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 am a PA who is still actually an RN. I researched MD, PA, and NP, obviously choosing PA for my own reasons. I would be glad to discuss those reasons with anyone who would like. By the way, I most certainly made the right choice for me.
Hello Pat,
I am going through this process now, in choosing NP vs. PA routes. I feel I am leaning towards PA because of more job opportunities & less time working up through the nursing ranks. What is your reasoning? Is it similar? Please feel free to e-mail me personally as well if you prefer. This is a very big eduational decision--hope to make the right one.
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.
First of all, I'm an RN, just like you...and I'm heading in the direction of PA or NP. I don't want to attribute to you something that you did not mean to convey, but this part of your post is REALLY going to rub any non-nurses the wrong way. It sounds like you are saying that we nurses are the only ones on the planet with good listening skills, empathy, and compassion and that no one can possibly compare to us.
Where did you learn these amiable traits? I went through the same nursing curriculum that you did, and I know you didn't learn those traits in school. You were definitely taught the importance of them, but they cannot be burned into your personality through study.
Your post also will likely feel insulting to others on a career path different from your own. Everyone leaves a different set of footprints as they wonder through life. Just because they didn't start as a nurse doesn't mean that they couldn't have developed amazing listening skills, compassion, and empathy. I know PLENTY of nurses who are no better than average in any of these areas. And on the other hand, I know people in life who don't work in health care at all who exhibit the most awe-inspiring levels of compassion, empathy, and listening skills. If you want to really learn about listening skills, go work in management or sales. You could read books non-stop for years just on that subject. And the top people in sales will tell you that honing this skill can make the difference between just scraping by and making a huge six or seven-figure income. You barely touch on the skill in nursing school.
I work with a group of PAs and physicians in a busy emergency department, and to be honest, they are EVERY bit as compassionate as we nurses are at the bedside. And to go a step further, it would be hard to argue that we nurses are better at knowing what questions to ask BEFORE we do the all-important listening that you mention. I LOVE listening to the docs and PAs as they interact with patients, because their advanced training has taught them the BEST questions to ask in order to diagnose and plan to improve their outcome. I'm forever thinking, "Crap, why didn't I ask the patient that!?" OR it prompts me to ask the doc/PA at a later moment why they asked that particular question in the patient interview. I learn SOOOOOOO much from these guys/gals! It's interesting to me that those people called medical students are willing to not only get their BSN, but also to follow it with four more years of medical school and then typically 3 - 7 years of residency beyond that in order to be able to help patients. You want to talk about compassion/commitment...WOW! So would you say these guys/gals don't know anything about empathy, compassion, and listening skills comparred to us nurses with a 2 or 4 year degree? That seems very arrogant to me. I apologize, however, if I am misunderstanding you. I am by no means bashing nurses, but what makes us the kings of compassion compared to others who have often worked MUCH, MUCH, MUCH, MUCH harder than we have academically to work in the health care field with the same patients? Percentage of time spent at the bedside is not the logical answer, because then the nurse aides, while they are giving baths and scooping poop and we are charting in our chairs at the nurse's station, would be balking at us saying that we don't know anything about compassion compared to them. After all, they spend more time with the patients than we do.
It's my conviction that if you have empathy, compassion, and good listening skills, it's because of who you were BEFORE you ever went to school to be a nurse. In fact, those qualities likely drove you to that career. Many people who are spending years furthering their education to be PAs, MDs, etc do so with the idea in mind that in those positions, even though less time is spent at the bedside, more choices can be made in order to improve the patient's outcome. They get to order and interpret diagnostic tests, and then write orders that they believe will best improve the patient's status. And being a bedside nurse in the latter category, I can certainly appreciate that perspective. Again, my apology if I am misunderstanding you.:wink2::wink2::wink2:
First of all, I'm an RN, just like you...and I'm heading in the direction of PA or NP. I don't want to attribute to you something that you did not mean to convey, but this part of your post is REALLY going to rub any non-nurses the wrong way. It sounds like you are saying that we nurses are the only ones on the planet with good listening skills, empathy, and compassion and that no one can possibly compare to us.
