Nurse Practitioner vs Physician Assistant

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    Debunking the myth that Physician Assistants can do more than Nurse Practitioners

    Nurse Practitioner vs Physician Assistant

    There is this myth that still seems to be circulating around that Physician Assistants (PAs) can do more than Nurse Practitioners (NPs). For example, if you want to have a role that involves more invasive procedures like central line or chest tube placement, you need to become a PA. This is not true and in fact is becoming more false each year as the NP role and profession keeps changing and adapting to hospital needs and patient populations.

    Many times in the past I had the discussion with my fellow nurse colleagues about whether to go to PA school or NP school, when contemplating going back to school. I considered going to PA school on the basis that I wanted to be able to do invasive procedures and assist in the operating room. At the time, in my hospital, we only had PAs in this type of role and I really didn't know how the NP role had evolved into invasive tracks such as the ACNP role.

    Don't get me wrong, I have absolutely nothing against PAs and work with some fabulous ones, I just want to provide a little "clarity" for those who are still unsure about which track they should take and what each role can actually do. The difference between the two roles is really just that one track requires a nursing license and one doesn't. The NP track tends to have a foundation that involves more nurse theory and evidenced based practice, while the PA track tends to have more of a straightforward medical approach.

    I'm not saying that you don't learn medical management in NP school, you're just relating that management to nurse theory and research, where as in some PA schools, they only have 1-2 classes on evidence based medicine. The prerequisites are different as well. Prerequisites for NP school are usually obtained in your undergraduate program so no extra classes are required, where as, some PA schools require organic chemistry and biochemistry. For somebody with a nursing degree, these classes would have to be taken post-nursing degree because most undergraduate nursing programs don't tend to require these types of chemistries. This is just something to think about if you're considering going to PA school.

    Looking at programs people can argue that PA schools require a lot more clinical hours to complete in their programs, but you have to keep in mind the general PA student. The general PA student doesn't have much hands-on patient experience, so the hospital is essentially a new environment for them and they will therefore require more hours. In NP School you still a lot of clinical hours to complete in the hospital (or clinic), but you've also probably worked a couple years prior to graduate school (and continue to work through school) so those extra hours at the PA students are getting, you've already had those in real world situations touching real patients.

    With all of this being said there is NOTHING WRONG with a nurse going to PA school. Sometimes people don't want the "nursing foundation," they want the straightforward medical foundation, which is totally fine, to each his own. Whether you go the NP or PA track, by the end of your program, you will still come out doing the same job, being just as good at your job, and eventually (hopefully) making the same salary. So, if you think that you want to become a PA because they can do invasive procedures, now you know that NPs can also do invasive procedures with the appropriate program and training. I have had an attending physician tell me that they would much rather hire an NP than a PA because NPs most likely already have nursing experience and know how to talk to patients. But, I also do realize I'm a little biased being that I'm an NP graduate.

    Check out PA or NP? Between the Two Careers video

    Last edit by Joe V on Jun 14, '18 : Reason: added video to help readers understand the difference
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  3. by   WCSU1987
    I don't know if it is true or not. However, heard from an RT at this rehab hospital said PAs biggest gripe is every 2 or so years has to retake the test to keep their license. If that's true that be a pain in the but. I have worked with good PAs and APRNs (Mostly worked with CRNA in the past.)
  4. by   akulahawkRN
    There are a couple of differences in education of the NP or PA. One of those is the PA has to take a couple more classes and attends more rotations. The PA is, in effect, a generalist. They can go from department to department fairly easily. Your PA that was in Ortho today could tomorrow change to Cardiology or Oncology or Surgery. They're already educated to make that switch. The NP is typically trained as more of a specialist so your FNP isn't going to be be able to switch jobs to some other area of medicine without typically having to go back to school to be certified to work in that new position. This is not to say the PA or the NP is a better provider, just that the training they receive is different. Within a given field, a PA and NP should be nearly interchangeable and should draw the same salary. The only major difference is the PA technically requires a supervising physician whereas the NP may (or may not) be legally required to have physician oversight.

    It's also true that the PA does have to retake the PANCE every so often while the NP only typically takes their certifying exam once.
  5. by   PedNephNurse
    I'm in NP school and proud of it! The thought of going to PA school never crossed my mind. I am a nurse and would only want to build upon my current nursing degree.
  6. by   vgyore
    I'm pediatric NP and advanced practice RNFA. My love for the OR and procedures have sent me on a path of adventure and re-inventing my career when it gets boring. I feel so lucky to cross paths with so many encouraging Docs, NPs and PAs. They have help me on my way and hope to pass on the kindness. I say go for whatever professional model resonates with you. You can find the fun!
  7. by   Rocknurse
    I'm in the third and final year of an Acute NP program and I chose that route because I've been a nurse for nearly 25 years and it didn't make sense to abandon my nursing experience and license. It's a natural progression to become an NP, whereas as a PA I would feel like I was starting over again. I have always been in critical care and I want to be able to place lines and do invasive procedures so it made sense to follow the acute track.
  8. by   CraigB-RN
    There are many factors that come in to play with choosing PA vs NP.

