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?
I don't know wat state you're in but in Ct., AN NP only needs a collaborating MD. For me-I meet with one for lunch once a month and discuss cases-I practice independently and use the MD only as a consultant. We are working here to remove even the word"collaborative "from th mix-making NP's independent legally-like some of them are in real life. Do you realize that if you have a private practice and the MD ends your collaborative contract-you have to close your practice overnight or longer until another MD agrees to be your collaborating MD?-very bad for patients!
i did not know that the all caps thing was taken as yelling, so apologies if you took it to mean that. with respect to hoalistic therapies, perhaps you should familiarize your self more with other non western therapies. some of them are very beneficial, like accupuncture and some herbal remidies for things instead of using mainly pharamacuticals. aryuvedic medicine is supposed to be very cool as well. some western practitioners are also trying to learn other healing arts as well, which is what i'd like to do after getting the NP. it's unfortunate that practitioners in the ICU would attribute all of the healing to chemicals, rather than recognizing that it may be that they care about other human beings and their well being (that thier hearts may have something to do with medicine). i read the quack watch website and I actually thought some of the therapies sounded cool (why not try them in addition to traditional therapies). it is also good to avoid name calling because it discredits the person who calls names, especially in science. science is supposed to be objective, not biased and rude. science should be a process of discovery. western medicine has it's place, but it is not a panacea and there are other healing methods that have been used successfully by other cultures that i think can be beneficial to us. if doctors respect science than they must keep an open mind, because that is what science is about. i truely believe that biology is more beautiful and complex that we think it is. it's bad to think that we know it all. thanks much for your response and no hard feelings.
I think that alternative medicine has its place. Some modalities such as accupuncture are well tested and have some science behind them. I use this not infrequently. Some such as chiropractic have some evidence based medicine behind them and used in a focal manner, for low back pain for example, are not inferior to medical treatment. That being said as a provider you owe the patient the best possible treatment. The principle behind evidence based medicine (which has been adopted by nursing) is to critically look at the data behind treatment options and offer the patient a variety of options with the advantages and disadvantages clearly described so the patient can make an informed choice.
That being said, the vast majority of "holistic" medicine is simply ineffective. While most is not harmful, some is or may delay patients seeking better treatment options. At its worst it takes money from patients with extravegant promises that give them hope with no real chance of acheiving what is promised. In the realm of herbal remedies, I saw more than 50 patients last year with abnormal LFT's from herbal medicine. Three were in fulminant liver failure, one of which died and one went to transplant. This is not benign stuff here. As providers we need to understand alternative medicine mostly in the realm of drug interaction, but also if it will interfere with our therapies. It also induces patients to try to treat themselves with naturopathic remedies to save money. While this may have little practical effect since many conditions that we see patients for are benign and self-limiting, it also delays treatment for more serious conditions with potential serious complications.
At its worse it gives false hope and puts patients with terminal conditions through useless treatments. Here is a fairly classic example from the naturopathy world (although in all fairness it is unclear wether he was a licensed ND (whatever that is)):
The upshot was that he was convicted and is now serving prison time. While the patients condition was probably ultimately fatal, nobody should have to go through this with a child.
Ultimately you have to understand that alternative medicine is unregulated and unsupervised. There is no guarantee for even minimal competence or safety studies. There is no guarantee that the "herbal remedies" even contain active ingredient. This is what you should be educating patients on concerning alternative medicine.
I think that alternative medicine has its place. Some modalities such as accupuncture are well tested and have some science behind them. I use this not infrequently. Some such as chiropractic have some evidence based medicine behind them and used in a focal manner, for low back pain for example, are not inferior to medical treatment. That being said as a provider you owe the patient the best possible treatment. The principle behind evidence based medicine (which has been adopted by nursing) is to critically look at the data behind treatment options and offer the patient a variety of options with the advantages and disadvantages clearly described so the patient can make an informed choice.
That being said, the vast majority of "holistic" medicine is simply ineffective. While most is not harmful, some is or may delay patients seeking better treatment options. At its worst it takes money from patients with extravegant promises that give them hope with no real chance of acheiving what is promised. In the realm of herbal remedies, I saw more than 50 patients last year with abnormal LFT's from herbal medicine. Three were in fulminant liver failure, one of which died and one went to transplant. This is not benign stuff here. As providers we need to understand alternative medicine mostly in the realm of drug interaction, but also if it will interfere with our therapies. It also induces patients to try to treat themselves with naturopathic remedies to save money. While this may have little practical effect since many conditions that we see patients for are benign and self-limiting, it also delays treatment for more serious conditions with potential serious complications.
