RN vs. PA

TraumaNurseRN · Feb 23, 2008

rgroyer.....I agree with you. When teamwork is essential for the care of a patient, no-one is above doing just that. A patient asking for assistance getting off of a bedpan as you are standing right there, expects to be assisted. I don't see what the big deal is. It seems to me that Craig has issues with what myself and my other team members consider to be valid concerns about patient care in general. His misplaced aggression is personal to him I think as his wife is a PA. He acts as if I was talking about her. This is not the only issue we've had with 2 PAs in MY ER. It has gotten so bad that it is being reviewed/investigated by management and the physicians. Another example is a PA writing a verbal order for an RN to set up their suture tray set. To me and others who are many times task overloaded feel they can set up their own flippin suture tray. I mean....give me a break! And as someone said, you scratch my back and I'll do the same for you. PAs are not above taking someone off the bedpan when asked while they stand at the bedside. Everyone else does it....what makes them any better.

alkaleidi · Feb 26, 2008

my team @ work is having difficulty with physician assistants attitude that they are superior to us:down:, are able to dictate how we prioritize the acuity we have:angryfire, and general things like...they'll walk out of a patient's room and find a nurse to take a patient off of a bed pan. (it takes them longer to find a nurse rather than do it themselves.)
this has angered many nurses. is anyone else experiencing this attitude with pa's in the er setting? our physicians and their pa's are not employed by the hospital but are contracted exclusively for our facility.

i haven't experienced this because i would never have the balls to expect one of our mds, pas, or nps to get a patient off a bedpan. sit their bed up or hand them their urinal? sure. but the other? no.

the pas function just like the md in our ed -- i don't wait on either of them hand and foot, don't jump out of my seat when a doc comes to the desk, i'm not that old-fashioned submissive nurse by any means, but they have far more important stuff to do than take pts off bedpans -- there are plenty of nurses and techs for that.

ZippyGBR, BSN, RN · Feb 26, 2008

I wouldn't expect a PA, NP or MD to take a pt off a bed pan. Not that this justifies any of the other behavior that you explain. But I don't think they should be taking pt off bed pans!

while you shouldn't be distracting them from other tasks ... if they are present why not?

especially if they wish to go and speak to / examine/ undertake an intervention...

caldje · Mar 23, 2008

If I may ask, what are you willing to do for a PA?

To me, there seems to be an underlying confusion among the entire nursing profession as to the role of PAs. Would you guys agree with this?

Nurses are trained to do what you do, PAs are not trained to do what nurses do. If PAs were doing other things they weren't trained to do that were say, a pharmacists job or a physician's job.. You would be outraged that they ARE doing them. Now, when they aren't doing things they weren't trained for you are outraged that they AREN'T doing them. I hope you see how frustrating this can be for PAs.

Blee O'Myacin, BSN, RN · Mar 24, 2008

If I may ask, what are you willing to do for a PA?
To me, there seems to be an underlying confusion among the entire nursing profession as to the role of PAs. Would you guys agree with this?
Nurses are trained to do what you do, PAs are not trained to do what nurses do. If PAs were doing other things they weren't trained to do that were say, a pharmacists job or a physician's job.. You would be outraged that they ARE doing them. Now, when they aren't doing things they weren't trained for you are outraged that they AREN'T doing them. I hope you see how frustrating this can be for PAs.

Building on that - I wonder if a PA knows how to do it? When I was in nursing school, I spent my first two clinical semesters doing basic care - bedpans and moving people from bed to chair, bedbaths, etc.

That doesn't stop me from asking the big, strong PA to help me move a patient, roll them or whatever - and our docs will also help us pick a person up off the floor (if anyone *ever* fell in our ER - which they don't )- but I bet that your run of the mill doc or PA doesn't know the first thing about bedpan mechanics - and I don't even want to think about the mess they'd leave behind or how they'd even start to change a sheet on an occupied bed:chuckle

Blee

caldje · Mar 24, 2008

exactly. be proud of the specialized skills and knowledge you have as an RN. It literally is a job nobody else could do without the training you have. Being offended when someone asks you to do something you are trained and good at makes it seem to me you may be the one who feels its beneath them. We all have different roles, yours' is as important as the PA's but they are also different and a PA doing a nurses job will fumble around to no end, unless they were a nurse before PA school.

