is off to those Georgia Lung PAs I see so often on my floor - nice guys!
PNP's can now practice independently in 7 states. quote]
Actually, Cyndee, NPs can practice independently in 21 states. With the exception of Georgia, all NPs have some ability to prescribe. And, in 10 states, NPs can prescribe independently.
you are absolutely correct. if you will notice, my post was made before georgia received rx privileges.
sorry, didn't even catch that. i'm still having my afternoon (instead of morning) coffee (pure exhaustion). this would be a perfect example as to why i want to hurry up and get on the road to becoming some kind of mid-level practitioner...just worked two 14 hour days in a row and my feet are killing me (and i'm a skinny girl). being a mid-level practitioner has got to be where it's at....i think at least you have time for lunch and don't need specialized footwear!!!
Hey, nurse cherlove.. You're completely right. SOME physicians believe NPs have more training. IN the same respect some physicians believe PAs have more training. On both sides of the fence, most of those things are just opinions and most docs have done very little research on the subject. It all depends on whom they got their information from. I would hope this had come across in my previous posts that the differences are PERSONAL. Autonomy and respect are a function of COMPETENCE and NOT the letters after your name.
Specializes in Education, FP, LNC, Forensics, ED, OB.
Sorry, didn't even catch that. I'm still having my afternoon (instead of morning) coffee (pure exhaustion). This would be a perfect example as to why I want to hurry up and get on the road to becoming some kind of mid-level practitioner...just worked two 14 hour days in a row and my feet are killing me (and I'm a skinny girl). Being a mid-level practitioner has got to be where it's at....I think at least you have time for lunch and don't need specialized footwear!!!
I understand that, NurseCherlove. No problem.
14-hour days are pretty gruesome, I'll admit to that.
A day in the life of an APN can be long and hard, too. When I have to make rounds before daylight and then leave around 10 that night, it makes for a long day. Many a day I eat with one hand and dictate with the other.
After 25 years of being BOTH an NP AND a PA, the misinformation about these two types of advanced practice still boggles my mind. I agree with the authors of the replies who stated that there is plenty of room for both professions. Actually, with the medical journals etc. concerned with the lack of medical students entering "general medicine/family practice", both professions will find PLENTY of work.
The reason so many PA's find themselves in specialties such as surgery and orthopedics, ER etc. is related to the origin of the profession. The first "PA's" were the service medics returning from WWII with extensive battlefield experience. Rather than becoming "male aides" (most were male) the idea of assistants to physicians was born.
Nurse Practitioners were "born" from the need for health care provider in underserved areas, and populations that were uninsured or underinsured, and their need for more than basic nursing care and the lack of MD's to provide it. The training for each varies but each group has it's strengths and weaknesses. The major difference...for me in my professional life...I practice as an NP...is in licensing. ALL NP's MUST be licensed RN's, passing a NATIONAL STANDARDIZED LICENSING EXAM FOR RN's to be eligible for the advanced training of a Nurse Practitioner, and then qualify for nationally certified via exam & practice, to be an NP.. My "skills" and didactic NP training was in the department of medicine at a large medical center with the medical students, interns, and residents etc.
Many PA's have certifications, licenses in varied health fields, including nursing, but there is no NATIONAL, specific standard required to be eligible for the PA programs. ALL PA's should pass the national certifying exam to practice, that requirement varies from state to state.
The other major difference is related to licensing. The NP works under her own license (RN's MUST be licensed in EVERY state) and malpractice, with a COLLABORATIVE MD, who acts as a consultant and/or referral, and the NP can be in private practice. For example, prior to the position I now hold, for 17 years I was the Director and primary care giver of college student health centers, 3000 students plus faculty and staff...my "private practice". The collaborative physician was hired and worked for me under his/her medical license!
The PA works under the license, malpractice and supervision of the MD (unless the PA has for example an RN license). However, an RN license alone, for a PA does NOT legally allow the unsupervised advanced PA practice.
