Nurse Practioner vs Doctors

Flare, ASN, BSN · Dec 9, 2008

Have you ever considered becoming a physicians assistant?

IcanHealYou · Dec 9, 2008

Hey Firefighter,

I thought about it but I believe NP's are able to practice without being under a doctors license. Although I still don't have a firm understanding of the difference between an NP and PA.

GilaRRT · Dec 9, 2008

PA's are typically educated under physician guidance, while NP's are typically educated under NP guidance. Both clinicians are considered midlevel providers. NP's typically specialize in a specific area such as family, psych, and neonatal, while PA's are a bit more generalized. (At least initially.) In many areas NP's can set up their own practice.

However, the bottom line being, both types are similar in that they are considered midlevel providers.

Personally, the PA route is a bit more appealing.

blondy2061h, MSN, RN · Dec 9, 2008

Personally, the PA route is a bit more appealing.

Why's that, when NPs have more independence, and the OP is already well on her way to a BSN?

GilaRRT · Dec 9, 2008

I would not want to work independently. I would always want to work with a physician. In addition, I really like the clinical experiences that many of the PA students go through. It seems they have a very intense clinical experience and spend that time working closely with physicians. I have even looked at a few programs that offer an elective rotation in other countries.

IcanHealYou · Dec 9, 2008

Why's that, when NPs have more independence, and the OP is already well on her way to a BSN?

Her way? Imma dude lol

Anyway, no one has really answered my question yet =/

GilaRRT · Dec 9, 2008

I think it has. NP's are mid level providers. They fill a vital role; however, a NP is not a physician. If you want to be a doctor, go to medical school. If you want to apply nursing practice at an advanced level, NP may be your ticket.

I think FNP is a wise choice. You will have a bit more freedom in caring for a variety of patients through their life span.

tryingtohaveitall · Dec 9, 2008

There's also ACNP for an ICU setting. That's more what I'm hoping to do when I finish my AC-PNP degree.

IcanHealYou · Dec 9, 2008

I think it has. NP's are mid level providers. They fill a vital role; however, a NP is not a physician. If you want to be a doctor, go to medical school. If you want to apply nursing practice at an advanced level, NP may be your ticket.
I think FNP is a wise choice. You will have a bit more freedom in caring for a variety of patients through their life span.

Thanks. Would you happen to know where I can find an exact layout of what an NP can do? I've only found general information like being able to prescribe drugs, diagnose, and do some surgeries like sutures? I just want to know where the limit is for an NP.

I would like to know specifically what drugs NP's can prescribe, the types of diagnoses they are able to make. Specifics. Thanks in advance.

Advanced Practice Columnist / Guide · Dec 9, 2008

Ken,

I saw your post in the NP forum. Funny, you did not get any response there but got some responses here. Let me tell you my thoughts as a nurse practitioner:

Nurse Practitioner Scope of Practice varies between states. The best way to find this information is to refer to the individual states. In majority of states, the Board of Nursing defines what a nurse practitioner is alllowed to do but in some states, the Board of Medicine and the Board of Nursing jointly regulate nurse practitioner scope of practice. There is a diagram floating around the internet that gives a list of states where NP's can independently practice. I am not going to post a link of that here only because laws change and NP "independence" is a concept that is poorly understood and never really well explained. However, an annual publication called the "Pearson Report" is available online and does give some degree of detail of state-by-state regulations on NP practice. This information can be accessed here: http://www.webnp.net/downloads/pearson_report08/ajnp_pearson08.pdf. Again, your state BON should be able to give you the details on how NP's practice in your state of residence or any other state you intend to practice in.

Board of Nursing rules alone do not guarantee full independence in practicing as a nurse practitioner. Be aware that like other professionals, health care providers including physicians, NP's, and PA's depend on revenue. It matters how one earns one's buck because that's how you earn a living. Currently, NP's as healthcare providers are eligible for a National Provider Identification or NPI number. This allows NP's to reimburse Medicare and Medicaid for their services to patients insured by these government-funded insurance carriers. However, the Centers for Medicare and Medicaid Services requires that all NP's have a written collaborative agreement with physicians. This document basically outlines what kinds of services the NP will provide, protocols for decisions on consultations or physician referrals, as well as periodic review of the NP's charts. There is also a Medicare rule that all hospitalized patients be under the care of a physician.

The above only applies to Medicare and Medicaid. Private insurrance carriers vary on their rules as far as empanelling NP's in the provider role and how much physician oversight is required although many follow Medicare and Medicaid rules. But my point is that this clearly shows that although some states do allow for NP's to be totally independent, there are federal and insurance laws that does make it so that NP's depend on a physician to maintain a practice. Despite these barriers, you will definitely see some NP's hanging their own shingle and owning their own "independent" practice. The key is to get around these administrative rules. Independently practicing NP's can always hire a physician to fill the role in the above requirements. The law does not state that the physician is physically present at all times.

Similarly, PA's have also been able to get around the rules and have also established "independent" practices on their own. They are also empanelled as providers by Medicare and Medicaid and are subject to almost the same rules. The difference is that instead of requiring a collaborative agreement, PA's are required to be under the supervision of a physician. In the same manner, the physical presence of the supervising physician is not required at all times.

Finally, I also would like to point to you the difference in educational models for both NP's and PA's. NP's are advanced practice nurses who are trained in a specific advanced nursing specialty that combines aspects of the medical model specific to the specialty and the nursing theories that govern the specific population of patients the NP is trained to treat. For instance, as an Adult Acute Care Nurse Practitioner, I am trained to provide care to acute and critically ill adults in a variety of settings. A Family Nurse Practitioner, on the other hand, is trained to provide primary care to patients across the life span from infancy to old age. However, their training does not involve care of acutely or critically ill patients. Some NP's who actually have multiple specialties to their credit have attended more than one nurse practitioner program in order to expand their scope.

Physician assistants are trained as generalists. PA-C programs are the same across the board regardless of what degree is granted in the specific program (Associate's, Bachelor's, or Master's) although there are a few heavily surgical PA training programs. PA-C training involves rotations in all branches of medicine including surgical rotations. In clinical practice, a PA-C's scope is dependent on what the scope of practice of their supervising physician is as this basically determines what the PA-C is allowed to do.

highlandlass1592, BSN, RN · Dec 9, 2008

Thanks. Would you happen to know where I can find an exact layout of what an NP can do? I've only found general information like being able to prescribe drugs, diagnose, and do some surgeries like sutures? I just want to know where the limit is for an NP.
I would like to know specifically what drugs NP's can prescribe, the types of diagnoses they are able to make. Specifics. Thanks in advance.

Why not look at the practice act for NP's inthe state you want to practice? Seems like some of your questions would be best answered straight from the horses mouth. Also, I'd direct youto the advanced practice forum here for more input.