Differences (Educative/Clinical) between NP & PA

[jstuben]

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?

Thank you very much!

[CoryRN]

Just a quick note... never posted before. I am an FNP and many of my friends and colleagues are PAs. In fact some of my preceptors in school were PAs. I believe it is what you make of it. I good provider is just that, a good health care provider, no matter what the title (MD, DO, PA, NP).

That being said, NPs do run their own practices in many states. I live in one of them. The law specifically allows us to hang our own shingle without "physician supervision". Any responisble NP or PA will consult a physician prn. Unfortunately, PAs do not have the legal luxury of hanging their own shingle without "physician supervision", but many of them do so functionally anyway and employ physicians to look over some charts here and there and answer a few questions by phone.

We compete for the same jobs, work side by side in many institutions, and are constantly mistaken for one another often. Because I am male, I am confused for both a PA and a physician on a daily basis. Doesn't bother me when I am confused for a PA!! We are more alike than different and we need to figure out a way to improve our relations so we can be a force together on a national level.

[TMPaul]

CoryRN said:

Just a quick note... never posted before. I am an FNP and many of my friends and colleagues are PAs. In fact some of my preceptors in school were PAs. I believe it is what you make of it. I good provider is just that, a good health care provider, no matter what the title (MD, DO, PA, NP).

That being said, NPs do run their own practices in many states. I live in one of them. The law specifically allows us to hang our own shingle without "physician supervision". Any responisble NP or PA will consult a physician prn. Unfortunately, PAs do not have the legal luxury of hanging their own shingle without "physician supervision", but many of them do so functionally anyway and employ physicians to look over some charts here and there and answer a few questions by phone.

We compete for the same jobs, work side by side in many institutions, and are constantly mistaken for one another often. Because I am male, I am confused for both a PA and a physician on a daily basis. Doesn't bother me when I am confused for a PA!! We are more alike than different and we need to figure out a way to improve our relations so we can be a force together on a national level.

Very well said Cory. I'd be pleased to work along side of you any time. ?

Tina, APRN-BC

[MrBob]

Hi...I am new here actually administrate on a PA forum at a different site...can I say that I am impressed with this forum and appreciate the attitudes of the NP's who feel that we are "partners". I too feel that way and impress on my students the importance of our collaboration. I hope that you folks don't mine my participating here occasionally and will NOT be a part of flame wars regarding one being better than the other. Neither do I intend to come here to "start anything" . I am intersted in both of our views and look forward to sharing ideas and comments.

To the poster worried about getting into PA school without experience, while a few PA schools do not require it, in those you may not be competitive (the rest of the applicants may have it) so yoiu may want to try to get some contact. You can, however get in without it if that is the only thing you lack in soem programs. My best students oftne have no experience...no bad habits to break (LOL)

Bob

[TMPaul]

MrBob said:

Hi...I am new here actually administrate on a PA forum at a different site...can I say that I am impressed with this forum and appreciate the attitudes of the NP's who feel that we are "partners". I too feel that way and impress on my students the importance of our collaboration. I hope that you folks don't mine my participating here occasionally and will NOT be a part of flame wars regarding one being better than the other. Neither do I intend to come here to "start anything" . I am intersted in both of our views and look forward to sharing ideas and comments.

To the poster worried about getting into PA school without experience, while a few PA schools do not require it, in those you may not be competitive (the rest of the applicants may have it) so yoiu may want to try to get some contact. You can, however get in without it if that is the only thing you lack in soem programs. My best students oftne have no experience...no bad habits to break (LOL)

Bob

Hi All,

Having worked (and still working) with some awesome PA's and being a NP myself, I ask what (really big) difference it makes to compare and contrast the roles of PA and NP? Isn't our goal to work for the care of our patients?? ?

I believe it's time to start supporting and collaborating with one another. We each have a lot to contribute to the profession. ?

Tina

Nurse Practitioner

[patnshan]

CoryRN said:

We compete for the same jobs, work side by side in many institutions, and are constantly mistaken for one another often. Because I am male, I am confused for both a PA and a physician on a daily basis. Doesn't bother me when I am confused for a PA!! We are more alike than different and we need to figure out a way to improve our relations so we can be a force together on a national level.

Hello,

I am a PA who is still actually an RN. I researched MD, PA, and NP, obviously choosing PA for my own reasons. I would be glad to discuss those reasons with anyone who would like. By the way, I most certainly made the right choice for me. I have been a PA for about five years.

I agree with Cory that we do compete for the same jobs in many cases. At my academic institution, this is certainly true. The training and philosophy behind the training is different, but once out of school, we become quite similar.

NP's do practice medicine, despite many arguements against that fact. Also, in most cases, collaboration = supervision. It is different from state to state, as is supervision for PA's.

I truly believe that most NP's do not actually seek to be independent, they just seek a certain, significant level of autonomy. That is what most PA's seek as well.

The "powers that be", or the nursing lobby seem to be the one's pushing for independence. It is for that reason that NP's and PA's will never fully be able to work together for a common good, and why the NP profession is "shooting itself in the foot". Remember, "I fought the law and the law one"? The AMA is the law. You will never win fighting it. PA's realize this, most NP's realize this. I doubt national nursing leadership realizes this.