All this being said, we ALL have our gifts and strengths and collaboratively we make a dynamic, and powerful team...much needed in this time of too many folks without access to affordable health care, which BOTH professions provide very successfully.
Choose the profession, PA OR NP by what YOU want to do and what draws your interest. Good luck, feel free to contact me if I can help with anything....
Many PA's have certifications, licenses in varied health fields, including nursing, but there is no NATIONAL, specific standard required to be eligible for the PA programs. ALL PA's should pass the national certifying exam to practice, that requirement varies from state to state.
The other major difference is related to licensing. The NP works under her own license (RN's MUST be licensed in EVERY state) and malpractice, with a COLLABORATIVE MD, who acts as a consultant and/or referral, and the NP can be in private practice. For example, prior to the position I now hold, for 17 years I was the Director and primary care giver of college student health centers, 3000 students plus faculty and staff...my "private practice". The collaborative physician was hired and worked for me under his/her medical license!
The PA works under the license, malpractice and supervision of the MD (unless the PA has for example an RN license). However, an RN license alone, for a PA does NOT legally allow the unsupervised advanced PA practice.
....
As a "PA" you should know that all 50 states require PAs to pass the PANCE in order to be eligible for licensure. This does NOT vary state to state. Also, PAs have their OWN license to practice medicine AND have a "supervising physician of record." Please provide me literature proving otherwise. If you want, I will provider you literature proving what I am saying is true.
Thanks, and it IS amazing how much misinformation there is.
I am a NP in georgia and have been so for about 18 months now. Keep in mind the only true differences in NP and PA is the way that they are trained. PA's are trained on a medical model and NP's are trained on a nursing model. Difference you ask?? Well it's kinda like comparing MD to DO. NP's approach the patient from a holistic approach and PA's tend to approach the patient from a sytems or disease specific approach. In the end NP's and PA's take care of the same types of patients ranging from all the specialites and subspeciality areas including surgery, etc.
Depending on the type of NP program that you do whether it be family, acute, peds etc will determine where you are most marketable as a NP. I chose the family route because I wanted to be able to see patients across the lifespan and that makes you very marketable if you want to stay in the ER.
As for the nursing diagnosis, this is a real misunderstanding among NP's and PA's. When you are a nurse yes you do for nursing diagnosis and you should be thinking about differential diagnosis with all of your patients nurse or not. When you become a NP you no longer use nursing diagnosis because you no longer truely are functioning as a nurse, you are a practitioner and you use just like the PA's do a list of differentials and then you actually order labs, xrays, meds and then you interpret your findings and diagnose with a medical diagnosis not a nursing diagnosis. Keep in mind that before even going to NP school most programs require atleast 5 years of previous experience and all programs that I am aware of is of a master's level. PA's on the other hand are not required to have a masters degree nor are they required to have previous healthcare experience.
NP's and PA's are both midlevel providers and do the same things and infact more and more you will see the term midlevel provider rather than pitting NP's and PA's against each other. Look at both types of programs and see which is best for you.
XXX NPs can open there own medical practice and PAs cannot. NPs do not have to have there charts cosigned by a Physician and PAs do!! XXX Also, there are plenty of NPs working in surgery and in the ER. PAs don't even need a medical degree prior to starting the PA prgram. How safe is this!! Ask any patient and they will tell you how much they like NPs because they actually take the time that the patient prefers. XXX
You know, very few posts in this long thread have addressed the OP’s question – what are the CLINICAL differences between PAs & NPs. Instead there has been a lot of rhetoric, much of it unfounded, about the educational and perceived professional differences. Unfounded information has come from both views. I hope I am not violating TOS by saying this, but as a PA I am embarrassed by the garbage in that old post by Kristen.
I am a PA in emergency medicine. In my practice setting there are NO clinical differences between PAs and NPs. None – not even one single one.
Granted, I do work in a state that is friendly to both professions.
