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?
When a MD/DO/PA performs a procedure, it is "medicine".
When an NP performs the exact same procedure, for the exact same reasons, it is "nursing".
Is this correct? If so, then you are saying that the definition of an action as "medical" or "nursing" is solely dependent on which Board licenses the individual clinician?
The PA is licensed by the state BOM, right? Or by the state's board of osteopathic medicine, if the supervising physician is a DO? Is a PA working with a DO thus practicing "osteopathy"?
I have similar questions regarding "models". As above, nurses operate under the "nursing model" by definition, simply based on being under the purvue of their state's BON?
This is on topic to the OP. One big difference between PAs and NPs is that the PA scope is determined by the BOM. They (PAs) seem to have no problem calling what they do "practicing medicine". In fact, I would hazard to say that most (all?) PAs would never consider saying they provide patient care under the "phycician assisting model".
I have just assumed that calling a medical action as "nursing" by APNs was just a way around the whole "practicing medicine without a license" thing, i.e. just a political/semantic/legal work-around of BOM control of all things medical. This is to allow APNs to legally provide medical care.
Your posts in this thread, detailed as they are, seem to directly state that defining a medical action as "nursing" is purely semantic. Am I missing something?
When a MD/DO/PA performs a procedure, it is "medicine".
Correct, because (at least in California) MD/DO are considered "physicians" that practice medicine and use the medical model as a framework for care. PA's (and I'm far from being an expert on PA practice) are trained using the medical model and provide care using the medical model as a framework.
When an NP performs the exact same procedure, for the exact same reasons, it is "nursing".
Correct, except in California, where NP's do not have a scope of practice promulgated by the board of registered nursing. Unfortunately, due to the heavy power of medical associations, coupled with a palpable lack in consensus by NP's in who they are (nurses or physician extenders), what they are doing (practicing medicine versus advance practice nursing) and the product they are delivering (medical care versus advance practice nursing care) the last bill to give NP's their own scope died in committee. This will only change, and I do mean only, when NP's come together and make it clear that we are not PA's nor are we mid level anything nor are we physician extenders or anything of the like.
Is this correct? If so, then you are saying that the definition of an action as "medical" or "nursing" is solely dependent on which Board licenses the individual clinician?
I would say this is partly correct. I would say that the function is dependent upon the individual and to which profession that individual belongs and most importantly, the professions and disciplines models and framework which gives context to the action. Think about the time, a few years back, when nurses were precluded from doing blood pressures because this was solely the providence of medical practice. How have times changed since then? Is the function of performing a blood pressure a medical or nursing procedure? Does it depend on who is doing the blood pressure? In the context of the framework by which individual professions use to direct, guide and inform care, what philosophical and practice components underpin why this function is taking place. Now relate this to what you know about the medical and nursing models of providing care to individuals and families.
The PA is licensed by the state BOM, right? Or by the state's board of osteopathic medicine, if the supervising physician is a DO? Is a PA working with a DO thus practicing "osteopathy"?
I'm not absolutely sure if physician assistants are licensed to practice "physician assisting" whereby they have their own independent scope of practice like NP's do in 49 states, or if they are licensed to practice medicine with the caveat that they may only practice under the supervision of a physician (M.D./DO).
I have similar questions regarding "models". As above, nurses operate under the "nursing model" by definition, simply based on being under the purvue of their state's BON? This is on topic to the OP. One big difference between PAs and NPs is that the PA scope is determined by the BOM. They (PAs) seem to have no problem calling what they do "practicing medicine". In fact, I would hazard to say that most (all?) PAs would never consider saying they provide patient care under the "physician assisting model".
The nursing process directs, guides and informs care provided by nurses. This is made clear, at least in California, where a competent nurse is a nurse who utilizes the nursing process in caring for their clients. Yes, and unfortunately, there is the mandate for the utility of nursing diagnosis in the context of primary care for NP's because the BRN does not have a separate scope of practice for NP's. I don't know any NP's in California, however that use nursing diagnosis' in the context of primary care because, even though it is mandated, it does not fit well within the schema of providing care and the advance nursing level in the context of providing primary health care services.
I have just assumed that calling a medical action as "nursing" by APNs was just a way around the whole "practicing medicine without a license" thing, i.e. just a political/semantic/legal work-around of BOM control of all things medical. This is to allow APNs to legally provide medical care.