At its worse it gives false hope and puts patients with terminal conditions through useless treatments. Here is a fairly classic example from the naturopathy world (although in all fairness it is unclear wether he was a licensed ND (whatever that is)):
The upshot was that he was convicted and is now serving prison time. While the patients condition was probably ultimately fatal, nobody should have to go through this with a child.
Ultimately you have to understand that alternative medicine is unregulated and unsupervised. There is no guarantee for even minimal competence or safety studies. There is no guarantee that the "herbal remedies" even contain active ingredient. This is what you should be educating patients on concerning alternative medicine.
David Carpenter, PA-C
I'm not a huge fan of naturopathy, but the "doctor" in Colorado was not a graduate of a university-type / accredited ND program, so using him as an example is poor choice. In addition, using a site as blantantly biased as quackwatch does not really futher your position. There are enough ways to pick apart most alternative treatments, i.e., lack of research or implausible mechanisms, without resorting to any of Mr. Barrett's websites [please please please...don't feed the troll].
As for herbal medicine, I am presenting a seminar tomorrow morning to a group of older adults about the dangers of herbal supplementation. I have a degree in Chinese herbal medicine, and while I order my herbs from companies that test the herbs they import as well as performing research [ http://honsousa.com/Research/defult.htm ], it is highly unlikely that the average salesperson at GNC actually knows anything about the herbs the sell or that the customer can be sure they are getting what they pay for. In addition, many of the most commonly used Western botanical herbs are known to interact with many of the most commonly used pharmaceuticals (as you already know). If you can recall what herbs those patients were taking, I'd love to hear it.
There is a good overview article in the American Journal of Nursing, Volume 101(4), April 2001, called "Three Herbs You Should Get to Know". It has some good guidelines to give patients if they choose to use herbs.
Oh, and it if a patient goes to a ND, it is unlikely that their supplement will be cheaper than prescription meds [read: 300% markup is standard].
Actually, NPs in several states can, and do, run their own practices. I used to be the office nurse for an NP in Idaho who owned her own business and hired an Internal Medicine MD as her employee
with respect to hoalistic therapies, perhaps you should familiarize your self more with other non western therapies. some of them are very beneficial, like accupuncture and some herbal remidies for things instead of using mainly pharamacuticals.
jzzy, may I suggest that you familiarize your self more with the commmunity and members of allnurses before advising the professionals that actually work in the field. As you mentioned on another post you "have no experience in the field."
core0 is a PA--if you read his posts you will also see that he supports his claims with previous experience and published literature.
Sure, we are all entitled to our own opinions, so you may disagree with me--I will not get offended. I guess I just don't feel the need to keep mentioning my Biology degree from UC Berkeley (which I have) because it does not entitle me to make extraordinary claims .... and it alone is not enough to get me into PA or NP school. ... No hard feelings.
Specializes in ED, Cardiac-step down, tele, med surg.
jzzy, may I suggest that you familiarize your self more with the commmunity and members of allnurses before advising the professionals that actually work in the field. As you mentioned on another post you "have no experience in the field."
core0 is a PA--if you read his posts you will also see that he supports his claims with previous experience and published literature.
Sure, we are all entitled to our own opinions, so you may disagree with me--I will not get offended. I guess I just don't feel the need to keep mentioning my Biology degree from UC Berkeley (which I have) because it does not entitle me to make extraordinary claims .... and it alone is not enough to get me into PA or NP school. ... No hard feelings.
I may not have any experience in the field, but I have a mind that works, and I have experience as someone who takes medication. And the reliance on Big Pharma for most of our therapies is a big mistake, because in the end, they look at the bottom line. Also, just because someone has and M.D. or what ever degree does not mean they are too grand to take advice from a lay person. Do you have experience in the field? Maybe you are upset because your own biology degree hasn't gotten you into the field? I checked out one of the links that he provided and it went to something called "quack watch" which is not scientific. Scientists should not call eachother names. But before going on, I have no problem with core0, infact his response to me when I questioned the "quack watch" website was very respectful and informative. And furthermore, herbal therapies and non western medical therapies do exist and everyone would probably benefit from knowing more about them. And I think I will get into a good program because I am openminded and capable of thinking outside of the western medical box. I want to use complementary therapies to augment western medical therapies.
