PA vs. ACNP

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I was wondering if there is any advantage to being an ACNP versus a PA in adult acute care. I can see how, in states where NPs have independent practice, being a primary care NP versus a primary care PA could be advantageous. However, would an NP's level of autonomy really be any different from that of a PA in an inpatient setting--even in states with independent NP practice? I would think some level of physician supervision would be necessary in the critical care arena, for example. What do you all think?

Thanks!

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I would also like to know why PA's average salary is about 5K more than NP's. http://money.cnn.com/magazines/moneymag/bestjobs/2009/full_list/index.html

I was looking at OSU's jobs and the salary range only went up to 115k for NP but 130k for PA...

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I think it's related to the fact that more PAs work in higher-paying specialties (like ED, ICU, Surgery, etc...).

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Anyone?

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I would also like to know why PA's average salary is about 5K more than NP's. http://money.cnn.com/magazines/moneymag/bestjobs/2009/full_list/index.html

I was looking at OSU's jobs and the salary range only went up to 115k for NP but 130k for PA...

Also, I would be willing to bet it is because more PA's are male and more experienced and more hard line when it comes to negotiating.

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Specializes in Critical Care, Emergency, Education, Informatics.
I was wondering if there is any advantage to being an ACNP versus a PA in adult acute care. I can see how, in states where NPs have independent practice, being a primary care NP versus a primary care PA could be advantageous. However, would an NP's level of autonomy really be any different from that of a PA in an inpatient setting--even in states with independent NP practice? I would think some level of physician supervision would be necessary in the critical care arena, for example. What do you all think?

Thanks!

Your correct in most things. One of the other differences is that each states scope of practice and nurse practice act is different. Another problem is that medical staff does'nt understand NP's. THey understand PA's and it shows in the hospital bylaws in some cases. ACNP's are pretty new in the grand scheme of things. For example in one hospital I work the PA's are allowed to place and reposition PA catheters but the NPs aren't per hospital policy. I"m not sure were that came from. As to the $$$ well in one of the hospitals I was CNO at the NP's were paid out of nursing and the PA's by the medical staff.

As to independent practice, not in inpatient medicine. YOu'll be working for a medical group no matter what your state says about independent practice. And you'll have to follow the hospital bylaws and policies.

There are a lot of factors involved and in deciding one or the other you have to look at the location you plan on working and the current work environment.

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Specializes in SICU, MICU, CICU, NeuroICU.
Also, I would be willing to bet it is because more PA's are male and more experienced and more hard line when it comes to negotiating.

I find that statement to be completely false.

I'm a male nurse and my wife is a nurse also. She has much better negotiating skills than I. At my former hospital, the PA's were 50/50 male/female.

IMO, I believe that PA's are more advanced in their training. I've never worked with a NP, but I don't know if they're allowed to put in lines, or perform bedside procedures. Also, I don't think NP's scrub in, in the OR.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I was wondering if there is any advantage to being an ACNP versus a PA in adult acute care. I can see how, in states where NPs have independent practice, being a primary care NP versus a primary care PA could be advantageous. However, would an NP's level of autonomy really be any different from that of a PA in an inpatient setting--even in states with independent NP practice? I would think some level of physician supervision would be necessary in the critical care arena, for example. What do you all think?

Thanks!

In my experience, the advantage depends largely on employer preference. I've worked in three different ICU settings since becoming an ACNP and 1 out of the 3 settings will only hire NP's in the group. The other 2 hire both PA's and NP's and there is no distinction made in the roles between the two providers. You are also absolutely right. I find that even though ACNP's function as advanced practice nurses who technically work under the nursing model and under a nursing license, the complexity of the health needs of hospitalized patients as well as insurance regulations at the federal level make it so that ACNP's rely on very close NP-physician working relationships and collaboration. I actually see no difference in the job description between the PA's and NP's who practice in the ICU settings I've worked in.

I find that initially, ACNP's with significant ICU experience feel more at ease in the ICU setting compared to a new PA who may not have worked in an ICU before. After a significant period of time on the job, I think both professionals may actually function with equal competence all factors considered. I would reiterate though that this is based on my experience as a Critical Care NP. ACNP's who work in surgical specialties may actually experience a disadvantage in settings where only PA's are credentialed to assist in the OR.

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Specializes in Pediatric critical care.
In my experience, the advantage depends largely on employer preference. I've worked in three different ICU settings since becoming an ACNP and 1 out of the 3 settings will only hire NP's in the group. The other 2 hire both PA's and NP's and there is no distinction made in the roles between the two providers. You are also absolutely right. I find that even though ACNP's function as advanced practice nurses who technically work under the nursing model and under a nursing license, the complexity of the health needs of hospitalized patients as well as insurance regulations at the federal level make it so that ACNP's rely on very close NP-physician working relationships and collaboration. I actually see no difference in the job description between the PA's and NP's who practice in the ICU settings I've worked in.

I find that initially, ACNP's with significant ICU experience feel more at ease in the ICU setting compared to a new PA who may not have worked in an ICU before. After a significant period of time on the job, I think both professionals may actually function with equal competence all factors considered. I would reiterate though that this is based on my experience as a Critical Care NP. ACNP's who work in surgical specialties may actually experience a disadvantage in settings where only PA's are credentialed to assist in the OR.

A regular OR nurse can become credentialed in first assisting. There are programs out there and an NP can also become an RN first assistant.

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A regular OR nurse can become credentialed in first assisting. There are programs out there and an NP can also become an RN first assistant.

Yes a "regular" nurse can become credentialed as can an NP. What NP Gilly was presumably referring to is that its generally easier to get OR privileges as a PA than as an ACNP for a number of reasons.

David Carpenter, PA-C

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Also, I would be willing to bet it is because more PA's are male and more experienced and more hard line when it comes to negotiating.

Actually the breakdown is about 60% Female, 40% Male:

http://www.aapa.org/images/stories/2008aapacensusnationalreport.pdf

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I work in California so may be geographically biased. At both hospitals I work at ACNPs make a lot more than PAs. In fact, PAs make less per hour than most staff nurses (I make 79/hour as an NP). You can view UCSF's pay scale on line (lower than most hospitals). Northern California Kaiser Permanente now has an official policy that you must hire an NP before an equally qualified PA. We do have numerous PAs in the surgical specialties, especially orthopaedics. Few NPs work in the surgical specialties, possibly because there is only one ACNP program in Northern California. Both professions seem to be well respected at my facilities, but NPs a little more so. I think this is because of the quality of UCSF graduates vs the local PA programs, and not the professions in general. Good luck.

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