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Why NP and not PA?

I'd appreciate all your input! I've been a research nurse for 5 years and have always had an interested in midlevel work and am ready to pursue. I'm having a hard time deciding which route to go. I've talked to both NPS and PAs. Many of the PAs from my clinic were nurses. I hear more negatives about the job from NPs than I do PAs. The floor was not a good fit for me. It's hard to explain, but I'd say I didn't like the technical aspects at all (hanging blood, fluids, giving meds etc). I liked the monitoring and assessments and teaching. I also like it when my coworkers come to me and report labs out of range, or what they should do in certain situations that are not always clear. I like to direct the care and I feel I'm more confident in that than I was hanging blood. I think it's the equipment that makes me nervous, to be honest!! Since I have limited hands on experience, do many of you NPs out there think the PA route would be better for me? I've already read the threads about PAs and RNs going to NP school without experience. Appreciate your time to read this. Many thanks....

What do you actually want to do as a NP or PA... if you go to surgery including first assisting that is a very technical role, so can some areas in practice such as ortho, or neuro. Even a hospitalist position may be very hands on with chest tubes and lines.

PA education gives a solid foundation in all aspects of medicine, as a NP you can focus your training but limit your career choices (peds, adult, psych).

One benifit for NP there are more programs, an you can apply to NP or PA school as a RN.

In the real world both providers are often used the same in my area.

EricJRN specializes in NICU.

For my career direction, it's simply a matter of staying in the specialty that I enjoy. In my geographic area, they just don't hire PA's in my specialty, so I'd either have to move or choose NP school.

I think applying to both schools and going on interviews to decide which specific school fits best with your intentions and personality is a pretty good idea. The rest will probably work itself out.

WSH-RN specializes in ER, ICU/CVR.

I think it really depends on what state you will want to practice in. In MS, it is better to be an NP. PAs are few and are tied directly to a physician. NPs can open their own clinic and run everything as long as they have a physician to audit their charts. MS was one of the last states to recognize PAs, so again, it is state dependent.

WSH

Personally, I think I'd prefer a PA program to an NP program because of my learning style and interests. I found nursing school frustrating in its approach. Just a preference, most of my classmates were satisfied. Anyway, if I were to go back to school, I'd want to try a different take. It sounds like maybe you're leaning towards the PA route but have some doubts. You are likely only going to have this training once. Go with a program (either NP or PA) that you think will best prepare you based on your own preferences/strengths/weaknesses/goals/etc even it takes a bit longer or if some of your nurse colleagues would do it differently. If you're not concerned about the difference in training style, the NP would seem to be the practical option as it's generally faster and easier for a nurse to get accepted and finish an NP program than a PA program. Of course, if you've got a very specific type of practice in mind, that might determine the best option depending on where you live.

If I was someone off the street, I'd prob want to be a PA, because it would be quicker. Already being a nurse, I would definitely go NP. NPs treat with nursing philosophy. PAs treat with doctor philosophy. Plus, as someone already mentioned, PAs need to work under an MD license where NPs work under their own. I've never heard of a PA who was a nurse first. That's wierd.

Not saying PAs are less valuable, and I don't know if there's a pay difference. But NP. :idea:

Oh yeah, another thing, I know where I live at least, PAs have to take a huge test every 5 years to stay current in their license. And even if they work in a specialty, the test is comprehensive. Yet another reason for me.

If I was someone off the street, I'd prob want to be a PA, because it would be quicker. Already being a nurse, I would definitely go NP. NPs treat with nursing philosophy. PAs treat with doctor philosophy. Plus, as someone already mentioned, PAs need to work under an MD license where NPs work under their own. I've never heard of a PA who was a nurse first. That's wierd.

Not saying PAs are less valuable, and I don't know if there's a pay difference. But NP. :idea:

Oh yeah, another thing, I know where I live at least, PAs have to take a huge test every 5 years to stay current in their license. And even if they work in a specialty, the test is comprehensive. Yet another reason for me.

We had three nurses in our class out of 50 students. This is probably about average. There is one program that is a combined NP/PA program and another that until recently accepted only RN's. Nurses are fairly common in the PA profession.

Pay on the average is about $5-10k more for PA's than NP's according to MGMA. This is probably due in part to the greater number of PAs in surgery. Part of this is that according to MGMA is that PAs are much more productive than NPs.

As far as the licensing issues, I would suggest a search here. I will point out that according to Advance for NPs about 2% of NPs have their own practice. Interestingly this is about the same number of PAs that report being self employed. Mostly NPs and PAs work in physician practices and work in the same practice environment.

