NP or PA?

[nsc2x]

Hello,

I've been stressing about what I am about to explain to you for quite some time now and decided to come here for advice. I am currently a pre-nursing student in Tennessee and will apply to my college's nursing program in October. I have spectacular grades and have done well in all of my pre-req's. I'm also a CNA and have been for a little over a year. If I decide to graduate with a BSN I fully expect to apply to an NP program as quickly as I am able because I want education beyond a BSN. There is one issue however that is holding me back from wanting to be a nurse. The facility I work in isn't very pleasant, the lateral violence and "bullying" so to speak really sets a negative vibe towards nursing for me. I know hostility and lateral violence is a common problem among nurses and I am also aware that every facility is different. As a CNA I am treated poorly and I do not want this feeling of unimportance to carry on in to my nursing career as I know graduate nurses are often treated this way as well. The majority of nurses that I have encountered are very unhappy, stressed, mean, and just plain hateful. Are you all unhappy with your jobs that much? Do I need to second guess my career plans? Would you go back and do everything differently? Yes, I know it is a high stress job and burnout is a very real thing that happens. I genuinely enjoy patient care and bettering lives and have wanted to be in the medical field my entire life. From experience would you suggest a college student to redirect their career goals? My backup plan is to major in Biology-Physiology and minor in Chemistry and apply to PA programs. What are the pro/cons of NP vs. PA? I simply need advice and for someone to give me insight.

[MinneNurse, BSN, RN]

Sorry you're experiencing bullying at your job right now. Before I entered nursing school, I also worked as a CNA to gain some experience while completing my pre-reqs. There was a lot of aggression, drama, and bullying where I was worked as well and I did find it discouraging. I questioned if this was the right thing for me and if I would be miserable in the future (like I was at that point in time.) I ended up leaving that job and finding a job somewhere else within health care, and I am very happy both with school and work! I hope this current situation at work doesn't discourage you from pursuing nursing.

In terms of PA vs NP, I think part of that decision should come based off the state you plan to practice in and if you have an area you would like to go in. I understand your want to get your graduate degree after your BSN, because I too felt the same way. If I can give an additional word of advice, what I learned after entering nursing school is that what you think you want to go into might not actually be for you. So try to test the waters everywhere before you make that decision. Initially, I thought that critical care and ER was where I always wanted to be, but after working on floors like ortho and oncology, I realized how well I worked in that environment, which was something I never even considered before. Additionally, as many others have mentioned, many NP schools require a certain amount of time and experience working as nurse (and sometimes within particular specialties.) This might seem discouraging before you enter nursing school, but I believe there is an important reason behind that. I love nursing school but nursing school is just a piece of the pie and a lot of what you learn is from on the job training (beyond clinical.)

Good luck in nursing school and your future endeavors!

[New_Man_Nurse]

Hi,

Well a discussion I can relate to briefly however, eyes telling me no more no more!

I've just entered grad school and I have opted to take a Masters Generalist approach, take the "core" masters classes, get to know all my professors, see what opportunities I have presented. so far I have been asked to go overseas, work in cultural diverse populations like native Americans and the local dominant population. I can into the profession after 20 years or resistance to becoming a RN by the State I lived in, my own family's cultural bias and now at over 50 yrs, well here I am.

So NP or PA, there go hand in hand. NP's make about 85% generally then physicians do, because the ACA, CMS, and AMA all have continued to erect barriers to the well trained NPs independence. But NP's are not PA's, nor are they physicians. However, there is plenty of data that a NP may be a viable "substitute" for physician, citing equally quality outcomes (for treatments and Dx's that NPs are within scope to treat), additionally, safety, quality, and patient satisfaction seems to be higher when a NP is the PCP. There is also evidence that NP's may not be as cost efficient as thought previously, this is due to slower consult, assessment times, and NP's tend to order more tests, and are just slower when presented with a acute care decision. The good news is that is likely to go away as NP's and PA's acquire more clinical experience (Naylor & Kurtzman, 2010).

Practice restrictions are an issue for the NP, and those vary from place to place, State to State, and hospital to hospital, but there is a move toward a greater reliance on the NP, and this trend isn't diminishing especially in rural areas and public home nursing.

If a NP practices with a MD, and the MD does what is called a face-to-face before the patient is treated by a NP, and collaborative team, then the MD's provider number can be used as the billable # and 100% reimbursement is the reward. Otherwise a NPs billing number can be used just the same for less CMS monies. Except where the scope is exclusively NP then 100 % reimbursement may be had for that DRG cluster, and subsequent episodes are billed as you know at a higher rate (Naylor & Kurtzman, 2010).

Many of the problems of independent verses supervised practice are a result of the legal aspects not being worked out completely as of yet. You might want to take a look at this article I will attach if I can, and have a good personal moment. I have been treated stereotypically as a male since hitting the floor, hospitals didn't want to hire, (4.0 GPA) for last 10 years, excellent skills, but forced to go work in areas that were difficult for new grads typically. So just because the market isn't friendly here where I'm located isn't going to stop me from reaching a terminal degree before I'm 70, even if from the day I sat for my first lecture it's been an uphill battle. This is a life long journey for me. Others will give up, or just find a little place to practice and ignore the substandard mission, and estranged MD's, and pocket the cash. I became a RN as a lifelong desire to promote the profession, and change takes planning, teamwork, and cooperation between disciplines. Does that sound like the kind of country you want? No, and some of us will have to step up on occasion and be educated, and work to promote a better triple aim for this "health care system".

It is truly up to the individual, so best wishes, I hope you find the thing that make your days brightest!

Reference

Naylor, M. D., & Kurtzman , E. T. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899. Retrieved from The Role Of Nurse Practitioners In Reinventing Primary Care.

[AlwaysLearning247, BSN]

I am sorry all you have seen is hostile nurses, that is not what nursing is like everywhere. I would certainly not let that discourage you from choosing nursing. There are tons of other places to work. In my opinion I would choose to be an NP. Where I live in MA, the NPs are more independent. All the PA's I see here need to work with a physician and have them sign off on everything they do. If you are into surgery and stuff like that being a PA may be more for you. For me I like the aspect of being a family nurse practitioner one day. It really depends on your personal preference. I would try watching youtube videos on "a day in the life of a PA or NP" so you will have a better understanding. It also helps to ask fellow colleagues, I did that in the hospital I worked at as a CNA and it made my decision more clear. Good luck!!

[JenWork]

You have to get your feet wet. You can work different areas of nursing. And before you're an NP you must have nyrsing experience and judgement to diagnosis, perform assessments, and treatments. And most nurses honestly are more than willing to help new grads out and if you ask they will teach you. That's what I've experienced being a new nurse. You might just work with some unhappy people.