Where did you learn these amiable traits? I went through the same nursing curriculum that you did, and I know you didn't learn those traits in school. You were definitely taught the importance of them, but they cannot be burned into your personality through study.
Your post also will likely feel insulting to others on a career path different from your own. Everyone leaves a different set of footprints as they wonder through life. Just because they didn't start as a nurse doesn't mean that they couldn't have developed amazing listening skills, compassion, and empathy. I know PLENTY of nurses who are no better than average in any of these areas. And on the other hand, I know people in life who don't work in health care at all who exhibit the most awe-inspiring levels of compassion, empathy, and listening skills. If you want to really learn about listening skills, go work in management or sales. You could read books non-stop for years just on that subject. And the top people in sales will tell you that honing this skill can make the difference between just scraping by and making a huge six or seven-figure income. You barely touch on the skill in nursing school.
I work with a group of PAs and physicians in a busy emergency department, and to be honest, they are EVERY bit as compassionate as we nurses are at the bedside. And to go a step further, it would be hard to argue that we nurses are better at knowing what questions to ask BEFORE we do the all-important listening that you mention. I LOVE listening to the docs and PAs as they interact with patients, because their advanced training has taught them the BEST questions to ask in order to diagnose and plan to improve their outcome. I'm forever thinking, "Crap, why didn't I ask the patient that!?" OR it prompts me to ask the doc/PA at a later moment why they asked that particular question in the patient interview. I learn SOOOOOOO much from these guys/gals! It's interesting to me that those people called medical students are willing to not only get their BSN, but also to follow it with four more years of medical school and then typically 3 - 7 years of residency beyond that in order to be able to help patients. You want to talk about compassion/commitment...WOW! So would you say these guys/gals don't know anything about empathy, compassion, and listening skills comparred to us nurses with a 2 or 4 year degree? That seems very arrogant to me. I apologize, however, if I am misunderstanding you. I am by no means bashing nurses, but what makes us the kings of compassion compared to others who have often worked MUCH, MUCH, MUCH, MUCH harder than we have academically to work in the health care field with the same patients? Percentage of time spent at the bedside is not the logical answer, because then the nurse aides, while they are giving baths and scooping poop and we are charting in our chairs at the nurse's station, would be balking at us saying that we don't know anything about compassion compared to them. After all, they spend more time with the patients than we do.
It's my conviction that if you have empathy, compassion, and good listening skills, it's because of who you were BEFORE you ever went to school to be a nurse. In fact, those qualities likely drove you to that career. Many people who are spending years furthering their education to be PAs, MDs, etc do so with the idea in mind that in those positions, even though less time is spent at the bedside, more choices can be made in order to improve the patient's outcome. They get to order and interpret diagnostic tests, and then write orders that they believe will best improve the patient's status. And being a bedside nurse in the latter category, I can certainly appreciate that perspective. Again, my apology if I am misunderstanding you.:wink2::wink2::wink2:
I agree, that any profession can have individuals who care and have compassion. Caring, however, is not just an attribute to nursing as it is to medicine, physician assisting or any other profession--caring is synonymous in every way to nursing.
Here's an article that identifies the concept of caring as it relates and is embedded within the profession of nursing.
Again, that's not to say that MD's, PA's can't be caring. Remember, it was Leininger, a nurse anthropologist who said and coined the concept, that "care is the essence of nursing and the central, dominant, and unifying focus of nursing" I'm not sure how this fits within the allopathic model, but again, I know many MD's and PA's who are caring individuals as I know many nurses who are not.
i am a member of a health care team. every day i'm surrounded by great docs, great techs, great respiratory therapists, and great pas in the emergency dept. each of them have a level of compassion and empathy that i cannot quantify. i would not ever in a million years have the audacity to look at them and say anything in the neighborhood of, "you guys might have some level of compassion and empathy, but that's clearly a nurse's domain." not only would i feel like i was insulting them, but i would feel rotten and presumptuous even thinking anything like that.
