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?
During my program I/we had to track clinical hours: hours spent in clinic or clinic related work, no breaks, lunch, drive time. We had to track each patient on a log, their diagnosis, Rx etc... verbatim: Our professors had a habit of visiting multiple times during our clinicals and would talk with the patients and staff as well as check those logs. I was allowed to count the hours spent reviewing labs, tests results and consults. An office with 3 providers wracks up a lot of results that have to be reviewed and with the providers asking you to interpret those results one is on the hot seat patient being present or not, plus the results I reviewed one day I was often times following up the next with the patient.
This is one more reason why there should be a minimum mandatory clinical requirements for each and every program. I know there are accrediting agencies for schools/programs but I guess there also would need to be a entity that would be checking those requirements are really being met.
Most if not all PA programs use either a PA or web based program to count patient encounters. It logs patients and included age, medical condition and time in the encounter. Do NP programs not use these?
David Carpenter, PA-C
my program has computer log system that tracks this info - what isn't included includes orientation, drive time, meetings, lectures, condition/disease discussions, etc. in a given 8 hour day (excluding lunch), i may only log 5-7 hours of patient time with the rest as chart reviews, f/u letters, review of labs, care coordination between office & hospital, or the myriad of others things included in providing care in a family practice. in contrast when we have medical students float through they count every minute from when they set-foot in the building until they leave for the day. (ie - my 5 hours equals their 9).
A little over four years ago I posted the original question as I was planning to advance my medical education. I must say it has been a lively discussion, with too many uneducated and inappropriate statements. The anonymity of the internet seems to encourage people to say things they might not otherwise say in person. Thankfully, there have been a few intelligent voices on both sides of the debate, and I thank those who took the time to present reasoned and professional opinions.
In case anyone is interested, I went to PA school and have been practicing in an intensive care unit. I am happy to say that I work with a fantastic NP. We have the same job description, duties, and supervisory requirements. This just goes to show you that despite what your state rules may be, the particular hospital you work at may still set their own additional requirements. We both put in central lines, arterial lines, and do the occasional intubation. We round and treat the more chronic stable ICU patients, and we do most of the transfers to the medical floor. As far as I can tell, the nursing staff and the physicians do not treat one of us different than the other.
So, for anyone reading these posts, take them with a grain of salt. Watch out for hyperbole and bias. Pursue the training you want.
I know you want to close this thread and hope you'll forgive me for my uneducated commentary to follow.
I have been considering nursing and will probably only be happy with myself if I pursue the highest level of certification I am able to. For me, this would be an NP. My concerns and interest in this thread was to better understand the differences in services NPs and PAs provide, how they relate to the overall care provided etc.. Your commentaries have all be eye opening! I certainly hope in the rural hospitals in Maine that NPs have come into their own so to speak :).Be well!
One comment I will make is regarding the training you get in NP or PA school. For all prospective persons considering one education or the other, the most important aspect of what education you choose is the amount of training you will receive specifically in DIAGNOSING and TREATING. All the other considerations of autonomy, pay, duties, etc etc have their place, but do not forget that your highest responsibility is to the patient, and you owe it to them to get the best education possible to manage their care.
As PAs and NPs our job is to diagnose and treat illness, that is what separates us (as well as physicians) from other health care professions. Ask your prospective school carefully about the amount of training you will receive in formulating a differential diagnosis and in the pharmacologic and nonpharmacologic management of disease, as well as physical exam training. Ask them to what depth your training in pathophysiology will be, as well as anatomy and physiology. Finally, find out how many clinical hours you will do, and how much of that involves diagnosing and treating. Don't pretend that the research paper you may write counts the same as these skills.
Remember that whatever you did before NP or PA school, though it will no doubt help you as a clinician, is NOT a substitute for learning to diagnose and treat. Implementing someone else's care plan is not the same as coming up with your own. My time as an EMT was great but it did nothing to help me evaluate (for example) the various causes of hemolytic anemia or the diagnostic tests for acute oliguria. You may have put in one thousand foley catheters but can you stand at the bedside and explain what renal indices you want to evaluate and why?
The established PAs and NPs I know all agree that previous medical experience as nurses, medics etc etc was very valuable. They also agree that what they did before NP or PA school and what they do now are two different things. It is what you do in school that will truly prepare you for life after graduation.
The established PAs and NPs I know all agree that previous medical experience as nurses, medics etc etc was very valuable. They also agree that what they did before NP or PA school and what they do now are two different things. It is what you do in school that will truly prepare you for life after graduation.
Best wishes to all,
jstuben
I agree but do think that prior experience CAN mean more than what some might think if you are an eager sort of person. For example, just think what I've seen in my years of experience, the heart sounds and lung sounds I've heard, the patient responses I've seen, etc., etc.. In my first job in a level I trauma center, the chief resident asked me to quit filling out the lab and xray forms so his students could learn to do something. I spent many years looking at what physicians wrote and would consider what, if anything I'd do differently. In short, I've been hitting the books forever, not just going in and doing a job. Yes, I'm learning new things in NP school, but I have one heck of a database to consult.
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.
The degree a PA receives is irrelevant to their training. It is like saying if you went to a top MSN program and completed it with straight As and passed all your certification exams, but decided not to receive the actual degree, that you would be less of a practitioner. All PA programs provide the same level, time, and rigor of education regardless of the actual degree received. The degree is irrelevant.
Who would you rather have treating you?
A. Army medic or diploma prepared RN for 20 years who went back and completed a 2 year associates PA program, and passed the licensing exam
B. A new college grad who had never stepped foot in a hospital til PA school, completed a 2 year masters program, and passed the licensing exam
In our NP program the requirement to pass is 82% on tests, it deos not included any papers, logs anything extra in your grade. If you dont meet the 82% in tests you fail, even if your overall grade is in high 80's or 90's %.
I've just started a NP program in Alabama and a friend of mine has chosen to do PA. I've not found much differences in the duties, but the difference lie in to what extent you can do them. A NP license allows him/her to pursue their work under their own license; however, a PA is kinda work under a MD. For instance, a NP can open up his/her on practice, legally, as well as bill for his/her own service in most states. And, a NP CANNOT practice with an associate degree. Although a NP can open up his/her own practice, he/she will have to have a MD to come into the facility so often to do "paper work" sort of like an auditor. PAs cannot open up their own practices. To add, I cannot say that a PA with an associate degree is not skillful bc working in the field of nursing, there are a lot of associate degree nurses who have gotten additional certifications w/ extensive medical background in ICU and they are awesome, referring to being a good resource for all nurses. Moreover, I have often seen medical resident rely on them. So, I think skills come from exposure. Which ever you do, get a lot of exposure and you'll do well at either. Hope this helps.
JDCitizen
708 Posts
During my program I/we had to track clinical hours: hours spent in clinic or clinic related work, no breaks, lunch, drive time. We had to track each patient on a log, their diagnosis, Rx etc... verbatim: Our professors had a habit of visiting multiple times during our clinicals and would talk with the patients and staff as well as check those logs. I was allowed to count the hours spent reviewing labs, tests results and consults. An office with 3 providers wracks up a lot of results that have to be reviewed and with the providers asking you to interpret those results one is on the hot seat patient being present or not, plus the results I reviewed one day I was often times following up the next with the patient.
This is one more reason why there should be a minimum mandatory clinical requirements for each and every program. I know there are accrediting agencies for schools/programs but I guess there also would need to be a entity that would be checking those requirements are really being met.