I may not have any experience in the field, but I have a mind that works, and I have experience as someone who takes medication. And the reliance on Big Pharma for most of our therapies is a big mistake, because in the end, they look at the bottom line. Also, just because someone has and M.D. or what ever degree does not mean they are too grand to take advice from a lay person. Do you have experience in the field? Maybe you are upset because your own biology degree hasn't gotten you into the field? I checked out one of the links that he provided and it went to something called "quack watch" which is not scientific. Scientists should not call eachother names. But before going on, I have no problem with core0, infact his response to me when I questioned the "quack watch" website was very respectful and informative. And furthermore, herbal therapies and non western medical therapies do exist and everyone would probably benefit from knowing more about them. And I think I will get into a good program because I am openminded and capable of thinking outside of the western medical box. I want to use complementary therapies to augment western medical therapies.
Yes herbal therapies and non-western therapies exist. The problem is the claims made are not backed by scientific data. Anything can be "proven" anectdotally. We have been down this road before. At the turn of the 19th century patent medicine was widespread. There was an article published in 1905 called "the great american fraud" which showed the actual ingredients in these patent medicines and the false claims made with them. This led to the pure food and drug act in 1906 which banned false claims and which banned most patent medicines in 1936. Unfortunately congress passed the
1994 Dietary Supplement Health and Education Act (DSHEA), which placed the burden of proof on the FDA to prove that herbal suppliments were unsafe instead of the normal procedure to prove that a medication is safe and efficacious. This is why despite causing over 150 deaths, herbal practitioners are trying to return ephedra to the market as a diet drug.
This places the herbal medications outside of clinical medicine. If you give someone asprin then you know what is in it and what the effects are (although this is a bad example since you probably couldn't get ASA approved under FDA guidelines). On the other hand the patient has no idea what is in a hebal supppliment and the manufacturer can make whatever claims they want. Other countries such as Germany regulate herbal suppliments the same way the regulate drugs. They have a consistent purity, uniformity and potency. If my patients want to take herbal suppliments, I recommend that they get one made in Germany for this reason.
Western medicine has a mixed track record and the pharmaceutical industry is profit driven. However, medicine currently on the market have for the most part a good track record. I generally prefer established medicines so that you can watch post marketing analysis. This is also why our practice does clinical research - to understand these drugs before they get to markets. If you want to think outside the box of western medicine you owe it to your patients to inform them about the scientific validity and reliability of any treatments (just as you should with a western medicine). The sad reality is that there is little to no reliable data on this.
Specializes in ED, Cardiac-step down, tele, med surg.
Yes herbal therapies and non-western therapies exist. The problem is the claims made are not backed by scientific data. Anything can be "proven" anectdotally. We have been down this road before. At the turn of the 19th century patent medicine was widespread. There was an article published in 1905 called "the great american fraud" which showed the actual ingredients in these patent medicines and the false claims made with them. This led to the pure food and drug act in 1906 which banned false claims and which banned most patent medicines in 1936. Unfortunately congress passed the
1994 Dietary Supplement Health and Education Act (DSHEA), which placed the burden of proof on the FDA to prove that herbal suppliments were unsafe instead of the normal procedure to prove that a medication is safe and efficacious. This is why despite causing over 150 deaths, herbal practitioners are trying to return ephedra to the market as a diet drug.
This places the herbal medications outside of clinical medicine. If you give someone asprin then you know what is in it and what the effects are (although this is a bad example since you probably couldn't get ASA approved under FDA guidelines). On the other hand the patient has no idea what is in a hebal supppliment and the manufacturer can make whatever claims they want. Other countries such as Germany regulate herbal suppliments the same way the regulate drugs. They have a consistent purity, uniformity and potency. If my patients want to take herbal suppliments, I recommend that they get one made in Germany for this reason.
Western medicine has a mixed track record and the pharmaceutical industry is profit driven. However, medicine currently on the market have for the most part a good track record. I generally prefer established medicines so that you can watch post marketing analysis. This is also why our practice does clinical research - to understand these drugs before they get to markets. If you want to think outside the box of western medicine you owe it to your patients to inform them about the scientific validity and reliability of any treatments (just as you should with a western medicine). The sad reality is that there is little to no reliable data on this.
