Nurse Practitioner vs Physician Assistant

nomadcrna, DNP, CRNA, NP · Jan 8, 2011

What you are forgetting is that the FNP builds on a prior nursing education and years of experience while an accountant can go to PA school.

After working with many PA and NP, I find any differences to be the person and not the title.

If you know of any states thT limit practice, post them but please don't "think" there are some. :)

Ron

FNP and PA are the most similar and FNPs get the most "rounded" education out of all the NPs, but still after looking at side to side comparisons, PAs will recieve more "rounded" education in more specialties than an FNP for example. I'm not in any way putting down NPs, infact my girlfriend (soon to be wife:rolleyes:) is an FNP, but for the sake of dexterity, I've looking into this and while an FNP does rotations pertaining to primary care and some specialties throughout ~1000 hours, PAs rotate through all the major specialties, including primary care, throughout ~2400 hours and their didactic/clinical education is IMO, more rounded in thorough. Regardless, I think FNP is the way to go, being a nurse as well, not to include the fact that PAs generally have to ALWAYS work under a doctor, while a NP can open up their own clinic and have more independent for advancement. I think states that limit FNPs ability to practice acute care medicine is probably because some FNP programs only have ~100-200 hours in acute care and if acute care is the preference, then an acute care NP program would be better suited.

physio · Jan 8, 2011

This hasn't taken into consideration the approximately 1875 hours of acute care experience as an RN that is required to get into an NP program that PAs probably do not have.

Not true. The average PA student had >41 months of medical experience, I'll cite the source and exact figures when I get home but gross generalizations like such are not well intended. I respect both NPs/PAs and NPs have the advantage of the RN, which is important, but PAs generally come from medical backgrounds as well, sometimes even prior nurses. My girlfriend went to a direct-entry program with her only experience as a medical scribe, which this isnt the norm, saying its required is a gross-generalization. Both get adequate medical backgrounds on average, I cannot speak to the exceptions to the norm stated above.

nomadcrna, DNP, CRNA, NP · Jan 9, 2011

You are correct. Various schools cite different lengths of medical experience but it appears to be 3-4 years. Some RNs go to PA school but the majority of experience appears to be EMS.

In any case, I think a person would be happy with either route. As I said before, there really is not much difference in actual practice. I've seen good and bad in both the PA and FNP camps.

I fully support independent practice for PAs as well. I would bet with the changes coming in healthcare, PAs will attain independent practice and NP will get independence in the states that require collaboration now.

ImThatGuy, BSN, RN · Jan 9, 2011

This hasn't taken into consideration the approximately 1875 hours of acute care experience as an RN that is required to get into an NP program that PAs probably do not have.

Yes, but don't discount that many (most) PA students have been healthcare professionals in other disciplines. Respiratory therapists and paramedics often make up the lot, but you'll find a many nurses in the mix as well along with surgical techs and some others. NP students aren't the only one on the mix that have worked in healthcare prior to advancing their education.

True, there are PA programs that don't require previous experience, but there are NP programs out there that are the same.

nomadcrna, DNP, CRNA, NP · Jan 9, 2011

I agree with most of this post except the last part. :)

To go to a NP program, you MUST be an RN, hence you have experience. :)

Ron

Yes, but don't discount that many (most) PA students have been healthcare professionals in other disciplines. Respiratory therapists and paramedics often make up the lot, but you'll find a many nurses in the mix as well along with surgical techs and some others. NP students aren't the only one on the mix that have worked in healthcare prior to advancing their education.
True, there are PA programs that don't require previous experience, but there are NP programs out there that are the same.

ImThatGuy, BSN, RN · Jan 9, 2011

I agree with most of this post except the last part. :)
To go to a NP program, you MUST be an RN, hence you have experience. :)
Ron

Yeah, but there are programs, such as that in Vanderbilt, where you pick the RN up along the way and will likely never work as an RN enroute to the NP. I personally don't view being a student as experience, but maybe some others do. I think of it more as as exposure. :twocents:

iangood · Jan 9, 2011

I work at the VA as an NP in Urology and I work with a PA. They are used interchangeably where I work, although NPs make more money than PAs at the VA. I've been there 2.5 years and I make more than my PA colleague who has been there 15 years. As far as duties go, we are about equal.

I agree with what some have posted about experience level. Where I live, the PA program is through a community college (Foothill), but affiliated w/ a medical school (Stanford). One of my former colleagues went to that school with 5 years of experience as an ER Tech (mainly pushing patients back and forth to x-ray, assisting with splinting, minor medical duties). To be an NP, you must be an RN (or be in a program where you get an RN on the way to being an NP) and you must have a Master's degree (to bill Medicare). As some have mentioned, you can be a PA with a certificate or a Bachelor's degree.

Here in NorCal, there are several schools (UC Davis for one) that train both PAs and NPs in the same program. If you are an RN, you can get both an NP and a PA license, if your are not an RN, you only get PA.

Others have mentioned the difference in style. PA is definitely a medical model, disease based approach to treating patients. Whereas NP is based on a whole person wellness model. It may be a subtle distinction, but it is why NPs are consistently rated higher than physicians by patients in terms of listening and bedside manner.

As a side note, I get called a PA all the time by patients and even colleagues. I guess some people just assume that a male mid-level provider is a PA.

core0 · Jan 9, 2011

*** That makes me wonder why some states are limiting FNPs ability to practice acute care medicine, but not PAs. I never see any FNPs in CV or neuro or general or ortho surgery. I only see PAs. Is that just the preference of the physicians in this area or is there some other reason?

The limitations are due to the way that different states interpret scope of practice. The PA scope of practice is defined by the scope of practice of the supervising physician. This is the dependent scope portion of the PA license. The supervising physician in most cases is allowed to define what the PA is allowed to do. The caveat is that the physician cannot allow the PA to do things that they cannot do.

