Hello, I am coming here to see if I can pick some information off of you all. I will state that I appreciate ahead of time the responses I will hopefully receive and hope to put them to good practice.
I am an ER physician in the southeast-ish area of the US, and usually do much travelling around. I work for various staffing agencies, usually just taking the most needed bids and such. I tend to work with many different nurse practitioners and physician assistants in the various locations, mostly in the bigger ERs. The smaller ones usually it is just me since the volume is low.
The reason I come here is because I am looking or some info on the education of nurse practitioners. Sine I occasionally lecture on ER topics at one of the local PA schools in front of medical students and Pas I have been able to get a thorough glimpse at the PA ED model, which really is not too much different than a condensed version of ours it seems. I did go to a med school here in the US which also has a PA program close by so I understand this aspect.
I have noticed at many of the facilities I work at, a higher than average (in comparison to PA and other docs) the nurse practitioners often (not a total majority) seem to be oblivious to many aspects of ER level care. Some are unable to understand the interpretation of a basic set of lab panels, X-rays, and some are unable to suture well, if at all. There are a few that are Excellent at what we do (the term we used because we are a team and I dislike the dichotomy many use separating physician practice from other types of providers since it just stems unneeded conflict and perpetuates social gaps).
I have not noticed such a large gap in practice from the physician assistants that I work with though. Nearly all of them are able to suture, interpret labs, splint, suture, read most X-rays (abdominal X-rays can be very difficult to read at times, often we physicians consult rads on these). (I am also referring to flat plate x rays not CT/MRI and the such when providing the term Xray).
The gap is narrowed it seems between the PA/NP when it comes to diagnosing illness in the fast track though, I do notice it seems the PA do edge out slightly on better diagnosis (but my time is limited in the fast track, I am only there when they have a question about something, if something gets miss-triaged, or if family requests to see me, etc etc.)
But the whole point of me coming here is to ask if they teach nurse practitioners during their educational adventure how to read X-ray, suture, splint, read basic lab panels, intubate, and what not. I have looked through curriculums but course names often do not tell accurate stories in any aspect of education.
I would feel rather rude asking my coworkers these questions, since they may take it as demeaning and I like to maintain great relationships with the other providers. So again, here I am looking for a bit of info on what type of education they provide nurse practitioners in school (we use mostly FNPs in er) to see what you all thought of the situation.
Hope I am not stepping on toes with this,,,, just looking to gather some information in an objective manner.
As for physician assistants their training is geared more toward inpatient and acute medical management of patients, unless you are referring to an ACNP. An acute diagnosis needs a broader management strategy and is more complex at times. This would explain the medical model of treating the underlying condition rather than the systemic issues relevant to the patient in PA programs. Many of my paramedic friends have chosen this path as it is a great extension of their knowledge, experience and education.
Incorrect. PAs are trained as medical generalists and able to treat 95% of what comes their way, referring the rest to specialist PAs and physicians. Most PAs work in out-patient settings tho many do work in high acuity in-patient settings. PAs are trained in the medical model which seeks to correct the underlying condition, if possible. Nursing does not.
I am about to graduate from PA school. We had two entire semesters where we had to learn how to read and interpret X-rays, CTs, MRIs, Ultrasounds, PET scans, and combo PET/CTs. We were very thoroughly tested on these skills, with an emphasis on X-rays for diagnosing pneumonia, CHF, pneumothorax, aspirations, abdominal xrays for small and large bowel obstructions, KUBs, and musculoskeletel xrays. We were absolutely required to know how to tell the difference between a Salter-Harris Type 2 (most common) and Salter-Harris Type 5 (most devastating). To read that the NP curriculum does not include basic chest/abdominal/musculoskeletel xrays makes me extremely concerned. While there is a radiologist available to read Xrays that usually doesn't happen until the next day. If an NP had a patient with fever + cough and can't interpret an xray then the PT may be sent home without the right (or any) treatment. What's the benefit of ordering a CXR if you can't interpret it? That is medical negligence and a lawsuit waiting to happen. If you can't interpret a basic chest xray then you have no business treating any patient with any sort of cough as you can't tell the difference between pneumonia or a Kerley B line.
Congratulations on your upcoming graduation. I do hope that a year or two into practice, you revisit this thread. The perspective you gain from actual experience in the provider role may change your thoughts on the matter. I am sure most providers reading this post from a student about their confidence in reading not only routine imaging but MRI/PET/CT imagining are smirking a bit. In all honesty, it's a bit of an overestimate, and most providers know that overestimating your own ability is a very dangerous thing.
So let me ask you, you have a patient with a fever and a cough. You order a chest x-ray and read it as demonstrating a small lobar consolidation. What's your diagnosis? Whats your treatment?
I am sick with PA/NP/MD debates on allnurses forum. It seems same stuff keeps coming back ..
which adds no value at all in healthy and fruitful discussions.
First, this is a NP specialty sub topic in the allnurses website. I see RNs/LPNs/PAs etc posting in this sub group of NP and start venting about NPs and comparing with their professions. Guys and Gals, if you are not an NP, please stick to your groups and do not post here. I am sure there are numerous groups for PAs, search google, go and put your feelings in these groups.
Second, there are endless opportunities for each & every provider in healthcare. Their goal should be providing quality healthcare and services to needy patients rather than belittling each other with their education, knowledge and social skills.
Third, if there is a gap in skill which you need in your workplace, do some research and retrain yourself. One should never stop learning, and every day at your workplace you experience something new to learn as long as you are open to criticisms.
So let me ask you, you have a patient with a fever and a cough. You order a chest x-ray and read it as demonstrating a small lobar consolidation. What's your diagnosis? Whats your treatment?
Most likely dx is pneumonia. I'd order a few other tests to be sure, such as CMP and CBC w/diff. Treatment all depends on age, comorbidities, and if I will manage them as an outpatient or inpatient.
Most likely dx is pneumonia. I'd order a few other tests to be sure, such as CMP and CBC w/diff. Treatment all depends on age, comorbidities, and if I will manage them as an outpatient or inpatient.
The most likely diagnosis is pneumonia? What kind? What about a PE? What about bronchitis? Has your read of a chest X-ray helped limit your differential?
Why do you need a CMP over a BMP to confirm your diagnosis of pneumonia? Are you ruling out hepatitis as a source of the cough and fever?
RockMay
84 Posts
Incorrect. PAs are trained as medical generalists and able to treat 95% of what comes their way, referring the rest to specialist PAs and physicians. Most PAs work in out-patient settings tho many do work in high acuity in-patient settings. PAs are trained in the medical model which seeks to correct the underlying condition, if possible. Nursing does not.