Name and scope of NP/PA's

[zoidberg, BSN, RN]

With all the talk of PA's wanting a new name and both parties wanting to practice their full scope in all states, I think it should be discussed together. I realize the nuances between the two groups, but one cannot deny how similar the two are in what most do on a day to day basis. NP's name is so well known it would be hard to change (never thought it was an issue until i saw another thread, but i think its not even a thought). PA's could change to physician associate because people would probably not notice, and i think it fits what they do better.

As far as both go, it seems with scope there is independence from physicians, and the extent to which they can practice medicine/nursing/whatever(another discussion). Here in the SC, PA's can practice medicine more freely (my impression) but must be in practice with a physician who has to be in the building a certain percentage, but the paperwork is hardly anything. NP's have freedom to see patients where they want, have do not have as much freedom to treat as they please, and have to follow protocols set out in collaboration agreement. I know its different in every state, so this discussion is not valid for everywhere (talking to you wyoming NP's) but i think the two groups should be discussed together.

I think both NP's and PA's are (for the most part) well educated and valuable to the community. I also think that NP's who trade independence to practice with an MD should have the increased scope(if they are trained) PA's have. Also, If a PA wishes to practice with more independently a collaborative agreement, it should be allowed, but with stipulations, such as not do things the PA would have done knowing there is a physician backing him/her up.

Any thoughts?

[AbeFrohman, BSN, RN]

Absolutely. NPs and PAs can come a lot further together than apart.

As for the PA name change, it would help PAs be taken more seriously by insurance, executives, and legislators. Many specialist PAs, many of which already own their own clinic, are shot down by banks for business loans, insurance reimbursement, or fight law makers because "how can an assistant employ their supervisor."

Furthermore, there are many states legislating for law changes to allow PAs to sign off on more forms and removing supervision requirements. This will allow for better access to care, and help PAs from getting left in the ditch. What happens to a PA when their supervisor decides to move or quit? They can't give so much as a flu shot. They are left out in the cold with no job. Is that fair? Supervision is currently being lobbied for removal by Northeastern U in Massachusetts. More than likely it will be replaced with something like Washington state has with "sponsoship" only and no need for strict supervision. Nursing needs to look into helping back these advancements for PAs because wins for one non-physician provider will help show our usefulness and strengths for all non-physician providers. What is good for the goose will be good for the gander.

[Psychcns]

I like the idea of trading independence for scope. I am a psych APRN. I can practice indep in NH. My certification is adult psych and in NH I am limited to adults. But if I go to MA I need a collaborator and if he or she is a child psychiatrist I can see kids.

Also agree APRNs and PA's should work together for independence and voluntary supervision to expand scope etc

[myelin]

I like the idea of trading independence for scope. I am a psych APRN. I can practice indep in NH. My certification is adult psych and in NH I am limited to adults. But if I go to MA I need a collaborator and if he or she is a child psychiatrist I can see kids.

Also agree APRNs and PA's should work together for independence and voluntary supervision to expand scope etc

Without any more training? Is the psychiatrist overseeing you seeing kids or something? It just sounds kind of weird to me, since you're not trained to see kids.

[zoidberg, BSN, RN]

yeah that seems like malpractice waiting to happen, treating psych disorders in kids as an adult psych provider,... .In SC if you are trained in child psych you have to have a child psychiatrist supervising collaborator.

[Psychcns]

I think with continuing education, collaboration, and supervised practice you can practice safely and effectively in an area you are less familiar with. At least that is my experience. Some states allow this and some don't.

[myelin]

I dunno, I would be really worried about treating a population I hadn't been trained to teach without direct supervision. I mean, I'm doing FPMHNP, so I guess it won't be a concern for me.

[SycamoreGuy]

Personally I think NPs need to be careful to not "get in bed with" PAs or the AMA anymore than they have to. Perhaps PAs should change their name to Medical Practitioner. As far as Independent practice goes, Im not sure I want a PA straight out of school opening their own practice but I think some of the more seasoned ones would be perfectly safe practicing independently. Maybe a mandatory 5 year supervised practice before independent practice would fix that.

[zoidberg, BSN, RN]

I agree. If anything PA's need to find a way to separate from the AMA (not likely, i know) so they and NP's can do better at working together. The current state of things makes cooperation difficult (annoying nursing politics + AMA = no progress)

[BlueDevil,DNP, DNP, RN]

I don't generally give much thought to my independent practice, I guess I just take it for granted. Last week I was catching up with a friend with whom I went to school who practices in a different state, and it is just shocking to me what some of my colleagues have to put up with elsewhere. The restrictions on NP practice around the country are mind boggling! I don't know that my family will never leave our current locale, but I do know I will never go to a state that doesn't recognize NPs as fully independent providers. I don't blame PAs for wanting out from under the yoke, either. They are exceptionally well educated and trained, and I can only imagine they are as frustrated as my old classmate.

Rising tides raise all boats. I don't know if or how they can get out from under the stranglehold they are under, but if we could help them, I think we should.

[harmonizer]

Personally I think NPs need to be careful to not "get in bed with" PAs or the AMA anymore than they have to. Perhaps PAs should change their name to Medical Practitioner.

I agree. PA are well-educated but their education is too general. If PA becomes independent, then there is no purpose of the specialty fields for NP (pediatric, acute care (ACNP), women health's, psych, and midwife). Maybe we'll just create a "Holistic NP" curriculum. I don't agree with independence without no specialized formal education in PA curriculum. Maybe after they establish residency in these areas. Maybe I just envy PA for changing specialty with no further formal training. They just have to find MD to supervise:) I think for this reason, PA should not be independent.

[zoidberg, BSN, RN]

Yeah perhaps the PA education is too general. What about PA's being allowed to be independent with a few years experience + only allowing independence in the primary care specialties? Then PA's can do their thing if they want, they can stay in a specialty with their doc if they want, and NP's still can do their thing, especially the specialties like psych and acnp, who are becoming so valuable.