Are PAs and NPs "interchangeable"?

[myironlung]

Here's something for thought...I could be way off but, talking in general i think it's safe to say (i hope) that nurses get into the field with being ok with NOTpracticing medicine, but are ok with taking and carrying out orders. Of course other students get into nursing because they know they will eventually want to become an NP and practice medicine.

 

For a PA, students generally get into the field knowing they WILL practice medicine and have a DESIRE to from the very beginning. There is no time when they will be just "taking orders" and moving the patient along.

 

I think this mindset factors into NP/PA in regards to simple motivation/purpose and desire. Some NP's it seems like just "fall" into NP, and therefore might be more prone to that kind of laid back approach to practicing medicine which may in turn affect performance. Whereas PA's brains could be wired differently from the start and therefore could benefit from that original motivation to help performance.

 

Just a thought though. I love nurses and everything they do. They are my backbone and I don't know where I'd be without them.

[polarbebe]

Here's something for thought...I could be way off but, talking in general i think it's safe to say (i hope) that nurses get into the field with being ok with NOTpracticing medicine, but are ok with taking and carrying out orders. Of course other students get into nursing because they know they will eventually want to become an NP and practice medicine.

 

For a PA, students generally get into the field knowing they WILL practice medicine and have a DESIRE to from the very beginning. There is no time when they will be just "taking orders" and moving the patient along.

 

I think this mindset factors into NP/PA in regards to simple motivation/purpose and desire. Some NP's it seems like just "fall" into NP, and therefore might be more prone to that kind of laid back approach to practicing medicine which may in turn affect performance. Whereas PA's brains could be wired differently from the start and therefore could benefit from that original motivation to help performance.

 

Just a thought though. I love nurses and everything they do. They are my backbone and I don't know where I'd be without them.

I also respect nursing and their profession.

 

Just as a counterpoint I would argue the opposite. That nurses that choose to go the NP route (excluding the direct to entry NP programs) would preferentially select for the medical professionals who are more focused on their career. Those that only want to follow orders, stay a RN in general.

 

The trend for PA programs is for high school and college graduates to enter the program with no or minimal health care experience. Many (dare I say >50%) I have interacted with (work in NYC, NY has the highest number of PA programs with 22) see it as a job and not a career; want a 9-5 job and are content being an "assistant" and do not seek greater autonomy, not involved with PA practice rights or member of their state PA association.

 

The majority of NPs were at least somewhat experienced RNs.

 

Anyway, I also believe PA training is superior... after several years it evens out.

 

As an aside, any more experienced PAs out there if they could list the specific instances where RNs/nursing lobby or administration (hospital, local, state, federal) opposed PA friendly legislation or regulations? Would be interesting to see ... and maybe get more PAs involved by making them aware of these practice issues. "Light their fire" if you will...

[andersenpa]

Here's something for thought...I could be way off but, talking in general i think it's safe to say (i hope) that nurses get into the field with being ok with NOTpracticing medicine, but are ok with taking and carrying out orders. Of course other students get into nursing because they know they will eventually want to become an NP and practice medicine.

 

For a PA, students generally get into the field knowing they WILL practice medicine and have a DESIRE to from the very beginning. There is no time when they will be just "taking orders" and moving the patient along.

 

I think this mindset factors into NP/PA in regards to simple motivation/purpose and desire. Some NP's it seems like just "fall" into NP, and therefore might be more prone to that kind of laid back approach to practicing medicine which may in turn affect performance. Whereas PA's brains could be wired differently from the start and therefore could benefit from that original motivation to help performance.

 

Just a thought though. I love nurses and everything they do. They are my backbone and I don't know where I'd be without them.

Agree with the previous post.

 

You could easily say that some PAs are looking to only be an "Assistant". There was an old news story we made fun of here- "Physician's Assistant- Doctor's Job with Banker's hours" or something to that effect.

 

On the NP side I'd bet that the majority going into it now have NP on the mind from the outset- becoming independent practitioners.

[matchb0x]

I also respect nursing and their profession.

 

Just as a counterpoint I would argue the opposite. That nurses that choose to go the NP route (excluding the direct to entry NP programs) would preferentially select for the medical professionals who are more focused on their career. Those that only want to follow orders, stay a RN in general.

 

The trend for PA programs is for high school and college graduates to enter the program with no or minimal health care experience. Many (dare I say >50%) I have interacted with (work in NYC, NY has the highest number of PA programs with 22) see it as a job and not a career; want a 9-5 job and are content being an "assistant" and do not seek greater autonomy, not involved with PA practice rights or member of their state PA association.

