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?
Independent NP practice does attract a lot to the field. However, there are still many barriers to total independent practice for NP's even in states where the law seems to indicate that an NP can practice without physician involvement. The American Academy of NP's lists Michigan as one of the states where no physician involvement is required. However, in our state prescriptive authority is a delegated role so that makes it hard to prescribe without indicating a physician's name. Many private insurances do not recognize an NP's independent practice so that's another barrier unless the NP goes through the insurance company's credentialing process. In my state, not many NP's have been able to accomplish that.
I have tried to explain this to people.. even very educated people.. and most won't even entertain the idea that independent practice for NPs is not much more possible than independent practice for PAs. At one point I went through 3/4ths of the states listed as "completely independent" and found that only one offer actual independence. The others all had barriers to practice that included physician involvement of some sorts. In the end, the only truly independent provider is a physician and "independence" isn't really the truth of the matter for them either. It really is a shame, sometimes it can be almost adolescent, how we try to play the "I could be independent if i wanted to" game.
Specializes in Education, FP, LNC, Forensics, ED, OB.
Can I tweek that last statement a little bit and say that "NPs and PAs need to come together and create a large unified voice." The american college of clinicians attempted that but doesnt seem to have worked out all that well. If we all worked together, recognizing the strengths and weaknesses of both professions and working together to standardize training and certification by getting rid of the collective bad and promoting collective good NPs and PAs alike, as "midlevels" could really improve public health by doing what they both do best. oh well. it will never hapen.
1. Some states do allow NP's to have solo practices. I live in one of them.
2. "PA students ALWAYS have some kind of professional certification prior to becoming PAs. "
ABSOLUTELY FALSE!! More and more schools are accepting new college graduates. They might require some "clinical experience" but there is no across the board requirement for a professional certification.
Given the responsibility of the profession, there should be...
I think the NP/PA debate is useless, but incorrect info is harmful.
SJ
I work with a PA who did not have any prior medical experience before entering PA school. He does just fine and we do exactly the same thing and we get paid exactly the same amount. The only thing I have on him is the option of starting my own practice. Also, where I live, docs prefer NP's because they consider us less of a liability. When a PA gets sued, the doctor is always involved, which isn't the case with NP's.
I work with a PA who did not have any prior medical experience before entering PA school. He does just fine and we do exactly the same thing and we get paid exactly the same amount. The only thing I have on him is the option of starting my own practice. Also, where I live, docs prefer NP's because they consider us less of a liability. When a PA gets sued, the doctor is always involved, which isn't the case with NP's.
go to this website for info re: PAs and NPs being able to start their own practices.
there is no experience like a nurses experience,I dont think there is no profession that forces you to become one with the patient like nursing does, why I believe NP are the future in healthcare delivery.
I thought NP can open private practices at least I know someone who has, but PA never heard, can they?
Both NP's and PA can open practices. The difference is how they are structured. PA's form a company that can be up to 99% owned by the PA (the other 1% can either be owned by a physician or anyone else depending on the state). The company then hires a physician supervisor. An NP can either use this system or hire a physician directly if they need one.
You should also be aware that the notion of actual independence is a myth. There is only one state that does not require physician collaboration/supervision for either practice or prescriptive authority. In addition Medicare requires physician collaboration to bill medicare. Also most insurance companies will not allow direct billing by NP's.
That being said there are hundreds and possibly thousands of clinics where NP's and PA's are practicing with defacto independence.
there is no experience like a nurses experience,I dont think there is no profession that forces you to become one with the patient like nursing does, why I believe NP are the future in healthcare delivery.
Both NP's and PA can open practices. The difference is how they are structured. PA's form a company that can be up to 99% owned by the PA (the other 1% can either be owned by a physician or anyone else depending on the state). The company then hires a physician supervisor. An NP can either use this system or hire a physician directly if they need one.
You should also be aware that the notion of actual independence is a myth. There is only one state that does not require physician collaboration/supervision for either practice or prescriptive authority. In addition Medicare requires physician collaboration to bill medicare. Also most insurance companies will not allow direct billing by NP's.
That being said there are hundreds and possibly thousands of clinics where NP's and PA's are practicing with defacto independence.
