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 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.
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The reason that I put "holistic" in quotes I am used to seeing holistic use thus: "The term can imply a pretechnological lifestyle which uses alternative healing practices vs. contemporary established western practices."
I tend to practice in a fairly holistic manner by the true definition. I tend to see most people use holistic to be synonymous with CAM or whatever new age patchouli wearing pyramid sitting methodology they use (spent my own time in Boulder:D). My disgust with CAM is not with the patients. Instead its with the "practitioners" who claim their "holistic" methods work magic. I am aware that most medications originally would be considered CAM, but along with the development of modern medicine we have fairly strong scientific evidence of efficacy of most medications and we have removed those that are dangerous like mercury. If you look at three of the more popular CAM "medications" Saint Johns Wort, Saw Palmetto and Milk Thistle, all have been tested against placebo for efficacy. The data on Saint John's Wort is all over the place. Despite being the number one selling medication for depression in Germany most studies show it similar to placebo. There is good evidence that Saw Palmetto is somewhat efficacious in very mild BPH. There is also evidence that Milk Thistle is not harmful in liver disease even if it does not do much. So even among those "herbal supplements" that have been tested they do not preform much better than placebo. The rest have shown to be harmful in some cases and pretty much a complete waste of money in others. Despite this consumers in the US spend more than $4 billion. Interestingly ethically and legally I could not prescribe a placebo for my patient but I could recommend an herbal supplement. Thats the most telling point of there power in the market.
In my usual attempt to make this somewhat relevant to the topic at hand and to avoid angering the all powerful Siri I have noticed that most of the nurse practitioner programs in CAM have gone by the wayside (the UCSF program in particular). At least the ivory tower types are waking up to the dangers of tying their horse to that particular wagon (my provocative statement for the day).
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 where I worked in the MICU and ER at 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.
Man that brings back memories. I worked at SAC and most of the Health One system (Mostly Pres, Swedish and Rose). I did more than my fair share of Paul Bunyans.
Let me preface this post by saying that I chose to go to NP school because first of all I am a nurse and I wanted to advance my degree. I had originally wanted to obtain a CRNA degree, but my husband's Army assignment sort of dictated a few decisions we had to make. I wasn't ready to leave my 2 year old child and my active duty husband to pursue my dreams of becoming a CRNA. In turn, I chose to get my MSN with a focus on FNP, and after completing my graduate program, I am sure that I made the right decision.
I did several of my rotations with a PA in an urgent care center. My graduate program usually only permits preceptorship with a NP, but in all honesty, there were no clinical rotations available for me in my area. I literally spent hours and hours on the phone calling clinics, going into clinics and emailing trying to find a rotation. I wasn't from this area, so obtaining a preceptorship was not always easy for me. I called the urgent care center at a local ER and was told that they could accommodate my learning with a PA. It was phenomenal.
I had a broad overview of the roles and responsibilities of a NP, but I honestly had NO CLUE about the roles of a PA. I had heard mixed feelings regarding the role of the NP vs. the role of a PA. I can say now that the experience I gained is invaluable. I learned so much from him...
There are differences between a NP and PA, however, I do not think one is inferior to the other. Rather than looking at PA's as competition, we need to look at them as partners in health care. They play a vital role in healthcare as much as a NP does. I do feel that physicians see us differently, but I feel it is our duty to educate other providers and the public on the NP roles and responsibilities. It is our duty to provide our patients with the education to know that we also have a lot to offer within the health care field.
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.
I do believe joint commission has weighed in on all the different codes being called over PAs in hospitals..
I do believe joint commission has weighed in on all the different codes being called over PAs in hospitals..
Not my experience. There is a joint commission requirement that employees know what all the overhead pages mean. But no specific requirement on what those pages are (at least as of the last inspection).
I just found out that PAs in my state must have a bachelor's degree (it can be in anything) then take 3 semesters of classroom(didactic), then 3 semesters of clinicals.
Hi, I would like to know what is the difference between NP and PA in terms of time of studies. Which one is the most practical way for a register nurse? and could an LVN apply to any of both profetions? any information would be a great help for me. Thankyou very much.
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?
Just curious........
Complete independent practice means: No MD oversight, however we are supposed to refer when needed. That's just common sense. It also means total prescriptive authority - the DEA license will be under our name and not tied to a physician. We can already order tests, do procedures and refer patients. BTW, this is for a primary care practice only, in other words, we can't set up shop as a cardiologist, nephrologist, etc. New Mexico's NP's have full independence. Currently, we have "collaborative" agreements with physicians in TX.
Get this, one day I referred a patient to a neurologist and the nurse called his office and was told that the neurologist wouldn't accept a referral from a NP. The doc I worked for flipped out. He actually called the neurologist's office and told the receptionist that we would no longer refer patients, since his NP wasn't allowed to make the referral. He got a call within 5 minutes FROM THE NEUROLOGIST and was told that he would LOVE to accept a NP's referrals. Trust me, I don't think this would have happened if I didn't have a doctor to back me up. So, even though we can "legally" refer to specialists now, I don't know that every specialists will accept those referrals. On the other hand, I've had some of the newer specialists totally schmooze me...they ain't stupid ($$$).