 

The majority of NPs were at least somewhat experienced RNs.

 

Anyway, I also believe PA training is superior... after several years it evens out.

 

As an aside, any more experienced PAs out there if they could list the specific instances where RNs/nursing lobby or administration (hospital, local, state, federal) opposed PA friendly legislation or regulations? Would be interesting to see ... and maybe get more PAs involved by making them aware of these practice issues. "Light their fire" if you will...

As an actively working nurse I can tell you this is exactly it.  I work with several intelligent experienced nurses who have said, when asked by me as to if they have considered advancing their education, they don't want the added responsibility.  It really boils down to that simple idea for most of the ones who continue to be a floor nurse.  For me, I'm going NP because it is the only way I can continue to work while attending school and get to have a greater impact on my patient's health.  I want the responsibility.

[matchb0x]

Also, there is a small, albeit real, percentage of NP/NP hopefuls who are coming at the whole thing with a load of ego.  This comes from being talked down to and verbally abused by MDs which is becoming less common but still occurs.  It's funny to me to see some of the attitudes towards NPs expressed by Docs when you consider that they essentially created the initial desire to create a NP profession with their poor treatment of "support staff" so many years ago.  The world is funny like that.

 

*edit function acting weird*

[Guest Paula]

It's the same for PAs...profession developed by an MD/MDs and now some of them do not like us at all.  We are all the competition in their minds, I think.  Too bad it is that way.  It could be much better when all the medical practitioners learn to respect each other for what we do know, what we do, how we continue to grow in each profession, and take the responsibility seriously. 

[JBNP]

An interesting question and as a NP I thought I would respond.

 

I may be somewhat biased having been educated as a nurse but I do think that PAs and NPs are interchangeable in most cases. I think you have to look at the individual candidate and their educational and professional experiences and then make hiring decisions. One should hesitate to make broad generalizations about either PAs or NPs as both have a lot to offer as healthcare providers. There are good and bad providers at every level of healthcare (CNA, EMT, RN, NP, PA, MD/DO, etc). I am not aware of any research that validates a difference in clinical outcomes by NP vs PA prepared providers. 

 

I do agree that PAs have an edge in some specialties and overall I greatly favor the generalist nature of the educational preparation. Although NPs seem to have a stronger political lobby in many states, I think the fragmentation of the education preparation only hinders the profession. I would be an advocate for increasing educational standards in NP programs and had hoped that this would be the effect of the DNP. However, any educational gaps are quickly overcome by professional experience. I would think that most NPs and PAs that have had the same clinical position for several years would have equal clinical knowledge and outcomes. 

[KMD16]

^^^ Fair analysis!

[Acromion]

I very much resent the NP/PA designation, because it blurs the line between what we are, what we do, and how we are educated. I suppose the logic behind using NP/PA as interchangeably is that we are both "midlevels," but even that isn't entirely accurate. Some NP's are midlevels, but some are out there practicing on their own and are not legally, or in practice, "midlevels." NP's practice advanced practice nursing; PA's do not. Therefore, using the NP -slash- PA designation is something entirely different using, say, "MD/DO."

 

The other thing that gets my goat about NP/PA is that this deliberate blurring of the lines between our brands is something that benefits NP's and degrades PA's. There was a recent editorial in PA Professional about maintaining our PA brand image, which I entirely agreed with. By saying we are synonymous with NP's just because we are both "midlevel providers" we are diluting our brand. No, we need to insist that we are a different breed than the NP's (let them do their own thing) and promote our unique image to the public more aggressively. 

 

A lot of the NP/PA debate I encountered puzzled me until I went to an AAPA conference and talked about the issue with PA's from NP-predominant states. I live in a very PA friendly state with a half a dozen well established PA schools (Michigan) where the PA/NP debate is essentially a non-issue. It is widely accepted that PA's have a superior education and are generally highly regarded by patients and doctors alike. I recently started my first job out of school in ER and I have never once encountered a patient who was unaware of my role or uncomfortable with seeing me. Actually I can think of ONE patient that asked not to see me and it was a narc seeker. 

