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?
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!
:typing
As far as Texas I would suggest you reread the statues, specifically rule 221.13 (link won't post)
For reasons that are unclear NPs in rural areas actually have more supervision requirements than those that aren't.
As an alternative the Pearson report is fairly definitive:
I have the list of NP states at home. I can post it later. As discussed in other posts Medicare requires a collaborating physician to bill.
As far PA education, PA educational programs range from 18-36 months. They usually encompass a didactic and a clinical phase although a number of programs are integrating their clinical phase in PBL. The great majority of PA programs are 24-27 months. After graduating a small minority of PAs go on to post graduate programs in Medicine or Surgery. The rest enter practice.
You can probably find the rest of the information (including the part that I posted) in the previous 37 pages of posts. Or perhaps someone will post it:rolleyes:.
Isn't that funny? I can't trust MD's telling me the truth about my own practice, hum! aren't MD's the ones that regulate what NP's can and can not do? don't they also delegate? I wonder why this guy told me that? I did go to that clinic (while doing my rotation for Community Nursing) and I never saw a doctor there and I was there for 12 hr days...weird.
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.
Did you know that NP's can have independent practice in the rural areas of Texas?
I practice in Texas and it is not true that NP's can practice independently in rural areas. We are fighting for full independence at this time (it's currently before the legislature) and we're hoping to "settle" for independence in rural areas.
I practice in Texas and it is not true that NP's can practice independently in rural areas. We are fighting for full independence at this time (it's currently before the legislature) and we're hoping to "settle" for independence in rural areas.
Good luck with that. Seriously, I hope y'all get the independence you deserve. I do have to tell you that I went to a very small town south Dallas (about 1 hr away) and there was no MD, no where to be seen. The statement from the MD I got was during my intership. I don't know if he was kidding or whatever but he did make that statement. I have been praying for NP's, all NP's to get independent practice.
Y'all are strong, proud and extremely full of knowledge. You deserve it. We have "collaborative" practice (so far) in CT and also going in front of legislation this coming fall.
Good luck with that. Seriously, I hope y'all get the independence you deserve. I do have to tell you that I went to a very small town south Dallas (about 1 hr away) and there was no MD, no where to be seen. The statement from the MD I got was during my intership. I don't know if he was kidding or whatever but he did make that statement. I have been praying for NP's, all NP's to get independent practice.
Y'all are strong, proud and extremely full of knowledge. You deserve it. We have "collaborative" practice (so far) in CT and also going in front of legislation this coming fall.
It will happen, is just a matter of time.
When one speaks about independent practice is that:
1) No MD oversight whatsoever?
2) Total prescriptive authority?
3) Ability to order/request testing, procedures, consults?
I guess it depends on what state you are in. For example, in Maine you have to be under supervision for two years and then you have independence. In Rhode Island you have independent practice (no MD on site) but you can't write prescriptions, In other states you may not be able to diagnose and yet in others you may not order diagnostic tests. So it basically depends on where you are.
Also the word "collaborative" practice has different meanings in different states. In CT (where I'm from), you have no need for the MD to be on the premises, you can diagnose, you can prescribe but you have to have a contract with very specific instructions of what you can and can not do. That includes what medications you may give, etc.
Check your state statutes and the Pearson Report for which someone put a web link on a prior post. Check it out, is very informative.
Specializes in ER and family advanced nursing practice.
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.
David Carpenter, PA-C
I think it is irresponsible to say that. All too often, holistic medicine is somehow thought to be synonymous with complimentary and alternative medicine (CAM), and I can understand where that comes from, but truly holistic just means treating the disease or problem in the context of the patient. It is not just using some CAM and ignoring evidence based medicine/practice. There is plenty of evidence that the holistic (mind/body/spirit) approach is effective. This approach is not just limited to the provider but should come from the team that is treating the patient. That is why hospitals employ patient educators and chaplains to help with patient care. When we as healthcare professionals do not consider the patient in their context then we contribute to setting the patient and us up for incomplete treatment and increased likelihood of a repeat event. Don't get me wrong. We can be as huggy shmoopy as want and still not be effective, but the holistic approach is sound. This is most definitely not limited to eastern medicine. I have worked in busy systems, and I have seen many physicians, NPs, and PAs, beat down and tired, take a look at/consider/treat the whole person and walk away the better for it in terms of patient AND staff satisfaction and respect. Now how is that ineffective? It does not do any good for the patients blood sugar if the patient has low self esteem which leads to actions that cause self care deficits to include not taking the medicine to fix the blood sugar issue.
