NP vs PA vs CNS

allnurses Guide · Jul 1, 2013

Hi,

I hope I can help, but please remember this is only one person's opinion and I certainly don't know it all! All of the degrees you're considering may take about the same amount of time. I have heard (and seen in my part of the country), that CNS programs and positions are being phased out. I know that the position of CNS was entirely eliminated at the mid sized community hospital I previously worked at, unfortunately. I don't know if that's true nationwide. PA vs. NP-different educational model, but there's often a lot of overlap in the actual jobs both professions do. I'd ask myself some questions first. What do you see yourself doing? Inpatient vs. outpatient, surgical vs. medical, primary care vs. specialty, adults vs. peds vs. family?? Will your current employer help pay for school if you continue to work while you're in school? The answers to these questions might help you determine which route and school is right for you.

Take a look at the AANP (www.aanp.org) and AAPA (www.aapa.org) websites to get a good overview at both professions (NP and PA). Best of luck to you, whatever you decide.

Medic2BSN13, BSN, RN · Jul 1, 2013

I have little input on the CNS portion of your question as I have not worked with any or know any in my area. I will agree with the previous poster in that while the educational models are different, there is overlap between the functions of the NP and PA professions. I have worked with both NP's and PA's in the past and have had a good experience with both professions thus far. In regards to your comment about going to NP school for 4 years, that can vary on the type of program and your course load. There are still many schools offering the MSN option and you do not have to attend school full-time while completing an NP degree. This is a polar opposite to PA schools where PA schools are all full-time with more clinical hours than NP schools offering an MSN. You will be able to work while in NP school versus being a full-time student in PA school. This could help financially as you earn an advanced degree without taking a great deal in loans. Just my two cents.

IcySageNurse · Jul 2, 2013

CNS is being phased out for the most part, and in many states the term CNS isn't even legally protected.

As for NP vs PA:

Everyone (especially here) will tell you to become an NP because of the "autonomy." While this sounds good on paper, it really only comes into play if you open your own office or contract. The overwhelming majority of NPs work in the exact same setting as a PA - that is, in a hospital or under a physician in a private office. In both of these cases, the autonomy aspect doesn't matter, and for the most part the PAs and NPs will both be able to function similarly.

Education between the two, however, is vastly different. I wanted to be an NP - but I looked into the curriculum. Over half of the classes are fluff and theory. Very little medicine is involved. No gross anatomy, immunology, etc. One pharmacology class, many of which are taught using undergraduate textbooks. PA school on the other hand is practically medical school lite - many of the same classes, all clinically relevant, little to know theory or fluff.

If you do NP, if you want a solid education, you must go to a reputable school with a strong curriculum, and percentage-wise there aren't that many compared to the fully online, for-profit schools. PA school is much more standardized and you will likely recieve a much better education.

HM-8404, BSN, RN · Jul 2, 2013

I believe the OP meant going to NP school will take 4 years because he has a non-nursing BS. To qualify for NP school he would have to get BSN first.

One downside to the PA program is every 6 years you will have to take a recertification exam to keep your license.

I have little input on the CNS portion of your question as I have not worked with any or know any in my area. I will agree with the previous poster in that while the educational models are different, there is overlap between the functions of the NP and PA professions. I have worked with both NP's and PA's in the past and have had a good experience with both professions thus far. In regards to your comment about going to NP school for 4 years, that can vary on the type of program and your course load. There are still many schools offering the MSN option and you do not have to attend school full-time while completing an NP degree. This is a polar opposite to PA schools where PA schools are all full-time with more clinical hours than NP schools offering an MSN. You will be able to work while in NP school versus being a full-time student in PA school. This could help financially as you earn an advanced degree without taking a great deal in loans. Just my two cents.

elkpark · Jul 2, 2013

I believe the OP meant going to NP school will take 4 years because he has a non-nursing BS. To qualify for NP school he would have to get BSN first.

Not necessarily true -- there are NP programs that take nurses without BSNs (there are programs that take RNs without any baccalaureate degree at all). The OP would not have as wide a selection of programs to choose from, but would certainly be able to find a program.

