PA speaks poorly of RN's

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PA's who are they? I just heard of them within the last few years. If not mistaken, I believe there are two per state (joking). Any hoot, I had an interesting conversation with a high school friend that I have not spoken to in about a year. She is now a physician in the OR and currently working on her residency to become a surgeon. As we were catching up on current situations, she had the audacity to put a PA on the phone after I told her I was in nursing school. The PA kind of caught me off guard as I was in the midst of running errands and in and out of loud places. To be respectful I stepped out of the store to speak with this unknown person and to be able to hear her clearly. I was told that they are now phasing RN's out, so getting a BSN will soon be worthless. I chuckled as I could not believe what I was hearing. I remained calm and did not unleash the "pitbull" from its skirt. I was told that in order to get $$$$ one will have to become an NP. RN's are getting paid bedpan money for doing bed pan work. I was flabbergasted by her comments. Has anyone else heard of such a thing? Please share your thoughts and comments. If I ever have an opportunity to speak to this person again I thought about given her a piece of my mind, but then again why bother; not worth the time and energy.

Also, your statement that a PA is a bachelors prepared practitioner is false. To be admitted to a PA program (even one in NY), you must have completed a Bachelor's degree already.

In some states PA is still an associates' level degree, so that varies widely. I know someone who moved out west to go to PA school at a community college.

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In some states PA is still an associates' level degree, so that varies widely. I know someone who moved out west to go to PA school at a community college.

There are two issues here, which I was trying to get at in my previous post

1. PA education is competency based, which means that regardless of the academic credential awarded, the clinical skills of a PA from a certificate, associates, bachelors, or masters program is the same. The masters PA is no better than the cert PA, the cert is no worse. San Joaquin Valley College in CA is an outstanding PA program with a dedicated mission to train primary care PAs. They award an AS. Are they any less of a clinician than a Duke masters grad?

2. Credential creep is a very real issue that all of us in established practice recognize for what it is. It is NOT about clinical ability. We are all, for the most part, in patient care roles. Very few PAs or NPs are strictly academic as a percentage of the whole. There is a continual underlying tone on these boards (and in this thread) that implies a correlation between degree awarded and competency. Does anyone here have any evidence to back that claim?

I understand that organized nursing has acquired a strong focus on credentials, but the rank-and-file nurses/NPs on this forum should (hopefully) see through that and "don't believe the hype" that because an RN or NP has a masters of doctorate makes them any more qualified than docs or PAs who have well established track records as stellar clinicians.

None is better than the other. I didn't post on this thread to back the ridiculous statements quoted in the OP. But the dismissive tone about PAs only furthers the divide. We all benefit by working together.

So the the previous poster, what do you mean by your comment about PA school at a community college?

Takeback, PA-C, MPAS, BS!

university grad to boot......

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Specializes in ER.

So TakeBack pretty much nailed it and to answer your question there are 3 schools in California that are CC based. Standford's PA program is associated with Foothills Community College (I think), Riverside Community College and the school I go to which is a private school, San Joaquin Valley College. SJVC awards an associates degree upon completion and for those that possess a bachelors degree during the final year they can complete their MPAS through St Francis University.

The PA mentioned by the OP is ignorant of the role RN's play and his/her opinion should be disregarded but what bothers me the most is the number of replies here that slam on PA's just because of the ignorance of of this one. I've been through nursing school and currently in PA school and I can say this with complete honesty, I studied more in the first month of PA school than I did the entire time in nursing school. My nursing program had a 50% attrition rate and my class had a 99% 1st pass on boards so don't try to question the rigors of either program. PA school is hard, make no mistake about it. For those that question this statement do a survey of PA's and NP's that you know and ask how many worked during school. I've never encountered a PA that worked during school but many NP's continued to work during school. That's not saying NP's are less qualified by any means. I've worked with and have the highest respect of many NP's, it just points to the differences in educational tracts.

Just a note about me, I've got 19yrs of health care experience from ER-tech, LPN, RN and current PA student. I've worked in about 25 different hospitals during that time with the past 7 years as a travel nurse. I've worked coast to coast, border to border and out to Hawaii so there is a little bit of experience there to back up what I've said.

Good luck to all and to the OP, good luck in becoming a nurse. Just remember, it's all about making a difference in one patients life. Once you do that you can move on and do it again. You can make a difference for just one patient.

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Specializes in Family Practice, Mental Health.
Where can an RN make close to a 100K as a new grad. Please tell me because I'd love to work there.

You obviously are not familiar with the Bay Area, California. LOL.

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Specializes in CCRN, Med-Surg, ED, Geri, Psych.

Just a couple comments/observations.

1.) Degrees/Credentials: The 3 other NPs that I work with daily are Bachelor's Prepared NPs. Like PA's, the NP role was "competency based." Meaning, until recently (~ 1999-2000) fully licensed and practicing NPs held ASN's, BSN's, MSN's. The deal was that pretty much ANY RN (ASN/BSN/MSN) could apply to, be accepted at, and complete a NP program and if they passed the NP boards, could be fully licensed to function as a NP. So there are A LOT of experienced NPs out there without Masters degrees. These NPs are going to be found among the ones who have been practicing greater than 15 yrs. So the whole issue about what degree the current NPs hold versus what degree PA's hold is disingenuous at best.

2.) Salary/Compensation: The Average compensation package for ALL PAs & NPs is generally greater that $70k/yr, includes Disability Insurance, paid health care for the provider (family members sometimes extra), paid, Licensing and Credentialing fees paid, around $1500-$2000 plus 5 paid days in CME/yr and other perks (professional fees, books/journals, lab coats, parking, meals, equipment, etc.) This often includes office space, and ancillary staff.

There is NO comparison of this to the compensation and working conditions of RNs/LPNs.

3.) Licensing: While it is true that APNs have fought for and secured independence in many states, many/most the overwhelming majority of ARNPs/APN DO NOT work independently. In most cases it would be foolish to do so for a myriad of legal/ethical/professional/$$$ reasons. As a matter of fact, MOST graduates of APN programs NEVER work as APNs (do some research).

While it is true that PA-Cs need to be affiliated with a Physician to practice, it is a often repeated myth that all PA-Cs need to be "supervised" or that they work "under a physician's license." PA-Cs have their own license, their own NPI numbers and their own DEA numbers.

In many states, PA-Cs require "sponsors" not necessarily "supervisors." In many/most states, "Supervision/Sponsorship" is NOT as it implies for licensed and currently Certified PA-Cs. In most cases, "supervision" for the Licensed and Currently NCCPA Certified PA-C merely means that the physician ONLY needs to be in electronic communication (phone, fax, email) with the practicing PA... and NOT/rarely/never at the same site as the "experienced" practicing PA-C. So in these cases, PA-C "supervision" is the same as the NP "collaboration" requirement in many states.

As a matter of fact, there are hundreds of instances where PAs (and NPs in states that require "collaboration" agreements) have purchased buildings, set up clinics and paid Physicians as consultant/employees for "supervision"/sponsorship. This is all perfectly legal and the going rate around here seems to be about $1000/mo for the Physician-employee to answer their cell phone on the rare occasion the PA or NP practice owner calls.

4.) As a former CCRN, I can state that it is absolutely untrue that the average RN has anywhere close to the general health care knowledge of the average new-grad PA or NP. Its just NOT TRUE regardless of how bad many here want it to be so. Claiming that this is true, is the equivalent of the EMT-"para-gods" that show up with crappy attitudes, to facilities across the nation daily, claiming that they have the same or more training & knowledge than the Nurses. When in reality we KNOW that a EMT-B can be completed in 14 days and a EMT-P can be completed in 6 months.

5.) There is NO difference in the roles of a clinically practicing PA or NP or Physician in a Primary Care setting. As a Matter of fact, if no one wore a name tag, the casual observer would be hard pressed to point out who was who and what credential they held.

See... what many don't understand is that PA's/NP's and Physicians all "practice medicine." The NPs like to label what is being done for the patient as the practice of "advanced nursing" for political reasons, but its basically the "practice of medicine."

This is why if a patient presents to a PA/NP/Physician with anything from Azotemia-to-Zoster the treatment/plan of care will essentially be the same because the legal and ethical "Standard of Care" is the same.

6.) There ARE organization dedicated to the elimination of the unnecessary contentiousness between NPs & PAs. "Clinician 1" is but one organization with this as one of its goals.

Also... it has been my experience that the NPs and PAs out here "in the trenches" actually practicing together aren't the ones with the bitterness and spite. The vitriol is usually spewed b the "wanna-bes"... :uhoh3:

Just some initial thoughts after reading this thread...

YMMV

Lannister, EMT-B/I/P--> LPN--> RN, FNP, PA-C

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Specializes in Peri-Op.