if we want to speak of compassion and empathy, we should put ourselves in the shoes of other people on the health care teams that we work with and consider how comments like these would make them feel if they read the pages of our forums. i think when we make statements like that we open up a can of worms and practically beg for a “pissing match.” and then feelings get hurt, tempers flare, and folks begin saying very divisive things. i can see some doc reading this forum and sniping back with, “yeh, and superior academic and clinical preparation is clearly the doc’s domain!” and personally, i can’t argue with that! that’s exactly what my prideful mind would come back with if i was a doc or pa and felt insulted…whether right or wrong.
the article that you provided a link to is an interesting read, and i appreciate you posting it…but nurses don’t have more compassion just because some nursing theorist said so. nursing theorists theorize about a field that does not, strictly speaking, require any compassion at all. and let me qualify that statement. all i needed to become a nurse was enough intelligence to be admitted to a nursing program and enough commitment to finish. at no point in the admission process was anything other than academics looked at. i’d love to think that everyone who enters nursing does have compassion and wants to make a difference in people’s lives. and i like to think that i'm a very compassionate person myself. but the same nursing schools that teach all the wonderful things that nursing theorists say about our noble profession screen for hardly anything besides academics. in the majority of schools, if you get the scores, you get a seat in the nursing program. and if you keep the grades, you stay in the program. there are some schools that interview as a part of their admission process, but it's easy enough to say all the right things. for the most part, however, it's all based on academics. i've known lots who bombed out part way through the program because they didn't maintain good enough grades...yet i've never known one to bomb out for lack of compassion, empathy, or listening skills. nursing schools demand the former, not the latter. the bottom line is that nursing programs guarantee a certain amount of academic ability. they do not guarantee any compassion or empathy at all. i’m sure the same is true for med schools and pa schools.
so that being said, i'm not sure how we can support the notion that we nurses are more compassionate and empathetic than other health care professionals. but more importantly, i don't know why we even want to try! why not just appreciate our coworkers for who they are as individuals and the care that they bring to the patients rather than being divisive about which profession is better at what? there's a doctor names jessica and a pa named renee that i work with, and both of them never cease to blow me away as i watch them interact with patients. they are both so incredibly caring and pleasant. they are truly amazing women! and i, as a nurse, can't match these wonderful ladies! i work very hard for my patients...hand-in-hand with jessica and renee. we all appreciate each other, and i think we're a pretty awesome team!
PA's can only work UNDER a doctor, NP's can work independantly, so there really isn't an issue with that. I work with a few NNPs who were ASNs as well and grandfathered in back in the day. That is what they will do with the MSN NPs after 2015. Many that I know are actually WANTING to go back and do the year required for DNP now...it's actually a great program! Of course, I'm biased, as I always knew I'd go back to grad school, and when I was accepted as 4 out of 100+ for Peds psych NP student in the new DNP program at ASU, it was an absolute shock, and compliment! But, like I said, I WANTED to do this. You know as well as I do that so many people that work in nursing are SO opposed to any kind of change, big or small, and people make an enormous deal out of it! If they don't like it, they shouldn't do it! Easy enough!
Specializes in Critical Care, Emergency, Education, Informatics.
PA's can only work UNDER a doctor, NP's can work independantly, so there really isn't an issue with that. I work with a few NNPs who were ASNs as well and grandfathered in back in the day. That is what they will do with the MSN NPs after 2015. Many that I know are actually WANTING to go back and do the year required for DNP now...it's actually a great program! Of course, I'm biased, as I always knew I'd go back to grad school, and when I was accepted as 4 out of 100+ for Peds psych NP student in the new DNP program at ASU, it was an absolute shock, and compliment! But, like I said, I WANTED to do this. You know as well as I do that so many people that work in nursing are SO opposed to any kind of change, big or small, and people make an enormous deal out of it! If they don't like it, they shouldn't do it! Easy enough!
