Do RNs have to take PA's order?

Nurses General Nursing

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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.:D

EvePooh

Specializes in Geriatric/LTC, Rehab, Home Hhealth.
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.
I agree! I am quite satisfied with our on-call staff which includes the MDs but the NPs and PAs are also great and at times ask more questions and follow an acute episode much more closely than the MDs.
I agree! I am quite satisfied with our on-call staff which includes the MDs but the NPs and PAs are also great and at times ask more questions and follow an acute episode much more closely than the MDs.

In Pennsylvania there was new law enacted that should have already been incorporated into hospital policies that orders must be taken which come from NPs and PAs

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.

You know, this heirarchy may be changing. Perhaps not right away, but definitely in the not too distant future. I found this article on US News some time ago that discusses the ongoing changes in healthcare. For now, the buzzword is 'teamwork', but I wouldn't be surprised to see more states passing legislation allowing trained, licensed non-MDs to perform certain medical procedures. Its already happening. The HMOs would love nothing more than if the states were to grant more autonomy to ARNPs because they can independently perform many routine medical procedures and for far less money than the physicians are paid.

The article shows that the squabbles about heirarchy in healthcare is much more about 'turfdom' than it is about the delivery of safe patient care. Very interesting article. Long, but definitely worth reading.

http://www.usnews.com/usnews/health/articles/050131/31turf.htm

I am very cautious about taking orders from PAs, mostly because the only PAs I ever worked with were...ehm, not great.

One demanded that I start LiCO3 on a peds pt who had major heart probs. and was taking an ACE inhibitor. Yeah, sure. The kid wasn't even bipolar, so LiCO3 would not have even been indicated. I called the attending who said, "No, don't give it." Somehow, the PA managed to finagle it anyway when I wasn't there, then he forgot the tiny, minor detail about checking levels. Kid got sick. You guessed it...lithium toxic. :angryfire

Every practice has its good and bad practitioners, but I have had more probs with PAs being arrogant and abusive to nurses than many docs. Maybe that's just the area where I'm from, but hey, I don't take that guff from a doc, so I sure as shoot am not going to take it from someone who is a midlevel.

If the order is reasonable, I'll do it, but when it came to that guy, I told him the only order I'd accept from him was for Tylenol, and I was going to even scrutinize any Tylenol orders he wrote. He blustered about and told me I had to follow his orders. Didn't get him any extra congeniality points for saying that.

I am very cautious about taking orders from PAs, mostly because the only PAs I ever worked with were...ehm, not great.

One demanded that I start LiCO3 on a peds pt who had major heart probs. and was taking an ACE inhibitor. Yeah, sure. The kid wasn't even bipolar, so LiCO3 would not have even been indicated. I called the attending who said, "No, don't give it." Somehow, the PA managed to finagle it anyway when I wasn't there, then he forgot the tiny, minor detail about checking levels. Kid got sick. You guessed it...lithium toxic. :angryfire

Every practice has its good and bad practitioners, but I have had more probs with PAs being arrogant and abusive to nurses than many docs. Maybe that's just the area where I'm from, but hey, I don't take that guff from a doc, so I sure as shoot am not going to take it from someone who is a midlevel.

If the order is reasonable, I'll do it, but when it came to that guy, I told him the only order I'd accept from him was for Tylenol, and I was going to even scrutinize any Tylenol orders he wrote. He blustered about and told me I had to follow his orders. Didn't get him any extra congeniality points for saying that.

Thank you for sharing that experience with us and I am sorry that you have had to encounter a "bad" PA. Truth be told I encounter very bad nurses almost daily (only daily of course because of the number of nurses I encounter), very bad Physicians, PAs, NPs semi-regularly. The only point that I was trying to make out of that post is that if you were a nurse in Pennsylvania it is law that you take the orders from PAs and NPs. I understand that if you feel the order will harm a patient you can question it and probably deny your implementing of the order. I dont know I am not familiar with nursing regulations. I know that if I saw something that would be harmful I would question as I follow the Hippo oath....first do no harm! I do know however that the hospitals in pennsylvania have implemented a law and I am sure the opposite could be true. Say you do not take an order from a PA and the order is not done and something happens to the patient....Your fault! Now this is just theorhetically. Just my input. Thanks for hearing.

It depends on the state they are in (for PAs and NPs). NPs can't prescribe narcs in Florida.

Yep. It definitely varies by state.

In California you can take an order from an NP, but you definitely cannot take an order from a PA.

:coollook:

Specializes in Obstetrics, M/S, Psych.

In Maine, RN's take orders from NP's and PA's. I can confirm it has been that way for at least the last 15 years. I'm suprised it varies so much state to state. I've been fortunate enough to work with many very competent PA's in this area. (And NP's for that matter.)

Thank you for sharing that experience with us and I am sorry that you have had to encounter a "bad" PA. Truth be told I encounter very bad nurses almost daily (only daily of course because of the number of nurses I encounter), very bad Physicians, PAs, NPs semi-regularly. The only point that I was trying to make out of that post is that if you were a nurse in Pennsylvania it is law that you take the orders from PAs and NPs. I understand that if you feel the order will harm a patient you can question it and probably deny your implementing of the order. I dont know I am not familiar with nursing regulations. I know that if I saw something that would be harmful I would question as I follow the Hippo oath....first do no harm! I do know however that the hospitals in pennsylvania have implemented a law and I am sure the opposite could be true. Say you do not take an order from a PA and the order is not done and something happens to the patient....Your fault! Now this is just theorhetically. Just my input. Thanks for hearing.

