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.

[Dranger]

C'mon we all have anecdotes. Just two nights ago I had a physician who apparently didn't know the difference between cardio selective and non cardio selective beta blockers. In addition they didn't even know the demarcation between b1/b2 fibers with regard to pharmakinetic action.

They were convinced flat out that beta blockers aren't given to people with reactive airway issues.

I'm surprised the students couldn't do a procalc but I have seen and heard equally stupid deficiencies with residents and even attendings.

50%? Where did you pull that number from?

[cayenne06, MSN, CNM]

I chose my educational path deliberately, and would choose it again with the benefit of hindsight. Of course, my case is slightly different because PAs don't seem to have much of a presence in my specialty.

I do, however, unfortunately agree with the previous posters who think that nursing education is sometimes a little light on the hard sciences. I think this fact is less true of ASN programs and NP programs, and more widespread in BSN and DNP schools. But it's definitely a problem. I remember spending a large amount of time on "nursing research" and "nursing theory," in my bachelor's. The more time i spent on it, the more annoyed I became. It was all a bunch of practically indistinguishable "theories of nursing care" or whatever, and long essays about why the "nursing model of care" makes us NPs so much more empathetic and caring and holistic than the docs we work with. Hour long lectures about a diagram that showed the different "circles of caring." Or whatever.

Please, nursing schools, a little less time with this self aggrandizing, and a little more attention on pathophysiology and pharm. There is plenty of incredible research being conducted by nurses, more than enough to fill our journals. Why is so much space given to these fluffy topics, that for the most part do not contribute to the actual practice of nursing?! And there is a dangerous trend toward more APRNs adopting/promoting pseudoscientific "alternative" medicines like homeopathy or naturopathy. To me, that speaks to a Deficit in Critical Thinking, related to lack of sufficient analytical science training in school, as evidenced by an NP friend of mine who recommends Oscillococcinum to his patients with suspected flu (or really even a sniffle). Pretty sure that diagnosis is NANDA approved.

[PG2018]

PA schools are better regulated and have historically required some level of healthcare experience prior to admission. The curricula is pretty nice and dances circles around anybody's NP classes. PAs have no true specialization although their slant is toward primary care although half of them seem to go to subspecs. They can do whatever they're trained to do to the extent the supervising physician feels comfortable. I'm not in a PA-rich area so I don't run into them much. All the hospitalist "midlevels" I know are acute care NPs with the exception of one who is actually a geriatric NP. In my state, the dept. of health (which regulates hospitals) states only physicians may admit patients to hospitals so even attending NPs have to have a physician come do an arbitrary exam and sign admission paperwork.

For the most part, NPs and PAs are used interchangably. You'll see more PAs in surgery because their curriculum is more procedural-oriented, and they rotate in surgery. NPs don't get this, and NPs are stuck in their "certification field." PAs can bounce between anything their doc will let them bounce in. For ERs, you'll find most PAs and NPs get the urgent care or fast-track side of the department regardless of experience or specialization. Despite the licensure and training, they're used laterally to each other. I've not known any ED PAs and FNPs who were or weren't allowed to do some given skill based on their cognitive abilities or psychomotor training.

[smd2521]

Nurses become nurse practitioners. If you don't want to be a nurse, then become a PA. 21 states and DC have COMPLETE independent practice for nurse practitioners. A big fat 0 for PAs remember that. Everyone in my class in NP school had 10yrs or more of RN experience. I for one was titrating multiple drips, chasing hemodynamics of critically ill patients on the verge of death for 12yrs before grad school. while most of theses PA graduating with 2 yr of training were still popping pimples deciding on a undergrad degree. I hate the PA vs NP argument, just take care of patients and stop the comparison.

[Goldenfox]

You are talking about two surgeons who have a particular opinion about nurses. Its a BIG old world of opportunities out here with many other surgeons who would disagree with those two. I say this from experience. If you are a nurse who wants to work in surgery as an NP then you supplement your career goals by getting OR and First Assist experience and credentials. You will do fine. If you are a PA, your clinical experiences will bring you to the same place. How much you learn as a student depends largely on how much you want to learn. The lectures and clinicals teach you the basics. You have to do a lot of extra reading and research on your own if you REALLY want to learn things. In other words, don't just learn the rationales and the outcomes, also learn the why's and the how's. It is that extra effort that will differentiate you from the run-of-the-mill student. And you might be surprised to find that you eventually get to know more that some of those same doctors who are knocking NPs. I've seen that, too.

What you hear depends on who you're talking to, and people do have their biases. I've known more than a few physicians who aren't all that bright and who do questionable things and make mistakes that, fortunately, are caught by the very nurses who they so love to put down. And I've worked with NPs who are as sharp as a razor. In many cases, its not so much about your title and education but more about common sense. I remember when I used to work in the trauma ICU at a level 1 teaching hospital how the doctors there used every opportunity to ridicule the NPs and CRNAs. And most of it was nothing but envy because those NPs and CRNAs were excellent clinicians. But, even within our own ranks you will find that there are those who love to put down NP education and NPs on the whole.

Don't think too much about it. If you have ER and med surg experience and you want to work as an NP in an ER then stay on your path. You're going to find that there are other physicians out there who will want to work with you.

[PG2018]

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.

Probably because NP roles are too niche oriented. I haven't noticed PAs having required critical care rotations. Conversely, many of the ACNPs probably wouldn't recognize OM or less likely OE. But those CC guys with their electronics and waveforms and drips are usually good -ology guys. Oddly enough most primary care guys are not.

[Rocknurse, MSN, APRN, NP]

Nurses become nurse practitioners. If you don't want to be a nurse, then become a PA. 21 states and DC have COMPLETE independent practice for nurse practitioners. A big fat 0 for PAs remember that. Everyone in my class in NP school had 10yrs or more of RN experience. I for one was titrating multiple drips, chasing hemodynamics of critically ill patients on the verge of death for 12yrs before grad school. while most of theses PA graduating with 2 yr of training were still popping pimples deciding on a undergrad degree. I hate the PA vs NP argument, just take care of patients and stop the comparison.

I can't like this post enough!

[Conqueror+, BSN, RN]

I used to work with a doc who LOVED NP's when he was talking to nurses and HATED them when he was talking to the medical director who was not fond of their existence. It taught me a valuable lesson. I have often wondered how he actually felt or if he had a real opinion at all.