PAs are in some form always supervised. The attending has the right to come and over rule any decision you make about that attendings patient. They may not always chose to use their supervisory position depending on how much they trust you but they could, because they are supervising you. I work in surgery, the PAs that work in surgery are heavily supervised and limited on what they can and can not do, they are basically a glorified scrub tech thats a first assist..... CRNAs on the other hand, at least in Texas, can and do work independently with 0 supervision. I have worked with them both as independents and supervised by MDA's..... NPs(aside from in surgery) can and do work independently without the supervision of a physician, PAs do not.... Again, my exposure is limited to mostly surgery but this is my take on it all and what supersixeightmd is saying. I have a few friends/family members that are PAs, friends/family that are NPs, friends/family that are MDs

CRNAs also make about twice what PAs make in my area..... the salaried NPs make a slightly less than what I make annually but I put in lots of OT. One of my best friends is a OB/Gyn and he makes less than some of the CRNAs do.

Friblet.... The cost of living is quite low in my area. Average homes go for around $150k, mine was $100k when I got it 10 years ago. There are no toll roads, no state income tax, fairly average home/county taxes of about $3200/year for my 2500 sq/ft home......

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Debating, and I'm putting that lightly, is fine. Quite healthy. But what is with all the venomous comments about someone's career? No matter how much you look down on it, PA's, NP's, Nurses, etc worked hard for said title. Why the trouble of trying to make someone feel less than? Is that making you feel any more accomplished as an individual or a professional? The PA that commented here has been nothing but cordial in his attempt to educate about his profession. Not once did he get defensive or get lured into a tit for tat. It was the PA in the OP's story that's the culprit. :down:

I actually commend him for staying on course without resorting to snide and plain mean comments like the ones he's been receiving. A lesser man, with a superioty complex, surely would have done so 3-4 comments ago.

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The attending has the right to come and over rule any decision you make about that attendings patient. They may not always chose to use their supervisory position depending on how much they trust you but they could, because they are supervising you.

Correct. Again, no argument.

I work in surgery, the PAs that work in surgery are heavily supervised and limited on what they can and can not do, they are basically a glorified scrub tech thats a first assist..... CRNAs on the other hand, at least in Texas, can and do work independently with 0 supervision.

One model. There are multiple models for both PA and NP practice. In my experience (surgery) they are similar. PA/NP sees pt. Plan is made, carried out. Discussed with doc at a later time if needed. Both the same. The supervisory/sponor relationship ON PAPER may be different. Less than half the states have independent NP practice and most have sponsor/collaborative physician relationships for inpatient settings. I don't have the numbers on those, please someone share if they do.

I have worked with them both as independents and supervised by MDA's..... NPs(aside from in surgery) can and do work independently without the supervision of a physician, PAs do not.... Again, my exposure is limited to mostly surgery but this is my take on it all and what supersixeightmd is saying. I have a few friends/family members that are PAs, friends/family that are NPs, friends/family that are MDs

The PAs that I have worked with over the yrs in outpt settings typically have been experienced, which may bias a bit, but they generally had their own pt panels and used the model of "periodic percentage chart review"....at the end of a given time period (month, quarterly) a handful of charts are pulled and reviewed (meaning not at the point of care or day of visit etc). Again, there needs to be a clear distinction between the legal supervisory relationship and the practical supervisory interplay between the PA and doc. The criticism of PAs I read on this forum and their need for "supervision" usually stems from this distinction not being made (or better, not understood).

CRNAs also make about twice what PAs make in my area..... the salaried NPs make a slightly less than what I make annually but I put in lots of OT. One of my best friends is a OB/Gyn and he makes less than some of the CRNAs do.

CRNAs make great money! I review the salaries for ours every yr or so. In general nationally for salary its CRNA>>>>>>PA>NP. THe PA salaries are on average higher b/c of our greater presence in specialties. (CT Surgery here, guilty......)

Best.....................

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Problem is whenever lurkers see PA or CRNA they get all crazy and join AN.

Everybody has got their own "ankle-biter" or "butt-burr" in this business so to speak. Especially with all the changes going on. It's all ONLY about who still gets to make money, right? I'd be PO'd too to have gone to med school and find out I could've gone and done a PA or CRNA and been financially better off by decades. Sux. But nobody cares who has been to school longer, or who had more chem...... The money people get to decide who they want to hire, it's The Corporation we all work for. They call the shots. This puts some MDs in that expendable zone where, The Corporation is trying to see how feasible it would be to cull the herd in order to make more money.

Here in lies the reason for all the wagon-circling. Everybody wants to protect what they got, and others want a crack at it. It's what I'd do too.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Closed for review.

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