KatieBell · Mar 24, 2008

exactly. be proud of the specialized skills and knowledge you have as an RN. It literally is a job nobody else could do without the training you have. Being offended when someone asks you to do something you are trained and good at makes it seem to me you may be the one who feels its beneath them. We all have different roles, yours' is as important as the PA's but they are also different and a PA doing a nurses job will fumble around to no end, unless they were a nurse before PA school.

I just have to comment, I do not think handling a bed pan is one of my specialized skills. I did not have a class on bedpans in school. I had classes in Pharmacology, physiology, etc. I find the thinking that putting someone on or off a bedpan is so difficult to be ridiculous, as many family members manage it when their family is in the ER and have no skill or training. My Skills involve other things, IV starts, Accurate and appropriate triage, titrating Dopamine and Levophed, recognizing a critical change in patient condition, and taking steps to manage it....not putting a patient on a bed pan. I do it, sure, but it isn't a skill, if it were, I'd have to list it on my resume.

I have had no issues with PA's, or NP's in general, I have met a few I didn't like as they were not in the right role (SOme people are not cut out to be in the ER).

I did have an issue with an MD once who said, "I didn't go to med school to put gowns on paitents" I had 9 patients, 2 going to the unit on drips, etc. The gown was on the bed. All the Doc had to do was say, "please put this on." Unfortunately for her, she said this in front of a Senior attending, who proceeded to bless her out in front of all of us. I guess its the culture of a place.

I'll bend over backwards for a PA, NP, MD, other Nurse, or technician that treats me with respect, but bedpans are bedpans. THey aren't that difficult.

Miss Mab · Mar 25, 2008

To me, there seems to be an underlying confusion among the entire nursing profession as to the role of PAs. Would you guys agree with this?
Nurses are trained to do what you do, PAs are not trained to do what nurses do.
I hope you see how frustrating this can be for PAs.

It sounds like, as a current PA student, this has been your impression throughout clinicals?

I don't believe the entire nursing profession stands confused as to what role a PA can play within healthcare. I do know there is certainly some confusion r/t education pathways (i.e., Associate Degree PA, no other exp. etc.), probably much the same as our confusing structure! Time and exposure and learned mutual respect will hopefully sort these out.

To the point, however, I can assure you that my ABSN program spent what i feel is the appropriate amount of time concerning 'training' with bedpans.....what, like 5 min?

FWIW, in my ER anyone(RN, doc, NP, PA) who's in the room who can will attend to a pt rather than track someone else down. Maybe we just have a great patient focused team.

Not to be snarky but if you really believe this to be among an RN's learned 'specialized skills', it sounds like any underlying rampant confusion about training and roles very clearly rests on your end.

I can understand how some PA's could be frustrated while trying to find their place in certain resistant environments. I hope after you finish school you are able to share your experiences from a working perspective as well. Are you joining us in ER?

caldje · Mar 25, 2008

No. I will be in surgery, and I am experiencing the same issue there.

I cannot speak for the PA in the ER but I can speak for myself. I have no idea what is involved in using a bedpan and assisting a patient with a bedpan. For that very reason, it is a skill you have, that I don't. To me, a nurse is best at taking care of the day to day issues a patient faces. If you want to delegate that to a CNA, thats fine. But I myself, have no idea what each individual facility rules are (I will be practicing out of multiple hospitals) and for my own, my patients, and other professional's sakes I try to leave their part of the patient's care to them. I try to help out whenever I can, I enjoy helping. However, most of the time when I help I get yelled at by one or the other, a nurse or a doctor. Either the doctor says "you're supposed to be working (learning) with me not being a nurse" or the nurse says "that's not where that is supposed to go" or "didn't you know we recycle those scope biopsy instruments?" My answers? Well, if I don't help the nurses they get mad at me, and when I do help them I usually don't know enough about the workings of the specific unit/hospital to do things right. So I've learned to just do my job and move on, I can't keep everyone happy. I'm positive you can identify with that feeling.