David Carpenter, PA-C
Well what about Celebrex and Vioxx? These med's caused many deaths too. Look at what older typical antipyshcotics have done to the nervous system-permanent dammage. More recently, Zyprexa, has been shown to cause diabetes. AZT and other antiretrovirals to treat HIV have been permanently debilitating as well. Some of these drugs have only recently been discovered. They don't know what the long term effects are. We are the guinea pigs. One of the other problems I have with Big Pharma, asside from being all about the bottom line, and believe me that is what they care about, is the cruelty that goes into testing medications on animal and sometimes on humans in other poorer countries. We have to look at the ethics involved in how we get our drugs, because that energy goes into the healing process. Also, there have been doctors in the western medical system that have made big mistakes, like amputating the wrong leg. I'd bet that more people have died from western medical proceedures. Infact, I'm going to do some research and see if there has been any research on that, if western therapies have been more toxic over all. I also think that anecdotal evidence is not entirely unreliable. I believe we need to evolve our conscience and consciousness with respect to healing and open our minds to new possibilities. Thanks much for your response I really enjoy your imput and I respect your expertise.
Well what about Celebrex and Vioxx? These med's caused many deaths too. Look at what older typical antipyshcotics have done to the nervous system-permanent dammage. More recently, Zyprexa, has been shown to cause diabetes. AZT and other antiretrovirals to treat HIV have been permanently debilitating as well. Some of these drugs have only recently been discovered. They don't know what the long term effects are. We are the guinea pigs. One of the other problems I have with Big Pharma, asside from being all about the bottom line, and believe me that is what they care about, is the cruelty that goes into testing medications on animal and sometimes on humans in other poorer countries.
Yes Celebrex and Vioxx may have caused some deaths. But arthritis is very debilitating and the other options that we have carry other risks. Yes AZT and antiretrovirals cause side effects - but I was there in the era before antiretrovirals. Those people are dead. They don't worry about debilitating effects. The problem we have with drug development is that the medications are good enough that they do not show side effects in relatively large trials. It is only with post marketing effects that we see these. So yes we are guinea pigs in some ways, but we know the long term effects of the disease process if it goes untreated. You can argue about cruelty and testing, but overall animal testing is well regulated in the US and human testing in other countries is well regulated by WHO.
We have to look at the ethics involved in how we get our drugs, because that energy goes into the healing process. Also, there have been doctors in the western medical system that have made big mistakes, like amputating the wrong leg. I'd bet that more people have died from western medical proceedures. Infact, I'm going to do some research and see if there has been any research on that, if western therapies have been more toxic over all. I also think that anecdotal evidence is not entirely unreliable. I believe we need to evolve our conscience and consciousness with respect to healing and open our minds to new possibilities. Thanks much for your response I really enjoy your imput and I respect your expertise.
If you want to look at the effect on western therapies, look at life expectancy. Almost all of the increases in life expectancy are due to better sanitation and medicine. You can also look at what people die from. The major causes of death in the US is cardiovascular disease. This is a disease of industrialization. If you are in Zimbawbwe for example, you do not die of CV disease, you die of a number of cureable infectious diseases, untreated HIV or trauma.
Anectdotal evidence is fraught with selection error, observer bias and reporting errors. If you look at the Cochrane reports - probably the best developed body of evidence based medicine - they put anectdotal evidence below evidence from experts (their lowest level of evidence).
If my patient is crashing and burning in the ICU with no blood pressure I guess I could think about evolving consciousness (and I'll definitely be praying hard) but I'm going to reach for the Levophed. Thats what I know works (sometimes).
Ultimately you owe your patient the best treatment. You need full disclosure about the evidence of your treatment. The problem that I have with herbal medications is that even though there is a fair body of evidence and clinical trials now I have a hard time coming up with more than one treatment that beats placebo (saw palmetto comes to mind maybe St. Johns Wort) much less being as good as medical treatment. The growth of herbal medications is due to two things in my opinion. One is distrust of the medical profession primarily due to failure to properly communicate with our patients. The other is poorly educated patients trying to save money by turning to herbal preperations that are inappropriately described as efficacious. The reality is that evaluating medical treatment is beyond the ability of most people. One of our primary goals should be to educate and help patients make wise decisions.
Specializes in Education, FP, LNC, Forensics, ED, OB.
I hate to break up a good discussion on alternative medicine/remedies and the like, but the topic is "Clinical Differences of NP's and PA's".