I have my doubts about some CAM. For example, I just can't bring myself to embrace homeopathy (despite what my Boulder Colorado wife has to say:). I love ya baby...). For others it has been different, and remember this: almost by definition almost every current "accepted" practice started out as a CAM. Once studied and examined these practices became standard, but that made them no less effective when they were still CAM. I do agree that the use of CAM needs to be monitored closely and I think they can be very dangerous. But to clarify "Holistic" and CAM are not synonymous. Related perhaps, but not the same.
As far as NP/PA/independent practice. I am working for my NP. It just works out better for me this way since I am already a nurse. If I was not already a nurse I would have probably gone the PA route. I work with both PAs and NPs, and I see no difference at the bedside in terms of patient/staff satisfaction or patient outcomes. None. I have heard NPs grumble about PAs having associates degree and no medical backgrounds. That is just silly. Many of them do have bachelors or masters, and some type of medical background. Many PA programs require it. What about a med surg nurse that only works with low acuity patients (still an important job) and has only been working for a year or maybe less. Does that count enough to be experience? Heck, CRNAs not only have to have a certain amount of experience, but they are required to have a certain kind of experience (usually ICU). PAs go though a lot of didactic and clinical training, and might I remind people that there are still NPs out there who do not have masters degrees, just post BSN certificates. PAs are vastly moving towards masters degree, have to take many hard science classes and deserve respect for completing their very hard programs. My wife's cousin just completed hers, and we are very proud of her.
As for this independence business, I have worked at two teaching hospitals, and I have seen the intense training that physicians receive, and what they have to go through and you know what? I want to be able collaborate with one when I need to. I think the states that require a certain number of years experience before independent practice are on the right track, and it is no reflection on me or my profession if I am required to have some form of collaborative practice in place even if its not on site. I have also been a paramedic for 15 years, and when I work in that capacity I work under the license of a doctor, and that is just OK with me. As a paramedic I get to do a lot of independent high speed/low drag type stuff like traumas, GSWs, and yes, cor zeros, but when I need a doc, all I gotta do is shout. I in no way shape or form think that two years of training (PA or NP) particularly without any kind of residency is enough for me to go out and hang a shingle. It is not fair to the public and its not fair to me.
I think it is irresponsible to say that. All too often, holistic medicine is somehow thought to be synonymous with complimentary and alternative medicine (CAM), and I can understand where that comes from, but truly holistic just means treating the disease or problem in the context of the patient. It is not just using some CAM and ignoring evidence based medicine/practice. There is plenty of evidence that the holistic (mind/body/spirit) approach is effective. This approach is not just limited to the provider but should come from the team that is treating the patient. That is why hospitals employ patient educators and chaplains to help with patient care. When we as healthcare professionals do not consider the patient in their context then we contribute to setting the patient and us up for incomplete treatment and increased likelihood of a repeat event. Don't get me wrong. We can be as huggy shmoopy as want and still not be effective, but the holistic approach is sound. This is most definitely not limited to eastern medicine. I have worked in busy systems, and I have seen many physicians, NPs, and PAs, beat down and tired, take a look at/consider/treat the whole person and walk away the better for it in terms of patient AND staff satisfaction and respect. Now how is that ineffective? It does not do any good for the patients blood sugar if the patient has low self esteem which leads to actions that cause self care deficits to include not taking the medicine to fix the blood sugar issue.
I have my doubts about some CAM. For example, I just can't bring myself to embrace homeopathy (despite what my Boulder Colorado wife has to say:). I love ya baby...). For others it has been different, and remember this: almost by definition almost every current "accepted" practice started out as a CAM. Once studied and examined these practices became standard, but that made them no less effective when they were still CAM. I do agree that the use of CAM needs to be monitored closely and I think they can be very dangerous. But to clarify "Holistic" and CAM are not synonymous. Related perhaps, but not the same.
