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 am not sure you understood what I was trying to say. Regardless of the amount of males/females in either field, the way NPs are educated is fundamentally different bc of the nursing model. For example, when in my NP program we would have a case study in class or on a test, etc, we had to include discourse on what the patient was feeling, on what the patient's social situation was, on whether the patient was able to pay, etc. Not only did we have to include it in our treatment plans, but it was worth a significant amount of our grade or our performance in class (probably 50% or more) As I said before, I am not saying that PAs are not as compassionate, but from what I understand about their educational experiences (and that is ALL I am commenting on here) more time is spent on the disease states and the physical situation of the patient than on the social situation of the patient, etc. And I am not passing judgement on which I think is a better way of educating. I think both are important. I am basing my information on PAs entirely on things I have heard, bc of course, I am not a PA, but an NP. If my information is incorrect, let me know. Also, NPs move around jobs constantly too. I have only been out of school for 2 years and everyone in my class is at least on their second job, if not their third already.
As I said before, I am not saying that PAs are not as compassionate, but from what I understand about their educational experiences (and that is ALL I am commenting on here) more time is spent on the disease states and the physical situation of the patient than on the social situation of the patient, etc.
Yes, PAs spend a significant ammount of time on pathophysiology and the scince of medicine vs psychosocial dynamics. This is necessary to facilitate compenet practice in multiple environments. PA education is design to train, a trainable provider that can move from specialty to specialty as needed and be a competent primary care provider autonomously. However, dont be mistaken that PAs dont spend any time one the psychosocial aspects. It is required by the accreditation board for pa programs that the school address cultural competency and socially disadvantaged populations. In addition, psychiatry and behavioral medicine is a required component in didactic and clinical training of PA programs. I think the only reason one might see a difference in the compassion of PAs vs. NPs is the TYPE of person that enter each field. NPs are still primarily RNs first although there are direct entry programs that are changing this. But, I think by the nature of the job it generally takes a compassionate person to be a nurse. That person is still the same person as an NP. Many PAs are former army and civilian medics. These folks are often short spoken as is needed in their prior jobs. I dont believe you can train a person to be compassionate but I do believe a person HAS to be trained in the sciences to enjoy the "trainability" that PAs have. Compassion is a personal trait. Also, please realize that fiscal concerns and social concerns are DEFINATELY addressed in PA programs, the only difference is are the people sitting in the class listening to that part? In my experience, about half are. All the more reason to say.... "IT DEPENDS ON THE PROVIDER" once again.. there are good and bad NPs, docs, PAs, RNs, etc. We have to evaluate each person at a time. My only concern is, does someone who ALREADY has a decent head on their shoulders and compassion for their patients NEED more "Education" on that... or would they be better served learning the science of medicine and flushing out their diagnostic skills, and understanding of pharmacology.
I keep hearing that NPs use the nursing model while PAs use the medical model, but is this really accurate? I'm not in NP school yet, but from what I have been told by some of my friends that are NPs, they are basically doing the medical model + good bedside manner. They use medical Dx instead of nursing Dx, they use medical treatment protocols instead of nursing care plans...
I keep hearing that NPs use the nursing model while PAs use the medical model, but is this really accurate? I'm not in NP school yet, but from what I have been told by some of my friends that are NPs, they are basically doing the medical model + good bedside manner. They use medical Dx instead of nursing Dx, they use medical treatment protocols instead of nursing care plans...
Am I missing something?
What I've observed is that mostly NP's and PA's use a medical model. At least where I work most use a SOAP note which is medical charting. I have never seen a NP use a nursing care plan. There is some accuracy to the nursing model vs. medical model, but it has more to do with functional areas in my opinion. Nursing is generally divided into functional areas ie. Med/surg, ICU, ortho etc. Medicine is usually aligned along either organ specific systems or broad medical areas ie. endocrinology or internal medicine.
Most NP fields grew out of these areas. For example the ACNP is the logical extension of ICU nursing skills. The FNP grew out of GP nursing (a position which really doesn't exist anymore). This is why you see seven or eight functional nursing areas for the NP.
The PA role grew out of the FP physician model (or really the old GP model if you go back far enough). This was originally meant to provide primary care service with about 80-85% of the FP physician knowledge base. As the profession matured the training has been augmented to provide a base in more areas. For example there has been an increase in the mandated surgical time as more PA's have gone into surgery.