And you have hit right on the head of the crux of the strong medical associations arguments to oppose NP advancement. We, as nurses, tend to scoff at the utility of the nursing process, nursing diagnoses, nursing theorists that have provided models to direct care. Even in my own FNP program, my fellow students make comments like, "Thank God I got through nursing theory so I will never have to deal with that again." What some fail to recognize is that these theorists have indeed set up frameworks, models and guides to use in informing, directing and guiding our care as nurses. This, essentially is the very mechanism and instrument that we need to make it very clear that what we do as nurses is indeed nursing, and not a spin off of another discipline. It's the very process that we use as nurses that distinguishes our process from that of the medical model.
Your posts in this thread, detailed as they are, seem to directly state that defining a medical action as "nursing" is purely semantic. Am I missing something?
It is semantics that drive, underpin and inform others that nursing is its own discipline and profession, and while many may lump PA's and NP's together as the same, they are both quite different animals.
Specializes in ED, Cardiac-step down, tele, med surg.
I think the confusion here is that the MD is not the only one who diagnoses and treat diseases, hence it's not only the practice of medicine. Other professionals can do that. It's the lens that's looked through that is the practice of what ever. Medical diagnosis is not longer only the practice of medicine. Practice of medicine is not only making a medical diagnosis.
You can try and compare the education all you want to....the whole "well PA's have more clinical time than NP's"....but for every argument a PA has an NP has two....lest we forget that there are actually PA's running around out there treating patients with just an associates degree....scary huh....not that I have anything against an associates degree but if someone is going to diagnose me they better have a little more education than a two year community college degree
If the pre-req's are the same (minus a bachelor's degree, but same science/gen ed courses) and the actual PA training is the exact same, who cares if they have an associates or masters? I've met plenty of incompetent fools with masters or higher and very competent clinicans with certificated (hosp. based) or associates that both had the same training.
One major change: for a master's program, you need to score 80% to pass.
And in an associates they can change on a program to program basis the minimum to pass. If they want it 80%, they can make it 80%.
hey pat, if you get this i would really like to talk with you. i am a bsn nursing student graduating in may 2009. i recently applied to pa school because i am frustrated with my particular nursing school's complete lack of any kind of hard scientific education. it is all social science, at best. anyways, i am afraid, however, that as a pa i am going to miss that up close and personal care you give as an rn. i'm also concerned that if i get in right away i am going to regret not working as an rn for at least a little while, but i don't want to deny it if i do get in. basically, i'm just wondering how you managed to keep up your rn as a pa. is there any kind of conflict in working as an rn while in pa school or possibly even after pa school. i mean i know m.d.s can work as emts as long as their stay within that role's scope of practice...is it similar for pas working as rns? out of curiosity, i was also wondering what your personal reasons were for choosing pa over np, because i am still fairly undecided and getting nervous that i may have to make a decision soon. my reasons at this point in time for favoring pa is: the medical (more scientific) education really appeals to me and i want to work in an ed and it seems as though there are more opportunities for pas in the ed (anyone have any input on that?). also, does anyone live in the minneapolis/st. paul area and know what the job market is like for pas vs. nps. also, anyone have any input on how the transition to dnp is going to change the job market for nps? sorry, that was a lot of questions, but i would greatly appreciate input from anyone (np, rn, pa, md, anyone!) on this because i simply am not getting the answers from nursing instructors i talk to or pa advisors. thanks!!
Specializes in ED, Cardiac-step down, tele, med surg.
Thanks above for asking those questions. I would also like to know about that, because I am considering going to PA school after a couple years experience as an RN. I've got a science background and like to go into depth with biological science. One more question if anyone knows, is the first 2 years of med school comparable to the first 2 years of PA school? Thanks much!
hey pat, if you get this i would really like to talk with you. i am a bsn nursing student graduating in may 2009. i recently applied to pa school because i am frustrated with my particular nursing school's complete lack of any kind of hard scientific education. it is all social science, at best. anyways, i am afraid, however, that as a pa i am going to miss that up close and personal care you give as an rn. i'm also concerned that if i get in right away i am going to regret not working as an rn for at least a little while, but i don't want to deny it if i do get in. basically, i'm just wondering how you managed to keep up your rn as a pa. is there any kind of conflict in working as an rn while in pa school or possibly even after pa school. i mean i know m.d.s can work as emts as long as their stay within that role's scope of practice...is it similar for pas working as rns? out of curiosity, i was also wondering what your personal reasons were for choosing pa over np, because i am still fairly undecided and getting nervous that i may have to make a decision soon. my reasons at this point in time for favoring pa is: the medical (more scientific) education really appeals to me and i want to work in an ed and it seems as though there are more opportunities for pas in the ed (anyone have any input on that?). also, does anyone live in the minneapolis/st. paul area and know what the job market is like for pas vs. nps. also, anyone have any input on how the transition to dnp is going to change the job market for nps? sorry, that was a lot of questions, but i would greatly appreciate input from anyone (np, rn, pa, md, anyone!) on this because i simply am not getting the answers from nursing instructors i talk to or pa advisors. thanks!!
