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!
First of all, in order to sit for the exams the school has to be accredited which means that it meets a set of criteria. This is the same for online as well as campus based programs. I would not be able to continue my education if there was no offering of online programs because of my rural location. The school I will be starting at in the summer requires 750 hours of clinical time for FNP (even more than Vanderbilt). I have to find my own preceptor. There are lengthy forms and evaluations that have to be done all through the program. As far as access to the instructors, I would think that the online environment makes this even easier. I don't have to wait until lecture day- every day is lecture day via e-mail and newsgroups.
here's the ucdavis website where they combine the pa and FNP programs:
http://fnppa.ucdavis.edu/index.htm
and here are the requirements:
http://fnppa.ucdavis.edu/admissions/require.htm
they both require 4000 hours hands on experience, to be gained as a nurse for the np, as an ma, paramedic, emt, or whatever for the pa.
rns must be licensed in california, plus have some specific courses, and if they are doing the "master's track", they must have a bachelor's.
pas must have an aa, plus some specific courses such as a&p, microbiology, etc.
here is a quote from their website:
"what is the difference between an fnp and a pa?
an fnp comes from a nursing background while a pa generally has a different health career background. their respective fields have quite different origins and histories. they operate under different state laws and titles. however, their roles in the health field can be so similar that the uc davis fnp/pa program educates these professionals together. "
I am graduating from an adult NP program in June. There is not anyone in my progam who has not been practicing less than 3 years and most have been practicing 10 years or more. Everyone has a BSN as a requirement for admission. This is a traditional graduate program, not the GEP (graduate entry pathway) which does not require you to be an RN prior to entering the program. That is an entirely different program. We, in the traditional master's program have 540 hrs of clinical in adult primary care and for a subspecialty, such as geri, 180 hrs additional, for a total of 720 hrs. which is 24 hrs of clinical for 36 weeks. Why anyone would make a generalization that NP programs do not have stringest admission requirements as well as a hefty clinical component is beyond me.
One more thing...NP's are taught to have a more holistic view of healthcare (mind, body, soul), whereas PA's are taught by the medical model...which is very reductionist in nature. For an extreme example so you get my point: an anorexic with a cut on her arm may visit the doctor or PA and get excellent treatment for the wound, but leaves the office without anyone questioning her BMI(body mass index). As I am very pro-preventitive and holistic medicine-minded, the choice of NP fit my style much better than the PA medical model did.
thats all fine and good, but be warned that Medicare/insurance companies WILL NOT REIMBURSE YOU FOR THAT KIND OF STUFF. Thats why so many people dont engange in it, because it you have to do that kind of work for free. They'll pay you for scripting out antibiotics for strep throat, but they wont pay you for a 15 minute conversation on how to lose weight
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!
Be careful.
ONe thing you will NEVER find on any state board of nursing website is that NPs practice "medicine." They swear up and down that we dont practice medicine, we practice nursing.
the reason is becasue state law says that ONLY the state medical boards can regulate the practice of medicine.
As long as we practice "nursing" NPs are fine. But the day that the state nursing boards argue that we practice "medicine" will be the day that we lose a court battle because the judge will say that only state medical boards can regulate the practice of medicine.
Hi,
Fairly new to this board but I must reply to the response that attending to details aside from the initial presention (the person with a lac and low BMI and having discussion about that circumstance) will not get reimbursed from Medicare.
In my role I bill for what I do. If i have a conversation about preventive health or about circumstances that may contribute to the complaint it is documented in my note. I use a modifier and bill appropriately as an extended visit.
I'm sure that sometimes I spend more time that I will actually get reimbursed for but that's the breaks. I'm not going to skimp because of medicare, I'd rather take 5 extra minutes and detail the note in case it does get audited and make sure that i've taken care of the patient fully.
Thank you, for letting others know that there are ways a provider can find to be reimbursed for attending to health education/prevention, and other matters that are brought up during the visit, other than the CC.
Platon20, is not even in NP school, and has spoken about a subject for which he has no personal experience.
I am encouraged by holistic providers such as yourself; I am not idealistic, but I will strive to provide this same type of care when I finish my current NP education.
Thank you, for letting others know that there are ways a provider can find to be reimbursed for attending to health education/prevention, and other matters that are brought up during the visit, other than the CC.Platon20, is not even in NP school, and has spoken about a subject for which he has no personal experience.
I am encouraged by holistic providers such as yourself; I am not idealistic, but I will strive to provide this same type of care when I finish my current NP education.
platon20 is over at physicianassistant.net also saying hes a PA
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.
zenman
1 Article; 2,806 Posts
Probably much like any other program. We find our own clinical sites; I don't know if any program sets you up. I'd rather find my own. I can do it in any country as long as the physician is board certifed in the US or with an NP certified in the states. That means I can get a clinical site at a US Embassy or military base or even with some private physicians. Even here in Bangladesh there are Harvard trained physicians who are board certified in the US.
And I r a Xcellesior gaduate.:rotfl: