Differences (Educative/Clinical) between NP & PA

[jstuben]

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?

Thank you very much!

[ECMOismygame]

Bibeau1 said:

Mea culpa , you are right, "compassion and empathy are acquired traits. Many apologies, I have recently witnessed people in my profession who clearly are lacking in the traits that I admire ........

So true.....some of the nicest people I know are nurses, while at the same time some ppl who I would swear are the incarnation of the anti-Christ are nurses....lol

Empathy is acquired not something learned in school

This goes for all medical professions, NP, PA, MD, DO, RN, RT.......

[FurmanGirl]

MUSC has both a nursing (BSN and MSN) program and a PA program. I once asked the Dean of Nursing to help clarify the difference b/w pursuing the PA or MSN before I applied. Simply put, she told me that the PA program was written and taught from a physician's perspective. However, the nursing program is written and taught by nurses, whose philosophy is slightly different. But as far as practicing goes, there's not too much difference.

[mango-lo-maniac]

FurmanGirl said:

MUSC has both a nursing (BSN and MSN) program and a PA program. I once asked the Dean of Nursing to help clarify the difference b/w pursuing the PA or MSN before I applied. Simply put, she told me that the PA program was written and taught from a physician's perspective. However, the nursing program is written and taught by nurses, whose philosophy is slightly different. But as far as practicing goes, there's not too much difference.

That has been my experience, too, at least in places where PAs & NPs work side-by-side.

PS Go Paladins! I'm a Furman Girl, too!

[wtbcrna, MSN, DNP, CRNA]

NPs can be totally independent providers depending on their state laws. All PAs do not have prior medical training or professional certifications. I realize some of the more competitive schools might be that way, but that is not the case for all of them. All NP certifications now require an MSN. That means you have to either have a BSN prior to admission or do a combined BSN/MSN while obtaining your NP.

Also, nurse practitioner's don't usually use nursing diagnoses they use medical diagnoses just like PAs and MDs/DOs.

I think the reason that doctors sometimes prefer PAs over NPs is that they understand their schooling better, being designed as a abbreviated medical school, and they don't feel threatened by them.

I have worked w/ new NPs and new PAs they are both about the same. The philoshopies are different, but the end is usually the same. The crack about nurse practitioners not going to surgery etc.... that is because nurse practitioners are specialized per their licensure/training from the start. PAs are generalist from the start and then specialize so therefore the need to go to all the different specialities during training.

Now as far as my advise to the original poster, if you're ultimate goal is to work in ER as provider I would go the PA route.... It should hopefully be the shorter to your goal depending on how much college you have done now.

[wtbcrna, MSN, DNP, CRNA]

By the way there is more than two ENP programs. I know of atleast one more at Univ of Tx Arlington.

[rvazqu6]

From what I've read in peer-reviewed/scientific journals, the clinical differences between the two fields have not been explored (at least not with methods that meets the standards of the journals). From my experience, I have never had a patient be able to identify which person was the pa and which was a np. Personally, I can usually distinguish physicians from np/pas, but not between the latter.

Both nps and pas become better practitioners after years of experience. Both seem to have similar earning potentials. My surgical pa friends earn ~80k - 90k, but they work more than 40 hours a week (60+) so the hourly wage is probably not that different. Also, nurses seem to be better organized in terms of pushing for legislation that they want. Pas need to improve in that area.

Really, the major difference that I've seen in the field (not schooling) is that nurse practitioners (or advanced practice nurses) need to "specialize," while pas do not. That is, a pa can work in a family practice office for a few years and then switch to ortho. Surgery, neurology, pediatrics, or dermatology. Of course, they would need to find an md/do willing and able to train them to perform their tasks. You can shadow 50 different pas and have different experiences with each due to differing laws in each state and physician preferences. Some physicians have been known to "look over the shoulder" of the pa, while other pas run their own clinics with minimal interaction with the md/do.

Both are exceptional fields. If you're not sure about which to pursue- shadow both for several months and see which one you're drawn to the most.

Every field has its pros/cons, but bashing each other gets us nowhere and it only serves to minimize the contributions made by each profession - is it any wonder nps/pas don't get the respect they deserve?

