jstuben

One comment I will make is regarding the training you get in NP or PA school. For all prospective persons considering one education or the other, the most important aspect of what education you choose is the amount of training you will receive specifically in DIAGNOSING and TREATING. All the other considerations of autonomy, pay, duties, etc etc have their place, but do not forget that your highest responsibility is to the patient, and you owe it to them to get the best education possible to manage their care. As PAs and NPs our job is to diagnose and treat illness, that is what separates us (as well as physicians) from other health care professions. Ask your prospective school carefully about the amount of training you will receive in formulating a differential diagnosis and in the pharmacologic and nonpharmacologic management of disease, as well as physical exam training. Ask them to what depth your training in pathophysiology will be, as well as anatomy and physiology. Finally, find out how many clinical hours you will do, and how much of that involves diagnosing and treating. Don't pretend that the research paper you may write counts the same as these skills. Remember that whatever you did before NP or PA school, though it will no doubt help you as a clinician, is NOT a substitute for learning to diagnose and treat. Implementing someone else's care plan is not the same as coming up with your own. My time as an EMT was great but it did nothing to help me evaluate (for example) the various causes of hemolytic anemia or the diagnostic tests for acute oliguria. You may have put in one thousand foley catheters but can you stand at the bedside and explain what renal indices you want to evaluate and why? The established PAs and NPs I know all agree that previous medical experience as nurses, medics etc etc was very valuable. They also agree that what they did before NP or PA school and what they do now are two different things. It is what you do in school that will truly prepare you for life after graduation. Best wishes to all, jstuben

Dear colleagues: A little over four years ago I posted the original question as I was planning to advance my medical education. I must say it has been a lively discussion, with too many uneducated and inappropriate statements. The anonymity of the internet seems to encourage people to say things they might not otherwise say in person. Thankfully, there have been a few intelligent voices on both sides of the debate, and I thank those who took the time to present reasoned and professional opinions. In case anyone is interested, I went to PA school and have been practicing in an intensive care unit. I am happy to say that I work with a fantastic NP. We have the same job description, duties, and supervisory requirements. This just goes to show you that despite what your state rules may be, the particular hospital you work at may still set their own additional requirements. We both put in central lines, arterial lines, and do the occasional intubation. We round and treat the more chronic stable ICU patients, and we do most of the transfers to the medical floor. As far as I can tell, the nursing staff and the physicians do not treat one of us different than the other. So, for anyone reading these posts, take them with a grain of salt. Watch out for hyperbole and bias. Pursue the training you want.

Hello, I am looking into nursing. I keep hearing about the "Nursing Model" and "Nursing Theory." What is it? How is it different than the "medical model?" Also, I've heard some nursing students, as well as employed nurses criticize nursing theory and the model. I've never really gotten an answer that I understand. Can anyone out there explain what the nursing theory/model is, and especially how they specifically use it in their practice. Thanks!

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.

Hello. I am considering NP and PA school. I have a few years of experience as an ED Tech in a Level 3 Trauma Center in California (busy, but not too intense). Our ED is staffed with PA's no NP's. I have a few questions about clinical differences between NP's and PA's. I know that PA's seem to have a great ability to work in surgery specialties like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interprets tests, and prescribe meds (at least in 47-49 states). Are there any NP's on this forum who do this? Are there any in California who can comment? Second. I know that most PA schools have a much longer clinical component than do NP schools. I have been told it is because NP's already have so much clinical experience as nurses. But can you really compare the two? In our ED, the nurses are not making differential diagnoses, determining etiology of disease, etc. etc., they are monitoring the pt's overall state and response to the treatment ordered by the Physician (or sometimes PA). Therefore, does this experience compare to the rigorous training PA's get in diagnosing? Part of my interest in medicine is the actual procedures themselves. I want to do chest tubes, central lines, suturing, first assistant surgery, etc. etc. Are there any NP's out there who are doing this? Finally, I know some people (including some nurses) who deride the "nursing diagnosis" concept. Can anyone offer up a brief rationale for how nursing diagnoses are of value to an NP in clinical practice? Thank you very much!