As far as the PANRE. Most PAs have to take this every six years. It is a comprehensive test that covers basic medical knowledge . This is the direction that most physician certification organizations are going. I find it difficult to believe that you think that demonstrating knowledge is the area that you are trained in is a bad thing. Even if we work in a specialty we are still required to know basic knowledge.

Ultimately the decision to go to PA or NP is multifactorial. The nurses in my program were universally critical of the amount of time that they spent on nursing theory which they considered completely unrelated to advanced practice nursing. They also wished to study in a medical model with experience in all aspects of medicine vs. studying in a particular area of advanced practice nursing. It is about learning style as well as the employability of the provider in a particular market.

David Carpenter, PA-C

HeartsOpenWide specializes in Ante-Intra-Postpartum, Post Gyne.

NP and PA go to the same school, have the same classes and graduate together. However, nurses with BSNs become certified NPs and PAs and are licensed under the nursing board; where as PAs are PAs period. NPs can write triplicate medication and PA;s can not (at least in my state of California). There are a few minor procedures that a NP can do that a PA can not, but not many. Once an NP is done seeing a patient the chart can be file in the wall, for PAs every since one of their charts has to be reviewed and signed off by a doctor. An NP will more than likely also receives a master's degree (its only a few more courses) while a PA is considered a medical practitioner but does not have any degree associated with being a PA (minus any degrees her or she may already have). If you are a BSN nurse you would graduate with a NP and PA title. If you are an ASN nurse you probably have enough clinical hours to immediately apply to the PA portion/title. I have worked with both PAs and NPs and my good friend is in PA school at UCDavis. I asked an FNP I worked with if she felt she had an advantage over those in her class that were going for the PA title and did not have any nursing background. She said that other than things like EKG and other hands on things she did not feel that she had that much of an advantage (she went through the program before having a BSN first was required, not that that would make much difference on her academic performance). My friend who is in PA school right now said that she did not go on the NP portion because she would have to spend three years in nursing school and she had worked in the medical field hands on in some form since she was in high school: CNA, MA.

np and pa go to the same school, have the same classes and graduate together. however, nurses with bsns become certified nps and pas and are licensed under the nursing board; where as pas are pas period. nps can write triplicate medication and pa;s can not (at least in my state of california).

if you are talking about uc davis you can chose to be licensed as a pa, np or both. many of the graduates use whatever language is most advantageous. for example if the graduate wishes to apply for a job that is outside the scope of the fnp then they can use the pa license. also triplicates no longer exist and pas can write schedule drugs just like nps (as of 2005).

there are a few minor procedures that a np can do that a pa can not, but not many. once an np is done seeing a patient the chart can be file in the wall, for pas every since one of their charts has to be reviewed and signed off by a doctor. an np will more than likely also receives a master's degree (its only a few more courses) while a pa is considered a medical practitioner but does not have any degree associated with being a pa (minus any degrees her or she may already have). if you are a bsn nurse you would graduate with a np and pa title. if you are an asn nurse you probably have enough clinical hours to immediately apply to the pa portion/title. i have worked with both pas and nps and my good friend is in pa school at ucdavis. i asked an fnp i worked with if she felt she had an advantage over those in her class that were going for the pa title and did not have any nursing background. she said that other than things like ekg and other hands on things she did not feel that she had that much of an advantage (she went through the program before having a bsn first was required, not that that would make much difference on her academic performance). my friend who is in pa school right now said that she did not go on the np portion because she would have to spend three years in nursing school and she had worked in the medical field hands on in some form since she was in high school: cna, ma.

for california the pa needs to have 10% of their charts reviewed. you are correct that pas do not have a degree associated with it. the profession is based on medical competence as demonstrated by the national certification exam and graduation from an arc-pa accredited program. the emphasis on competence means that anyone who has the basic prerequisites can apply. as you point out a nurse with an adn would be able to apply for pa school but not for np school.

the big issue with uc davis is that nps from there can be licensed in california, but cannot bill medicare as nps unless they take additional classes to get their msn. the stanford program which is similar has this to say:

licensure for fnps: at present, rns who complete the program may practice in california as fnps. however, effective january 1, 2008, the california board of registered nursing requires that nurse practitioners hold a masters degree. the masters degrees available through the pca program (mph and mms) will qualify for fnp practice in california. however, without a masters degree in nursing and national certification, an fnp cannot bill medicare or medicaid for services rendered. this may limit the fnp's practice opportunities.

both pa and np practice vary widely not only state by state but within regions. there are different elements that may make one or the other more advantageous. the stanford and uc davis programs will probably no longer be able to offer the dual option much longer.

david carpenter, pa-c

As far as the licensing issues, I would suggest a search here. I will point out that according to Advance for NPs about 2% of NPs have their own practice. Interestingly this is about the same number of PAs that report being self employed. Mostly NPs and PAs work in physician practices and work in the same practice environment.

