Differences (Educative/Clinical) between NP & PA

[jstuben]

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?

Thank you very much!

[dgenthusiast]

pedspnp said:

I never said that those things will determine the quality of care I provide, what I am referring to is not just treating the patient as just a disease but taking into account the whole person, and being able to have a intelligent conversation about things that they have an interest in. maybe I am just too sensitive that way. the quality of the care I provide is based on my clinical knowledge and expertise and pt outcomes. But it looks like this is off subject so on my next post I make sure I discuss the educative clinical differences between NP/PA sorry about that moderators.

Treating the "whole patient" is just a buzzword that doesn't really have any meaningful contribution to patient care. Not only that, it fuels the common misconception that Western medicine, for some odd reason, cares only about the disease; you'd know this is not true if you've spent more than a day in the hospital. Being nice, able to discuss various topics with ease, etc, are all nice to have but in no way are they required to provide quality care. Nor do they make an iota of difference in medical outcomes. This is one reason why patient satisfaction surveys/websites are next to useless...because they don't matter.

To stay on topic, PAs are trained under the medical model while NPs are trained under the nursing model.

[wowza]

dgenthusiast said:

Treating the "whole patient" is just a buzzword that doesn't really have any meaningful contribution to patient care. Not only that, it fuels the common misconception that Western medicine, for some odd reason, cares only about the disease; you'd know this is not true if you've spent more than a day in the hospital. Being nice, able to discuss various topics with ease, etc, are all nice to have but in no way are they required to provide quality care. Nor do they make an iota of difference in medical outcomes. This is one reason why patient satisfaction surveys/websites are next to useless...because they don't matter.

To stay on topic, PAs are trained under the medical model while NPs are trained under the nursing model.

I hate to derail but I have to respond. I roll my eyes whenever I hear the term holistic or hear anyone say something with regard to treating the the whole patient- not because I don't agree but because it is such a mindless term. Any quality nurse, doctor, or PA will take the whole patient into account as they all use the biopsychosocial model and have for a while now.

That said, the "whole patient" does not take precedence over real medical conditions. It is nice to know that the patient just went through a hard divorce and is feeling a little down but knowing that does not absolve you from prescribing the right antibiotics for their pneumonia.

I would compare it to wood paneling on the dashboard of a car. Wood paneling makes the car look nice and will probably get you some compliments. It can add a lot to the car. However, without a motor and transmission the fact the car has wood paneling is completely ridiculous.

[zenman]

dgenthusiast said:

I don't understand how being able to discuss literature and government with patients will determine the quality of care you provide.

It may or may not but that's not the point. You do know what education is for don't you? (Please look it up or talk to an educator). You won't find courses in high school for example, titled, "Literature for Nurses, Literature for Welders, etc.. I've only been back in the states for a few days but if you and others can't even understand this, I'm heading back overseas to be with the "educated" people.

[zenman]

wowza said:

I hate to derail but I have to respond. I roll my eyes whenever I hear the term holistic or hear anyone say something with regard to treating the the whole patient- not because I don't agree but because it is such a mindless term. Any quality nurse, doctor, or PA will take the whole patient into account as they all use the biopsychosocial model and have for a while now.

That said, the "whole patient" does not take precedence over real medical conditions. It is nice to know that the patient just went through a hard divorce and is feeling a little down but knowing that does not absolve you from prescribing the right antibiotics for their pneumonia.

I would compare it to wood paneling on the dashboard of a car. Wood paneling makes the car look nice and will probably get you some compliments. It can add a lot to the car. However, without a motor and transmission the fact the car has wood paneling is completely ridiculous.

True, you may need that ABX first, but you're not treating the "whole" patient unless you're addressing four levels:

1. Physical

2. Symbolic

3. Mythic

4. Energetic

Most people are being treated at level 1.

[RNTwin]

zenman said:

It may or may not but that's not the point. You do know what education is for don't you? (Please look it up or talk to an educator). You won't find courses in high school for example, titled, "Literature for Nurses, Literature for Welders, etc.. I've only been back in the states for a few days but if you and others can't even understand this, I'm heading back overseas to be with the "educated" people.

wow...you just lost total credibility...also their waiting for you oversee already, can you please do some teaching/educating on personal hygiene since it seems as if they don't get that...

but anyways back to OP NP education is geared towards the whole body/mind/soul bv11$H!+(sorry moderator), were PA is geared towards the actually problem of the patient.

[wowza]

True, you may need that ABX first, but you're not treating the "whole" patient unless you're addressing four levels:

1. Physical

2. Symbolic

3. Mythic

4. Energetic

Most people are being treated at level 1.

This has got to be a joke. Sure physical, maybe even symbolic. You lose credibility at mythic. Mythic. Seriously? Come on. `That 2 people thus far have given this malarkey Kudos makes me laugh.

[futurenp89]

imisscoco said:

I will graduate in June with my Master's in Nursing, and this summer will sit for both the Adult Primary Care Boards and Geriatrics, and hopefully I will pass both and be dual certified as an NP. I have been an RN for 30 years this summer. There are 45 students in my class. All have at least BSNs and none have been RNs for less than 5 years, most longer. PAs and NPs alike practice the medical model. It's just the way it is. And both are supervised by physicians. People come into each profession through different doors. Don't kid yourself. There are GEP programs (graduate entry pathways) for NPs now, where in 3 years you can become an RN, then NP. I thought this was a terrible idea, until I met some of the students in the GEP program at my university. Some GEP students have maturity and life experiences that make them better practitioners than nurses in the traditional programs who have been practicing for years. And some don't. It all depends on the individual, and the program. My program wants us to think that NPs practice in a nursing model. My preceptors have been very upfront with us and have told us the truth, which I am finding in my clinicals this year, and we are indeed practicing in a medical model. There are good NPs and PAs and bad ones. Practice with integrity, whatever you do, whichever path you choose, but come together as health care professionals, value what we have in common, and stop nitpicking the differences. I am sick to death of this argument.

This is 100% correct. All you future students should understand this.

[Ellen NP, MSN, NP]

Just an FYI, in an independent state, were are NOT supervised by physicians. In fact, in my state, new grads can have their two year supervisory requirement met with an NP or physician.

I happen to love both PAs and NPs. Neither is 'better' than the other.

[futurenp89]

ERNP said:

In the ED setting I don't see much difference between NPs and PAs. We can see the same patients, write the same orders, prescribe the same drugs, and perform the same procedures.

I have a friend that insists NPs can bill under their own number but that PAs can't. I can't find one shred of anything that backs up her way of thinking but she is insistant about it.

When I was finishing up my program I did clinical rotations at the same time as a PA student. She did fine considering she didn't have my 10 years ED experience under her belt. PA programs are a different type of program because they need to be a different type of program to get a good result. It doesn't mean one is better and one is worse.

If NPs and PAs would somehow band together instead of having conversations like these we could accomplish tremendous things.

Excellent!