The other major difference is how the educational system is structured. The PA education system uses the medical model which uses compentencies and standards. For example in the PA competency one competency would be:
"Patient care includes age-appropriate assessment, evaluation and management. Physician assistants must demonstrate care that is effective, patient-centered, timely, efficient and equitable for the treatment of health problems and the promotion of wellness. Physician assistants are expected to work effectively with physicians and other health care professionals to provide patient-centered care"
The standard for this is:
"B1.02 The curriculum must be of sufficient breadth and depth to prepare the student for the clinical practice of medicine.
B3.02 The program must provide students with instruction in patient assessment and management, including:
a) techniques of interviewing and eliciting a medical history.
b) performance of physical examinations across the life span.
c) generation of differential diagnoses.
d) ordering and interpretation of diagnostic studies.
e) development and implementation of treatment plans.
f) presentation of patient data in oral form.
g) documentation of patient data.
h) appropriate referral of patients.
C3.04 The program must assess and document student demonstration of professional behaviors.
B3.01 The program must provide instruction in interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.
B6.03 The program must provide instruction on c) the physician-PA team relationship
For NP's the standards are based off nursing practice and are more broad.
From the FNP competencies:
"Diagnosis of Health Status
The family nurse practitioner is engaged in the diagnosis of health status. This diagnostic process includes critical thinking, differential diagnosis, and the integration and interpretation of various forms of data. These competencies describe this role of the family nurse practitioner."
"1. Identifies signs and symptoms of acute physical and mental illnesses across the life span.
2. Identifies signs and symptoms of chronic physical and mental illness across the life span.
3. Orders, performs, and interprets age-, gender-, and condition-specific diagnostic tests and screening procedures.
4. Analyzes and synthesizes collected data for patients of all ages.
5. Formulates comprehensive differential diagnoses, considering epidemiology, environmental and community characteristics, and life stage development, including the presentation seen with increasing age, family, and behavioral risk factors."
There are seperate NP competencies for assessment and treatment. This really follows the pattern of the nursing care plan where as the medical field looks at the whole process (assessment, diagnosis and treatment as one process). Speaking with local NP's this is how they are taught. In the real world since they usually work in a physician practice they follow the medical model.
There are no accompanying standards so it is essentially up to each program to decide if the training meets the standard.
The final piece here is that as a NPP you need to have somewhat of a plastic medical decision making model. I work with eight physicians and can adapt my style to thiers. Over the years I have developed my own style and the physicians that I work with respect that. However, one of the hardest things for new grads to realize is that there is more than one way of practicing medicine, and the physician (employer) is usually right.
What I've observed is that mostly NP's and PA's use a medical model. At least where I work most use a SOAP note which is medical charting. I have never seen a NP use a nursing care plan. There is some accuracy to the nursing model vs. medical model, but it has more to do with functional areas in my opinion. Nursing is generally divided into functional areas ie. Med/surg, ICU, ortho etc. Medicine is usually aligned along either organ specific systems or broad medical areas ie. endocrinology or internal medicine.
Most NP fields grew out of these areas. For example the ACNP is the logical extension of ICU nursing skills. The FNP grew out of GP nursing (a position which really doesn't exist anymore). This is why you see seven or eight functional nursing areas for the NP.
The PA role grew out of the FP physician model (or really the old GP model if you go back far enough). This was originally meant to provide primary care service with about 80-85% of the FP physician knowledge base. As the profession matured the training has been augmented to provide a base in more areas. For example there has been an increase in the mandated surgical time as more PA's have gone into surgery.
The other major difference is how the educational system is structured. The PA education system uses the medical model which uses compentencies and standards. For example in the PA competency one competency would be:
"Patient care includes age-appropriate assessment, evaluation and management. Physician assistants must demonstrate care that is effective, patient-centered, timely, efficient and equitable for the treatment of health problems and the promotion of wellness. Physician assistants are expected to work effectively with physicians and other health care professionals to provide patient-centered care"
The standard for this is:
"B1.02 The curriculum must be of sufficient breadth and depth to prepare the student for the clinical practice of medicine.
B3.02 The program must provide students with instruction in patient assessment and management, including:
a) techniques of interviewing and eliciting a medical history.
b) performance of physical examinations across the life span.
c) generation of differential diagnoses.
d) ordering and interpretation of diagnostic studies.
e) development and implementation of treatment plans.
f) presentation of patient data in oral form.
g) documentation of patient data.
h) appropriate referral of patients.
C3.04 The program must assess and document student demonstration of professional behaviors.
B3.01 The program must provide instruction in interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.
B6.03 The program must provide instruction on c) the physician-PA team relationship
For NP's the standards are based off nursing practice and are more broad.
