Why NP and not PA?

tiredfeetED · Jul 14, 2007

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

jer_sd · Jul 14, 2007

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.

core0 · Jul 14, 2007

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

jer_sd · Jul 14, 2007

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.

tiredfeetED · Jul 14, 2007

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 · Jul 18, 2007

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 · Jul 21, 2007

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.

core0 · Jul 21, 2007

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

Atl_John · Jul 22, 2007

Thanks David, luckily that program is at UAB and i just happen to live in Alabama 100 miles away from UAB. :) I was thinking of doing the ACNP/RNFA and then doing a post masters FNP or PNP so that I could see peds. I've been looking at the programs at UAB and I really like what I see in them, what are your thoughts from looking at them from the other side of the fence? Now quick question with the peds, as far as I know ACNP's can see kids that are 13 and older, do most ortho surgeons see a lot of kids younger than that, or is it primarily older adults, adults and adolescents?

Are there any ACNP's here who do work for an Ortho Surgeon by chance or does anyone now of any who do?

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

core0 · Jul 22, 2007

Thanks David, luckily that program is at UAB and i just happen to live in Alabama 100 miles away from UAB. :) I was thinking of doing the ACNP/RNFA and then doing a post masters FNP or PNP so that I could see peds. I've been looking at the programs at UAB and I really like what I see in them, what are your thoughts from looking at them from the other side of the fence? Now quick question with the peds, as far as I know ACNP's can see kids that are 13 and older, do most ortho surgeons see a lot of kids younger than that, or is it primarily older adults, adults and adolescents?
Are there any ACNP's here who do work for an Ortho Surgeon by chance or does anyone now of any who do?

It sounds like you are doing a lot of work to get somewhere where their may or may not be a job. While there are some NPs working in surgery (assisting), they are for the most part FNPs that were granfathered in (the one that I can think of works in pediatric urology). You have to look at the way the system works. For the most part NPs are not assisting and the surgeons are going to be a little unwilling to go out on a limb.

While I respect what UAB is doing, this is a new program. The UAB PA program is closing is more than 40 years old and has been producing top notch surgical PAs for that whole time. Pretty much every one of their grads has a choice of jobs. Finally the age thing seems to vary state by state. I was told in Colorado that non-FNP/PNP could not see patients under the age of 16 (by a PNP). The regulations do not seem to differentiate, but this would add substantially if you ever end up in court.

David Carpenter, PA-C

Atl_John · Jul 22, 2007

Hey David,

Thanks as always for your input. I guess for me the biggest reason for wanting to do this particular program is that the courses that are surgical are PA courses. I would be getting the same surgical education and level of rotation as a surgical pa (1500+ hours just for RNFA) That was appealing to me, and I believe I can sell that to a potential surgeon. Most are familiar with PA's surgical training well I'll have had the same training. There is one important lesson that I learned, dont' be afraid to do something because you are afraid of failure. If I do this program I will find a job, even if its in Anchorage, AK (which woudlnt' be bad actually wouldn't mind going back there) I was unhappy for too long to not take a chance on doing what I really want to do. If that means I have to do extra work thats ok I've never minded hard work. :) I would love nothing more than to assist in surgery and then see the patients post op in the hospital. Sounds like a great job to me. :)

It sounds like you are doing a lot of work to get somewhere where their may or may not be a job. While there are some NPs working in surgery (assisting), they are for the most part FNPs that were granfathered in (the one that I can think of works in pediatric urology). You have to look at the way the system works. For the most part NPs are not assisting and the surgeons are going to be a little unwilling to go out on a limb.
While I respect what UAB is doing, this is a new program. The UAB PA program is closing is more than 40 years old and has been producing top notch surgical PAs for that whole time. Pretty much every one of their grads has a choice of jobs. Finally the age thing seems to vary state by state. I was told in Colorado that non-FNP/PNP could not see patients under the age of 16 (by a PNP). The regulations do not seem to differentiate, but this would add substantially if you ever end up in court.
David Carpenter, PA-C

jer_sd · Jul 22, 2007

one thing to keep in mind is that most if not all states have rules or advisory concerning the practice RNFAs. It is possible to be a NP and function as a RNFA in an area outside of your NP cert, as long as you meet the requirements for RNFA practice. So an adult NP could hypothetically first assist peds surgery. It is the preop and postop care that will use the NP license. But if you look at AORN guidelines they allow RNFAs to participate in the preop and post op care (so rx might be the only sticky point). Acute NPs are still a new creature in the midlevel arena compared to other NPs or PAs. If I wanted to work ortho I would consider the np residency in ortho to facilitate this.............Jeremy