In most states NPs possess and independent license to practice advance practice nursing. The limitation of the scope of practice is what the NP has been trained in as an advance practice nurse. The NP must be able to show that they have received training in the area of advanced practice nursing that they are practicing. Generally an NP can extend their practice through additional training. In states that interpret this closely you specifically cannot expand your practice through additional training into an area that is already within the scope of practice of another specialty. For example an adult nurse practitioner that wished to see pediatric patients would not be able to take additional training, but would instead have to complete training to be certified as a PNP. Similarly a FNP could do some OB/GYN but if they wanted to do specific procedures such as colposcopy they would need a CNM or WHNP certification.

Texas regulates these specific scopes very closely. When examining the FNP they decided that an NP trained primarily in outpatient ambulatory medicine should not be working in an inpatient acute care environment. This was the scope of the ACNP. Maryland looked at the inpatient environment and decided that any monitored patient had to be seen by an ACNP. Because of the attempt to make an NP compact many states are looking at their scope in regards to Texas in particular. Also several law firms have used the lack of acute care training to sue hospitals in the Southeast for failing to properly credential providers. This has caused several hospitals to change credentialing standards. However, other states have taken a hands off approach choosing not to try to interpret NP scope of practice.

So fundamentally the difference between PA and NP scopes is the difference between a dependent and independent scope of practice.

The difference in PAs vs NPs in surgery usually involves nursing credentialing. PAs are trained in surgery as part of their required training. Nursing has decided that the "APN" for surgery is the RNFA (despite not being an APN by the traditional definition). This imposes an extra hurdle that most physicians are not willing to go through when hiring an NP for surgery. Most NPs that work in surgery (ie in the OR) were RNFAs prior (as I believe someone else explained). YMMV

linearthinker, DNP, RN · Jan 9, 2011

I just Thought I'd put out there that I have approximately 25,000 hours of RN experience, at least 20,000 of which is in various tertiary care critical care units and level 1 trauma center EDs. Outstanding experience, but don't feel that my much of it has been applicable to learning the NP role.

nomadcrna, DNP, CRNA, NP · Jan 9, 2011

Excellent post. In Montana, I saw many FNPs working in surgery doing ortho. Thankfully Montana lets FNPs do anything they can show they have had training for. The training can be on the job as with the ortho surgeon.

FNPs are also used routinely here as hospitalists and intensivists. It all comes down to the training. I believe in the northwest states model of totally independent practice. You can go to a conference and learn chest tubes, ultrasound and even thorocentesis. Of course you need a hospital to credential you for them, that may be difficult initially.

I routinely get credentialed for chest tubes, central lines and such.

Texas is really behind the NP ball. They still don't give NPs full prescriptive authority or independent practice.

Ron

The limitations are due to the way that different states interpret scope of practice. The PA scope of practice is defined by the scope of practice of the supervising physician. This is the dependent scope portion of the PA license. The supervising physician in most cases is allowed to define what the PA is allowed to do. The caveat is that the physician cannot allow the PA to do things that they cannot do.
In most states NPs possess and independent license to practice advance practice nursing. The limitation of the scope of practice is what the NP has been trained in as an advance practice nurse. The NP must be able to show that they have received training in the area of advanced practice nursing that they are practicing. Generally an NP can extend their practice through additional training. In states that interpret this closely you specifically cannot expand your practice through additional training into an area that is already within the scope of practice of another specialty. For example an adult nurse practitioner that wished to see pediatric patients would not be able to take additional training, but would instead have to complete training to be certified as a PNP. Similarly a FNP could do some OB/GYN but if they wanted to do specific procedures such as colposcopy they would need a CNM or WHNP certification.
Texas regulates these specific scopes very closely. When examining the FNP they decided that an NP trained primarily in outpatient ambulatory medicine should not be working in an inpatient acute care environment. This was the scope of the ACNP. Maryland looked at the inpatient environment and decided that any monitored patient had to be seen by an ACNP. Because of the attempt to make an NP compact many states are looking at their scope in regards to Texas in particular. Also several law firms have used the lack of acute care training to sue hospitals in the Southeast for failing to properly credential providers. This has caused several hospitals to change credentialing standards. However, other states have taken a hands off approach choosing not to try to interpret NP scope of practice.
So fundamentally the difference between PA and NP scopes is the difference between a dependent and independent scope of practice.
The difference in PAs vs NPs in surgery usually involves nursing credentialing. PAs are trained in surgery as part of their required training. Nursing has decided that the "APN" for surgery is the RNFA (despite not being an APN by the traditional definition). This imposes an extra hurdle that most physicians are not willing to go through when hiring an NP for surgery. Most NPs that work in surgery (ie in the OR) were RNFAs prior (as I believe someone else explained). YMMV

ImThatGuy, BSN, RN · Jan 9, 2011

I just Thought I'd put out there that I have approximately 25,000 hours of RN experience, at least 20,000 of which is in various tertiary care critical care units and level 1 trauma center EDs. Outstanding experience, but don't feel that my much of it has been applicable to learning the NP role.

I've seen others on this forum suggest that their nursing experience didn't help much with being an NP either. Some people suggest it does, and I always take that with a grain of salt as if it's more of a professional defense strategy, i.e. "you Can't be (or Won't be accepted as) an NP without putting in your time (read: paying your dues) as a floor nurse."

nomadcrna, DNP, CRNA, NP · Jan 9, 2011

Of course it helps. Any medical experience helps.

Some experience is more valuable obviously.

I spent 12 years in ICU/ER before going to anesthesia school. There is no doubt it helped.

Spending 19 years as a CRNA then going to FNP school, heck yes.

Once again I think the person gets what they want out of it, or puts into it. :)