Differences (Educative/Clinical) between NP & PA

acutecarenp · Mar 15, 2005

Zenman,

If I ever make a concious decision to grow up....I want to be just like you!

zenman · Mar 16, 2005

acutecarenp said:
Zenman,
If I ever make a concious decision to grow up....I want to be just like you!

No one should ever have to grow up!

Tony35NYC · Mar 27, 2005

I know there will probably be a tomato throw after I say this, but I don't understand why there are so many contentious debates about the differences between NPs and PAs. At the hospital where I work, many of the physicians work with both NPs and PAs. Both do pretty much the same things from what I have observed and they also make about the same amount of money from what I've heard.

As an RN-to-be I admit I am partial to APNs, and I hope to become one someday. But I just want to say that even though state laws say that PAs must be supervised by an MD, that doesn't necessarily mean that the MD is always present and looking over the PA's shoulder and signing off on every little thing the PA does. From what I've seen in the hospital, the MDs give the PAs a lot of autonomy, and many times the MDs don't involve themselves in cases that the PA's are managing except for a general patient status report, or if the case is too complicated for the PA to handle on his/her own. I don't understand why the dependent relationship between an PA and an MD is seen by some people as a negative thing. Chill out, people! NP or PA---Its just a job, and at the end of the day, everybody is accountable to somebody else---even the all mighty physician.

SusanJean · Mar 27, 2005

Tony35NYC said:
I know there will probably be a tomato throw after I say this, but I don't understand why there are so many contentious debates about the differences between NPs and PAs. At the hospital where I work, many of the physicians work with both NPs and PAs. Both do pretty much the same things from what I have observed and they also make about the same amount of money from what I've heard.
As an RN-to-be I admit I am partial to APNs, and I hope to become one someday. But I just want to say that even though state laws say that PAs must be supervised by an MD, that doesn't necessarily mean that the MD is always present and looking over the PA's shoulder and signing off on every little thing the PA does. From what I've seen in the hospital, the MDs give the PAs a lot of autonomy, and many times the MDs don't involve themselves in cases that the PA's are managing except for a general patient status report, or if the case is too complicated for the PA to handle on his/her own. I don't understand why the dependent relationship between an PA and an MD is seen by some people as a negative thing. Chill out, people! NP or PA---Its just a job, and at the end of the day, everybody is accountable to somebody else---even the all mighty physician.

Nothing to throw Tony, just agreement that there need not be so much debate. We are all part of the same health care system/team.

I think that there is confusion because people don't understand exactly what PA's do (when I told one MD I was enrolled in PA school, he thought it was MA, the 12 mo program) and also, that there is no consistency state-to-state. I have spoken w/ PA's in some states where a doctor must see and review pt. status before release. Other states, a sit down w/ the PA q 6 mo to review a few charts is within the realm of the law (and comfort of the dr/PA.) The key is the relationship between the dr/PA.

Having said all that, I finally decided that I did not want to work that route and am now in BSN program w/ goal as NP. For me, while it will take more time, it there are other benefits - I agree more w/ the nursing model than I do w/ the medical model. But that is just MHO -- and I have 20 yrs in the medical field.

Ironically, I didn't consider nursing before PA school because I had no familiarity w/ the nursing model, and the diversity that is available to nurses now days. Poor marketing? I've seen where they are used in the business world, but that is where I am running from. :rolleyes:

SJ

Bibeau1 · Mar 27, 2005

Hi, I will be graduating from graduate school with a msn /FNP. I always thought there was no difference between the NP role and a PA role , But there are many.

One of my preceptors is a PA. She has been a great teacher and role model. We have compared education and this is what we have concluded.

PA's do have more actual clinical time then NP's . The focus of an NP program is academics because they feel we are already nurses. That I believe is our short coming. I really feel there should be more focus on actual practicums and less on the profession at hand , ( but that's my opinion ).

NP's, on the other hand, bring our compassion , & our hands on in patient care that ONLY an experienced nurse can bring. our caring touch, the fact that we listen is most valuable in a time when time with a patient is so very limited.

I want you to look at the how the PA's interact with patients as compared to a NP. Any one can function clinically , but compassion and empathy are clearly a nurses domain.

jstuben said:
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 specialites like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interpret tests, and prescibe 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 monitering 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!

patnshan · Mar 28, 2005

Bibeau1 said:
Hi, I will be graduating from graduate school with a msn /FNP. I always thought there was no difference between the NP role and a PA role , But there are many.
One of my preceptors is a PA. She has been a great teacher and role model. We have compared education and this is what we have concluded.
PA's do have more actual clinical time then NP's . The focus of an NP program is academics because they feel we are already nurses. That I believe is our short coming. I really feel there should be more focus on actual practicums and less on the profession at hand , ( but that's my opinion ).
NP's, on the other hand, bring our compassion , & our hands on in patient care that ONLY an experienced nurse can bring. our caring touch, the fact that we listen is most valuable in a time when time with a patient is so very limited.
I want you to look at the how the PA's interact with patients as compared to a NP. Any one can function clinically , but compassion and empathy are clearly a nurses domain.