So, let's stick to the topic with no further discussion of the aforementioned. If ya'll want to continue this discussion, please feel free to start another thread on the topic.
Thanks and hope you have a great day!!!!! (I, on the other hand, need coffee)!!!!!
Hi-to bring the thread back around to topic I have a few comments. I was reading the postings to this thread from a long time ago (like two years) and someone made the comment that compassion, etc. is not learned, that you either are compassionate or you are not and that following the nursing model does not automatically make you compassionate. I both agree and disagreee with this. It is definitely true that individuals do have individual personalities and that regardless of profession, some people are more caring and compassionate than others. We have all known Physicians and PAs that were extremely compassionate and wonderful people and we have all known nurses and NPs that were really NOT. However, while I do think that these traits cannot be learned, I do think that special attention to them in your educational program can make one MORE THOUGHTFUL about the importance of remembering to include compassion in your practice. I think just about everyone is capable of compassion, but I think when you are busy or very focused on a disease state or whatever, it can be easy to forget to be compassionate. I do think that the nursing model tends to try and remember to look at the patient as an individual and to try to see things from the patient perspective and tends to try to REMEMBER TO BE COMPASSIONATE more than the medical model does. This is what I think is THE BIGGEST DIFFERENCE between the medical model and the nursing model, ie the biggest difference between NPs and PAs (for the kids out there). Now- before anyone freaks out-let me finish. I do not always think that it is appropriate to focus mainly on the patient. What I mean by this is that sometimes, the patient's disease DOES need to be the main focus. That is why an NP and physician relationship and even an NP-PA relationship is so neat. We both bring different perspectives to the table and together we can provide the best care possible to the patient by applying our different perspectives to a given case. OK- I'm done. You can freak out now.
Hi-to bring the thread back around to topic I have a few comments. I was reading the postings to this thread from a long time ago (like two years) and someone made the comment that compassion, etc. is not learned, that you either are compassionate or you are not and that following the nursing model does not automatically make you compassionate. I both agree and disagreee with this. It is definitely true that individuals do have individual personalities and that regardless of profession, some people are more caring and compassionate than others. We have all known Physicians and PAs that were extremely compassionate and wonderful people and we have all known nurses and NPs that were really NOT. However, while I do think that these traits cannot be learned, I do think that special attention to them in your educational program can make one MORE THOUGHTFUL about the importance of remembering to include compassion in your practice. I think just about everyone is capable of compassion, but I think when you are busy or very focused on a disease state or whatever, it can be easy to forget to be compassionate. I do think that the nursing model tends to try and remember to look at the patient as an individual and to try to see things from the patient perspective and tends to try to REMEMBER TO BE COMPASSIONATE more than the medical model does. This is what I think is THE BIGGEST DIFFERENCE between the medical model and the nursing model, ie the biggest difference between NPs and PAs (for the kids out there). Now- before anyone freaks out-let me finish. I do not always think that it is appropriate to focus mainly on the patient. What I mean by this is that sometimes, the patient's disease DOES need to be the main focus. That is why an NP and physician relationship and even an NP-PA relationship is so neat. We both bring different perspectives to the table and together we can provide the best care possible to the patient by applying our different perspectives to a given case. OK- I'm done. You can freak out now.
I think that this may have been more apparent in the past when PAdom was more male dominated and NP's were more female dominated. There have been numerous studies that show on the average female physicians tend to be better listeners and are percieved as more compassionate. Now with 75% of the new grad PA's being female this perception may be changing. The other clinical difference that I have noticed between NP's and PA's is that PA's tend to move around more. The average PA changes jobs every 5 years. While some move into more specialization and some stay in the same field, the number of moves into another field is very large. I did pediatric GI before doing adult GI. So I have seen conditions that none of my SP's have seen. This brings a unique perspective to patient care. On the other hand the breadth of med/surg nursing may give a unique perspective to disease process and hospitalization.
Psychaprn
153 Posts
I don't know wat state you're in but in Ct., AN NP only needs a collaborating MD. For me-I meet with one for lunch once a month and discuss cases-I practice independently and use the MD only as a consultant. We are working here to remove even the word"collaborative "from th mix-making NP's independent legally-like some of them are in real life. Do you realize that if you have a private practice and the MD ends your collaborative contract-you have to close your practice overnight or longer until another MD agrees to be your collaborating MD?-very bad for patients!