Do RNs have to take PA's order?

Tweety, BSN, RN · Jan 16, 2005

Here PA's work with an MD and it's the MD who gives the orders. Seems to me the docs who have priviledges at this hospital tend to use RNs and ARNPs more than PAs as their assists, so this probably indicates that the RNs are making less, but I honestly don't know. (Could it possibly be that RNs are just as good as PA's at examining patients and rounding with/for the MD????)

Many times the PAs come in alone and independently write telephone orders or verbal orders and we know they really haven't consulted with the MD, unless it's a really serious situation. But the MDs always sign the orders at a later time. So perhaps this is what your friend means. They come in, examine the patients and write orders, but here at least those orders are always followed with a "telephone order of" or "verbal order of" an M.D.

So to answer the title of your thread, the orders the PA's write are from the MD's, so we do carry out orders PA's write, as we do the RNs who round for the MDs. :)

Malt123 · Jan 16, 2005

I talked to a friend who was thinking either going to nursing program or PA program. She said someone told her the PA program is more difficult coz PA have to learn both medical stuff and nursing stuff. Also, PA take doctors' order and then they order nurses. I'm a nursing student and I have never heard that before from any of my instuctors:confused: . Personally, I don't think they have the authority to give order to any NP or RN. My friend also said that PA earn much more than nurses. If compared PA with LPN, it might be true. But if compared PA with NP, that might not be the case. Anyone here knows more about that? I appreciate for the input.
EvePooh

PA's can write orders but they can't write narc orders at least in the LTC setting. and they have to work under an MD, NP's can have their own practice and can write any kind of order

BETSRN · Jan 16, 2005

I talked to a friend who was thinking either going to nursing program or PA program. She said someone told her the PA program is more difficult coz PA have to learn both medical stuff and nursing stuff. Also, PA take doctors' order and then they order nurses. I'm a nursing student and I have never heard that before from any of my instuctors:confused: . Personally, I don't think they have the authority to give order to any NP or RN. My friend also said that PA earn much more than nurses. If compared PA with LPN, it might be true. But if compared PA with NP, that might not be the case. Anyone here knows more about that? I appreciate for the input.
EvePooh

PA's and NP's are both advanced degrees, but a nurse practitioner has far more autonomy than a PA. A PA can never practice alone and an RNP can. So in that sense, being a PA is a dead end job (no offense meant here). Nursing has far more to offer in the way of advancement.

mattsmom81 · Jan 16, 2005

Well if it is facility policy and you are comfortable with the order, and it helps the patient, why not. But I would never hesitate to call the MD if I wasn't comfortable.

Nurse Ratched, RN · Jan 16, 2005

I work in an office that utilizes PA's, NP's and MD's and I take orders from all of them, documenting them as PVO (per verbal order) of whomever.

Scope of practice of mid-level providers (PA's and NP's) varies according to state, but one does not order the other.

Salary also varies according to location. An agency nurse working a lot of OT could probably give either a run for their money, so to speak.

Ultimately, the decision to be an RN or LPN versus a PA or NP depends on how much autonomy you want (as well as the money side of things, but education ain't cheap either.) I personally have no desire ever to have prescriptive authority.

chicoborja · Jan 16, 2005

I don't mean to offend anyone but some of the responses I've read have somewhat irritated me. I do agree that PAs and NPs are relatively equal. Neither mid-level is inherently superior. When comparing the two, it really comes down to the individual clinician. The statement that being a PA is a dead-end job is ignorant. PAs are nearly identical to APNs. Although they are different in training, many positions may be filled by either. PAs may advance into faculty positions the same way APNs can. Although there are fewer administative positions available to PAs, there is still plenty of room for advancement. It is unrealistic to believe that NPs frequently engage in autonomous practice (CRNAs and CNMs excluded). Less than a handful of states allow for autonomous practice and they all have restricted formularies where complete autonomy is available. Most states require collaborative practice with a physician but this isnt dramatically different from being supervised. I will concede that NPs have a far more viable chance of establishing an independent practice; however, until legislation changes further (as a whole) it isn't going to thrive. PAs and NPs each have theri advantages and disadvantages. PAs may change specialty at a whim; whereas, NPs require further coursework (e.g., peds to psych). PAs may suture minor wounds but NPs do have less physician supervision. With regard to PAs giving orders to an RN, PAs are a rung above RNs in the healthcare hierarchy. MDs and DOs are at the top with limited license practitioners below (e.g., OD, DPM) and mid-levels (NPs, PAs) right below them. Then of course is RN with LPN right below RN and CMAs and CNAs below LPN. I'm not saying that someone's better because they are at a higher tier in the hierarchy, but rather they have more authority and responsibilty. Keep in mind that each rung tends to require more time in didactic eduaction. Physicans have 4 year clinical doctorates with about 3-5 years in residency. Limited license practitoners have 4 year doctorates with maybe a 0 to 2 year residency. NPs and PAs often have master's degrees. RNs have a bachelor's or associates. LPNs have a diploma and CMAs/CNAs have certificates. Alright, I'll shut up now.