[DKU]

Wow!!!! Why is their so much animosity in this discussion. From looking at the PA/NP debate from a future practitioners view this debate does seem pointless as many have already pointed out. Both profession preform many of the same duties harmoniously where I live. A certain person seems to have outdated info and a predicial attitude. I have looked into both programs and I am having trouoble deciding. The last thing a prospective student needs is false info and attitude kristenwiz. If you need to be that judgemental become something else. All of the Np/Pa's that I have met are truly concerned with their patients.....Isn't that what this is all about?

[DKU]

P.S. PA schools do take many applicants without any clinical experience. The one I am interested in requires 750 hours of clincal experience. The FNP school that I am looking at requires a year of specialty nursing experience;ED or ICU on top of all other clinical experience. In this case the NP program requires at least 3x as much clincal time on top of the patho-physiology, microbiology and pharmacology coursework and experience without even mentioning the psychology and pateint relations skills required by the NP school. Other requirements are different, perhaps combining the two disciplines would be the answer. Once again, the pateint is what this is all about..if your focus is not on your pateint I feel you should be doing something else.

[DKU]

This discussion has made me think of the primary difference in thought; Beneficience Vs. Mal-feasance. Should we as the medical model entails simply do no harm, or should we hold ourselves to the higher standard of what is in the pateints best interest? With that , isn't it amazing the things we remember from college?

[sirI, MSN, APRN, NP]

DKU said:

Wow!!!! Why is their so much animosity in this discussion. From looking at the PA/NP debate from a future practitioners view this debate does seem pointless as many have already pointed out. Both profession preform many of the same duties harmoniously where I live. A certain person seems to have outdated info and a predicial attitude. I have looked into both programs and I am having trouoble deciding. The last thing a prospective student needs is false info and attitude kristenwiz. If you need to be that judgemental become something else. All of the Np/Pa's that I have met are truly concerned with their patients.....Isn't that what this is all about?

Hello, DKU,

Some of these negative remarks have been made by members who no longer post here, if you have noticed. Some of these remarks are over a year old.

Please, do not let a couple misinformed individuals mar your outlook.

You are correct in the fact that PA and NP are admirable professions, each different and at the same time, very similar.

Please, keep posting and ask any of us well-informed members any question you might have. ?

[brownrice]

Hello DKU:

I researched the NP/PA thing heavily before deciding to go the NP route...even though it meant getting a BSN first, then getting my NP. I called the president of a state PA organization and he was very nice in chatting with me and answering all my questions. I also talked with NP's about their profession, pros/cons etc. Here's what I came up with: both professions approach academics quite differently. However, once graduated, both professions are virtually interchangeable when it comes to answering job ads. Through the eyes of the person hiring, either an NP or a PA can fill the position...they can diagnose, treat, and write the Rx (in most states).

Ultimately, I decided on NP as an NP can work independently (in most staes), whereas a PA is more often associated in working with an MD rather than in private practice.(although there are PA's that do have a practice, with an arrangement with a doctor for oversight specific to the particular laws of the state.) I do not know of any state where a PA could practice totally independent of a physician. However, there are many states where an NP can practice independently...absolutely no oversight from a physician.

The downside to the NP route in my opinion, was all the BS nursing courses/theory that I have had to endure. Whereas, in the PA program, it's pretty much straight science and clinical practice. Yet, I have felt it has been worth it to endure this stuff so that I could in the future have the choice to not be under a physican, that I could have autonomy in my career making decisions.

One more thing...NP's are taught to have a more holistic view of healthcare (mind, body, soul), whereas PA's are taught by the medical model...which is very reductionist in nature. For an extreme example so you get my point: an anorexic with a cut on her arm may visit the doctor or PA and get excellent treatment for the wound, but leaves the office without anyone questioning her BMI(body mass index). As I am very pro-preventitive and holistic medicine-minded, the choice of NP fit my style much better than the PA medical model did.

I hope this will help. It can be confusing when you first start comparing these two disciplines.

[Cyndee, MSN, NP]

FNP/DNP said:

As an NP new to the emergency room, I would recommend PA school to you, unless you attend an EDNP program (Houston or Loyola). They are better trained in all of the things you mentioned. I am sure some NP's will get riled up over this, but not many NP programs are offering extensive procedure training in addition to primary care with pediatrics, as you would need in the ED. ED programs do and you can then sit for the FNP exam.

I agree. I'm a Adult/Geriatric NP and I'm getting ready to begin a new job working for a Pain Management Specialist. He wants me to assist in the OR, but I will have to complete a "first assist" program in order to do it.