Physician assistant versus Nurse practitioner - page 3

Does anybody know what is the difference between a physician assistant and a nurse practitioner. They seem to have the same responsibilities and same range of salary.... Read More

  1. by   rnto?
    Quote from SuesquatchRN

    Do you really think we just learned to fluff pillows?
    Don't forget about butt wiping 101!
  2. by   bajasauce07
    Sesquatch: Calling out sepsis is not a diagnosis. Learning the difference between the manifestations of sepsis and addisonian crisis, or myxedema coma is diagnosis. Understanding the significance of proteinuria which could be anything from multiple myeloma, CKD, MGUS, amyloidosis, HIV nephropathy, or a billion other things or nephrotic syndromes, is diagnosis. Half of those things aren't mentioned at all in your nursing curriculum. Recognizing patters to be able to complete a diagnostic workup for MM, MGUS, waldenstom's macroglobulinemia, cryoglobulinemia etc. THAT is diagnosis. MOST nurses ARE drones. And its sad. and YOU know it.
    Don't get me wrong. a nurse who understands why he/she is giving X medicine is gold, or why the doctor is ordering X test is invaluable. It leads to better patient care. The sad thing is that most nurses have no idea. I've worked at multiple major and rural medical hospitals and many nurses choose to let any pathophys, or pharmacology they did know slip in favor of mindlessly carrying out the orders.
    Again, not saying this is ALL nurses. I've met a couple of nurses who I think would make excellent NP's PA's etc and their talents and knowledge are an excellent BASIS for further education. Maybe you are one? But DIAGNOSIS is not taught in nursing school. You go to NP/PA school for that. Unless of course you can honestly tell me you recognize those disorders from your original nursing training?

    ChiroMed: You cannot "fight the fire" without having the knowledge to spot it. Delivering a baby does not equate to coming up with a differential for belly pain. That is literally a list of at least a thousand differentials including autoimmune, infectious, malignant, genetic, and multiple unnamable others. It is not just "constipation" and "pregnancy."\
    Understanding patients is nice, but also has NOTHING to do with managing care and is far less important. That's like me saying knowing the proper alignment of the spine is nice, but as long as you UNDERSTAND patients anyone can be a chiropractor, it's ludicrous.
    I would be willing to bet you have not taken all the same courses as an MD. I know you take some of the pathophys, biochem, etc. I doubt that it matches up. (I can't say for sure since I've never bothered to look into that curriculum, but I will ask a good Chiropractic friend of mine currently in 3rd year Chiro school, I may be wrong.)
    Either way, I've never said that those courses are what makes an MD an MD, neither will you find an MD who says that. Everyone freely admits that you forget those things after STEP 2. What makes an MD an MD is the years of practice in diagnosis. Once you have a diagnosis treatment involves looking it up with occasional patient specific variations. If you are never taught all the differentials you can't even smell the smoke. Yes NP's and PA's can treat patients obviously, My point was only that the previous experience nurses carry to the table means nothing. All of the "medical" training happens in NP or PA school. nothing more was implied.
  3. by   bajasauce07
    Oh, and I don't think there are ANY NP's in "solo" practice anywhere. Hospital bylaws do not allow it.
  4. by   rnto?
    [quote=bajasauce07;4208439]Sesquatch: Calling out sepsis is not a diagnosis. Learning the difference between the manifestations of sepsis and addisonian crisis, or myxedema coma is diagnosis. Understanding the significance of proteinuria which could be anything from multiple myeloma, CKD, MGUS, amyloidosis, HIV nephropathy, or a billion other things or nephrotic syndromes, is diagnosis. Half of those things aren't mentioned at all in your nursing curriculum. -

    [quote] And where exactly did you get your nursing educatuon?

    Bajasauce, why are you here? Do you seriously have nothing better to do with your time than to visit nursing forums and proclaim to be an expert on nursing education (or, as you put it, the lack thereof?) Yes, there are some moronic nurses, but I've also seen doctors who don't know septic shock from a septic system, so that argument is not relevant at all.

    The post is entitled physician assistant versus nurse practitioner, your arguments have been that registered nurses aren't capable of diagnosing, most nurses are drones, nurses aren't taught anything in nursing shool, etc. You say that being a nurse would provide no benefit in PA school-so a background in pathophys, pharmacology, assessment skills, practical experience in direct patient care, regardless of whether or not nurses can "diagnose" (which you brought up unneccessarily anyway), is of no benefit compared to a 22 y/o BS who took anatomy as a freshman?

    You have done what you intended to do-stir up drama. Good for you! Your maturity level speaks for itself. I would not want to have you as MY provider. By the way, what exactly are your credentials? You proclaim to know everything about every aspect of healthcare education, but for all we know you could be a disgruntled pre-med who didn't get into a nursing program.

    Posts like these just breed resentment between different levels of professionals, and frankly, that is the opposite of what we should be doing. Patients deserve to have a healthcare team that have mutual respect for each other and are working toward a common goal. The ones who really suffer when it dissolves into nurses vs. PAs vs. NPs vs. MDs are the patients.
  5. by   rnto?
    Quote from bajasauce07
    can you honestly say that anything you are learning would help you come up with a decent differential diagnosis for even a cough? or belly pain?
    Again, where did you get your nursing education? Or even your basis for this statement? Nurses couldn't come up with a basic differential for a cough? Sure, we don't know everything. We are not claiming to. We aren't physicians, nor is anyone here claiming to be, but we are NOT idiots who learn only to fluff pillows and hold hands. What do you think IS taught in nursing school? I'm not going to justify these ridiculous comments by arguing over the differential for a cough. We have nothing to prove to you.
  6. by   bajasauce07
    Look, sorry that my posts seem so inflammatory, I apologize for that. If you'll read the post previous to the one where I talk about nursing education it is in reply to the idea that NP's are "better" than PA's because of the nursing education they receive. It is also the basis for the argument as to why NP school can be done part time and with 600-1000 clinical hours of training which then allows one to practice independently.
    And yes, the problem is you could come up with a basic differential for a cough. I'm not arguing that. You just couldn't come up with a COMPLEX differential for a cough. My argument is not that nurses are dumb. My argument is that they are not trained to practice medicine and this training should not be used as a way to call yourself "better" or ready to practice solo after only a little more training.
    My argument is that "medical" training occurs in NP school and it has nothing to do with your previous education. I hope that seems less inflammatory, I think it comes across that way because I try to use too many examples and it makes me seem like I'm trying to be a know it all. I'm only trying to use the examples as evidence of my point. I DON'T know everything. I am very familiar with nursing curriculum however because I help tutor some nursing student friends of mine about once a week. We talk through the info they need to know. I know what they are expected to learn. Again, they are trained very well to be nurses, I don't think anyone can argue that they are not being trained to be practitioners though? Like I implied, there are EXCELLENT, AMAZING nurses that I've personally seen and met who definitely need to keep going to NP or PA or med school if they desire it, but they are not ready to be practitioners of medicine without that training. Nursing is the same as any field, most people are happy only knowing what they NEED to know in order to do their jobs. Same with NP's, PA's, and MD's. Thing is a lazy nurse knows only basic principles, a lazy midlevel knows enough to handle common, everyday things and a lazy doc know's more by virtue of all the mindnumbing, years of training than all of the above. Even by accident the laziest doc will know quite a bit.
    So if we know anything about human nature we know that there is a danger to credentialing people with less training than an MD to practice independently, not because of the good Midlevels, but because of the many lazy ones that would be out there hurting people without even realizing it sometimes. Even if that is not he majority.
    An excellent nurse who keeps up to date on her patho, pharmo, and reads about the underlying diseases of their patients could get CLOSE to knowing what their NP or PA counterparts know, an EXCELLENT NP or PA could get close to, and sometimes surpass the lower rungs of MD's on the same scale due to the virtue of their training etc. but a good PA/NP will NEVER outshine a good doc?
    So I don't understand this line of reasoning that we all use. "Well, if a good PA or NP can do better than a bad doctor, why can't they be independent?" I have an idealistic view of everything, especially medicine. I feel like we have a responsibility to our patients and to the respect of our professions by those who observe us to be THE BEST. If you want to be the best, and offer your patients the best as an independent practitioner, be a good doc, don't take a shortcut way which could lead to a bad outcome by simply failing to recognize something? We have our place, and we can manage very complex and rare cases. But it should not be as independent practitioners.
    As far as the question of whether or not nursing experience provides an advantage over a "22 y/o with a B.S.?" Not really, at least not once you get past the first week of PA school which is the only week in which normal laboratory values and medical terminology are covered. After that its all new material for nurses AND the 22 y/o. same with NP school I'm sure.
  7. by   bajasauce07
    and I'm not a nurse. I'm a PA