I have a real hard time believing that a Peds Psych NP is going to make 200k/yr. Last time I checked the only people who were making that kind of money were SOME CRNA's. But I've been wrong before, Post a web site or something with that information.
Your statement about MD's only focusing on one system, isn't the reality of the world, any more than all NP' s treat their patient holisticly. hang out in my ER sometime, NP, PA's MD, DO's all practice the exact same medicine. Anything more than that is up to the individual and not the "profession". You statements about the independence are exactly accurate either. There are about just as many PAs working independently (if you use the owning their own practice criteria) as there are NP's. there are some posts out here somewhere with the exact statistics.
Education is great and I'm all for it. I've got more letters after my name than there are spaces in the alphabet is seems. By the end of this month I'll even be able to call myself Dr if I want to. (PhD in a non health care related field) the extra education and more importantly the thought that goes into getting that education has helped me in my nursing career.
From my perspective it looks more like ego to me and not about patient care. In a few years when all this settles down, then maybe I'll change my mind. In the mean time, I'll stick to being an over educated RN who's ego gets off by knowing more than the interns and residents do, :)
I understand what you are saying, and first I have to say, PERSONALLY, my getting my DNP is not about ego, it's about a dream that I've always had. But that is me. And I may not be 100% accurate on the pay, but I'm close, as I received an open job offer from a practice in Hawaii that went out to all graduating MSN NP students and that was the high end of the pay offered. I will do my research and repost what I find. As for the PA practicing independently, they CAN'T! I will post a website at the end of this and it will take you to the PA committee link. PA-Physician's ASSISTANT. They in now way can practice independently of a physician, where as certain NPs can! That's just how it is.
I will tell you the reality though. accoding to a stat out of Advance for PA's from awhile back 2% of PA actually own their own practice. The same # as NP's. No one trully practices independently. Insurance compaies dictate what you do, Hospital pharmaciy commities dictate what medicaine you can prescibe in the hospial. Each state board of nursing tell you what you can and can not do and it's different in all 50 states.
There is no benifit from the mine is bigger than yours arguments. Last time I checked we were supposed to be a health care team.
To keep to the topic. Education is GREAT and I congradualte you on getting selected. To many nurses don't take the effort to advance and improve themselves. And choosing to do it in an area were there isn't a ton of reimbursment says something about you and what you want to do with your life.
Me once I finish the PhD and the MSN next years I'l start watching the develpment of the dnp programs and see were things go. Right now there is such a wide interpretation of what a DNP program should be. I'll wait till the first accredidations have been awarded and there is some history out there that I can look to stats on passing boards etc. Maybe even get a post grad cerficiate first and then the DNP is the time allows.
I understand what you are saying, and first I have to say, PERSONALLY, my getting my DNP is not about ego, it's about a dream that I've always had. But that is me. And I may not be 100% accurate on the pay, but I'm close, as I received an open job offer from a practice in Hawaii that went out to all graduating MSN NP students and that was the high end of the pay offered. I will do my research and repost what I find. As for the PA practicing independently, they CAN'T! I will post a website at the end of this and it will take you to the PA committee link. PA-Physician's ASSISTANT. They in now way can practice independently of a physician, where as certain NPs can! That's just how it is.
So tell me in what state can an NP practice independently (including prescriptive authority) and bill all insurances including billing for medicare and medicaid without the need for any physician involvement?
The word you are actually looking for is autonomy. The ability to own and direct your own practice. The way that PAs do this is they form an LLC that they own 99%. The other 1% can be owned by anybody else. The LLC then hires the supervising physician. The physicians contract must show sufficient autonomy that the PA is not able to directly affect their medical decision making. BTW this is the exact same mechanisms that NPs use to acheive "independent" practice in California.
There are approximately 150-200 PAs practicing autonomously in California. Mostly in the central valley and northern areas. This does not include independent surgical assisting groups in the large cities.
As for the salary, congragulations this is the upper 0.5% for NPs. Of course there is probably a reason for this:rolleyes:.
cz890
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