    The first one is that PA's are generalist in their basic education. That means they can move from specialty to specialty easier than NPs can. Notice I said easier. Nursing choose the specialty route. As an ACNP you can't take care of kids unless you go back to school (or so duel program in school) If PA's want to change specialties they just have to find someone to hire and train them, They don't have to go back to school.

    Some places have found that PA's are a bit more prepared to on day one than new grad NP's. Now after a year or so, there isn't any difference.

    Now this is a generalization here. NP programs make an assumption that you have a certain knowldge base when you get into school. This isn't always true any more. RN's are going right into NP programs with less than a year of experience. I constantly hear NP's complaing that they have to find their own preceptors. Some programs are better at this than others.

    If you have a certain specialty you want to work, you need to do your homework. In a few of the locations I've worked, the practice has choosen not to hire NP's because of the whole "I'm a Dr now and I can work independently" The practice wich is owned by MD's and didn't want to deal with that, so they hire PA's. At another hospital down the road, all the non MD practitioners are NP's. (notice I didn't say midlevel?). At another facility the PA's did the skills, NPs did planning, teaching and pt management. A good friend of mine in an NP and he runs the unit. He assigns the residents and has the final say over treatment plan.

    Then there is always the elephant in the room when choosing NP vs PA and that is the Board of Nursing in the state your working in and the specific nurse practice act. To me this is probably the biggist issue. In the majority of the states, a PA can do whatever his/her supervising physician can do and allow him/her to do.

    It's not an us vs them thing, it's about the best fit for what you want to do. I will say that after almost 40 years, for the most part, the whole nursing practive vs medical practice is a bit of BS. A septic work up is the same no matter if your a PA or an NP.

    P.s. They take the pance exam every 10 years now.

    p.s.s. Ex CNE that used to hire both NP's and PA's and faculty for both NP and PA programs.
  9. by   Coolcatnicki
    I am in the middle of applying to accelerated nursing programs! I have wanted to do PA for a while, but then nurses at the hospital I work at convinced me otherwise. I am so excited for nursing school. I was a little disappointed when everyone told me that in order to assist with surgery I have to become a PA. I like the fact that nursing is more of a stepping stone. I also LOVE surgery and feel like I would be very good---i am a very matriculate person and like everything perfect, and am also very patient. Thank you for the post!! How can you become a nurse/nurse practitioner in the ER? Should you become a CRNA, NP?
  10. by   Lindsr12
    So nps cannot have a job in the OR? And can't hop between mental health and other areas without going back to get certification/ specialization in each area?
  11. by   lilybatchelor
    Quote from vgyore
    I'm pediatric NP and advanced practice RNFA. My love for the OR and procedures have sent me on a path of adventure and re-inventing my career when it gets boring. I feel so lucky to cross paths with so many encouraging Docs, NPs and PAs. They have help me on my way and hope to pass on the kindness. I say go for whatever professional model resonates with you. You can find the fun!
    What types of procedures do you assist in?
  12. by   NurseNeLz
    As a nurse I am a bit biased but as an Np you can eventually practice independently in the state of NY so that in my mind is better than being a PA where they always have to work directly under a doctor.
  13. by   Cwoods
    Quote from Coolcatnicki
    I was a little disappointed when everyone told me that in order to assist with surgery I have to become a PA. How can you become a nurse/nurse practitioner in the ER? Should you become a CRNA, NP?
    First, RNs can assist during surgery. Look up RNFA - RN First Assist.
    2nd, NPs assist in surgery all. the. time. Your source is all kinds of wrong.
    3rd, To be a NP in the ED, just become a NP. EDs hire FNPs as well as ACNPs.
  14. by   fourdl
    This is not true- I know of NPs who work for surgeons who were OR nurses and may do some office procedures. I have a degree as a FNP but I work in a mental health clinic as I have worked in psychiatry for over 27 years. I became an FNP to be more flexible and have the capability to have more flexibility. Presently there is a great need for psychiatrist and right now NPs who have experience in psych are hired to work in this area. I know of several NPs who work in psych with an FNP.