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 am not sure where you got your information regarding pas. I am currently working on my master's degree (acnp). I believe that in all states nps must be master prepared. A pa up until I would say the last five years graduated with a bs degree. Now both professions the standard is a master's degree. Another area you are mistaken is that nps cannot practice independently. This is not true. Nps can and have opened their own practice. I recently read that I believe in New York city a group of fnps opened their own practice together. It is legal. Nps do not have to have their charts signed by a physician. That varies from institution to institution. I agree that pas have more clinical training and more classes than nps do. This is an area that I believe that our profession needs to improve. Another error that I must point out is that pas have 6-10 plus years of experience in healthcare. You are mistaken. It is strongly encouraged that they have smoe healthcare experience and/or shadow a pa prior to admission. Many go directly from hs to college to pa school. I went a girl who went on to pa school directly from college. All she did was shadow a pa prior to applying. I have a tremendous amount of respect for pas. I do not believe that a pa is better than an np nor do i believe that an np is better than a pa. We are both considered mid level practitioners. In some states they are considered physician extenders. Shame on you for degrading your fellow nurses who have chosen to further their education and advance their practice. We should not be in competition with pas. We need to see our selves as equals and a professionals.
Physicians DO have ownership of PA's. PA's will NEVER be able to practice independently because the State Medical Boards will never allow it! NP's can now practice independently in 7 states. There is a lot of talk concerning nurse practitioner programs becoming doctorate programs. Doctors will DIE when NP's are called "doctor" (try explaining the difference between the physician and nurse practitioner then). I thank my lucky stars that I had the foresight to become a nurse practitioner as opposed to a PA.
I live in Corpus Christi, TX and I know 2 NP's who own their own clinic. This has been allowed in Texas since 2003, so I'm sure we'll see more NP owned clinics popping up. There are seven states that allow NP's to practice COMPLETELY independent of physicians, including New Mexico and Washington. I advise you to go to their Board of Nursing websites and you will find proof that this is legal. PA's will NEVER be able to practice independently because their profession is CONTROLLED BY PHYSICIANS! Also, it is totally untrue that PA's have to be certified in another health field before getting into PA school. I know several PA's who have a BS degree and nothing more. The majority of states do NOT require a Master's degree in order to be a PA. Every state now requires a Master's degree for their Nurse Practitioners. Also, all those clinical rotations you mentioned...I did all of that IN NURSING SCHOOL!
p.s. NP's are trained in the nursing AND medical models! PA's are trained in the medical model ONLY. As a NP, I have never made a "nursing diagnosis"! I make MEDICAL DECISIONS!
Specializes in Education, FP, LNC, Forensics, ED, OB.
cyndee, msn, np said:
pnp's can now practice independently in 7 states. quote
Actually, cyndee, nps can practice independently in 21 states. with the exception of georgia, all nps have some ability to prescribe. and, in 10 states, nps can prescribe independently.
Someone please enlighten me on this. Why do I see more PAs and vertualy no NPs in surgical/ortho area. From what I understand these fields are quite competitive (for MD/DO that is), but tend to reimburse NP/PA more as well.That's not really an area of my interest anyway, just curious. I am a lot more interested in the field of PM&R (Physical Medicine and Rehab). Could NP specialize in it,and bill independently for some pain management procedures (nerve blocks, trigger point release etc). I'm already doing many of these things as an acupuncturist, but I can't inject any chemical/pharm agents under my acu licensure, and as an RN I should always get a "doctor's order" for just about anything. I guess what I've been trying to find out for a while now is...short of going back to med school...Is NP (FNP) going to be a good alternate route to the things that I want to do? I probably should have started a separate thread, but may be PA vs NP will draw more hits. Any NPs in surgery/ortho/invasive cardio?
1. Some states do allow NP's to have solo practices. I live in one of them.
2. "PA students ALWAYS have some kind of professional certification prior to becoming PAs. "
ABSOLUTELY FALSE!! More and more schools are accepting new college graduates. They might require some "clinical experience" but there is no across the board requirement for a professional certification.
Given the responsibility of the profession, there should be...