From the FNP competencies:
"Diagnosis of Health Status
The family nurse practitioner is engaged in the diagnosis of health status. This diagnostic process includes critical thinking, differential diagnosis, and the integration and interpretation of various forms of data. These competencies describe this role of the family nurse practitioner."
"1. Identifies signs and symptoms of acute physical and mental illnesses across the life span.
2. Identifies signs and symptoms of chronic physical and mental illness across the life span.
3. Orders, performs, and interprets age-, gender-, and condition-specific diagnostic tests and screening procedures.
4. Analyzes and synthesizes collected data for patients of all ages.
5. Formulates comprehensive differential diagnoses, considering epidemiology, environmental and community characteristics, and life stage development, including the presentation seen with increasing age, family, and behavioral risk factors."
There are seperate NP competencies for assessment and treatment. This really follows the pattern of the nursing care plan where as the medical field looks at the whole process (assessment, diagnosis and treatment as one process). Speaking with local NP's this is how they are taught. In the real world since they usually work in a physician practice they follow the medical model.
There are no accompanying standards so it is essentially up to each program to decide if the training meets the standard.
The final piece here is that as a NPP you need to have somewhat of a plastic medical decision making model. I work with eight physicians and can adapt my style to thiers. Over the years I have developed my own style and the physicians that I work with respect that. However, one of the hardest things for new grads to realize is that there is more than one way of practicing medicine, and the physician (employer) is usually right.
David Carpenter, PA-C
Well, all I can say is the more I practice, the more I realize how much I don't know and I am ever grateful for all the NPs and PAs I work with!:smilecoffeecup:
One major difference between PA's and NP's is that (at least in california) NP's do not have to practice under the licensure of a physician but PA's do, and NP's contrary to what someone previously wrote can have a private practice. From all of the squabbling above it sounds like there are some insecure PA's out there.
I do not understand why people come on to these threads and say offensive things or take things that other people say personally. I keep coming across this sort of combat on this website. This should be a community where we gather information from one another, not insult each other. ... I mean really, what is the point of it?
One major difference between PA's and NP's is that (at least in california) NP's do not have to practice under the licensure of a physician but PA's do, and NP's contrary to what someone previously wrote can have a private practice. From all of the squabbling above it sounds like there are some insecure PA's out there.
Yes you can open your own practice as long as you don't need to prescribe or see medicare patients.
One major difference between PA's and NP's is that (at least in california) NP's do not have to practice under the licensure of a physician but PA's do, and NP's contrary to what someone previously wrote can have a private practice. From all of the squabbling above it sounds like there are some insecure PA's out there.
No, in california NPs must have a physician involved in "standard care arrangements." Which is, in fact, a form of physician supervision.
Only notionally. Once the standard care arrangement is set there is no further physician involvement. On the other hand physician involvement is mandated when prescriptive authority is involved.
One major difference between PA's and NP's is that (at least in california) NP's do not have to practice under the licensure of a physician but PA's do, and NP's contrary to what someone previously wrote can have a private practice. From all of the squabbling above it sounds like there are some insecure PA's out there.
Wow you very first post and you start by insulting PAs. I believe someone has misinfomed you!!
One of the major differences is the certification exam required every 6 years for PAs.
As I was thinking about this I have started to wonder how difficult can this test be? All PAs take the same exam offered every 6 years. A family practice PA, a dermatology PA, every PA no matter what their current practice setting. The PAs I know take a review course just before the exam and they all pass even though they have spent the past 20 years in orthopedics. What am I missing? Aren't these exams covering all the content areas from their PA education.
KimHFNP
40 Posts
I am not sure you understood what I was trying to say. Regardless of the amount of males/females in either field, the way NPs are educated is fundamentally different bc of the nursing model. For example, when in my NP program we would have a case study in class or on a test, etc, we had to include discourse on what the patient was feeling, on what the patient's social situation was, on whether the patient was able to pay, etc. Not only did we have to include it in our treatment plans, but it was worth a significant amount of our grade or our performance in class (probably 50% or more) As I said before, I am not saying that PAs are not as compassionate, but from what I understand about their educational experiences (and that is ALL I am commenting on here) more time is spent on the disease states and the physical situation of the patient than on the social situation of the patient, etc. And I am not passing judgement on which I think is a better way of educating. I think both are important. I am basing my information on PAs entirely on things I have heard, bc of course, I am not a PA, but an NP. If my information is incorrect, let me know. Also, NPs move around jobs constantly too. I have only been out of school for 2 years and everyone in my class is at least on their second job, if not their third already.