As far as the PANRE. Most PAs have to take this every six years. It is a comprehensive test that covers basic medical knowledge . This is the direction that most physician certification organizations are going. I find it difficult to believe that you think that demonstrating knowledge is the area that you are trained in is a bad thing. Even if we work in a specialty we are still required to know basic knowledge.

In the place where I work, the PAs must have their notes signed off by an MD. The NPs do not. That is the big difference I notice between having your own license and not. Honestly I don't think I'd want to be a pt of an NP or a PA that was not affiliated with an MD. Just in case.

I personally don't want an advanced degree, quite happy with my RN. And I mean no offense against PAs. I've known great PAs, and not-so-great. Just like the NPs I've known.

And yeah, having to take a comprehensive written test every 6 years is a definite 'ugh' factor for me. I'm not ashamed to admit it! And I guarantee, if the BON decided to make RNs take the NCLEX every 5 or 6 years, there'd be a LOT of PO'ed RNs. So yes, your statement demonstrating knowledge is the area that you are trained in is a bad thing, is a true statement, particularly if you are talking about sitting me in in front of a computer for how ever many hours and taking a written test.

PAs DO have their OWN license. For the last time.. for goodness sakes.

The coignature issue is state and facilty dependent and is really nothing but a doc signing a piece of paper. Not a real difference in the way people practice.

NP and PA go to the same school, have the same classes and graduate together. However, nurses with BSNs become certified NPs and PAs and are licensed under the nursing board; where as PAs are PAs period. NPs can write triplicate medication and PA;s can not (at least in my state of California). There are a few minor procedures that a NP can do that a PA can not, but not many.

Once an NP is done seeing a patient the chart can be file in the wall, for PAs every since one of their charts has to be reviewed and signed off by a doctor. An NP will more than likely also receives a master's degree (its only a few more courses) while a PA is considered a medical practitioner but does not have any degree associated with being a PA (minus any degrees her or she may already have). If you are a BSN nurse you would graduate with a NP and PA title. If you are an ASN nurse you probably have enough clinical hours to immediately apply to the PA portion/title. I have worked with both PAs and NPs and my good friend is in PA school at UCDavis. I asked an FNP I worked with if she felt she had an advantage over those in her class that were going for the PA title and did not have any nursing background. She said that other than things like EKG and other hands on things she did not feel that she had that much of an advantage (she went through the program before having a BSN first was required, not that that would make much difference on her academic performance). My friend who is in PA school right now said that she did not go on the NP portion because she would have to spend three years in nursing school and she had worked in the medical field hands on in some form since she was in high school: CNA, MA.

I am kinda curious about what minor procedures a NP can do that a PA cannot? I am a RN who is now a PA student.

Just finished my ED rotation and did a very wide variety of procedures such as suturing, reductions, splinting, intubating, paracentesis, Lumbar punctures, central line placements just to name a few. In the clinic I do all the procedures that my MD preceptor does, he follows the motto...see one do one.

As always Core0 cleared the up the misconception of signatures and Scheduled scripts. ;) You are right about the dual programs, there time has somewhat come to a end as Stanford as of this new class is now just a PA program. Davis has now went to a dual program with MSN option.

Being a RN first going to PA school may not be a advantage but gave me very broad exposure to medicine compared to some of the students especially now that I am in my clinical year.

tiredfeetED, FNP-S, PA-S ;)

I am kinda curious about what minor procedures a NP can do that a PA cannot? I am a RN who is now a PA student.

Just finished my ED rotation and did a very wide variety of procedures such as suturing, reductions, splinting, intubating, paracentesis, Lumbar punctures, central line placements just to name a few. In the clinic I do all the procedures that my MD preceptor does, he follows the motto...see one do one.

As always Core0 cleared the up the misconception of signatures and Scheduled scripts. ;) You are right about the dual programs, there time has somewhat come to a end as Stanford as of this new class is now just a PA program. Davis has now went to a dual program with MSN option.

Being a RN first going to PA school may not be a advantage but gave me very broad exposure to medicine compared to some of the students especially now that I am in my clinical year.

tiredfeetED, FNP-S, PA-S ;)

I think that PAs are restricted to only do procedures under local anesthesia in the state of california. NPs don't have that restriction a NP can do a procedure under sedation. I am not sure if this law is actually enforced in general practice.

I think that PAs are restricted to only do procedures under local anesthesia in the state of california. NPs don't have that restriction a NP can do a procedure under sedation. I am not sure if this law is actually enforced in general practice.