I think the NP/PA debate is useless, but incorrect info is harmful.
SJ
What state do you live in SusanJean? Do you know the other states that allow NP's to have solo practices? thanks!
Is there somewhere which has all this info in one nice place? I will be entering a fnp program in June and am very curious about the states you mentioned. Thanks!
Someone please enlighten me on this. Why do I see more PAs and virtually no NPs in surgical/ortho area. From what I understand these fields are quite competitive (for MD/DO that is), but tend to reimburse NP/PA more as well.That's not really an area of my interest anyway, just curious. I am a lot more interested in the field of PM&R (Physical Medicine and Rehab). Could NP specialize in it,and bill independently for some pain management procedures (nerve blocks, trigger point release etc). I'm already doing many of these things as an acupuncturist, but I can't inject any chemical/pharm agents under my acu licensure, and as an RN I should always get a "doctor's order" for just about anything. I guess what I've been trying to find out for a while now is...short of going back to med school...Is NP (FNP) going to be a good alternate route to the things that I want to do? I probably should have started a separate thread, but may be PA vs NP will draw more hits. Any NPs in surgery/ortho/invasive cardio?
I graduated from Vanderbilt and they have just about every NP specialty there is with the exception of anesthesia. I am certified in Adult & Geriatric Health and I work as an independent contractor. I'm going to begin working a couple of days a week with a pain management specialist and we have discussed my scope of practice. I do not know of any states that allow NP's or PA's to do lumbar punctures, but they can perform intra-articular and trigger point injections. PA's can work in surgery, but a NP must complete a "first assist" course (9 hours online, 6 full days of training and then assist with 15 surgeries). I do not know of any NP programs that include the "first assist" courses in their programs, but all PA programs do. As far as lumbar injections, you would have to become a nurse anesthetist to perform those and it would depend on your state's laws as to whether you could actually practice independently and bill for those services.
If I were you I would go the PA route, otherwise you will have to go back and take that first assist course.
Is there somewhere which has all this info in one nice place? I will be entering a FNP program in June and am very curious about the states you mentioned. Thanks!
You will have to go to your states Board of Nursing website. I live in Texas and I just go to Texas Board of Nursing. There is a link to Advanced Practice RN info. Even though we can practice "independently" in TX, there is STILL some oversight. If you own your own clinic, you will still have to have a doctor audit 10% of your charts. That doctor must also be available to answer questions, but they do not have to remain on site. I know a NP who pays a doctor $1,000 a month for that service. In TX, we can write prescriptions, but in order to write controlled substances (only III, IV & V in TX), we have to have a physician's signature on the DEA application. Every state is different. I'm originally from New Mexico and NP's can practice totally independent of physicians in that state - no chart auditing...nothing! Something else...even though I have hospital privileges, I have to have a physician sign off on every chart at the hospital. This has nothing to do with the state law, those are the rules at the hospitals. I'm not allowed to order consults and write scripts for ANY controlled substances at one of the hospitals here NOR can I admit patients. So, there are still a lot of obstacles out there. The NP I know who has her own clinic is doing incredibly well. She said that the toughest part of getting her business started was getting listed as a provider on the various HMO's/PPO's etc. This surprised me because NP's are only reimbursed at 85% of what a doctor charges, so we save insurance companies a lot of money in the long run. I truly believe that one day insurance companies will mandate that patients see NP's FIRST before being referred to a physician. It makes sense financially.
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.
Vanderbilt and a few other universities are accepting students into their NP program who are NOT NURSES! As long as you have a 4 year college degree, the necessary prerequisites and a decent score on the GRE you can go that route. It is VERY competitive though. There is a lot of controversy about that, since most of us were RN's for years before becoming NP's. Another thing, it totally irks me when people say that PA's have so much more clinical training. I'm sure most BSN programs were just like mine and we spent 5 semesters (3 days per week) in clinicals! Combine that with the 780 clinical hours I spent in my Adult/Geriatric program and I've logged in FAR more clinical hours than any PA...this did NOT include my RN experience either!