You didn't read my post carefully. First of all, I did say that there are bad practitioners in every part of the medical field.

Second, I certainly would not be so imprudent as to just ignore an order; when there's an order I question, I ask for clarification, and God forbid, go all the way up the chain of command if necessary (that's happened about three times in my twenty years as a nurse). I do that no matter who is doing the ordering...NP, PA, MD/DO.

I wouldn't refuse to take an order from a PA out of sheer cussedness, but if it's someone who is not very competent, you can bet that I am going to really, really look at it, and if I am uncomfortable I am calling the attending. That is totally within my nurse practice act.

This particular individual was absolutely, positively incompetent. I was working in a peds psych unit at the time, and he would repeatedly order completely inappropriate doses of meds...way, way outside appropriate dosing parameters. That is why I told him I would not accept any orders from him without clarifying them with the attending, with the exception of Tylenol. I was not about to risk my license just to spare the guy's feelings.

You didn't read my post carefully. First of all, I did say that there are bad practitioners in every part of the medical field.

Second, I certainly would not be so imprudent as to just ignore an order; when there's an order I question, I ask for clarification, and God forbid, go all the way up the chain of command if necessary (that's happened about three times in my twenty years as a nurse). I do that no matter who is doing the ordering...NP, PA, MD/DO.

I wouldn't refuse to take an order from a PA out of sheer cussedness, but if it's someone who is not very competent, you can bet that I am going to really, really look at it, and if I am uncomfortable I am calling the attending. That is totally within my nurse practice act.

This particular individual was absolutely, positively incompetent. I was working in a peds psych unit at the time, and he would repeatedly order completely inappropriate doses of meds...way, way outside appropriate dosing parameters. That is why I told him I would not accept any orders from him without clarifying them with the attending, with the exception of Tylenol. I was not about to risk my license just to spare the guy's feelings.

Please dont get offensive........I did read your post very well and nowhere in my post did I imply or say that you were bashing PAs. Although if anything PAs should be offended by your generalization that they are not that great based on your experience with only a few! This clearly stated after reading back over your original message. I said that there were incompetant providers just as my opinion....not saying that you forget to mention that because I understood the content of your message and say that you briefly mentioned the incompetance of others (but while really calling out the PAs:)). Also again i did not SAY that you would ignore an order. As you can see if carefully reading my message. I was giving a theoretical situation which could be any nurse not just yourself! One more point...you discuss losing your license as opposed to hurting someones feelings if giving the wrong dose of medication ....be honest you are not expected to be responsible for what a practitioner orders. The PA and ultimately attending physician would be responsible for the mess up. Hats off to you for picking that up but ultimately the responsibility would not be in your hands. Also my original post was a simple short imformative quote stating that it is law for nurses to take orders from NP/PA in Pennsylvania. That is all. The law is law like it or not. My simple statement resulted in your "speal" about how incompetant PAs are either way again appreciate you sharing your experience. My post was not meant to be offensive or argumentative just a discussion. Sorry if you have taken my post out of context. Have a nice day :)

Deleted...double post.

I'm sure there are some great PAs out there; it's just been my misfortune not to have encountered one yet. Based on my experiences, therefore, I always thoroughly check orders from them. Maybe if I am lucky enough to work with a few good ones it might reduce my apprehension.

And my post was not in the least offensive. I'm not sure what it was you found "offensive."

Really, since you are from the studentdoctor site, surely you know that there are far, far worse (and blatantly sexist) things posted about nurses there on a daily basis. Recall the NP debates? Now we're talking offensive.

Anyway, this has strayed from the point of the original thread; my apologies for that. To the OP, check the nurse practice act for your state, and never just accept an order from anyone if it's questionable. Get clarification from your nurse manager/supervisor, and make sure you know the policy in your facility for what to do when you do get an inappropriate order.

One other thing, R2...yes, I am just as liable for a bad order if I don't catch it or take it through the proper chain of command. The BON has taken licenses away from nurses for these kinds of mistakes.

I'm sure there are some great PAs out there; it's just been my misfortune not to have encountered one yet.

Really, since you are from the studentdoctor site, surely you know that there are far, far worse

One other thing, R2...yes, I am just as liable for a bad order if I don't catch it or take it through the proper chain of command. The BON has taken licenses away from nurses for these kinds of mistakes.

I really dont want to argue about this but I have a few more things to discuss in regards to your comments:

*what is the studentdoctor site??? I am not quite sure what that is and I certainly am not from there?????

*You were offensive by generalizing PAs. Now if I came on here and said that I have worked with 3 lousy nurses therefore I am not sure there are any great ones out there and I am going to doubt every nurse I ever work with (which by the way this is not the case). I would get eaten alive on this site! Please think about what you are saying and why I said it was offensive... but it is only your opinion and your right to it. It is not going to change the fact that you still have to take orders from them. Everyone knows that there are Competant excellent PAs so it is not worth arguing over. Enough said!

* The reason I said that you would not be liable for certain orders that a practitioner makes is because you are not expected to know everything that these practitioners know. Its not a bad thing but I guarantee that you have implemented orders that were not the best orders and could have caused harm without a thought because you did not know any different. The practitioner is the one that is responsible for their actions/orders. If it is a mid-level than their supervisor is responsible as well. If it is something that as a nurse you are absolutely supposed to know then you all may be in trouble.

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