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?
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?
But it took you 3 specialties to complete just as many hours as you get in PA school? That is 4 years post BSN, right?
Just because PAs are allowed to first assist doesn't mean they dig their hands into patients upon graduation. Most surgical PAs either complete a residency or receive extensive OJT. Additionally, the PA programs I have looked at also have a surgical skills lab.
At least in my state, to be a RNFA, you need to be CNOR and have 2 years experience. However, if you are a advanced practice nurse, all those prerequisites are waived.
You will always have to be supervised by a doctor - you are a doctor's ASSISTANT and not an independent practitioner!
Nothing like name calling to bring the level of discussion down. You made a factual statement that was incorrect (which you had made before) and were called on it.
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!
Lets see a PA can bill under their Medicare number and lets see the NP can bill under their medicare number. So the difference is ? The true difference is that an NP can be reimbursed directly (ie. the payment can go directly to the NP) and the PA's payment must go to either to the physician or a corporation with a Medicare billing number. So they fired the PA because they want to have Medicare pay the NP directly and hope that they give back some of their money? You have some very unlucky PA "friends". They seem to be startlingly uneducated and work for similarly uneducated physicians. Of course they are all wet behind the ears and have no experience so that might explain things.
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?
For someone who claims to be from TX and claims to do surgery you seem strikingly uneducated about the law surrounding this. Here is the TX BON statement on this:
Is licensed to practice as a RN,
Has completed a nurse first assistant educational program approved or recognized by an organization recognized by the board, and
Is either (1) certified in perioperative nursing (CNOR) OR (2) recognized by the board as an advanced practice nurse and qualified by education, training or experience to perform the tasks involved in perioperative nursing.
Specializes in ER and family advanced nursing practice.
Maybe i'm biased being a future direct entry NP
but dont the 1000 hours in RN clinical count for anything? What about the fact that a NP picks a specialty ?
It a joke that PA's work with neonates? I mean they only have one peds clinical..maybe an elective neonate clinical.
NNP's have to work in a NICU for 2 years then do a master completely on neonates.
If it was so bad I just feel these programs wouldn't be around. IMO.
Truth is I have not seen any studies which indicate that patient outcomes or satisfaction are any different in terms of direct entry NP grad vs RN w/ experience NP grad, but here's the thing: When nursing "sells" the NP curriculum and role to the public, one area they focus on is the experience that the RN brings to the table. Now, that has become a big assumption. As has been pointed out on this thread there are NPs that work independently. I am more than a bit uncomfortable with the notion that a new grad direct entry NP could possibly be working under those conditions. Now, I think just plain ol' fear would keep a new grad direct entry NP from doing that, but what if it didn't?
I graduate in about 13 weeks. I feel that the training I have received compares favorably to any NP program in the country. Having said that, I can't imagine not having my background (16 years between paramedic and RN) as my foundation for my NP training. I would be lost. There is an RN in my class that has 40 years of experience! It is a long way from 10 years or so of experience to zero. Does 1000 hours of RN clinical count? I guess technically yes, it counts some, but honestly, some new grad RNs have trouble just being new grad RNs forget about moving directly to NP training, graduation, then advanced practice as an NP. Passing a class with high marks and having mastery over the material can often be two entirely different things.
Again, I am sure there are successful direct entry NPs working out there, but if these programs continue to proliferate then nursing needs to back of its message about the value of RN backgrounds, and people on threads like this need to quit bringing up RN background/experience as a trump card to PA training.
The true difference is that an NP can be reimbursed directly (ie. the payment can go directly to the NP) and the PA's payment must go to either to the physician or a corporation with a Medicare billing number. So they fired the PA because they want to have Medicare pay the NP directly and hope that they give back some of their money?
For someone who claims to be from TX and claims to do surgery you seem strikingly uneducated about the law surrounding this. Here is the TX BON statement on this:
Is licensed to practice as a RN,
Has completed a nurse first assistant educational program approved or recognized by an organization recognized by the board, and
Is either (1) certified in perioperative nursing (CNOR) OR (2) recognized by the board as an advanced practice nurse and qualified by education, training or experience to perform the tasks involved in perioperative nursing.
What do you mean...name calling?? There IS a difference in the titles, one is an assistant and the other is a practitioner.
The IM practice lost money by paying the PA "up front" and then waiting on reimbursement from Medicare. The NP is reimbursed by Medicare directly and therefore, that's why the docs decided to replace the PA. Do you blame them?
Secondly, I do not perform surgery, so get your facts straight. A physician approached me 3 years ago about assisting him in surgery. At that time, the only programs the TXBON accepted required 2,000 clinical hours assisting in various types of surgery. The program I checked into cost $10,000 and classes were done online (throughout 9 months), one week at the school and all surgeries had to be completed through a preceptor. I can assure you that the Texas BON is far more stringent about scopes of practices than other states. I have a NP friend in Florida who works as a First Assist and she was trained on the job.
What do you mean...name calling?? There IS a difference in the titles, one is an assistant and the other is a practitioner.
You stated that PAs couldn't own practices in TX. The response was yes they can and I do (as much as any information from anonymous people on the internet can be accurate). Your response was:
You will always have to be supervised by a doctor - you are a doctor's ASSISTANT and not an independent practitioner! (emphasis yours).
For the record its Physician Assistant (originally Physician Associate if that makes you happier). PAs in Texas hold their own license to practice medicine in collaboration with a supervising physician (remarkably similar to NP practice in Texas).
The IM practice lost money by paying the PA "up front" and then waiting on reimbursement from Medicare. The NP is reimbursed by Medicare directly and therefore, that's why the docs decided to replace the PA. Do you blame them?