Honestly, I think it is a very few doctor's, nurses, and PAs that ruin it for all of us. They have chips on their shoulders, feel insecure, or whatever, and it makes those of us who are honestly just in it because we love medicine feel like we are walking on glass because everywhere we turn (especially as a PA) someone is taking a shot at us. I had never had an issue like I had read about (and dreaded) on here until very recently when I ran into a couple of nurses with chips on their shoulders. Otherwise, I have learned a lot from nurses, how to start IVs back when I was in emt school, how to pull a central line, insert a foley, etc. I have also had nurses save me from writing an incorrect order as a student. These are all important things the nurses around me do, as is taking a patient off of a bed pan and talking them down from their anxieties before I even show up to do a procedure. I know.. trust me I know.

Anyways, I hope that helps you understand where I am coming from. It is just so dissapointing to come on here and see my colleagues talk about other health professionals the way I see nurses talk about PAs on here. Unfortunantly, I don't think there is anything I can type, or say to help the people who need to understand, understand.

Best of luck, and I hope this was at least worth reading.

Sincerely

KatieBell · Mar 26, 2008

As I said before, peope help their families with bed pans all the time with no training. It is not a skill, it is very basic and I have had multipe docs put and take off patients from pans, never with such a concern as the one you raise.

Personally, I think if you are experienceing the SAME response again and again in different areas of care, it just might be you. If it were just the ER or just surgery it might be those nurses, but...it's happening again and again with one factor thats the same.

caldje · Mar 26, 2008

Personally, I think if you are experienceing the SAME response again and again in different areas of care, it just might be you. If it were just the ER or just surgery it might be those nurses, but...it's happening again and again with one factor thats the same.

I was about the say the exact SAME thing to the nurses I am having a problem with. If you review my post you will see this quote of mine...

"I had never had an issue like I had read about (and dreaded) on here until very recently when I ran into a couple of nurses with chips on their shoulders."

I have never had a problem, just read about them on here and other forums. Now I am experiencing the issue and would be happy to explore my own faults. I often do, and I have plenty of them.

Please don't get stuck on the bedpan issue, because its not just about bedpans. We all have our jobs, sometimes we help eachother out because we are in it together/like eachother or whatever. In the end, though, we all have tasks we have to accomplish and if we don't accomplish our tasks because we are taking care of someone else's then that is not in the patient's best interest.

Again, I know that for some people, no matter what I say, their opinions won't change but hopefully the people reading here that do have an open mind will understand my point.

sincerely

SchnauzersRock · Mar 26, 2008

I am amazed with the responses to this issue! It doesn't matter the educational level a person has or that it is not in a "person's job description"... what matters is that a patient is on a bedpan, which is uncomfortable to be sitting on... and needs to get off! So if a clinical person is in the room, a doctor, NP, PA, RN, LPN or CNA, and a patient requests to get off of the bedpan JUST TAKE THE PATIENT OFF OF THE BEDPAN! Those of us in healthcare are SUPPOSED to be in it to help patients which sometimes may mean helping them off a bedpan!
By the way most jobs I have had the job descriptions have ALWAYS included a statement such as "...and whatever else the boss says is part your job." Why is it nurses could do housekeeping, dietary, maintenance, respiratory therapy, lab, CPD etc... and other "professions" are not expected to? Nurses are not the only members of the team.....and getting a patient off the bedpan is not anything beneath ANYONE who is really there to help people!

The reason this nonsense goes on is because that in spite of this being the 21st century, people look at nurses as little more than Florence Nightingales, who have nothing better to do than wipe fevered brows, feed the infirm soup, and fluff pillows. And folks, let's face it. We have no one but ourselves to blame. As nurses, we need to promote the idea that not only are we caregivers, we are decision-makers, supervisors, educators, life-savers. We are intelligent, dyanamic individuals, and we have much more to give to our profession as nurses than the world realizes. We are not to be subservient and meek all the while deferring to others. Having said all of that, we need to continue to assist our patients when needed, continue to promote wellness and independence in those we are taking care of, and enlist ALL healthcare workers in the care and healing of the general public. Just my :twocents: !