State law does not require my charts to be cosigned. The hospital requires chart cosignature for all midlevels with in 24 hours. The docs usually sit down with a pile and scribble on the bottom corner of each while chatting or doing something else. They are not looking at the actual chart. This is mean to be “midlevel supervision” but in actuality it is not. Supervision would be looking over our shoulder and guiding our actions during patient care.
State law allows me to write my own scripts, sched II-V. They do not have to be cosigned. I am limited to a 14-day supply of sched II & III. In my setting this is not a limitation – if you are sick enough to leave the emergency department with a script for a schedule II, you need to follow up with your PCP or specialist, who should manage your ongoing need for medications. In other settings, it may be a limitation to not be able to write a month’s supply of schedule II. I know that NPs can write up to sched II as well, but have never asked if they have a limit like ours.
For those who would say we are “only assistants” I invite you to spend a day with me in practice. You will see that while my badge says “assistant” I do not assist the docs with their patients. Instead, I see my own. I evaluate & treat, discharge & admit all without consulting a physician unless I feel it is needed. I see the same acuity of patients except for patients requiring immediate resuscitation. I hear/read nurses saying that the public does not understand the scope, intellect and abilities of nurses. I agree, but I submit to you the same for PAs. “Assistant” may have fit the job 35 years ago, but it does not any longer, except in the operating room.
I have my own license. I have my own malpractice policy, paid for in full by my employer. I have my own DEA number. I have my own UPIN. This is not new. Other than my lack of a nursing license I am no different from an NP in this regard. I do not practice under anyone else’s license, policy, etc. I don’t understand why some people refuse to accept the truth, and persist in claiming that we cannot be licensed or insured on our own. Perhaps it is because we are nationally certified but state licensed?
PAs in my state can (and do) own their own practice, but it is not common. I know PAs who own their own urgent care clinic, family medicine clinic, occupational medicine practice and psychiatric practice. NPs can own a practice here too, but I do not know of any off hand.
In all 50 states a PA must have active national certification in order to be licensed. Some states allow PAs to let that certification lapse, my state being one of them. To maintain national certification, a PA must log 100 hours of CME every two years for six continuous years, and take a primary care exam at the end of that period. In order to maintain state certification, a PA must log 100 hours of CME every two years. The only difference is not taking the primary care exam. Is this a sign of weakness or inferiority of the PA? I don’t think so. I know PAs and FNPs in neurosurgery. Both educated in primary care but practicing in a surgical subspecialty – would you think less of the FNP if her primary care knowledge were not retested every six years, so long as she maintained her knowledge though CME? If not, then why look down on a PA who chooses not to retest in primary care?
It is true that PA education is offered at several levels while NP education is almost entirely at the master’s level (there are a few stragglers in California). However, PA education is standardized nationally. Compare the applicant prerequisites and the curriculums at a certificate program and a master’s program. In almost every case you will see that the only true difference is they type of degree awarded at the end. The actual education is equal. Some may persist on looking down on the “lesser” degrees but I think that the quality of education is a more important issue. National curriculum standardization and accreditation ensures this quality.
It is true that some PA programs enroll students with no previous experience. Ironically, this tends to be the master’s programs – those that superficially seem to be superior degrees. Many PAs do not support this change in admission policies. However, there is verifiable proof that the majority of PA students do have prior clinical experience. Both professions, for better or for worse, are allowing new students without strong patient care backgrounds. To point at the PA profession as being inferior for this trend is to ignore the fact that the same thing is happening in the NP profession.
PA education is in the medical model, but I was not trained to focus on symptoms and throw medications at patients. I listen empathetically. I explain treatment options and side effects and encourage patients to have a role in deciding how their care will progress. I discuss complications and prognoses of diagnoses. During my training and also in my professional career, returning patients have asked for me by name, so I would say that they appreciate the care that I give. I am not a nurse and do not know how my training differs from the "holistic method" that nurses and NPs are trained in, but I do attempt to treat the whole person. I believe that most PA (and physician) training programs are going in this direction - rightfully so.