There is no way this is true. For an employee the situation is exactly the same. The practice pays the salary up front for any employee then bills for the services provided. The only difference that direct reimbursement makes is in a 1099 employment situation. In this case the NP can bill under their number and be reimbursed directly. For PAs in a 1099 situation they have to form a corporation which bills for the PA services and the company is reimbursed. In either case the employees are paid well before the reimbursement is received. Unless they got the NP to agree to wait until they got reimbursed to be paid (in that case I don't blame the PA for leaving).
Secondly, I do not perform surgery, so get your facts straight. A physician approached me 3 years ago about assisting him in surgery. At that time, the only programs the TXBON accepted required 2,000 clinical hours assisting in various types of surgery. The program I checked into cost $10,000 and classes were done online (throughout 9 months), one week at the school and all surgeries had to be completed through a preceptor. I can assure you that the Texas BON is far more stringent about scopes of practices than other states. I have a NP friend in Florida who works as a First Assist and she was trained on the job.
The RNFA change by the Texas BON was made in 2005. NIFA has been on that list for at least 3 years (when Medicare looked at allowing RNFAs to bill for first assist services). Although to be fair NIFA changes their class structure around every few months and you are right about the cost.
Bottom line, PAs can and do own practices in Texas. I am not aware of any state that directly bars PA ownership of practices. There are at least four states that prohibit direct employment of physicians by PAs but there are others that prohibit any non-physician employing a physician.
this isn't true. there are some states that allow np's to practice completely independent of physician oversight - meaning no chart audits, etc! most states won't allow np's to practice independently. pa's must be supervised by a physician in every single state, but they can definitely own a clinic in some states.
no disrespect, anyone can "own" any business if they are financially blessed but we are referring to practices.
The posts made by "alphabet" (ANPFNPGNP) are laughable! This is an individual who knows little to nothing about the PA profession. PA's DO have more education and training than NPs. It's evident throughout every training program in the country. Wa are all in the same boat, so why continue with the PA bashing on this site? As a practicing NP, I am apalled at the lack of professionalism by some of my fellow NPs on this site. Way to promote the profession!
The posts made by "alphabet" (ANPFNPGNP) are laughable! This is an individual who knows little to nothing about the PA profession. PA's DO have more education and training than NPs. It's evident throughout every training program in the country. Wa are all in the same boat, so why continue with the PA bashing on this site? As a practicing NP, I am apalled at the lack of professionalism by some of my fellow NPs on this site. Way to promote the profession!
I can assure you that I know plenty of PA's who are practicing with an associate's or bachlor's degree only. So, that's MORE education than a NP with a Master's degree? That doesn't even make sense!
Why don't you go to the Physician Assistant Forum site and read about all the NP bashing - this site doesn't even begin to compare!
There is no way this is true. For an employee the situation is exactly the same. The practice pays the salary up front for any employee then bills for the services provided. The only difference that direct reimbursement makes is in a 1099 employment situation. In this case the NP can bill under their number and be reimbursed directly. For PAs in a 1099 situation they have to form a corporation which bills for the PA services and the company is reimbursed. In either case the employees are paid well before the reimbursement is received. Unless they got the NP to agree to wait until they got reimbursed to be paid (in that case I don't blame the PA for leaving).
David Carpenter, PA-C
The PA and NP were not employees, but independent contractors. The doctors had a problem with the PA being an "independent contractor," yet the practice was having to pay the PA upfront and do the billing themselves. The NP has a contract with the physicians and she bills Medicare directly and then pays the doctors their share whe she is reimbused, which I believe is 50%.
Specializes in Education, FP, LNC, Forensics, ED, OB.
I'm going to ask that from here on out, the responses stay neutral, ie, no making replies pointed to a certain member especially if the replies might derail the conversation or place each other on the defensive. Nothing is gained by that. Please, we are all professionals with one goal in mind and that is to provide the best possible care for our patients.
There are many avenues to achieve this goal, Physician, NP, PA.........so, let's conduct ourselves professionally on the boards without bashing, name-calling, devaluing each other, etc.
It would be a sincere shame to shut down this thread after all this time and effort to educate about the educative/clinical differences between NP and PA.
I can assure you that I know plenty of PA's who are practicing with an associate's or bachlor's degree only. So, that's MORE education than a NP with a Master's degree? That doesn't even make sense!
Why don't you go to the Physician Assistant Forum site and read about all the NP bashing - this site doesn't even begin to compare!
The degree a PA receives is completely irrelevant to the amount of education they receive. Someone with a PhD could go back and get an associate's degree and be a PA. Does not mean they are less educated.
Most of those practicing with associate and bachelor's degrees have extensive health care backgrounds as paramedics or ADN prepared RNs first which generally makes them a much better PA than the person who went straight through a BS/MS combo program without stopping to get significant health care experience first.
You don't need a degree to be a PA. You could become an NP too without a degree (if it wasn't required) - just take the same curriculum and get a certificate of completion. The degree is just a way for school's to make more money.
foreverLaur
1,319 Posts
But it took you 3 specialties to complete just as many hours as you get in PA school? That is 4 years post BSN, right?
Just because PAs are allowed to first assist doesn't mean they dig their hands into patients upon graduation. Most surgical PAs either complete a residency or receive extensive OJT. Additionally, the PA programs I have looked at also have a surgical skills lab.
At least in my state, to be a RNFA, you need to be CNOR and have 2 years experience. However, if you are a advanced practice nurse, all those prerequisites are waived.