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?
if PA and NP'S do almost the same job why do NP's get paid more ?
Average salary for PAs last year was $86,214
Average salary for NPs (from Advance) was $81,397
Thats the closest its ever been. Usually the difference has been more on the order of $7-9k. The general thought is that the salary difference is due to more PAs working in surgery.
charles drew and riverside community college are pretty short
PAEA directory lists both of these programs as 24 months which is slightly less than the average of 27 months.
What sorts of things do PAs do in surgery. How do they participate in surgical procedures?
It depends on the type of surgery. For example in ortho the PA may get the ACL graft and prepare it on the back table while the orthopod prepares the knee. There are some PAs that have a very good relationship with their SP that will do one side of a bilateral TKA.
In CV its pretty common for the PA to prepare the saphenous graft either open or more commonly endoscopically. While they do this the surgeon gets exposure and mobilizes the heart. Then the PA moves up and helps sew in the graft. They also will typically place the chest tubes at the end of the case.
In general surgery PAs mostly first assist which entails exposure, tissue dissection and hemostasis. I do transplant so I either second assist which is mostly exposure and hemostasis or first assist where I also do some tissue dissection. I help close and of course there are always the post op orders. In my case we mostly do medicine with an occasional 3 AM foray into surgery. There are a lot of different roles for PAs in surgery and many different areas of surgery to practice.
Specializes in ED, Cardiac-step down, tele, med surg.
Probably for a different thread, but I'll post the question anyway. So, given that they are similar, why go PA or NP. I've heard that NPs are more "autonomous" like they can open their own clinics where PAs cannot. You don't have to repeat any info that was already posted, I'll try to find some of the answers myself, as I know it's probably been discussed at length here. But any new insight on this question?
Thats the closest its ever been. Usually the difference has been more on the order of $7-9k. The general thought is that the salary difference is due to more PAs working in surgery.
PAEA directory lists both of these programs as 24 months which is slightly less than the average of 27 months.
David Carpenter, PA-C
If you figure in the salaries of CRNA's, then the NP's blow the PA's out of the water.
Actually here in NC - the PA clinical is 2000 hrs (and no clinical experience is necessary prior to school) and the FNP at Duke University is 816 hrs - with the requirement of at least one year of nursing experience - so tack on 2000 hrs. And to be honest most of us RN's have more then 1 year experience before going back for a Master's degree.
The difference occurs with how the NP or PA are utilized and treated by the physician, not so much in their training. They both can function quite independently, it's just a matter of how much trust the overseeing MD has in their abilities. For real hands on experience as a FNP work in a rural clinic - that's where you can be very independent. The problem with big city ER's is that everyone wants to work at them and so there is always a struggle of who gets to do what.
Actually here in NC - the PA clinical is 2000 hrs (and no clinical experience is necessary prior to school) and the FNP at Duke University is 816 hrs - with the requirement of at least one year of nursing experience - so tack on 2000 hrs. And to be honest most of us RN's have more then 1 year experience before going back for a Master's degree.
Do you see the logical error in this statement. You start by saying that the PA school has more clinicals in the PA program but doesn't require prior experience. (completely ignoring that most people in the program still DO have prior experience) However, when you list the hours of training in the FNP program (less than half that of the PA program) you put an * beside it and say but we are required to have a year of RN experience (whether it is applicable to FNP practice or not) and take the opportunity to say BUT most have more than that.
It just seemed kind of slanted to me.
The second portion of your post was very well put though.
I would think that most any hospital nursing experience would help to prepare for the nurse practitioner role. I never planned to be a hospital nurse long-term, but I "did my dues" in preparation for obtaining a masters degree. Specifically, I learned much about health assessment, patient responses to disease processes, disease management, current medical therapy, monitoring lab results, time management... I could go on and on. In addition, the people skills one learns (both with other medical staff and with patients) are invaluable.
"I know quite a few of these A.S. PAs as, until recently, the local PA program was held a local Community College in conjunction with the local medical school. Most are quite good. Most also had a BA/BS in something in order to get in as the competition for the seats was quite high.
The program is now at the medical college as a MS level program. Actually, I don't think that they changed much - just the level of degree.
There is a PA program offered by the U. North Dakota (or is it So. Dakota?) which requires a BSN for admission. It has only 16 weeks on campus with the rest of the two years in a PCP office near your home.
Chip"
In reality, 1 or 13 years don't matter if you are a bad healthcare worker. I've known MD's who do not care what they do or who they do it to and they are veterans at their profession.
I know the program you are talking about. Is not that they require a BSN, is just that if you have a BSN, you have most of the requirements needed to enter the PA program.
I am recovering from cancer and all my healthcare team is female, MD, PA and NP's, oncology, surgery, and plastics. My favorite is my oncology NP and that's just because she listens to me and my worries. Not because she has 19 years under her belt. The surgeon had her intern come in and he was dismissive and callous. The day of my surgery I was in tears because of my disfigured breasts. He didn't say his name, he didn't introduce the PA student, the conversation was just between the PA student and the intern. The intern asked me to lift my gown to see the surgery. I asked him for his name and he said it and without losing a beat, he asked me again to lift my gown. I told him to get out of my room but the student could stay. The intern said he couldn't do that and walked away. The PA student apologize and wished me well and also stated he understood why I did what I did. I asked him to come back and would tell him everything I knew about my surgery.
It's not what letters go after your name or what people call you professionaly. It is really how your patients see you, and how safe you feel with them. I, for one, did not feel safe with the intern but my Onco NP, my plastics NP and the general surgeon were very good at their jobs and were kind. The PA learned not to be a pompous ass like that intern and got more information.
The PA ended up coming back the next day before going home. We talked and I begged him never to lose his humanity. I actually complained to my general surgeon about this intern and told her about the PA. On my last visit she thanked me for having referred the PA to her. He now works in that practice.
By the way, does anyone here know nurse practitioners do have complete independence in 13 states? and it's growing people...very soon we will have primary care in every state...
Also, can someone tell me about education? When a PA graduates, how many years of education can he/she achieve (at the most) before practicing (hands on patients)? How many years before a BSN? MSN? Anyone care to write it down somewhere? We need to educate our fellow HC workers who may be a little confused about our capabilities.
Did you know that NP's can have independent practice in the rural areas of Texas? Because most doctors (MOST) don't want to practice in a rinky dinky town. There is not money there. Yep! This was something a doctor working at Baylor University Medical Center told me... I read the Texas statutes and behold, it was true!
thanks for sharing such a personal story. It always helps to hear these kinds of things.. Keeps us realizing what we are doing on a daily basis.
Also remember, it doesn't have to be cancer to be important either. I hope I can always remember how significant the things that may seem 'little' to us really are to the patients and their families.
I will let David answer your question about PA training cuz he can do it without making anyone mad. :nuke:
core0
1,831 Posts
Average salary for PAs last year was $86,214
Average salary for NPs (from Advance) was $81,397
Thats the closest its ever been. Usually the difference has been more on the order of $7-9k. The general thought is that the salary difference is due to more PAs working in surgery.
PAEA directory lists both of these programs as 24 months which is slightly less than the average of 27 months.
David Carpenter, PA-C