IcySageNurse · Jul 2, 2013

One downside to the PA program is every 6 years you will have to take a recertification exam to keep your license.

A consider this a plus. Again, it proves more lax standards for NPs vs PAs. I do not consider faster time to completion, less studying, fewer or easier licensing exams, less clinical time, etc to be an asset of the NP education as many others do...in fact, the opposite.

mahaandai · Jul 2, 2013

For some reason my PA friends are having a tough time to get jobs in primary clinics and hospitals, whereas all of my FNP friends have landed in $95000 - $100000+ job offers. Not sure why...

lamazeteacher · Jul 3, 2013

Icy Sage Nurse's comment regarding superiority of PA v NP is erroneous. Having to recertify every 6 years doesn't come near to the requirement RNs have, for 30 hours of approved continuing education, every 2 years!

There is much information about both disciplines that isn't known by those in healthcare professions. To begin, a PA is strictly doctor originated and run. That's why it's regarded as mini-med school. The emphasis is on medical care only, without interfacing with nursing. Graduates function as time savers for physicians.

Nurse Practitioners need to have performed nursing care, and therefore they are more patient oriented, and know more completely how likely it is that patients will comply with their treatment plan. More time is taken to collect and evaluate patients' past histories, assess their conditions and discuss a plan of care with them that is based on their ability to carry it out.

Unfortunately employers of both disciplines have little appreciation of the above nuances. PAs, like physicians, have a more "cookie cutter" approach, treating the illness primarily. Nurses are taught more about patients' abilities to cope and cooperate. As one poster indicated, PAs focus on their success monetarily, similar to doctors. The bottom line is "what am I getting, rather than how much am I contributing to patients' wellbeing.

core0 · Jul 3, 2013

Icy Sage Nurse's comment regarding superiority of PA v NP is erroneous. Having to recertify every 6 years doesn't come near to the requirement RNs have, for 30 hours of approved continuing education, every 2 years!
There is much information about both disciplines that isn't known by those in healthcare professions. To begin, a PA is strictly doctor originated and run. That's why it's regarded as mini-med school. The emphasis is on medical care only, without interfacing with nursing. Graduates function as time savers for physicians.
Nurse Practitioners need to have performed nursing care, and therefore they are more patient oriented, and know more completely how likely it is that patients will comply with their treatment plan. More time is taken to collect and evaluate patients' past histories, assess their conditions and discuss a plan of care with them that is based on their ability to carry it out.
Unfortunately employers of both disciplines have little appreciation of the above nuances. PAs, like physicians, have a more "cookie cutter" approach, treating the illness primarily. Nurses are taught more about patients' abilities to cope and cooperate. As one poster indicated, PAs focus on their success monetarily, similar to doctors. The bottom line is "what am I getting, rather than how much am I contributing to patients' wellbeing.

Do you actually have experience with any of this? The awesome 30 CE requirement, does that apply to every state? You are also assuming that PAs don't have CME requirements (it would be 50 per year for your information). If you are making generalization you should have something to back it up.

IcySageNurse · Jul 4, 2013

CME is not nearly as intensive as a full recertification exam. I have Medscape on my phone and can usually get 2-3 CME with an hour investment reading articles and answering questions.

I think it's rude and bizzare to assume PAs and MDs only care about money, while NPs are some heavenly saints that would work without salary if they could. Everyone cares about money to some extent, and most providers (of all types) care about their patients just as much.

I may become an NP in the end, but I respect the PA profession a great deal. They have worked much harder to standardize their profession, and the classes they offer combined with the massive clinical hours is far above most NP programs. They teach skills in person and do not allow online programs so prevalent in nursing.

Here's the curriculum for the PA program vs the NP program at Stony Brook University (well regarded for both PA and NP).

