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?
I disagree that PA's have more education tha NP's(depends on the individuals' experience, training, etc). I'm an NP, work with both NP's and PA's, and have found individuals in both occupations to be excellent clinicians. I would happily see either an NP or PA if I believed the individual to be well qualified. That said, I would be hesitant to see an NP who was a direct entry program graduate. I believe that only experienced RN's should be admitted to NP programs.
I do not use nursing diagnoses in my practice. I am well versed in them as I teach in an undergraduate nursing program and students are required to use nursing dx in their clinical training. I address this issue by taking a patient dx or identified problem area and having the students find a nursing dx to fit it. They need to develop individualized plans of care to meet the identified needs, not the nursing dx.
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?
I practice in Maine. NP's are able to do procedures for which they are trained. I took classes in suturing, splinting, casting, etc. Training can be received on the job, too. NP's in my hospital do all of these procedures as do PA's.
I know brilliant PA's and NP's. Responsible and accountable clinicans will supplement their original training with that required to do the job well. I know both PA's and NP's that I would choose to see over some physicians..depends on the individual.
Look at regulatory and reimbursement issues in the state(s) and types of facilities in which you intend to work. Look at and compare both types of programs and choose the type that is the best match for you.
NP's and PA's are not equal. NP's can practice independently and PA's cannot. They must always have a supervising physician.
Just because someone practices independently doesn't mean they should be or are fully qualified to be doing so. Just because someone does not practice independently doesn't mean they aren't capable of doing so.
And how do PAs not receive more education? Most PAs and NPs have previous experience before starting. PAs have more didactic hours, more science coursework, and more clinical hours (usually even in the "specialty"). So how is that not more education?
Who would you rather have for your family practitioner? Both were RNs for 2 years previously. One went to PA school and got ~2,000 clinical hours (400 hours in family medicine, 200 hours in internal medicine, 200 hours in prenatal/gyn, 200 hours in peds, 320 hours in elective [potentially in family med making 620 hours], and the rest in surgery, EM, psych, geri, etc). The second went to NP school and got ~600 hours in family med and nothing else.
The educational preparation depends on the individual preparation as well as the program. I never suggested that the legal right to independent practice means that any individual clinician should or should not be able to do so. I did say that the responsible and accountable clinician will not practice in a way that they are unprepared and qualified to do.
I know MANY PA's who I believe are well prepared to practice independently. I also know NP's who choose not to (the majority). I'm certain that we all know physicians who should not be practicing independently, if at all.
NP's are educated to be specialists. Their clinical time is concentrated in that specialty. PA's are educated as generalist. They are, therefore, educated in MORE clinical areas than are NP's.
I also am one who does NOT believe in accepting inexperienced RN's(or non-RN's) into NP programs. NP programs were designed to build upon a body of knowledge and experience obtained in the practice of nursing. I would prefer to see an individual who has no health care experience choose to pursue PA education because I very much believe that the PA program of study adequately prepares them to practice.
I am a big fan of PA's and NP's. In my facility(level 1 Trauma Center, major teaching hospital) PA's and NP's work together collaboratively and we seem to have escaped the sniping that abounds elsewhere. Individuals should choose the program that best meets their needs and desires for future practice.
I disagree that PA's have more education tha NP's(depends on the individuals' experience, training, etc). I'm an NP, work with both NP's and PA's, and have found individuals in both occupations to be excellent clinicians. I would happily see either an NP or PA if I believed the individual to be well qualified. That said, I would be hesitant to see an NP who was a direct entry program graduate. I believe that only experienced RN's should be admitted to NP programs.
Ellen NP,
Which state do you reside? I think it's a good idea to require a few years of practice before venturing out on your own...I'm all for that! I live in Texas and I just opened a clinic 6 weeks ago. In fact, we just saw our 100th patient today! In Texas, it is required that we have a collaborating physician who reviews 10% of our charts and they must be on site 10% of the time every 30 days - very restrictive. We're hoping to rid ourselves of those restrictions in 2011. However, I really don't think it's a good idea for new NPs to become independent. I think it's important to practice as a NP a few years before being allowed to fly solo. I can see the Texas legislature going for something like that...a few years of NP practice before being allowed to become independent. In fact, I had always planned on getting 5 years of experience before starting my own practice and I'm right on track!
Another funny thing about Texas...if you're a MD you can supervise any type of NP. In fact, one of my friends is a Family NP and her supervising physician is a psychiatrist - my friend treats the primary stuff and the doctor treats psych. This is allowed in this state. Kinda like that cardiologist who was treating Michael Jackson - he could have legally supervised CRNA's here. Scary, huh?
I'm in Maine. We're required to have 2 years of supervision before becoming legally independent. At my hospital, I will always have a supervising physician. Even the attending physicians have an identified supervisor so it's not restricting in any way.
