PA's faster than NP's in ER??

TMPaul · Jan 3, 2005

Hi folks - I'm new to this forum - usually hang our in the ER forum. I am an RN,CEN and will be starting a graduate level FNP program in the summer. I have been trying to "sell" my current employer on the idea of using me as a mid-level practitioner in our ER (I love ER stuff, and want to practice in the ER) they currently do not use NP's or PA's. I had an astonishing conversation with my nurse-manager on this topic - he basically said "if we ever use mid-levels, we will use PA's because nurse practitioners are too holistic, not procedure oriented, and are slower than PA's because they spend too much time with the patients and do not use the medical model."
Now, I would not have been surprised if this statement had come from one of the doctors, but hearing that from the mouth of a nurse floored me! Actually, many of the doctor's in the group have responded more optimistically, stating they would rather have an experienced NP at their side than a PA who might be a "kid just out of school with no experience." They are especially fond of the idea of an experienced ER nurse in the NP role, as they already use us to make advanced clinical decisions and order treatments, order meds, etc based on our pt assessment and clinical protocols.
Anyone out there have experience with NP's working in the ER environment? Examples where NP's collaborate closely with MD's to perform procedures outside of the traditional FNP scope with MD's? Thanks.

How about first hand experience?! :) I worked an ER setting as an NP and did just about everything with no problems from the MD's or nursing staff. I also work for FEMA as part of their Disaster Medical Services and DO everything :intubation, ACLS, ATLS, suturing, minor surgical procedures, casting, etc).

I think it all falls back to nurses eating nurses syndrome. I've worked with some really great PA's & NP's and some really bad ones too. Feel free to contact me if you have additional ?'s.

Lilith · Jan 4, 2005

Thanks! Your "real life" situation is extremely valuable to me....could you tell me more about how policies are written to allow you to practice in this way?

How much MD supervision/cosigning is needed? (I will also send you a private email, if you prefer to correspond in that way).

lalaxton · Jan 4, 2005

I did some clinical time with an FNP in an ER when I was going through my FNP program. She worked faster than any other MD, PA or NP than I have ever seen, was efficient and excellent. I think you may need to educate your manager on how previous RN experience really does contribute to how you will practice as an NP. Since you currently work in an ER you can point out that as an RN you already practice 'wholistically' and can continue to do so in an expanded role and be efficient as well. By the way, if you worked as an NP in your present facility would she be your supervisor or would the physician group employ you? If it is the latter than she probably does not have a choice anyway!

Good luck in your future studies, remember that not everyone thinks like your manager does!

Lilith · Jan 5, 2005

lalaxton,

Good point about already working "holistically and efficiently" as I am one of the "faster" RN's in the ER. at this point, it looks like it would be the physician's group who would hire me, and therefore supervise me, in the ER.

If I were to work with the Hospitalists, then I would be hired by the hospital.

maleka · Feb 2, 2005

There is an ER/NP program in Houston at The University of Texas Houston Health Science Center. It was started in '94, with three students, Loyola also has a program, based on the UT program.

jstuben · Feb 2, 2005

Just thought I would throw this into the mix, because I am currently researching NP and PA school. I work in an ER with PA's.

My understanding is that few, if any, PA schools will let you in without >2000-4000 hours of hand's on experience (ie. you can't count waiting time on an ambulance between patients). If you look at statistics from PA school websites, you will see that the vast majority of PA students were nurses, paramedics, EMT's, etc., and yes, that "Other" column, which could be kind of scary.

Based on my research therefore, It is incorrect to talk about PA's as having no experience right out of school. PA clinical time is generally 13 months of solid rotations. Some are shorter hours, some like surgery are med student's 80 hr weeks. Assuming an average 40 hr week, 13 months is over 2000 clinical hrs. Finally, this clincal time is focused solely on diagnosis and treatment, aka the "medical model."