naggytabby, BSN, RN · Jan 16, 2005

As a PA now in nursing school (because I want to be a CNM and I cannot deliver babies as a PA- it'd quite complex, but all good:) )I will confirm that, in NC anyways and in many other states, RNs take orders from PAs. PAs have different training than RNs and write scripts (in NC that includes narcotics- and MDs no longer have to cosign) and provide medical care. Please talk with your DON and the medical person who deals with policy and procedure for wherever you work. That will clarify what you are expected to do. If you have a conflict, then you may need to make a choice about your work situation. It might also be helpful to talk to a PA program in your area and clarify what is truth and what is fiction- I find there is sometimes animosity and inaccuracies between nursing people and PA people-- very sad. Patients/clients/health care seekers need many types of care...

have a lovely day!!!

Malt123 · Jan 16, 2005

As a PA now in nursing school (because I want to be a CNM and I cannot deliver babies as a PA- it'd quite complex, but all good:) )I will confirm that, in NC anyways and in many other states, RNs take orders from PAs. PAs have different training than RNs and write scripts (in NC that includes narcotics- and MDs no longer have to cosign) and provide medical care. Please talk with your DON and the medical person who deals with policy and procedure for wherever you work. That will clarify what you are expected to do. If you have a conflict, then you may need to make a choice about your work situation. It might also be helpful to talk to a PA program in your area and clarify what is truth and what is fiction- I find there is sometimes animosity and inaccuracies between nursing people and PA people-- very sad. Patients/clients/health care seekers need many types of care...
have a lovely day!!!

when I was checking out the PA program's about 10 years ago they weren't allowed to write narcs. thanks for the update, don't see too many in LTC but they have always been a great asset, I usually preferred PA's and NP's over some of the doc's. they seemed to be a bit more compassionate and had a better repore with the nurses. some of the programs the courses could transfer if you wanted to go to med school. I was really interested in the PA program but NM didn't have one at the time, they have since started a program. years ago they had one for the native Americans but for some reason they were not able to do as well in that program so they closed it down. the one now seems to be doing much better.

Tweety, BSN, RN · Jan 16, 2005

PAs may suture minor wounds.........

Were a Level II trauma center, and the ER docs utilize ARNP's and they do suturing as well. The line between PA's an ARNPs is a little blurry here from what I've seen. As I've stated, I definately see more ARNPs around here than PA's. But that could be that there might not be a good school in the area, but there's a school with a large number of ARNP degrees around.

Otherwise, good perspective. Thanks.

ayndim · Jan 16, 2005

As a PA now in nursing school (because I want to be a CNM and I cannot deliver babies as a PA- it'd quite complex, but all good:) )I will confirm that, in NC anyways and in many other states, RNs take orders from PAs. PAs have different training than RNs and write scripts (in NC that includes narcotics- and MDs no longer have to cosign) and provide medical care. Please talk with your DON and the medical person who deals with policy and procedure for wherever you work. That will clarify what you are expected to do. If you have a conflict, then you may need to make a choice about your work situation. It might also be helpful to talk to a PA program in your area and clarify what is truth and what is fiction- I find there is sometimes animosity and inaccuracies between nursing people and PA people-- very sad. Patients/clients/health care seekers need many types of care...
have a lovely day!!!

I thought PA's could deiver babies. At least that is what I was told. Or are you just wanting to practice in the way CNM's do. You know low section, episiotomies, birthing centers and such? Just curious as I thought PA's did deliver.

Anyway all midlevels are pretty much equal in a pts eye. I usually see an NP for myself and an MD for the kids but there is a PA at the peds office. The baby was sick and needed to be seen that day. He was the only one with appts. I thought he was great. But the dr there also always has time for you. For myself, I have found that NP's (probably PA's too but I can't judge with my limited experience) have time for you.

CarVsTree · Jan 16, 2005

I work on a Transitional Trauma Unit and we are one of the only floors that utilizes PA's. The PA's get up even earlier than the docs and do kind of pre-roungs. The order anything that needs ordering before rounds, for example blood work, CT's, X-rays, etc. Just the other day, the nurse suspected his pt had a PE, the trauma resident didn't agree over night. In the morning, the PA was hemming and hawing about writing the order for the (forget the name of the radiologic test) but decided to write it even if she gets in trouble. So although she is allowed to write orders, she still answers to the attendings. So in this case, the PA added another person for the RN to go to to advocate for his patient.

OP sounded concerned though about taking orders from PA's. Its not really like that in the real world. The PA's may order stuff, but its not like the nurses are at the PA's beck and call. PA writes order for bloodwork. Tech (moi) draws blood). RN manages her patients as her scope of practice dictates. It works very well on our floor.

I would imagine that what a PA can and cannot write will vary from state to state based on the medical board in each state (they are governed by a medical board, right?).