We are required by the State BON to have a letter of supervision for our first 2 years. For those of us who work in hospitals or clinics, we do not need to have one identified physician; we can be supervised by the physician group. The purpose of the supervision is to have an available physician, not to have direct physical oversight of practice.
Nursing theory courses are variable in their value...just my opinion. I don't see other clinical programs requiring things like Theory of Medical Education or Theory of PA Practice, etc.
Those were the courses that my program did have..no Nursing theory work. I chose NP programs (have done 2) that required advanced science course and additional clinical work. I chose to more than double (actually, almost quadrupled) my clinical hours because I like learning and felt that the investment in time would make me a better clinician. All of us in my pedi NP program spent many more hours than required in our clinical settings. Most us us in my Psych NP program spent at least double the required hours in clinical practice. I also chose programs that only accepted RN's with years of experience. They did not accept direct entry or new grads into the programs.
The current plan to require doctoral preparation for NP's disappoints me specifically because the prgrams do not require even more advanced clinical courses and additional clinical hours. The focus of too many of these programs is on developing leaders and educators...we need to focus on preparing clinicians 1st.
This is my objection to the DNP programs. DNP's will not necessarily have more clinical hourse; they'll have additional theory, another research project(renamed capstone project). Practice hours can be spent in nursing leadership or administrative work. I do not see how that translates into a better clinician. There are direct entry DNP programs whose graduates will be considered by some(not sure yet by whom) to be better prepared for practice than those of us with extensive experience as RN's and NP's.
I had one research class, a research project, and NO nursing theory classes in my 2 MSN programs. We did study global health issues, epidemiology, etc. Our other courses were Advanced pharm, physiology and clinical courses with both didactic and clinical practice components.
I will not get a DNP unless I can find a program that would give me opportunity to get more clinical practice education. I'm always interested in learning more, but I am not interested in a non-clinical doctorate. The practice doctorate is believed by most people to be a clinical practice degree. No, it's a PRACTICE doctorate; practice can mean nursing political leadership or administrative practice.
I agree. There should absolutely be more clinical hours involved - the degree is misleading. I own a practice and I know how tough it is to get credentialed with insurance companies as it is. I'm just wondering if they'll require practice owners to have a doctorate when all this rolls around. It was a piece of cake getting myself credentialed when I was actually working FOR physicians, but it's much more difficult getting a NP owned practice credentialed - go figure!
I disagree that PA's have more education tha NP's(depends on the individuals' experience, training, etc). I'm an NP, work with both NP's and PA's, and have found individuals in both occupations to be excellent clinicians. I would happily see either an NP or PA if I believed the individual to be well qualified. That said, I would be hesitant to see an NP who was a direct entry program graduate. I believe that only experienced RN's should be admitted to NP programs.
I will have to disagree with you on the educational preparation of the NP vs PA. I'm an NP for many years and can easily see, in comparing the curriculums, that PAs have a far better and more consistent educational model than NPs do. Its as simple as black and white. Also, the ability to practice independently has zero to do with educational prep. It has to do with lobbys in congress of which the nursing profession has and they are powerful. IMHO, nps should not be in independent practice..Period. NPs who do this have no idea about what they don't know and that's dangerous.
Ther are NP's and MD's who should not be in private practices. Some individuals need to work in an organizational setting both for clinical support and business management. I agree that independent practice is a regulatory issue; however, if one aspires to this, they need to know that they cannot do so as PA's in any state.
Re education: PA's certainly have better standardization of curricula. This is a problem with nursing education at all levels. The reality is that the data support NP's practice as meeting clincial and patient expectations. Maybe PA's are overeducated for basic practice? They are certainly well educated as generalists. NP's are educated to be specialists. Ideally, NP's have experience as RN's first and have the clincial hours from their undergraduate programs and their continuing education and practice. I do not support direct entry into advanced practice programs. I do not believe that they can get the clinical practice through a direct entry program education. They may pass boards based on their didactic education, but they do not have adequate practice experience. I would really encourage those individuals considering this route to choose a PA program instead.
The nursing prefession needs to standardize basic undergraduate education before they start adding yet another level of education (DNP). We have enough confusion over multiple paths of entry into basic practice and now we're confusing entry into Advance Practice.
Ellen NP, MSN, NP
94 Posts
I disagree that PA's have more education tha NP's(depends on the individuals' experience, training, etc). I'm an NP, work with both NP's and PA's, and have found individuals in both occupations to be excellent clinicians. I would happily see either an NP or PA if I believed the individual to be well qualified. That said, I would be hesitant to see an NP who was a direct entry program graduate. I believe that only experienced RN's should be admitted to NP programs.