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?
BTW this is the exact same mechanisms that NPs use to acheive "independent" practice in California.
You're joking right? NP's in California can't even prescribe a Tylenol without a standardized procedure signed by a medical director with a supervising physician. And even then the NP can't prescribe--they can "furnish" or "make medications" available.
I think what the poster was saying is that in some states (although not stated as same) NP's operate independent (in the sense of a supervising physician is not required) of physician supervision where as physician assistants, in any state, may not practice independent of a practice supervisory agreement with a physician. I'm not sure, however, if that is correct. Are there any states in which PA's can practice independent of a physician supervisor relationship like NP's do in some states?
You're joking right? NP's in California can't even prescribe a Tylenol without a standardized procedure signed by a medical director with a supervising physician. And even then the NP can't prescribe--they can "furnish" or "make medications" available.
I think what the poster was saying is that in some states (although not stated as same) NP's operate independent (in the sense of a supervising physician is not required) of physician supervision where as physician assistants, in any state, may not practice independent of a practice supervisory agreement with a physician. I'm not sure, however, if that is correct. Are there any states in which PA's can practice independent of a physician supervisor relationship like NP's do in some states?
My point was that even in the 12 states that do not require physician involvement to prescribe or treat, there is still a requirement to have a collaborating physician to bill Medicare (and most other insurances). So the "independent" practice of NPs is largely a myth.
PAs require a supervising physician in all states. Its part and parcel of the profession. The thing that the uniformed don't understand is that having a dependent profession does not make me a lesser provider. The dependent part does not refer to my medical practice. I have my own medical license and am fully responsible for any medical decisions I make. Instead the dependent portion refers to my scope of practice which is defined by the scope of practice of my supervising physician. As a fairly well known PA educator states, "we have moved from the point where we work under a physician's supervision and to the point where we work with a physician's supervision".
Fortunately for me there are plenty of NPs like the previous poster that are happy to spout of their opinion about NP independence and run down PAs. We have a name for that in the office, the PA employment act.
Arizona (the OPs residence) is one of the best states to be a practicing NP. I'm pretty sure that AZ NPs can bill medicare independently. Nothing against PAs. My GP is a PA =).
I think you and I have butted heads on a different forum before. You are right about the salary that was offered for the specific job I mentioned...I've been a nurse long enough to know that generally when they offer a high amount, there is a reason. I agree that the amount I quoted is very much at the high end of the spectrum. I am also in a specialty that not too many people want to go into (pediatric psych) and there is very much need for. I also agree that working under a doctor does not make you a "lesser provider". If you remember , I told you that my PCP is a PA that runs circles around the MD I had previously seen. I have only admiration for PAs, as well as anyone in the healthcare field! I was only trying to share, and I'm learning that doing so just ****** people off and they want to continue to debate. I need to do better research to post for statistics, as Craig has shared some "real life" stats with me, and I appreciate him for it. It's just gonna have to be the rule, as you and I once discussed on another forum, that PAs and NPs will never agree, and we need to agree to disagree!
Fortunately for me there are plenty of NPs like the previous poster that are happy to spout of their opinion about NP independence and run down PAs. We have a name for that in the office, the PA employment act.
David Carpenter, PA-C
Unfortunately there are plenty of NPs, PAs and MDs like these on this board and others who push the right buttons to cause angry reactions. I don't see the value in a negative response. I do like the facts
I in NO WAY am trying to run down PAs...I just told you that I only have respect and admiration for PAs, as I do RNs, NPs, and doctors! Everyone chooses the area they want to work in, i.e., you as a PA, me as an NP...that's just the way it is! And could you be a little more specific about what "the PA employment act" you talk about at your job is? And me talking about NP independence is for people to become aware of it, not to "spout off". You seem to be a little too irritated over something you shouldn't. You need to relax. I was simply stating MY OPINION, and you don't have to read it if you don't like it!
Arizona (the OPs residence) is one of the best states to be a practicing NP. I'm pretty sure that AZ NPs can bill medicare independently. Nothing against PAs. My GP is a PA =).