Just as a disclaimer, I am not anti-NP by any means. I work with NPs, some whom I respect and some whom I don’t – respect is earned by showing me that you are a capable provider, and in the long run that is what I care about the most. My husband and I see a PA, but my OB care was from physicians, a PA and NPs. Our children see docs & PNPs. The sole purpose of this lengthy post is to address the OP’s question with my real-life experience and to dispel some untruths propagated about the PA profession. I encourage anyone who is trying to decide between PA and NP to research both and use verifiable, objective information to make your decision.
Mango, I have read all the posts starting from the original one, and this has to be the best post yet. I think you did a great job of outlining the similarities/differences between NP's and PA's without making one out to be better than the other. I am a nursing student who is planning on pursuing an advanced nursing degree, and I look forward to being able to eventually work pretty autonomosly (sp?) Recently, while doing clinical rotations I have seen PA's alot in the hospital, working very autonomosly (sp?), so much so that I started second guessing my NP route. Well, after doing some additional research, and reading your post as well as a few others I have decided that I am will continue on my path, because either one will get me where I need to be. Thanks!
quote=mango-lo-maniac]You know, very few posts in this long thread have addressed the OP’s question – what are the CLINICAL differences between PAs & NPs. Instead there has been a lot of rhetoric, much of it unfounded, about the educational and perceived professional differences. Unfounded information has come from both views. I hope I am not violating TOS by saying this, but as a PA I am embarrassed by the garbage in that old post by Kristen.
I am a PA in emergency medicine. In my practice setting there are NO clinical differences between PAs and NPs. None – not even one single one.
Granted, I do work in a state that is friendly to both professions.
State law does not require my charts to be cosigned. The hospital requires chart cosignature for all midlevels with in 24 hours. The docs usually sit down with a pile and scribble on the bottom corner of each while chatting or doing something else. They are not looking at the actual chart. This is mean to be “midlevel supervision” but in actuality it is not. Supervision would be looking over our shoulder and guiding our actions during patient care.
State law allows me to write my own scripts, sched II-V. They do not have to be cosigned. I am limited to a 14-day supply of sched II & III. In my setting this is not a limitation – if you are sick enough to leave the emergency department with a script for a schedule II, you need to follow up with your PCP or specialist, who should manage your ongoing need for medications. In other settings, it may be a limitation to not be able to write a month’s supply of schedule II. I know that NPs can write up to sched II as well, but have never asked if they have a limit like ours.
For those who would say we are “only assistants” I invite you to spend a day with me in practice. You will see that while my badge says “assistant” I do not assist the docs with their patients. Instead, I see my own. I evaluate & treat, discharge & admit all without consulting a physician unless I feel it is needed. I see the same acuity of patients except for patients requiring immediate resuscitation. I hear/read nurses saying that the public does not understand the scope, intellect and abilities of nurses. I agree, but I submit to you the same for PAs. “Assistant” may have fit the job 35 years ago, but it does not any longer, except in the operating room.
I have my own license. I have my own malpractice policy, paid for in full by my employer. I have my own DEA number. I have my own UPIN. This is not new. Other than my lack of a nursing license I am no different from an NP in this regard. I do not practice under anyone else’s license, policy, etc. I don’t understand why some people refuse to accept the truth, and persist in claiming that we cannot be licensed or insured on our own. Perhaps it is because we are nationally certified but state licensed?
PAs in my state can (and do) own their own practice, but it is not common. I know PAs who own their own urgent care clinic, family medicine clinic, occupational medicine practice and psychiatric practice. NPs can own a practice here too, but I do not know of any off hand.
In all 50 states a PA must have active national certification in order to be licensed. Some states allow PAs to let that certification lapse, my state being one of them. To maintain national certification, a PA must log 100 hours of CME every two years for six continuous years, and take a primary care exam at the end of that period. In order to maintain state certification, a PA must log 100 hours of CME every two years. The only difference is not taking the primary care exam. Is this a sign of weakness or inferiority of the PA? I don’t think so. I know PAs and FNPs in neurosurgery. Both educated in primary care but practicing in a surgical subspecialty – would you think less of the FNP if her primary care knowledge were not retested every six years, so long as she maintained her knowledge though CME? If not, then why look down on a PA who chooses not to retest in primary care?