Jayla...you are way beyond your years in wisdom regarding this matter....the fact is there is no CLINICAL difference....the difference is philosphical, pure and simple....I have been a PA for 25 years and at the grassroots level we all get along (at least in my state) I precept NP students in my clinic and was asked by the NP programs to do this.....My PA students are precepted by NP's ( I teach in one of the programs)....the difference is a topic sought out by those small PA's and NP's who think they are the only ones who exist.....those of us who really work for a living don't see the point in arguing small stuff and those of us who agree with you about joining forces have joined the American College of Clinicians...an organization born out of the same concerns you make....why don't we just stick together???
When the tomatoes come...just duck you are a bigger person for your insight and ability to look beyond the idiocy of that argument!! good luck on your journey to NP school!!
Robert Hollingworth MS, PA-C
I wish I knew more PA's like you. I used to work as a pharmaceutical rep (worked as RN on the side) and when I told my PA's I was going to go back and get my Master's to become a NP, they just about tore my head off! They kept telling me to enter a PA program because "PA's were trained by doctors and NP's were trained by nurses". That was totally not the case in my situation. I shadowed a NP for a month and then spent all my clinical rotations with internists/gerontologists. That may be the exception though, because most of the NP's I know did all their clinical rotations with NP's. Maybe it just depends on where one goes to school(?).
P.S. I'm not sure why those PA's thought that doctors (in general) were better at training students.
pnp's can now practice independently in 7 states. quote]
actually, cyndee, nps can practice independently in 21 states. with the exception of georgia, all nps have some ability to prescribe. and, in 10 states, nps can prescribe independently.
i understand what you're getting at, but if you go to the texas board of nursing website you will find that we practice independently, but in order for us to have our own clinic we still have to have a physician audit 10% of our charts plus they have to be available to answer any questions. so, we really aren't practicing independently after all. however, in new mexico and a few other states, a physician does not have to audit our charts and we are truly independent. unfortunately, hospitals are still controlled by physicians and they come up with all kinds of rules that limit what np's can do in the hospital.
I graduated from Vanderbilt and they have just about every NP specialty there is with the exception of anesthesia. I am certified in Adult & Geriatric Health and I work as an independent contractor. I'm going to begin working a couple of days a week with a pain management specialist and we have discussed my scope of practice. I do not know of any states that allow NP's or PA's to do lumbar punctures, but they can perform intra-articular and trigger point injections. PA's can work in surgery, but a NP must complete a "first assist" course (9 hours online, 6 full days of training and then assist with 15 surgeries). I do not know of any NP programs that include the "first assist" courses in their programs, but all PA programs do. As far as lumbar injections, you would have to become a nurse anesthetist to perform those and it would depend on your state's laws as to whether you could actually practice independently and bill for those services.
If I were you I would go the PA route, otherwise you will have to go back and take that first assist course.
Thanks for your repply,Cyndee,MSN,NP!
I've considered PA route also after leaving the med school. With all my pre-med prereqs, and NO BSN, PA could be a faster route, but I gather not neccessarily a better one.I've been an RN for 15 yrs now. "Crossing over" to another profession, rather than advancing one I'm in now, and basically starting from scratch..... . And all for the first assist thing.I'm a lot more interested in PM&R, cronic pain and fatique, fibromyalgia type of patients, rather than slicing someone open. I'm quite happy with what I do with acupuncture, but I haven't been able to truely blend it with my RN. So I thought may be NP would give me that edge of the decision making.
. And all for the first assist thing.I'm a lot more interested in PM&R, cronic pain and fatique, fibromyalgia type of patients, rather than slicing someone open. I'm quite happy with what I do with acupuncture, but I haven't been able to truely blend it with my RN. So I thought may be NP would give me that edge of the decision making.
Cyndee, MSN, NP
73 Posts
Physicians DO have ownership of PA's. PA's will NEVER be able to practice independently because the State Medical Boards will never allow it! NP's can now practice independently in 7 states. There is a lot of talk concerning nurse practitioner programs becoming doctorate programs. Doctors will DIE when NP's are called "doctor" (try explaining the difference between the physician and nurse practitioner then). I thank my lucky stars that I had the foresight to become a nurse practitioner as opposed to a PA.