NP autonomy in the ED setting

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As an FNP student, I have had the opportunity to spend a signifigant amount of my clinical time in the ED setting- mainly with NP's and PA's. I am considering going into the ED post graduation but have noticed that NP's in this role seem to have less autonomy than those that I have worked with in the primary care or other specialty areas. Is this just the ED's that I have been in or is this true in all Emergency Departments?

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How do you mean? I work in the ER and work basically independently seeing mostly lower acuity patients. If there are a lot of higher acuity patients sometimes I will see some of those as well and then will confer with a MD on their care/tx. There's nobody looking over my shoulder or anything..

This is a rural ER though, so maybe its different in big cities?

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Specializes in Emergency, MCCU, Surgical/ENT, Hep Trans.

Big city here...autonomous as much as I can stand it :)

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Maybe this is particular to that ED or your area? I work in an extremely busy "county" hospital. We work independently and just confer with our attendings when needed. Very independent setting here!

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Specializes in Plastic Surgery, ER.

I am a new FNP graduate and have been paying more attention over the last year to the PAs in the ED I work in. I am interested in the ED/urgent care setting too. Like the OP, I see that the doc's all physically see and co-sign all the patients/charts that the PA signs up for, even if it's a simple toe injury! This seems much different than what I experienced in the office setting as a student. While having the docs there for advice/mentoring, I'm not sure I'd like having to wait on the doc to see my patients before I can discharge. Sometimes this really ties up rooms and keeps patients waiting.

I've heard 3 versions as to why this set up is this way...not sure which is the true answer: I'm told by some that the MDs can 'charge' more by doing this. I'm told by others that the MDs simply are CYA. And one other person told me they thought this was just how EDs and midlevels are supposed to be set up...???

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Specializes in FNP.

I have worked as a RN in 2 different EDs recently. In one the NPs had as much autonomy with sniffles and back aches as their little hearts desired, but never got near an acute abdomen, chest pain or anything marginally interesting. In the other ED, there was no physician, so the NP handled everything. So, in my experience it depends upon the institution.

(We don't have any PAs here)

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Specializes in Critical Care, Orthopedics, Hospitalists.

Yup, depends on the institution and the rules / comfort level there. One facility I know of required the MDs to cosign everything, notes / scripts / etc. Very time consuming, especially considering my state requires MDs only to cosign on 10% of NP charts. Another place was more "call if you need me" kind of a setting (which I prefer!).

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Hi All -- I have a question along these lines. I have recently been admitted to both a PA school and a direct entry BS/MSN-FNP program, both at great institutions. The MSN-FNP program is WAY more expensive (tution is like $100,000 rather than $25,000) than the PA program. Both are about 2.5 years.

My interests lie in emergency medicine. Firstly, is a FNP license suitable to work in the ER or do folks find that ER's prefer an ACNP? Secondly, am I more likely to get a job in the ER with a FNP or a PA license? I have worked as an EMT and an ER Technician in the past.

Thanks. I've got a big decision I have to make very soon!

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Hi All -- I have a question along these lines. I have recently been admitted to both a PA school and a direct entry BS/MSN-FNP program, both at great institutions. The MSN-FNP program is WAY more expensive (tution is like $100,000 rather than $25,000) than the PA program. Both are about 2.5 years.

My interests lie in emergency medicine. Firstly, is a FNP license suitable to work in the ER or do folks find that ER's prefer an ACNP? Secondly, am I more likely to get a job in the ER with a FNP or a PA license? I have worked as an EMT and an ER Technician in the past.

Thanks. I've got a big decision I have to make very soon!

I am inclineed to say go to the PA-C program based on your stats, the relative cost of both programs, and your desire to work in the ED.

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I am inclineed to say go to the PA-C program based on your stats, the relative cost of both programs, and your desire to work in the ED.

I should also mention that I have interests in primary family care too. But the ED still beckons me. Thanks for your input.

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Specializes in Critical Care, Orthopedics, Hospitalists.

Agreed, a PA would cover all of the roles you are interested in! The nice thing about the PA is that it's pretty broad in scope - kind of like the BSN is. You go to clinicals in a variety of settings and come out as a type of generalist able to work anywhere. The ER and primary care are similar in a lot of ways, so you could easily bounce from one to the other IMO.

The good thing about the NP is that most NPs are experienced nurses who have a good idea what they want to do. If you were a nurse already, I'd tell you to go the FNP route.

I'd go with whichever program is cheaper! LOL - where I live, the NP is about $15-20K and the PA is $150k, not the other way around!

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Hi Christen -- I'm not allowed to send private messages (not enough posts). I asked you a few questions in this thread. Check it out and respond if you have the opportunity: https://allnurses.com/nurse-practitioners-np/pa-to-np-530712-page2.html

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