 

Having attended a school with an FNP and a CRNA program, I witnessed the FNP education first hand, and let me just state the plain truth of the matter: the curriculum consisted of large amounts of fluff. There wasn't much of anything approaching scientific or academic rigor in the education. The PA school I attended routinely weeded out poorly performing students every semester - not true of the NP's. PA school pushed me to the edge of my academic ability, while the NP students seemed to float through goofy nursing theory courses. Now, the practice of medicine has been a scientific endeavor for oh, a couple centuries now, and with the sheer complexity and scope of modern medicine it is a bit shall I say - delusional - that you can take a few fluff courses and be ready to practice medicine on your own. Any NP who readily concedes that PA's have a more "science based curriculum" is actually conceding that PA's have more of a medical education. There aren't two flavors medicine, one that is science based, and one that is somehow less scientific.

 

My ED routinely receives patients referred to us by local NP's who have so mismanaged their patients they end up getting dumped on us. Each time, it seems to come down to the same problems: lack of an understanding of basic medical science and failure to consider a broad differential. Once, I saw a teenaged patient from an NP clinic sent to us for supposed 'Hypotension," (whose BP was actually normal for his age) who had been told to eat more salt. He presented to the ED because he said that despite eating large amounts of salt, his blood pressure was still low when he measured it at the Wal Mart.

 

Insane and frightening are words that come to mind. Here, we have not only a failure to recognize normal age appropriate vital signs, but also a total lack of understanding of the physiological mechanisms regulating blood pressure and sodium concentration. 

 

Oh but wait, they are practicing advanced practice nursing, which is WHAT exactly? I have yet to see a convincing argument that advanced practice nursing is anything but a legal loophole. There is an old fashioned term for someone who attempts to practice medicine without the requisite training: QUACK. Yes, I'm sorry to say this but a lot of the NP's practicing Advanced Practice Nursing without supervision, are in reality, Quacks, whom I would never trust to see any of my loved ones. (Not the case with NP's who practice with supervision).

 

I realize this was a rather harsh diatribe, but I am someone who believes in looking at things clearly and unsentimentally. Before anyone accuses me of trying to degrade the NP profession in the interest of vanity I will readily concede THIS WAS NOT THE CASE WITH CRNA's. After school, I volunteered as an anatomy TA teaching CRNA's and PA's. The CRNA's excelled at it, a course that (along with pharmacology) was not required of the FNP's.

[CoastalPalm]

I must say, lurking here reading NP/nursing rants is very entertaining.  An FNP program without pharmacology...ok...an NP (let alone an RN) not knowing normal age appropriate vital signs (something I was taught as an unlicensed tech, i.e., by nurses)...ok...

 

Thanks!

[Lexapro]

All NP programs require pharmacology.

[CoastalPalm]

All NP programs require pharmacology.

 

Indeed.  Exactly my point.  Hence why I always find NP inferiority posts here amusing. 

[Dunedain]

I want to go PA because I prefer the areas they thrive in and the medical model.

 

However with that being said, as a nurse I often prod the hospitalists I work with regarding who they prefer to collaborate with. Most of them don't even know or can't tell a difference between the two and often are confused when I say I want to become a PA. They often just assume I go NP because of my BSN and a similar end route between the two. Many also just say the generic " I have met good/bad PAs and good/bad NPs".

 

/shrug

 

I don't have any experience with an outpatient mindset

[whoRyou]

I want to go PA because I prefer the areas they thrive in and the medical model.

 

However with that being said, as a nurse I often prod the hospitalists I work with regarding who they prefer to collaborate with. Most of them don't even know or can't tell a difference between the two and often are confused when I say I want to become a PA. They often just assume I go NP because of my BSN and a similar end route between the two. Many also just say the generic " I have met good/bad PAs and good/bad NPs".

 

/shrug

 

I don't have any experience with an outpatient mindset

 

I understand your pain. When I tell people I want to become a PA, they immediately think I am saying MA. UGH

[MedicalRN]

I understand your pain. When I tell people I want to become a PA, they immediately think I am saying MA. UGH

I've had this said to me before as well.

 

People assume I should be an NP because I'm a nurse. They don't get it when I explain I want to be challenged more. Also, all the physicians I speak to prefer PA to NP and advertise jobs only for PA applicants.

 

So no I don't think they are interchangeable

[andersenpa]

I very much resent the NP/PA designation, because it blurs the line between what we are, what we do, and how we are educated. I suppose the logic behind using NP/PA as interchangeably is that we are both "midlevels," but even that isn't entirely accurate. Some NP's are midlevels, but some are out there practicing on their own and are not legally, or in practice, "midlevels." NP's practice advanced practice nursing; PA's do not. Therefore, using the NP -slash- PA designation is something entirely different using, say, "MD/DO."