I was with you until you said that nurses are ahead in the compassion thing. That is individual, and is not LEARNED!

Otherwise, I agree with everything you said. NP's do need much more clinical time, or advanced practicum, as you call it. The amount I have seen involved in many NP programs I have researched is WAY too thin to even think about being ready to practice dependently, much less independently. That is where the gripe most PA's have with the NP movement arises from. We are trained much more in the clinical aspect especially, and still have no desire to be independent. I went to mursing school and practiced as a nurse, which gives me the experience to know that being a nurse is quite helpful, but no substitute.

I appreciate your most reasonable comment, except for the empathy stuff :wink2:

Pat, RN, PA-C, MPAS

Jayla · Mar 30, 2005

I know there will probably be a tomato throw after I say this, but I don't understand why there are so many contentious debates about the differences between NPs and PAs. At the hospital where I work, many of the physicians work with both NPs and PAs. Both do pretty much the same things from what I have observed and they also make about the same amount of money from what I've heard.
Exactly! I've been checking this post on occasion and can't believe how petty some comments have been.
I've heard lowly med students refer to NPs and PAs as "mid-level" practitioners. I'm sure this is an accepted term out there somewhere, but to me it seems way too condescending. PAs and NPs should be working together more to earn the respect they deserve.
PAs and NPs are in more demand these days to meet the needs of patients who may not otherwise have adequate access to health care. Maybe we should stop focusing on "who's better" and focus instead on providing patients with the care they need and deserve.
Jayla, RN-BSN, PHN, BA, ATBFNP (aspiring to be family nurse pracitioner)

KrisRNwannabe · Mar 31, 2005

I agree, I am not a nurse yet but I have always considered myself a kind and compassionate person. I have a friend who is a PA and she is the sweetest most caring person i have ever met. I have met several nurses that were standing in a different line when god was passing out kindness and compassion. these are traits learned in life, not in nursing school.

FNP/DNP · Mar 31, 2005

jstuben said:
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 specialites like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interpret tests, and prescibe 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 monitering 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!

As an NP new to the emergency room, I would recommend PA school to you, unless you attend an EDNP program (Houston or Loyola). They are better trained in all of the things you mentioned. I am sure some NP's will get riled up over this, but not many NP programs are offering extensive procedure training in addition to primary care with pediatrics, as you would need in the ED. ED programs do and you can then sit for the FNP exam.

patnshan · Mar 31, 2005

FNP/DNP said:
As an NP new to the emergency room, I would recommend PA school to you, unless you attend an EDNP program (Houston or Loyola). They are better trained in all of the things you mentioned. I am sure some NP's will get riled up over this, but not many NP programs are offering extensive procedure training in addition to primary care with pediatrics, as you would need in the ED. ED programs do and you can then sit for the FNP exam.

I am glad you said this. PA's spend on average of 400 clinical hours in emergency medicine alone, compared to 400 hours total clinical hours in NP school.

On the other hand, if someone were to tell me they wanted to do community health or OB, I would say to go to NP school. They likely touch on that stuff more than PA students do.

Thanks for your diplomatic response and honesty.

Pat, RN, PA-C

rnhunter · Apr 5, 2005

I am currently working on my master's degree (ACNP). I believe that in all states NPs must be master prepared. A PA up until I would say the last fve years graduated with a BS degree. Now both professions the standard is a Master's degree. Another area you are mistaken is that NPs CANNOT practice independently. This is not true. NPs can and have opened there own practice. I recently read that I believe in New York city a group of FNPs opened there own practice together. It is LEGAL. NPs do NOT have to have their charts signed by a physcian. That varies from institution to institution. I agree that PAs have more clinical training and more classes than NPs do. This is an area that i believe that our profession needs to improve. Another error that i must point out is that PAs have 6-10 plus years of experience in healthcare. You are mistaken. It is strongly encouraged that they have smoe healthcare experience and/or shadow a PA prior to admission. Many go directly from HS to college to PA school. I went a girl who went on to PA school directly from college. All she did was shadow a PA prior to applying. I have a tremendous amount of respect for PAs. I do not believe that a PA is better than an NP nor do i believe that an NP is better than a PA. We are both considered midlevel practitioners. In some states they are considered physcian extenders.

Bibeau1 · Apr 14, 2005

Mea culpa , you are right, "compassion and empathy are aquired traits. Many appologies, I have recently witnessed people in my profession who clearly are lacking in the traits that I admire ........ :crying2:

patnshan said:
I was with you until you said that nurses are ahead in the compassion thing. That is individual, and is not LEARNED!
Otherwise, I agree with everything you said. NP's do need much more clinical time, or advanced practicum, as you call it. The amount I have seen involved in many NP programs I have researched is WAY too thin to even think about being ready to practice dependently, much less independently. That is where the gripe most PA's have with the NP movement arises from. We are trained much more in the clinical aspect especially, and still have no desire to be independent. I went to mursing school and practiced as a nurse, which gives me the experience to know that being a nurse is quite helpful, but no substitute.
I appreciate your most reasonable comment, except for the empathy stuff.
Pat, RN, PA-C, MPAS