I work with many great NP's, all of whom believe that NP's function best in a collaboration, supervision type model with a physician. These are just my humble opinions.

Thanks,

Pat, RN, BSN, PA-C, MPAS

[PA-C in Texas]

NP's and PA's are hostage to the nursing vs. medicine feud. I wish to understand that a little better. I haven't met any PA's who regret the necessary relationship with a physician, but I see a lot of NP's who constantly scream "independent practice!". Why is that? I honestly want to know.

Every should join the American College of Clinicians. Perhaps we can start to think of ourselves commonly as practitioners instead of falling victim to the NP vs. PA aka Medicine vs. Nursing circle jerk. We might actually get some things done that benefit both sides of the profession.

[MrBob]

PA-C in Texas said:

NP's and PA's are hostage to the nursing vs. medicine feud. I wish to understand that a little better. I haven't met any PA's who regret the necessary relationship with a physician, but I see a lot of NP's who constantly scream "independent practice!". Why is that? I honestly want to know.

Every should join the American College of Clinicians. Perhaps we can start to think of ourselves commonly as practitioners instead of falling victim to the NP vs. PA aka Medicine vs. Nursing circle jerk. We might actually get some things done that benefit both sides of the profession.

I agree with you on most points, Tex. In our state ( and as you know they are all different and the huge mistake we both as PA's and NP's make is to generalize the whole of both professions from the point of view of our local colleagues and state regulations) we really don't see such bantering. In our state we BOTH are able to work independent of the physician and do so in a collaborative arrangement rather than a "supervisory " arrangemet (take a look at the new PA regulaltions for North Carolina). So my disagreement is in the NP only wanting to be independent. anyway...we all need to be a part of an organization that encourages an understanding of our differences and common goals. We need to stop this "us and them" business that is so prevalent on both of our forums ( I am an administrator on the Physician Associate forum at http://www.physicianassociate.com). It is a hot topic there too, and disturbs me, but we are all entitled to our opinions on both forums.

I would like to say that I did not post that website to advertise but to promote and understanding from our professional point of view for those intrested in joining conversation on our site. Several of you already do.

I find this site informative and really not near as "PA unfriendly" as I was led to blieve it was. In fact I have found it to be quite receptive to a PA joining in.

Bob

[ECMOismygame]

SusanJean said:

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

Yes, more and more colleges are accepting new college grads, but if you look at the entering class, look just how many of those actually got in with jsut the 90 hrs or BS degree with no experience. Even the traditional PA programs accept most PA students with about 3-4 years experience in healthcare. On top of 3.4-3.6 GPA with premed science courses...but then there are programs like at Stanford, UC-Davis and MEDEX which look more at experience (like NP programs)....look at the website for Stanford Primary Care Associate Program...I think its great (only if it were longer, only 15 months, better if it was 24-36 months)

http://pcap.stanford.edu/ if you're an RN and you complete the program you can either test to be a NP or a PA, if you're not an RN then you will take the PA exam.........

according to the website

"The Primary Care Associate Program offers students a 15-month curriculum that combines the traditional concepts of both physician assistant and nurse practitioner training. This reflects the program philosophy that no functional distinction in practice exists between these two types of primary health care professionals."

these two professions are very similar in the end and serve as physician extenders and ultimately are there to serve the needy.

[NurseFirst]

ramiro_ac said:

Yes, more and more colleges are accepting new college grads, but if you look at the entering class, look just how many of those actually got in with jsut the 90 hrs or BS degree with no experience. Even the traditional PA programs accept most PA students with about 3-4 years experience in healthcare. On top of 3.4-3.6 GPA with premed science courses...but then there are programs like at Stanford, UC-Davis and MEDEX which look more at experience (like NP programs)....look at the website for Stanford Primary Care Associate Program...I think its great (only if it were longer, only 15 months, better if it was 24-36 months)

http://pcap.stanford.edu/ if you're an RN and you complete the program you can either test to be a NP or a PA, if you're not an RN then you will take the PA exam.........

according to the website

"The Primary Care Associate Program offers students a 15-month curriculum that combines the traditional concepts of both physician assistant and nurse practitioner training. This reflects the program philosophy that no functional distinction in practice exists between these two types of primary health care professionals."

these two professions are very similar in the end and serve as physician extenders and ultimately are there to serve the needy.

The reason "Stanford's" PA program is 15 months is because, as they state, they require substantial prior health care experience to get in. "Stanford's" program is actually run through a local community college, Foothill College, and the credits are given thru Foothill, not Stanford.

NurseFirst

[zenman]

susanna said:

What do you mean antiquated medical model? Do you mean the nursing model?

No, the medical model. If a physicist were to attend a medical convention, he'd think he was thrown back into the stone age. :chuckle

[zenman]

PA-C in Texas said:

Anyway, PA's and NP's can do a lot more for themselves when they work together instead of trying to tear the other profession down. There's plenty work to go around.

That's true, but we can discuss the differences. Good luck in school.

[KrisRNwannabe]

Right about former experience. at the colleges I have looked at in michigan, they wanted you to have a degree. any degree. I wish I would have known this. I might have gone the PA route. since I already had a BS degree. I never realized they were master's degree program. around here i have noticed they are 2 years full time.