NP v. PA

[eacu]

OK so I am in my residency training class yesterday and we are talking to an ortho surgeon and a colorectal surgeon. A new grad nurse, like myself, asks why there are so many PA's and only one NP working in the hospital. They state it was a mandate by the physicians due to the model of their schooling to only hire PA's. They found NP's needed much more Medical training after school than the PA's did. Has anyone else seen this in their hospitals? I am starting RN-BSN-FNP in january and I really dont want to study FNP then not be able to get a job in a hospital preferrably an ER. I am currently on the waiting list to transfer to the ER here from medsurg so the experience will be there just need the degree.

[Seaofclouds, BSN, RN]

I see lot of NPs in my hospital, but many of them are being told they need to go back for their acute care NP certification to remain in the hospital.

[muirite]

I think it depends on location. I am from an area where it is equally divided between the two. Where I live now it's all about NP. New grad NP makes almost as much as my PA SO with almost 4yrs experience. NP are unionized up here and they get much better benefits and working conditions in the same hospital.

[TheCommuter, BSN, RN]

They found NP's needed much more Medical training after school than the PA's did.

Well...PAs are educated on the medical model of care provision, whereas NPs learn the nursing model. With that having been said, of course NPs might need to catch up on the 'medical' model of diagnosing and treating.

[AndersRN]

PA is legit.... A lot of NP schools are bad. My cousin (an internist) who has precepted both NP/PA told me he will never hire a NP because the quality of most of these students is not good...

[Dranger]

PA is legit.... A lot of NP schools are bad. My cousin (an internist) who has precepted both NP/PA told me he will never hire a NP because the quality of most of these students is not good...

I think it depends really. From a RN perspective working in an ICU I have found our ACNP hospitalists and those that work in the ICU a lot more competent than the PAs.

I have never worked outpatient so I can't comment on that. I do agree that there is a proliferation of poor NP programs that need to be cracked down on though.

[Palliative Care, DNP]

I'm graduating in May from a BSN to DNP program in May. If I were beginning today then I would go the PA route. Having experienced my curriculum I would have preferred the medical model but that's my opinion. I can also say having witnessed new grad PAs and NPs the PAs hit the ground running. It takes a new grad NP a while to catch up.

[AndersRN]

I'm graduating in May from a BSN to DNP program in May. If I were beginning today then I would go the PA route. Having experienced my curriculum I would have preferred the medical model but that's my opinion. I can also say having witnessed new grad PAs and NPs the PAs hit the ground running. It takes a new grad NP a while to catch up.

The DNP is a scam...

[Bluebolt]

A Physicians Assistant is taught with the medical model because they have no required clinical experience or knowledge before their program begins. They have two years to go from layman with an undergrad in history or biology to prescribing and diagnosing. This method of learning is similar to medical school because when you start med school you're essentially a layman as well usually. Their clinical knowledge and application is relatable to what a 1st semester nursing student would be, which is mostly nothing useful.

I made an A in Micro, Chemistry, Biology and Advanced A&P, Human Dissection etc, but when nursing school started I had no idea the difference between the bell and diaphragm on a stethoscope and what Lasix did in the human body. That's just an example of what I mean when I say no useful clinical knowledge or application, we all start there, no judgement.

NP programs are taking in a student who already has gone through 2 years of medical training with clinical rotations and most likely years of post graduation professional practice. Yes of course nursing school is not the exact same as med school and the learning style is more on the patient as a whole, but certainly still including the disease process, medications and treatments in depth. What NP school does is refine your focus to include the role of diagnosing (even though most good nurses already diagnose in our heads often) and being responsible for the exact prescription. After a few years of practice a good nurse can look at an elevated heart rate and know that typically metoprolol works well in this patient population but NP school will help you go more in depth, you'll learn the exact reason why, the specific milligram recommended for the desired effect and KG of the patient, possible alternative meds to use, etc. Also NP programs usually incorporate the nursing "holistic" or whole patient approach that incorporates medicine but also many other methods of treatment. It stresses that the patient is more than a diagnosis or a pill receptacle for the cellular process you've identified. By the time an NP is practicing they should have a minimum of 4 years of medical training including clinical rotation and who knows how many years of professional healthcare practice. MD's who discredit their NP counterparts will stress that the four years of education and clinical practice is useless and not as good as the 2 years of a PA's school but a smart person would ignore the bias commentary.

A PA is like the little brother to the MD. They are literally trained to be their assistant and are only licensed to practice under that MD's license. MD's pick on their little brother all the time, abuse them, make them do all their grunt work but at the end of the day they'll defend their little brother against this newcomer NP with a different educational background model who has their own license to practice.

Honestly in practice I've worked with lots of MD's, PA's, NP's and RN's. Each of these groups have some spectacular, average and below average types of people in them. All of these groups have endless amounts of resources for knowledge and growth at their fingertips and what makes the above average and excellent ones stand out is they seek out knowledge and are always growing clinically.

[AndersRN]

Anyone who thinks nursing school teaches anything in depth has no idea what he/she is talking about.

[Bluebolt]

Anyone who thinks nursing school teaches anything in depth has no idea what he/she is talking about.

Hah, speak for your own program only please. Obviously your supposed nursing program you claim to have attended was inadequate and you "somehow" managed to pass boards as your RN on your online screename suggests. I've never met a nurse going through their program who ever felt like they weren't receiving an extremely rigorous and in depth education. Over the years I look back and it doesn't seem as bad in retrospect but honestly, it's just the time that dulls the pain.

Most nurses probably dump about 50% of the things you're required to learn during the program and use the 50% that's relevant to the specialty area they end up working. For instance every nurse probably learned the pulmonary assessment method Egophony but has probably forgotten it due to never really using it. There are many NP/PA's and MD's who have said similar things to me about their education.

Besides, the term in depth is a relevant term in these contexts and I'm sure no matter what is said you AndersRN will argue that only Med school/PA is in depth and nurses are dumb poopyheads because you say so of course. I'm not interested in discussing it with you.

[AndersRN]

When over 50% of nurses can't do a simple dimensional analysis problem i.e. procalc, of course people (not me) would call them poopy heads. You can choose to believe whether I am a RN or not, or my school was not rigorous or whatever. I believe nursing education should change. They should stop accepting poopy heads (your words) who give the profession a bad name. They should incorporate more science into the curriculum... It's embarrassing tutoring some of these people! These are the people who will be in charge of patients' lives. Thanks God the system has so many checks!