Medicare defines "collaboration" as being a process in which a nurse practitioner works with one or more physicians to deliver health care services, with medical direction and appropriate supervision as required by the law of the state in which the services are furnished. Where a state does not have a law or regulations that govern collaboration, it is to be evidenced for Medicare purposes by the nurse practitioner documenting the scope of his or her practice and the relationships that he or she has with physicians to handle issues that arise which are outside the scope of his or her practice. For Medicare billing purposes, when billing under the nurse practitioner benefit (and not as an "incident to" service), the collaborating physician does not need to be present with the nurse practitioner when the services are furnished. Supervision requirements are set by state law.
I in NO WAY am trying to run down PAs...I just told you that I only have respect and admiration for PAs, as I do RNs, NPs, and doctors! Everyone chooses the area they want to work in, i.e., you as a PA, me as an NP...that's just the way it is! And could you be a little more specific about what "the PA employment act" you talk about at your job is? And me talking about NP independence is for people to become aware of it, not to "spout off". You seem to be a little too irritated over something you shouldn't. You need to relax. I was simply stating MY OPINION, and you don't have to read it if you don't like it!
Kristenwrn
I also had looked @ PA school, but in the end, to be an NP, you can work independant of an MD, but as a PA, you cannot! That was what helped me to make my decision!
Kristen
PA's can only work UNDER a doctor, NP's can work independantly, so there really isn't an issue with that.
I really tried to stay out of this, but for the benefit of others I will put this as succinctly as possible. 98% of NPs work for physicians, physician practices, HMOs or hospitals. Generally the physicians have significant input into the hiring. What they are looking for is someone who will work within the medical team. When I sit in on interviews, what I am looking for is someone who will be part of the team. When the physicians interview another physician they are looking for someone who works as part of the team. They never look for the word independent. A physician that is independent is a liability to the practice. An NP that is "independent" is a liability to the practice. What they want is autonomous medical providers. They want people that know what they are doing and know when to consult or collaborate on the care of the patient. When you use the word indepedent you are signalling that you do not understand the role of a healthcare provider as part of a multidiscliplinary team.
If you look at the excerpt of the third quote where you capitalized the term UNDER, its hard to see how thats not insulting. It shows you don't understand how PAs function or how they are licensed. To be honest, 90% of PAs couldn't tell you how NPs are licensed, certified or trained. Generally we don't try to put ourselves on a different plane though.
As far as the PA employment act, I told this to Craig so I guess I can share it here. We are hiring at a rate that is very high (for Georgia). We interviewed a DNP and the result was a disaster. It was all about my patients and independent practice. The when asked how would you work with PAs, she replied "since they have less training than I do, I would be happy to supervise them and make sure they get the work done that I want". Needless to say that was pretty much the end of the interview. Now normally I would just view this as more job security. However, there are several ACNPs that I think would be a good fit for our group. What we need is someone who is a team player regardless of the initials. However, because of the first interview, we probably won't interview them. That means a smaller pool for us to select our team player from.
Between this and the "incident" with our MEPN student the docs are rapidly souring on NPs. Its a shame that we can't mandate common sense.
BTW if Siri wants she can move this whole issue to the NP vs. PA area since its not really relevant to the title of the thread.
Why be the bottom of someone else's field when you can be the top of your own?
Salaries are about the same and in 11 states nurse practitioners can practice totally independently of physicians. More will be on the horizon. Most states offer physician collaboration. PA's can not practice independently!
in 11 states nurse practitioners can practice totally independently of physicians. More will be on the horizon. Most states offer physician collaboration. PA's can not practice independently!
I'm sorry, but why would one want to?? I do not think either NP or PA education is substantial enough to warrant going solo. I'm a nurse and hope to be either an NP or PA someday, but you can bet that I want that MD/DO knowledge to fall back on. Just my opinion, but I would not let that be a deciding factor.
Dr. Tammy, FNP/GNP-C
618 Posts
You're joking right? NP's in California can't even prescribe a Tylenol without a standardized procedure signed by a medical director with a supervising physician. And even then the NP can't prescribe--they can "furnish" or "make medications" available.
I think what the poster was saying is that in some states (although not stated as same) NP's operate independent (in the sense of a supervising physician is not required) of physician supervision where as physician assistants, in any state, may not practice independent of a practice supervisory agreement with a physician. I'm not sure, however, if that is correct. Are there any states in which PA's can practice independent of a physician supervisor relationship like NP's do in some states?