Interesting Physician Perspective On NPs

[PMFB-RN, RN]

I am not an NP. I am a full time rapid response nurse at a teaching hospital. This morning I stopped in to residents office to update the night residents on what had happened with their patients and what I had done. They were in the middel of sign out to the day team including several interns, residents, the chief resident and the attending. After I was done an intern speaks up and says "PMFB you should become a PA!". This was met with a rousing round of "NOooos" & "no way!" from the residents and attending. The intern looked confused. The chief resident leans over to her and says "PAs are at the bottom of the medical word. PMFB should become and NP, they are at the top of the nursing world".

The attending and other residents all readily agreed. I thought it was an interesting insight into physician thoughts about mid levels.

[myelin]

Interesting to hear docs being so critical of PAs. I think PAs are really well-trained for the most part and deserve credit for the great work they do. Not that I don't think NPs can be great as well, I certainly think that, after all, I am becoming one.

The fact that they're often chained to a doc makes people think a PA can do less, or so it seems. I dunno. I think NPs and PAs should unite to promote our shared interests.

[Lynn2]

Really? I see a big difference between the 2. A PA can have any kind of Bachelors degree, and get their PA training in 2 years. A NP on the other hand has a BS or BA and a MSN and now more recently has to have a Doctorate in order to become a NP. And for the record the fact that a NP can practice independently as where a PA can only practice under a MD makes the NP role above the PA as far as I am concerned.

[BCgradnurse, MSN, RN, NP]

Lynn2, I have to respectfully disagree. First, there is no requirement for an NP to have a doctorate, much as there is no requirement for an RN to have a BSN. A lot of NP programs have switched from MSN to DNP, but it's not mandatory to do so. There is no consensus yet on when or if a doctorate will be required. PAs, like NPs, go through advanced graduate training. Keep in mind that there are many NP programs where you can have a bachelor's degree in a non-nursing major and get your MSN in 2-3 years. How is that different from what you've said about PAs?

Second, NPs cannot practice independently in all states. PAs do have to have physician oversight in all states, which I hope they can change in the near future. I think it behooves NPs and PAs to have mutual respect for each other, and advance the roles and visibility of so-called midlevel providers. The NPs are better than PAs or vice versa stance only makes us look silly and petty in the eyes of the medical profession.

Just my 2 cents.

[Patti_RN]

Personally, I like the autonomy most NPs have (states do vary), but all PAs work under a physician. That, in itself, doesn't make anyone more or less competent. Most NPs do come from a BSN background and most have at least a few years of work experience--that means that after NP school they have about 8 years (or more) of relevant training and experience. I know several PAs with undergrad degrees in fields like Art History, Political Science, etc., who apply to PA school and two years later are prescribing meds. Given the choice of two such practitioners, personally I'd rather be a patient of the NP.

I've seen many threads on this site asking about 'easy' or 'fast' or 'cheap' NP programs, and there are certainly those wishing to attend similar PA programs. Beyond the NP vs. PA controversy, it also depends on the caliber school a person attends, and the individual's skills and abilities; a PA who attended a demanding, rigorous program could very well be a better practitioner than an NP who went the 'easy, fast, and cheap' route.

[Twinmom06, ASN, APN]

I thought PA's didn't have prescriptive authority where NP's did?

[wooh, BSN, RN]

All the "authority" differences between NPs and PAs depend on the state.

[Patti_RN]

States differ on what PAs can/ cannot do; ditto for NPs. I believe all (or most) states require PAs to work under a physician, some have the same requirements for NPs; some states don't allow NPs prescriptive authority, but most do; some states don't allow PAs to prescribe.... different states, different rules and scopes of practice. But, generally, NPs have more autonomy and a broader scope of practice than the PAs.

[Good Morning, Gil]

It was definitely intended as a compliment, but the MD stated that an NP is as good as you can get in the nursing world, and PA is the worst in the medical world, but both roles are very similar, so he's insinuating that an NP is not so great after all lol.

Both are very valuable, though, regardless of what some people say.

[CloudySue]

PA's are trained to think like doctors; NP's think like nurses. Huge difference in where they are coming from when they approach a situation that needs a resolution.

After 9 years of my husband being treated ineffectively for rheumatoid arthritis and seemingly regarded as an insurance money pinata (prescribed designer drugs that don't work, getting a new ankle brace each year, steroid shots that don't last more than 2 weeks, surgical consults, x-rays and MRI's) we realized that he will probably never be "cured", and since the meds have not put him in any sort of remission, he needs help to maintain the mobility he still has while coping with the pain. The doctors never seemed to address that issue. So we made an appt with our PCP's NP and just today he was finally prescribed a quad cane, PT/OT including aqua therapy, a handicapped parking placard, ordered a DEXA scan to check for osteoperosis d/t 9 years of oral steroids, and she also called all the doctors involved in his care that never communicate (rheumatologist, orthopedist, and pain management "specialist") and got them all on the same page. Some meds were d/c'ed, others added. She accomplished all this on one day. And I knew how she did it: she listened to my husband and me, reviewed all the notes that had been sent over from these doctors in the last year or so, and formulated a care plan in her head. Just like that. I told her right at the start of our meeting: "I'm done with these doctors. He needs someone who thinks like a NURSE who will treat him as a person, not a dx!"

[cardiacrocks, BSN, RN]

I have an idea, how about you could go to medical school, you could become a MD as well. Nobody mentioned that. I do agree with many of the OP, NP's ROCK!! I plan on receiving my DNP, It will be mandatory by 2015. I personally respect the ENTIRE team, care partner's (nursing assistance, RN's, PA's, NP's and Physicians).

[Novo]

Personally I think NPs are less knowledgeable than PA's. PA school is essentially medschool-lite whereas NP's take a few pharmacology courses and some. Just my opinion though.