there are a lot more np's working in the er's where i live (s. tx) than pa's. we outnumber pa's 20 to 1 in this area. i'm not familiar with the bon rules governing np's in your area, so i don't know if it's better to become a np or a pa.
Thanks above for asking those questions. I would also like to know about that, because I am considering going to PA school after a couple years experience as an RN. I've got a science background and like to go into depth with biological science. One more question if anyone knows, is the first 2 years of med school comparable to the first 2 years of PA school? Thanks much!
I'll answer the easy one first. When I've asked the few PAs that have done both is that it is different. PA school probably has the closest analogy to the 2nd and 3rd years of medical school. These are the clinical medicine portions and core clinical clerkships. On average a PA program will cram more hours into that one year than the med students. (1400 for PA vs. 1100 for MD). The clinical year on the other hand is very similar (2100 for PA vs 1900 for MD). Note the only studies on MD education are very small. The difference in didactic education is the lack of extensive basic science education found in medical school. At least from my small experience there is a difference in clinical education in that the expectations for PA students are more clinically focused. On the other hand the physician will have gone through a much more extensive clinically focused education during their residency.
To look at another way, PA education is dedicated to providing a minimally competent clinician within the program course. The physician education produces a broadly and extensively trained physician who become clinically competent during their residency.
One of the physicians compared it to running a 10k vs. running a marathon. Both are difficult but in different ways. If you want a working knowledge of biological concepts needed to practice medicine then PA school will give you that. If you want an indepth knowledge of biological sciences then medical school is more likely to give you want.
hey pat, if you get this i would really like to talk with you. i am a bsn nursing student graduating in may 2009.
welcome to all nurses. i will point out that the post is more than 3 years old and the poster has not posted since 2006. congragulations on wading through 41 pages of postings .
i recently applied to pa school because i am frustrated with my particular nursing school's complete lack of any kind of hard scientific education. it is all social science, at best. anyways, i am afraid, however, that as a pa i am going to miss that up close and personal care you give as an rn. i'm also concerned that if i get in right away i am going to regret not working as an rn for at least a little while, but i don't want to deny it if i do get in. basically, i'm just wondering how you managed to keep up your rn as a pa. is there any kind of conflict in working as an rn while in pa school or possibly even after pa school. i mean i know m.d.s can work as emts as long as their stay within that role's scope of practice...is it similar for pas working as rns?
on the average pas spend more time with their patients than physicians (less than nps). the job will determine how much time you get to spend with the patients (and the practice environment). as far as working during pa school its generally not advised. there were 4 rns in my class and only one worked (one saturday per month). none worked during clinicals.
it would be possible but unlikely to keep up your rn after graduating. working as an rn is common while waiting for certification and credentialling. after starting work as a pa you would have to keep up with ceus and cmes (required for certification). the other issue is that you would probably not be able to work in the same hospital where you are credentialled as a pa (role questions).
out of curiosity, i was also wondering what your personal reasons were for choosing pa over np, because i am still fairly undecided and getting nervous that i may have to make a decision soon.
i would look for some answers to this on the pa forum. this was posted recently:
my reasons at this point in time for favoring pa is: the medical (more scientific) education really appeals to me and i want to work in an ed and it seems as though there are more opportunities for pas in the ed (anyone have any input on that?). also, does anyone live in the minneapolis/st. paul area and know what the job market is like for pas vs. nps. also, anyone have any input on how the transition to dnp is going to change the job market for nps? sorry, that was a lot of questions, but i would greatly appreciate input from anyone (np, rn, pa, md, anyone!) on this because i simply am not getting the answers from nursing instructors i talk to or pa advisors. thanks!!
you can find a couple of posts about the ed thing here. like most things it depends on where you live and how the bon interprets the np practice act. the dnp issue is also discussed extensively here (sticky below).
as far as the pa market in minneapolis you probably can ask on the pa board. augsburg college has a very well regarded pa program.
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amzyRN
1,142 Posts
Very good debate. Good for you Tammy to stand up for the nursing profession!