As far as NP/PA/independent practice. I am working for my NP. It just works out better for me this way since I am already a nurse. If I was not already a nurse I would have probably gone the PA route. I work with both PAs and NPs, and I see no difference at the bedside in terms of patient/staff satisfaction or patient outcomes. None. I have heard NPs grumble about PAs having associates degree and no medical backgrounds. That is just silly. Many of them do have bachelors or masters, and some type of medical background. Many PA programs require it. What about a med surg nurse that only works with low acuity patients (still an important job) and has only been working for a year or maybe less. Does that count enough to be experience? Heck, CRNAs not only have to have a certain amount of experience, but they are required to have a certain kind of experience (usually ICU). PAs go though a lot of didactic and clinical training, and might I remind people that there are still NPs out there who do not have masters degrees, just post BSN certificates. PAs are vastly moving towards masters degree, have to take many hard science classes and deserve respect for completing their very hard programs. My wife's cousin just completed hers and I am very proud of her.
As for this independence business, I have worked at two teaching hospitals, and I have seen the intense training that physicians receive, and what they have to go through and you know what? I want to be able collaborate with one when I need to. I think the states that require a certain number of years experience before independent practice are on the right track, and it is no reflection on me or my profession if I am required to have some form of collaborative practice in place even if its not on site. I have also been a paramedic for 15 years, and when I work in that capacity I work under the license of a doctor, and that is just OK with me. As a paramedic I get to do a lot of independent high speed/low drag type stuff like traumas, GSWs, and yes, cor zeros, but when I need a doc, all I gotta do is shout. I in no way shape or form think that two years of training (PA or NP) particularly without any kind of residency is enough for me to go out and hang a shingle. It is not fair to the public and its not fair to me.
Thank you for this post, I hope it's not a stupid question- but what in the world is a cor zero? I've been a medic for 7 years and have never heard that term.
Thank you for this post, I hope it's not a stupid question- but what in the world is a cor zero? I've been a medic for 7 years and have never heard that term.
a Core0 in Denver (and only Denver as far as I can tell) is the same as a code blue at most other hospitals. Here in Georgia its seems to be a Dr. 99 (which in Denver was a restraint patient which continues to confuse me). Denver also has its other unique overhead pages. A fire alarm is a Mr Gallagher so named after a long time Denver fire Marshall who used to inspect the Denver hospitals.
Specializes in ER and family advanced nursing practice.
a Core0 in Denver (and only Denver as far as I can tell) is the same as a code blue at most other hospitals. Here in Georgia its seems to be a Dr. 99 (which in Denver was a restraint patient which continues to confuse me). Denver also has its other unique overhead pages. A fire alarm is a Mr Gallagher so named after a long time Denver fire Marshall who used to inspect the Denver hospitals.
David Carpenter, PA-C
David, I see we have covered some common geography. I was a DG medic, worked at Aurora Medical center, and then I moved to Atlanta and became a Grady medic and then worked in the MICU and ER also at Grady. My favorite Denver overhead was the Paul Bunyan which as I recall was used when security was used for a fight or to help restrain a psych patient.
core0
1,831 Posts
As far as Texas I would suggest you reread the statues, specifically rule 221.13 (link won't post)
For reasons that are unclear NPs in rural areas actually have more supervision requirements than those that aren't.
As an alternative the Pearson report is fairly definitive:
http://www.webnp.net/downloads/pearson_report08/pearson_Scarolina_wyoming.pdf
I have the list of NP states at home. I can post it later. As discussed in other posts Medicare requires a collaborating physician to bill.
As far PA education, PA educational programs range from 18-36 months. They usually encompass a didactic and a clinical phase although a number of programs are integrating their clinical phase in PBL. The great majority of PA programs are 24-27 months. After graduating a small minority of PAs go on to post graduate programs in Medicine or Surgery. The rest enter practice.
You can probably find the rest of the information (including the part that I posted) in the previous 37 pages of posts. Or perhaps someone will post it:rolleyes:.
David Carpenter, PA-C