2. NPs can have totally independent practices w/o physician involvement/collaboration it all depends on that states board of nursing.
Nurse Practitioner, 2003 by Segal-Isaacson, Adam Ezra
Twenty-six states now have laws that allow APNs to set up independent practices without physician involvement. Another 14 states allow independent practice with physician collaboration. This entrepreneurial possibility has led many APNs to strike out on their own.
3. APNs do have independent prescribing privledges in some states including controlled substances, but again it all depends on the state. http://www.medscape.com/viewarticle/440315
NPs can have totally indepent practice including prescribing authority, but it all depends on your state board of nursing.
that fact sheet is now 10 years old and was written at a time when np's in non-rural areas could not bill at all. nowhere does it address physician collaboration except to say that it does not have to be on-site. this is from the ana (i have the actual medicare language if you really want to see that also).
q. the new law requires that, in order for their services to be covered, an np or cns must be "working in collaboration with a physician." what does that mean?
a. the "collaboration" requirement in the new law is the same one that currently exists for services of nps and cnss provided in rural areas. "collaboration" is defined under both the old law and the new law as:
a process in which a nurse practitioner [or a clinical nurse specialist] works with a physician to deliver health care services within the scope of the practitioner's professional expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as defined by the law of the state in which the services are performed
2. nps can have totally independent practices w/o physician involvement/collaboration it all depends on that states board of nursing.
nurse practitioner, 2003 by segal-isaacson, adam ezra
twenty-six states now have laws that allow apns to set up independent practices without physician involvement. another 14 states allow independent practice with physician collaboration. this entrepreneurial possibility has led many apns to strike out on their own.
3. apns do have independent prescribing privledges in some states including controlled substances, but again it all depends on the state. http://www.medscape.com/viewarticle/440315
nps can have totally indepent practice including prescribing authority, but it all depends on your state board of nursing.
while this quote looks nice, this depends on how you define independent practice. the number bandied about is different depeding on the quote, but if you look here from the acnp:
this lists 23 states that require no physician involvement. if you look at one of those states, colorado, in their nurse practice act you would find this in the prescriptive authority section:
"(d) (i) execution of a written collaborative agreement with a physician licensed in colorado whose medical education, training, experience, and active practice correspond with that of the advanced practice nurse.
(ii) the written collaborative agreement shall include the duties and responsibilities of each party, provisions regarding consultation and referral, a mechanism designed by the advanced practice nurse to assure appropriate prescriptive practice, and other provisions as established by the board."
hmm sure looks like physician involvement to me. similary if you look through the other practice acts there is only one state that does not require some level of physician interaction. that being said, i will repeat what i stated originally, that there are plenty of np's (and pa's) with defacto independent practice. what i dislike is the idea being promoted that np's can charge out and open a practice withouth any physician involvement. it is naive to say the least. yes in at least 15 states you can open a practice without any physician collaboration, as long as you don't prescribe, don't bill medicare or most insurance companies. failure to have these elements is not associated with successful practice.
the internet is a tremendous source of information, but you have to look at any source critically. there is some tremendously poor information out there, some even in peer reviewed journals.
while this quote looks nice, this depends on how you define independent practice. the number bandied about is different depeding on the quote, but if you look here from the acnp:
you have been doing a great deal of research on the np and pa roles in practice. have you found the same depth of information on who is responsible for the performance of the pa or np? historically the physician has been responsible for the performance of the pa. while nps have been perceived as responsible for their own performance. has this changed?
you have been doing a great deal of research on the np and pa roles in practice. have you found the same depth of information on who is responsible for the performance of the pa or np? historically the physician has been responsible for the performance of the pa. while nps have been perceived as responsible for their own performance. has this changed?
caldje
177 Posts
I have tried to explain this to people.. even very educated people.. and most won't even entertain the idea that independent practice for NPs is not much more possible than independent practice for PAs. At one point I went through 3/4ths of the states listed as "completely independent" and found that only one offer actual independence. The others all had barriers to practice that included physician involvement of some sorts. In the end, the only truly independent provider is a physician and "independence" isn't really the truth of the matter for them either. It really is a shame, sometimes it can be almost adolescent, how we try to play the "I could be independent if i wanted to" game.