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?
not all PA schools have elective rotations/not all student would choose to do the nicu
just like not all NNP programs are only 600 hours
IMHO PA education does not triumph NP in every specialty. Neonates is definitely one of them. Peds Acute Care and Oncology are others. Just my opinion!
The point was not to say that PAs dominate NPs in regards to caring for neonates. The point was that if someone wanted to be a PA in the NICU, it would be possible to choose a school that would allow equivalent training in that area as NPs geting while completing a NNP program. NPs still seem to dominate in the NICU.
The main thing I think PAs have over NPs is that PAs can have the same amount of clinical hours in a specialty area, plus a substantial amount of clinical hours in other areas as well. I think a clinical provider is better when they have a broad medical education and training in a specific area.
The point was not to say that PAs dominate NPs in regards to caring for neonates. The point was that if someone wanted to be a PA in the NICU, it would be possible to choose a school that would allow equivalent training in that area as NPs geting while completing a NNP program. NPs still seem to dominate in the NICU.
The main thing I think PAs have over NPs is that PAs can have the same amount of clinical hours in a specialty area, plus a substantial amount of clinical hours in other areas as well. I think a clinical provider is better when they have a broad medical education and training in a specific area.
Actually the point was that a PA would not be at as much of a disadvantage as the previous poster thought. It also brings up again the primary difference in educative philosophy between NP and PA programs. PA programs follow the medical model which requires broad experience in a variety of medical areas. NP programs in theory focus on one specific area of advanced practice nursing and become experts in that area. No profession is necessarily better, just different approaches to taking care of the patient.
Specializes in ER and family advanced nursing practice.
No, PA's can't own clinics in every state, they can't do it in Texas. Just b/c a physician isn't on site, doesn't mean the midlevel isn't being supervised. There is not one single state where a PA doesn't require a supervising physician. There are something like 14 states where NP's aren't required to have a supervising physician. In New Mexico, NP's have been practicing completely independent for years. BTW, their patients have done very well.
I don't think NP's should be allowed to work independently until they have 5 years of full time NURSE PRACTITIONER experience!
I understand that they are still being supervised. In fact almost all states make some kind of provision that PAs must be able to establish contact with an MD either directly "in the building" or through some sort of electronic means such as cell or radio. In Texas a PA is not required to have an MD be on site, but they are required to be able to reach one at any time. Here is the link for PA practice regs: http://www.statutes.legis.state.tx.us/docs/OC/htm/OC.204.htm.
"Ownership" of business has nothing to do with a medical degree. Even in Texas a group of non MDs can form a corporation, lease a space, and hire an MD to be the provider for some type of doc n the box. Continuing on with that thought, those "non MDs" could be PAs who have gone in together, incorporated, and hired an MD to be their collaborating physician (this is how many NPs do it). However the question is why would they? The percentage of midlevels that own their practices is low. I suspect it has something to do with the massive headache of all that goes into it. Hiring and managing a staff, supplies, liability, and not a ton of dough. Or...get hired by a practice, come in, do your thing, and then go home while not having to take that big ol headache with you.
On the other hand the NNP student will get around 600 hours as an NNP student. I know of at least one PA program where students get at least 600 hours of NICU time in addition to the hours they get in peds and the rest of the required PA rotations. There are any number of programs where it would be easy to get 500-600 hours of NICU time. Its a very different model and the units that use PAs have developed a very extensive orientation just like those that use NNPs do.
David Carpenter, PA-C
Are you forgetting the more than 2 years of fulltime experience a NICU RN is required to have BEFORE even getting accepted into a NNP program? There is no way a PA can come close to that, unless they actually worked as a NICU RN for several years before going through their program.
PA's are making their way into the NICU's. I think their is maybe one neonate residency for PAs- correct me if im wrong.
I have a friend who went to PA school, she got to scrub in 7 times their whole month surgical rotation and got to close 4 of those times. She also did her family practice rotation and spent 3 minutes with the patient then the dr. would come in and she would then shadow. She is in a peds practice now and is very competent as far as I know. But she could be a surgical PA if she wanted to be.
Just my experience that everything isn't as 'green" on the other side as it made out to be.
I know, it's funny how the PA's on this forum talk about their "superior" clinical training - give me a break! I have several PA friends and they all said they barely got their feet wet during their surgical rotation. So, somehow this makes them superior to a NP who has years of OR experience - what a joke!
no.....but I can own the clinic holding company that hires me AND a doc....I live in Texas.
You will always have to be supervised by a doctor - you are a doctor's ASSISTANT and not an independent practitioner!
A PA friend of mine saw nursing home patients for a large IM group and they REPLACED her with a NP. Apparently, the PA can't bill Medicare directly and the NP can - I believe there's a difference there!
Specializes in ER and family advanced nursing practice.
Are you forgetting the more than 2 years of fulltime experience a NICU RN is required to have BEFORE even getting accepted into a NNP program? There is no way a PA can come close to that, unless they actually worked as a NICU RN for several years before going through their program.