As far as I know New York is the only state that prohibits PAs from doing general anesthesia. I am not aware of any states that prohibit PAs from doing sedation. A quick perusal of California state law does not show any reference to sedation. As usual in a western state the scope of practice is defined as this:

A physician assistant may only provide those medical services which:

(1)

he or she is competent to perform, as determined by the supervising physician,

(2)

are consistent with his/her education, training, and experience, and

(3)

are delegated in writing by the supervising physician responsible for the patients cared for by the PA.

California is a little more onerous in that they require a written delegation for medical services. Most western states do not. I would defer to EMEDPA here since I think he does a fair amount of sedation in the ER.

David Carpenter, PA-C

As far as I know New York is the only state that prohibits PAs from doing general anesthesia. I am not aware of any states that prohibit PAs from doing sedation. A quick perusal of California state law does not show any reference to sedation. As usual in a western state the scope of practice is defined as this:

A physician assistant may only provide those medical services which:

(1)

he or she is competent to perform, as determined by the supervising physician,

(2)

are consistent with his/her education, training, and experience, and

(3)

are delegated in writing by the supervising physician responsible for the patients cared for by the PA.

California is a little more onerous in that they require a written delegation for medical services. Most western states do not. I would defer to EMEDPA here since I think he does a fair amount of sedation in the ER.

David Carpenter, PA-C

Here is the exact wording from the legislation, it looks like the PA can provide sedation but can not preform surgical procedures if a patient has more than local anesthesia in the state of california.

(i) (1) Perform surgical procedures without the personal presence of the supervising physician which are customarily performed under local anesthesia. Prior to delegating any such surgical procedures, the supervising physician shall review documentation which indicates that the physician assistant is trained to perform the surgical procedures. All other surgical procedures requiring other forms of anesthesia may be performed by a physician assistant only in the personal presence of an approved supervising physician.

I think that PAs are restricted to only do procedures under local anesthesia in the state of california. NPs don't have that restriction a NP can do a procedure under sedation. I am not sure if this law is actually enforced in general practice.

At the facility I worked as a RN, the PAs were credentialed to order and do procedures under conscious sedation using meds such as ketamine, propofol, etomidate in the ED without a MD. Sometimes they give the MD a heads up but are not required. This does vary from hospital to hospital.

I am sure a ACNP could do these procedures since they were trained but a FNP cannot or shouldn't since it is out of their scope of training.

As for the quote from PA legislation, it just saying that a surgeon cannot delegate procedures done under general. No lap choles done by the PA while the surgeon is playing golf.;)

JALEXSHOE specializes in ICU, ED, Trauma.

So much good advice has already been given.

One thing I could add would be that you mention, if I understand it correctly, that while you like to teach or delegate, that you do not enjoy the bedside as much (hanging blood, procedures, machines).

I do not know all the scopes or versatility of a PA's practice. I know the Masters in Nursing has many options for advanced practice, some of them being administrative and educational. If you do not enjoy the hands on portion, you may want to seek a degree that put you more in line with your interests.

If this might be an issue, it may be an avenue you want to investigate a little further.

Atl_John specializes in Pulmonology/Critical Care, Internal Med.

Really, thats kind of neat, so NP's can do/give conscious sedation (propofol, etomidate, ketamine, versed/ w/narcs?) and then do procedures like reductions, etc? Thats awesome as thats what i would love to do, ACNP/RNFA and work for an ortho surgeon who specializes in long bone repairs or the ED doing things like LP's, chest tubes, etc.

At the facility I worked as a RN, the PAs were credentialed to order and do procedures under conscious sedation using meds such as ketamine, propofol, etomidate in the ED without a MD. Sometimes they give the MD a heads up but are not required. This does vary from hospital to hospital.

I am sure a ACNP could do these procedures since they were trained but a FNP cannot or shouldn't since it is out of their scope of training.

As for the quote from PA legislation, it just saying that a surgeon cannot delegate procedures done under general. No lap choles done by the PA while the surgeon is playing golf.;)

Really, thats kind of neat, so NP's can do/give conscious sedation (propofol, etomidate, ketamine, versed/ w/narcs?) and then do procedures like reductions, etc? Thats awesome as thats what i would love to do, ACNP/RNFA and work for an ortho surgeon who specializes in long bone repairs or the ED doing things like LP's, chest tubes, etc.

Just remember that there is only one RNFA/ACNP program. There are something on the order of 4000 PAs working in Othopedics. Also the Orthos around here would be leary about hiring an ACNP if they do any call because they see a fair amount of peds. Also the prohibition on sedation is particular to California. In Colorado I am credentialled to do sedation in all the hospitals I work in. If you want to do surgery (ie. assist in the OR) you are going to have a much easier time as a PA.

David Carpenter, PA-C

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