I am not trying to incite violence here, but isn't 2-4 years as a medic, plus the full year of clinical rotations focused on diagnosis and treatment an equal or perhaps stronger clincal background than a NP who has around 700 NP clinical hrs and a background in the psychosocial, holistic nursing model? Of course we all know poor examples of PA and nurses, so I am not talking about the exceptions and people's personal stories of fellow workers.

I have no agenda here about PA/NP. I simply want to understand more about the two professions. I would love to hear from some NP's about their views on the nursing model, ie. its strengths and weaknesses.

Thanks.

FNP/DNP · Feb 4, 2005

Hi folks - I'm new to this forum - usually hang our in the ER forum. I am an RN,CEN and will be starting a graduate level FNP program in the summer. I have been trying to "sell" my current employer on the idea of using me as a mid-level practitioner in our ER (I love ER stuff, and want to practice in the ER) they currently do not use NP's or PA's. I had an astonishing conversation with my nurse-manager on this topic - he basically said "if we ever use mid-levels, we will use PA's because nurse practitioners are too holistic, not procedure oriented, and are slower than PA's because they spend too much time with the patients and do not use the medical model."
Now, I would not have been surprised if this statement had come from one of the doctors, but hearing that from the mouth of a nurse floored me! Actually, many of the doctor's in the group have responded more optimistically, stating they would rather have an experienced NP at their side than a PA who might be a "kid just out of school with no experience." They are especially fond of the idea of an experienced ER nurse in the NP role, as they already use us to make advanced clinical decisions and order treatments, order meds, etc based on our pt assessment and clinical protocols.
Anyone out there have experience with NP's working in the ER environment? Examples where NP's collaborate closely with MD's to perform procedures outside of the traditional FNP scope with MD's? Thanks.

Hi!

I am also new to the forum- I stumbled on the PA forum this week accidentally and was directed here by a fellow APN. I am an FNP working in the ER for the first time (I have been there for 3 months). My background was in family practice for 4 years prior to that. There are four of us there (all NP's) and I think the situation works very well. We have ample opportunity to learn procedures such as Lumbar Puncture, I&D, extensive suturing, reductions, basically anything we are comfortable with we are allowed to do. I never feel pushed into doing anything I am not comfortable with. I think PA's have a much stronger background in reading xrays and procedures, which gives them an advantage. We just have some catching up to do, which can be done with some outside education. I am planning to spend some time with the radiologists and attend some classes to assist in this.

Let me know how things work out. I hear that Houston has a great EDNP program if you are sold on that. I liked the FNP because it makes you very marketable. You may not always like the hours of the ER (holidays, weekends, etc).

FNP/DNP · Feb 4, 2005

How about first hand experience?! :) I worked an ER setting as an NP and did just about everything with no problems from the MD's or nursing staff. I also work for FEMA as part of their Disaster Medical Services and DO everything :intubation, ACLS, ATLS, suturing, minor surgical procedures, casting, etc).
I think it all falls back to nurses eating nurses syndrome. I've worked with some really great PA's & NP's and some really bad ones too. Feel free to contact me if you have additional ?'s.

I am new to this forum and also an FNP in the ER- new to this area coming from a family practice setting. Are we able to certify in ATLS? Is it hard to find a class that will let us in? I completely agree with the nurses eating nurses syndrome. They are some of the NP's worst enemies. It is so unfortunate. I hope to pick your brain from time to time- I am just figuring out this new position- I LOVE IT!!! but having not had an ER background- have a lot to learn. Thank goodness I had 4 years of family practice under my belt but it doesn't help with the critically ill.

I am a big supporter of the nursing profession- I teach at the undergraduate and graduate level, but I hear so many negative remarks from other nurses- not sure what that is all about!

zenman · Feb 5, 2005

I had an astonishing conversation with my nurse-manager on this topic - he basically said "if we ever use mid-levels, we will use PA's because nurse practitioners are too holistic, not procedure oriented, and are slower than PA's because they spend too much time with the patients and do not use the medical model."

That's a great compliment to nurses, especially considering that the medical model is so outdated...even ancient in today's world. :roll