Two whole years? In a row? I am a NICU nurse so I do have some insight here. Yes, the experience helps. A lot. That is why I am against direct entry NP programs. This applies to the NICU because you don't have to be an NNP to work in a NICU. Many NICUs have PNPs and FNPs as well. But to suggest that "there is no way a PA can come close to that" is completely unfounded and based on your anecdotal experience at best. Even if a PA does not have NICU experience, they have a broad strong foundation to build on and they will get the experience on the job. I see PAs in our NICU and they rock.
I know, it's funny how the PA's on this forum talk about their "superior" clinical training - give me a break! I have several PA friends and they all said they barely got their feet wet during their surgical rotation. So, somehow this makes them superior to a NP who has years of OR experience - what a joke!
I have found most of the PAs on this forum to be very helpful. They have given guidance and education on what it means to be a PA while maintaining the high value of both professions. They do this while watching nurses make the most ignorant posts espousing the superiority of NPs based on statements like "NPs can practice independently!" even though only a tiny few do and that has nothing to do with patient outcomes.
How wet did your NP friends get their feet during their "zero" amount of experience or spending the last 2 years in a low acuity setting, or spending the last 10 years in a leadership role? There are a ton of NP students in my area that went straight to graduate school from nursing school or they spent a year at the bedside and said "forget this!" and then went to NP school.
You guys that want to turn this into a contest better watch out. You just may get what you ask for. Let the public come in a decide who they think is trained best.
For me, I believe PA training to be better, but I believe that as NPs and PAs specialize and spend some time on the job competency will equalize.
Specializes in ER and family advanced nursing practice.
bascially NP's have more education - that should mean something
Please elaborate, because that is simply not true as a general statement. Are you looking at this from the degree type awarded (MSN, BSN, etc) or the amount of hours spent, the complexity of those hours, the number of prereqs or what?
If you know any NPs and PAs please do an informal poll with this as the question: were you able to work during _____ school? All of the NP students in my class work. Many full time (like me). I have only met a few PA students that were able to work during their training. That means something to me. Not all NPs have masters although well over 90 percent do. The number of PAs with masters is climbing so if a PA has a masters degree then what are you saying?
You see I believe that if you look at the pre reqs, the high difficulty of those classes, and the amount of actual time spent earning the title, you will find that PAs have more education.
. They have given guidance and education on what it means to be a PA while maintaining the high value of both professions. They do this while watching nurses make the most ignorant posts espousing the superiority of NPs based on statements like "NPs can practice independently!" even though only a tiny few do and that has nothing to do with patient outcomes.
How wet did your NP friends get their feet during their "zero" amount of experience or spending the last 2 years in a low acuity setting, or spending the last 10 years in a leadership role? There are a ton of NP students in my area that went straight to graduate school from nursing school or they spent a year at the bedside and said "forget this!" and then went to NP school.
You guys that want to turn this into a contest better watch out. You just may get what you ask for. Let the public come in a decide who they think is trained best.
For me, I believe PA training to be better, but I believe that as NPs and PAs specialize and spend some time on the job competency will equalize.
If you think PA training is so much better, then why are you "supposedly" in a NP program? I can tell you this, I certainly wasn't able to work full time during my training. I'm board certified in 3 different NP specialties and I completed just as many clinical hours as a PA - not to mention the experience earned through working almost 10 years as a RN.
Furthermore, at least in TX, NP's can't bill as First Assists unless they complete a First Assist program. Unless they've changed things at the BON, they were only accepting education from 2 schools (neither were located in TX) and they required 2,000 clinical hours IN SURGERY! So, how is a new PA's "few weeks" of OR training going to compare to that?
Specializes in ER and family advanced nursing practice.
If you think PA training is so much better, then why are you "supposedly" in a NP program? I can tell you this, I certainly wasn't able to work full time during my training. I'm board certified in 3 different NP specialties and I completed just as many clinical hours as a PA - not to mention the experience earned through working almost 10 years as a RN.
Furthermore, at least in TX, NP's can't bill as First Assists unless they complete a First Assist program. Unless they've changed things at the BON, they were only accepting education from 2 schools (neither were located in TX) and they required 2,000 clinical hours IN SURGERY! So, how is a new PA's "few weeks" of OR training going to compare to that?
As an RN it made sense for me to become an FNP. I am not the one who is getting caught up in PA vs NP. I think they are both awesome. I believe that I will learn much of the career on the job. Maybe if I had thought about it more when I was working as a medic, I might have gone for PA and skip the nursing thing all together.
So it has taken you three NP specialties to equal the training of a PA? Interesting. And yes, I am sure your 10 years of experience have helped you immensely. I am sure when you were new you brought much to the table. That is laudable. So what do you think about direct entry NP programs or low/no experience RNs becoming NPs?
As for the surgery stuff, I have no idea. I didn't think you had to be an NP to be a first assistant (at least in GA anyway). I would think that whatever the route both NPs and PAs must receive some type of additional training as surgery is not something you can just walk in off the street and perform.
sunshine0509
73 Posts
not all PA schools have elective rotations/not all student would choose to do the nicu
just like not all NNP programs are only 600 hours
IMHO PA education does not triumph NP in every specialty. Neonates is definitely one of them. Peds Acute Care and Oncology are others. Just my opinion!