PA:

[TABLE]

[TR]

[TD]

HBA 561 Human Gross Anatomy
HAP 504 Professional Practice Issues

[/TD]

[/TR]

[TR]

[TD]Fall[/TD]

[TD]

HBY 501 Human Physiology
HAP 512 Principles of Clinical Pharmacology (continues in the Spring)
HBP 511 Pathobiology (continues in the Spring)
HAP 510 Clinical Laboratory Medicine
HAP 514 POMR: History & Physical Examination
HAP 516 Problem Based Learning (PBL) (continues in the Spring)
HAP 518 Medical Director Presentation Rounds (MDPR) (continues in the Spring)
HAP 521 Clinical Medicine I
HAP 528 Genitourinary, Sexual and Reproductive Health
HAP 532 Diagnostic Imaging
HAP 551 Research Design and Evidence-Based Medicine

[/TD]

[/TR]

[TR]

[TD]Spring[/TD]

[TD]

HAP 522 Clinical Medicine II
HAP 523 Clinical Medicine III
HAP 524 Clinical Medicine IV
HAP 534 Introduction to Clinical Psychiatry
HAP 545 Ethics and Health Care
HAP 540 Clinical Prevention and Population Health
HAP 549 Clinical Skills

[/TD]

[/TR]

[TR]

[TD] [/TD]

[/TR]

[TR]

[TD] [/TD]

[TD] Year II

[/TD]

[/TR]

[TR]

[TD]Summer[/TD]

[TD]

Clinical Clerkships 1 and 2
HAP 561 Masters Project I

[/TD]

[/TR]

[TR]

[TD]Fall[/TD]

[TD]

HAP 562 Masters Project II
Clinical Clerkships 3 - 5

[/TD]

[/TR]

[TR]

[TD]Spring[/TD]

[TD]

HAP 563 Masters Project III
Clinical Clerkships 6 - 10

NP:

[TABLE=class: threeCol]

[TR]

[TD=class: leftCol]

[/TD]

[TD=class: middleCol]

[TABLE=class: sonTableBorder]

[TR]

[TH]Graduation Requirements [/TH]

[TH=align: center] Credits[/TH]

[/TR]

[TR]

[TH=colspan: 2]

Core [/TH]

[/TR]

[TR]

[TD]HNG 519 Advanced Theory & Clinical Practice in Adult Health Nursing I[/TD]

[TD=align: center]4[/TD]

[/TR]

[TR]

[TD]HNG 529 Advanced Theory & Clinical Practice in Adult Health Nursing II[/TD]

[TD=align: center]5[/TD]

[/TR]

[TR]

[TD]HNG 539 Advanced Theory & Clinical Practice in Adult Health Nursing III[/TD]

[TD=align: center]5[/TD]

[/TR]

[TR]

[TD]HNG 549 Advanced Theory & Clinical Practice in Adult Health Nursing IV[/TD]

[TD=align: center]5[/TD]

[/TR]

[TR]

[TD][/TD]

[TD=align: center]19 (minimum)[/TD]

[/TR]

[TR]

[TH=colspan: 2]

Graduation Requirements By Individual Advisement (Gap Analysis)[/TH]

[/TR]

[TR]

[TD]HNH 504 Quality Improvement, Safety, and Health Care Technologies[/TD]

[TD=align: center]3[/TD]

[/TR]

[TR]

[TD]HNH 505 Health Policy and Advocacy[/TD]

[TD=align: center]2[/TD]

[/TR]

[TR]

[TD]HNG 515 Advanced Health Assessment [/TD]

[TD=align: center]3[/TD]

[/TR]

[TR]

[TD]HNG 540 Pharmacology[/TD]

[TD=align: center]3[/TD]

[/TR]

[TR]

[TD]HNG 588 Pathophysiology Across the Lifespan[/TD]

[/TR]

[/TABLE]

[/TD]

[/TR]

[/TABLE]

[/TD]

[/TR]

[/TABLE]

kguill975, MSN, APRN, NP · Jul 4, 2013

Getting back to the OP question:

If you need to work part-time or full-time while in school, it's only possible with NP. You may be able to work per diem in PA school, but I don't know. (Any PAs can chime in on this?)

I honestly would have gone the PA route, only because of the surgical rotations involved in their programs. As of now, there are a few NP programs that are now offering surgical rotations as well. If you're considering a surgical specialty, then it may be a good idea to look into PA programs, but if not, there's no real difference between the two roles.