Specializes in ER and family advanced nursing practice.
complete independent practice means: no md oversight, however we are supposed to refer when needed. that's just common sense. it also means total prescriptive authority - the dea license will be under our name and not tied to a physician. we can already order tests, do procedures and refer patients. btw, this is for a primary care practice only, in other words, we can't set up shop as a cardiologist, nephrologist, etc. new mexico's np's have full independence. currently, we have "collaborative" agreements with physicians in tx.
($$$).
for me personally, i feel that there needs to be some sort of caveat regarding this whole independent practice thing. i am doing my np clinicals in the er right now and we see some fairly complicated patients, but i can tell judging by the pace we are going the notion of a new grad fnp having independent practice is a bit scary and completely unnecessary. i like that some states have rules in place that grant fnps independent (or at least more independent) practice after one to three years of practice. that seems more reasonable to me. i don't know what the average is, but many np programs get around 700-800 hours of practicum and that is over two years. pas get what, 1900 hours in one year? please don't talk to me about nurses bringing other experiences to the table. it is very possible to be a floor nurse in a low acuity area (and be a new grad even in that area) and go straight to fnp school. i don't think pas should have complete independent practice right out of school either and that also should apply to fnps as well. i don't know why we as nurses have this big chip on our shoulder as a profession that being "independent" makes us better people or something.
Specializes in ED, Cardiac-step down, tele, med surg.
Very very interesting and informative discussion. Thanks everyone for your input. I'm almost done with a 2nd degree BSN, and as I predicted would be the case, am very interested in the medical aspect of health care, i.e. the diagnosis and treatment of disease. I love the spiritual-psycho-social stuff also. I get the impression that NPs and PAs diagnose and treat complex illness, not just the basics. Does the PA course work more prepare the clinician to treat complex cases or do you think NP curriculum, though different provides the knowledge base required. Thanks
for me personally, i feel that there needs to be some sort of caveat regarding this whole independent practice thing. i am doing my np clinicals in the er right now and we see some fairly complicated patients, but i can tell judging by the pace we are going the notion of a new grad fnp having independent practice is a bit scary and completely unnecessary. i like that some states have rules in place that grant fnps independent (or at least more independent) practice after one to three years of practice. that seems more reasonable to me. i don't know what the average is, but many np programs get around 700-800 hours of practicum and that is over two years. pas get what, 1900 hours in one year? please don't talk to me about nurses bringing other experiences to the table. it is very possible to be a floor nurse in a low acuity area (and be a new grad even in that area) and go straight to fnp school. i don't think pas should have complete independent practice right out of school either and that also should apply to fnps as well. i don't know why we as nurses have this big chip on our shoulder as a profession that being "independent" makes us better people or something.
ivan
i couldn't agree more. fnp's programs should require a minimum of 2,000 clinical hours. even then, they should be required to work a couple of years in primary care under the supervision of a physician until they are able to go out on their own. i don't know if the np's are required to have any experience in those states where they can practice independently. if not, let's hope they are smart enough to get a few years of experience before they attempt something like that.
core0
1,831 Posts
The reason that I put "holistic" in quotes I am used to seeing holistic use thus: "The term can imply a pretechnological lifestyle which uses alternative healing practices vs. contemporary established western practices."
I tend to practice in a fairly holistic manner by the true definition. I tend to see most people use holistic to be synonymous with CAM or whatever new age patchouli wearing pyramid sitting methodology they use (spent my own time in Boulder:D). My disgust with CAM is not with the patients. Instead its with the "practitioners" who claim their "holistic" methods work magic. I am aware that most medications originally would be considered CAM, but along with the development of modern medicine we have fairly strong scientific evidence of efficacy of most medications and we have removed those that are dangerous like mercury. If you look at three of the more popular CAM "medications" Saint Johns Wort, Saw Palmetto and Milk Thistle, all have been tested against placebo for efficacy. The data on Saint John's Wort is all over the place. Despite being the number one selling medication for depression in Germany most studies show it similar to placebo. There is good evidence that Saw Palmetto is somewhat efficacious in very mild BPH. There is also evidence that Milk Thistle is not harmful in liver disease even if it does not do much. So even among those "herbal supplements" that have been tested they do not preform much better than placebo. The rest have shown to be harmful in some cases and pretty much a complete waste of money in others. Despite this consumers in the US spend more than $4 billion. Interestingly ethically and legally I could not prescribe a placebo for my patient but I could recommend an herbal supplement. Thats the most telling point of there power in the market.
In my usual attempt to make this somewhat relevant to the topic at hand and to avoid angering the all powerful Siri I have noticed that most of the nurse practitioner programs in CAM have gone by the wayside (the UCSF program in particular). At least the ivory tower types are waking up to the dangers of tying their horse to that particular wagon (my provocative statement for the day).
David Carpenter, PA-C