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    Differences (Educative/Clinical) between NP & PA

    Mango, I have read all the posts starting from the original one, and this has to be the best post yet. I think you did a great job of outlining the similarities/differences between NP's and PA's without making one out to be better than the other. I am a nursing student who is planning on pursuing an advanced nursing degree, and I look forward to being able to eventually work pretty autonomosly (sp?) Recently, while doing clinical rotations I have seen PA's alot in the hospital, working very autonomosly (sp?), so much so that I started second guessing my NP route. Well, after doing some additional research, and reading your post as well as a few others I have decided that I am will continue on my path, because either one will get me where I need to be. Thanks! quote=mango-lo-maniac]You know, very few posts in this long thread have addressed the OP’s question – what are the CLINICAL differences between PAs & NPs. Instead there has been a lot of rhetoric, much of it unfounded, about the educational and perceived professional differences. Unfounded information has come from both views. I hope I am not violating TOS by saying this, but as a PA I am embarrassed by the garbage in that old post by Kristen. I am a PA in emergency medicine. In my practice setting there are NO clinical differences between PAs and NPs. None – not even one single one. Granted, I do work in a state that is friendly to both professions. State law does not require my charts to be cosigned. The hospital requires chart cosignature for all midlevels with in 24 hours. The docs usually sit down with a pile and scribble on the bottom corner of each while chatting or doing something else. They are not looking at the actual chart. This is mean to be “midlevel supervision” but in actuality it is not. Supervision would be looking over our shoulder and guiding our actions during patient care. State law allows me to write my own scripts, sched II-V. They do not have to be cosigned. I am limited to a 14-day supply of sched II & III. In my setting this is not a limitation – if you are sick enough to leave the emergency department with a script for a schedule II, you need to follow up with your PCP or specialist, who should manage your ongoing need for medications. In other settings, it may be a limitation to not be able to write a month’s supply of schedule II. I know that NPs can write up to sched II as well, but have never asked if they have a limit like ours. For those who would say we are “only assistants” I invite you to spend a day with me in practice. You will see that while my badge says “assistant” I do not assist the docs with their patients. Instead, I see my own. I evaluate & treat, discharge & admit all without consulting a physician unless I feel it is needed. I see the same acuity of patients except for patients requiring immediate resuscitation. I hear/read nurses saying that the public does not understand the scope, intellect and abilities of nurses. I agree, but I submit to you the same for PAs. “Assistant” may have fit the job 35 years ago, but it does not any longer, except in the operating room. I have my own license. I have my own malpractice policy, paid for in full by my employer. I have my own DEA number. I have my own UPIN. This is not new. Other than my lack of a nursing license I am no different from an NP in this regard. I do not practice under anyone else’s license, policy, etc. I don’t understand why some people refuse to accept the truth, and persist in claiming that we cannot be licensed or insured on our own. Perhaps it is because we are nationally certified but state licensed? PAs in my state can (and do) own their own practice, but it is not common. I know PAs who own their own urgent care clinic, family medicine clinic, occupational medicine practice and psychiatric practice. NPs can own a practice here too, but I do not know of any off hand. In all 50 states a PA must have active national certification in order to be licensed. Some states allow PAs to let that certification lapse, my state being one of them. To maintain national certification, a PA must log 100 hours of CME every two years for six continuous years, and take a primary care exam at the end of that period. In order to maintain state certification, a PA must log 100 hours of CME every two years. The only difference is not taking the primary care exam. Is this a sign of weakness or inferiority of the PA? I don’t think so. I know PAs and FNPs in neurosurgery. Both educated in primary care but practicing in a surgical subspecialty – would you think less of the FNP if her primary care knowledge were not retested every six years, so long as she maintained her knowledge though CME? If not, then why look down on a PA who chooses not to retest in primary care? It is true that PA education is offered at several levels while NP education is almost entirely at the master’s level (there are a few stragglers in California). However, PA education is standardized nationally. Compare the applicant prerequisites and the curriculums at a certificate program and a master’s program. In almost every case you will see that the only true difference is they type of degree awarded at the end. The actual education is equal. Some may persist on looking down on the “lesser” degrees but I think that the quality of education is a more important issue. National curriculum standardization and accreditation ensures this quality. It is true that some PA programs enroll students with no previous experience. Ironically, this tends to be the master’s programs – those that superficially seem to be superior degrees. Many PAs do not support this change in admission policies. However, there is verifiable proof that the majority of PA students do have prior clinical experience. Both professions, for better or for worse, are allowing new students without strong patient care backgrounds. To point at the PA profession as being inferior for this trend is to ignore the fact that the same thing is happening in the NP profession. PA education is in the medical model, but I was not trained to focus on symptoms and throw medications at patients. I listen empathetically. I explain treatment options and side effects and encourage patients to have a role in deciding how their care will progress. I discuss complications and prognoses of diagnoses. During my training and also in my professional career, returning patients have asked for me by name, so I would say that they appreciate the care that I give. I am not a nurse and do not know how my training differs from the "holistic method" that nurses and NPs are trained in, but I do attempt to treat the whole person. I believe that most PA (and physician) training programs are going in this direction - rightfully so. Just as a disclaimer, I am not anti-NP by any means. I work with NPs, some whom I respect and some whom I don’t – respect is earned by showing me that you are a capable provider, and in the long run that is what I care about the most. My husband and I see a PA, but my OB care was from physicians, a PA and NPs. Our children see docs & PNPs. The sole purpose of this lengthy post is to address the OP’s question with my real-life experience and to dispel some untruths propagated about the PA profession. I encourage anyone who is trying to decide between PA and NP to research both and use verifiable, objective information to make your decision.
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