It is true that PA education is offered at several levels while NP education is almost entirely at the master’s level (there are a few stragglers in California). However, PA education is standardized nationally. Compare the applicant prerequisites and the curriculums at a certificate program and a master’s program. In almost every case you will see that the only true difference is they type of degree awarded at the end. The actual education is equal. Some may persist on looking down on the “lesser” degrees but I think that the quality of education is a more important issue. National curriculum standardization and accreditation ensures this quality.
It is true that some PA programs enroll students with no previous experience. Ironically, this tends to be the master’s programs – those that superficially seem to be superior degrees. Many PAs do not support this change in admission policies. However, there is verifiable proof that the majority of PA students do have prior clinical experience. Both professions, for better or for worse, are allowing new students without strong patient care backgrounds. To point at the PA profession as being inferior for this trend is to ignore the fact that the same thing is happening in the NP profession.
PA education is in the medical model, but I was not trained to focus on symptoms and throw medications at patients. I listen empathetically. I explain treatment options and side effects and encourage patients to have a role in deciding how their care will progress. I discuss complications and prognoses of diagnoses. During my training and also in my professional career, returning patients have asked for me by name, so I would say that they appreciate the care that I give. I am not a nurse and do not know how my training differs from the "holistic method" that nurses and NPs are trained in, but I do attempt to treat the whole person. I believe that most PA (and physician) training programs are going in this direction - rightfully so.
Just as a disclaimer, I am not anti-NP by any means. I work with NPs, some whom I respect and some whom I don’t – respect is earned by showing me that you are a capable provider, and in the long run that is what I care about the most. My husband and I see a PA, but my OB care was from physicians, a PA and NPs. Our children see docs & PNPs. The sole purpose of this lengthy post is to address the OP’s question with my real-life experience and to dispel some untruths propagated about the PA profession. I encourage anyone who is trying to decide between PA and NP to research both and use verifiable, objective information to make your decision.
NurseCherlove
367 Posts
Siri, I'm pretty sure that I read something earlier this year that Georgia FINALLY got it together and began allowing NPs prescriptive authority- Yeah! (I live in Georgia).
For everyone else, this is definitely an interesting debate. As I read, I find myself swinging back and forth on which way to go. I have not done extensive research on these subjects as many of you all have, as I am still working on becoming "seasoned" as an RN. But I know that this site is a great place to start - gaining insight from those who have already been down this road.
I will make this comment though: My boyfriend is a Gastroenterologist and he has encouraged me to get enrolled in an NP program. In the more distant past, I think we had this NP/PA discussion and do you know what he said (PLEASE DON'T SHOOT THE MESSENGER!!!)? He advised me not to go the PA route because he said I will get more respect as an NP (from the doctors I assume?) because they have more education under their belt. Now mind you, in fairness to the PAs, I'm not sure that he is aware that PAs now have master's level training.
Now again, PAs, please don't get mad at me for the above comment, as I have really considered taking this path and certainly have not ruled it out yet. I can say that at the hospital where I work, most of the PAs are excellent - very professional and just really cool people. But, I'll say this too, there are also 2 or 3 that come to mind that seem to have this superior attitude towards nurses...almost like those stuffy docs who don't mind abruptly interrupting nurse/pt interactions as though their time is so much more important than the nurses'. Or when they walk away expecting you to follow them while you are trying to convey important pt information to them. That is so rude and unprofessional from anyone - MD or PA. Those individuals I spoke of really need to check themselves and realize that they are NOT DOCTORS and lose the attitude. On a nice ending note...my hat is off to those Georgia Lung PAs I see so often on my floor - nice guys!