 

The other thing that gets my goat about NP/PA is that this deliberate blurring of the lines between our brands is something that benefits NP's and degrades PA's. There was a recent editorial in PA Professional about maintaining our PA brand image, which I entirely agreed with. By saying we are synonymous with NP's just because we are both "midlevel providers" we are diluting our brand. No, we need to insist that we are a different breed than the NP's (let them do their own thing) and promote our unique image to the public more aggressively. 

 

A lot of the NP/PA debate I encountered puzzled me until I went to an AAPA conference and talked about the issue with PA's from NP-predominant states. I live in a very PA friendly state with a half a dozen well established PA schools (Michigan) where the PA/NP debate is essentially a non-issue. It is widely accepted that PA's have a superior education and are generally highly regarded by patients and doctors alike. I recently started my first job out of school in ER and I have never once encountered a patient who was unaware of my role or uncomfortable with seeing me. Actually I can think of ONE patient that asked not to see me and it was a narc seeker. 

 

Having attended a school with an FNP and a CRNA program, I witnessed the FNP education first hand, and let me just state the plain truth of the matter: the curriculum consisted of large amounts of fluff. There wasn't much of anything approaching scientific or academic rigor in the education. The PA school I attended routinely weeded out poorly performing students every semester - not true of the NP's. PA school pushed me to the edge of my academic ability, while the NP students seemed to float through goofy nursing theory courses. Now, the practice of medicine has been a scientific endeavor for oh, a couple centuries now, and with the sheer complexity and scope of modern medicine it is a bit shall I say - delusional - that you can take a few fluff courses and be ready to practice medicine on your own. Any NP who readily concedes that PA's have a more "science based curriculum" is actually conceding that PA's have more of a medical education. There aren't two flavors medicine, one that is science based, and one that is somehow less scientific.

 

My ED routinely receives patients referred to us by local NP's who have so mismanaged their patients they end up getting dumped on us. Each time, it seems to come down to the same problems: lack of an understanding of basic medical science and failure to consider a broad differential. Once, I saw a teenaged patient from an NP clinic sent to us for supposed 'Hypotension," (whose BP was actually normal for his age) who had been told to eat more salt. He presented to the ED because he said that despite eating large amounts of salt, his blood pressure was still low when he measured it at the Wal Mart.

 

Insane and frightening are words that come to mind. Here, we have not only a failure to recognize normal age appropriate vital signs, but also a total lack of understanding of the physiological mechanisms regulating blood pressure and sodium concentration. 

 

Oh but wait, they are practicing advanced practice nursing, which is WHAT exactly? I have yet to see a convincing argument that advanced practice nursing is anything but a legal loophole. There is an old fashioned term for someone who attempts to practice medicine without the requisite training: QUACK. Yes, I'm sorry to say this but a lot of the NP's practicing Advanced Practice Nursing without supervision, are in reality, Quacks, whom I would never trust to see any of my loved ones. (Not the case with NP's who practice with supervision).

 

I realize this was a rather harsh diatribe, but I am someone who believes in looking at things clearly and unsentimentally. Before anyone accuses me of trying to degrade the NP profession in the interest of vanity I will readily concede THIS WAS NOT THE CASE WITH CRNA's. After school, I volunteered as an anatomy TA teaching CRNA's and PA's. The CRNA's excelled at it, a course that (along with pharmacology) was not required of the FNP's.

First off we’re not midlevels. They aren’t, you aren’t and I’m not. If I am expected by the state, the attorneys, and my group to practice to the same gold standard as a physician, then there’s no “Mid” about it.

 

Second, all legislative maneuvering aside, NPs are practicing medicine. I stand by my statement that if you blinded a doc, a PA, and NP, and joe public to an office visit with each of our professions and tried to figure who had which credential, you wouldn’t get a reliable guess. It’s all about evaluation and management, history and physical, treatment and follow up. Call it what you will. They figured a way to get out from under the BOMs. They succeeded. But we’re meeting at the same level.

 

Re: blurring lines, right or not, we all benefit.

NPs benefit from the standardized training and physician acceptance PAs have.

PAs benefit from the legislative ground NPs have assumed.

Yes, we are a different breed than NPs, but we’re grazing the same grass.

 

Your opinions on the substance of NP curricula is an opinion, and keep in mind that docs say the same thing about their training vs PAs. We live and practice in an outcomes based world now, and that will be the standard by which the adequacy of training is measured, not external opinions on who is worthier.

 

We’ve all seen bad referrals and I’m sure the Seriously Derogatory Network has its share of “ohmygodyoushouldhaveseenthedumpIgotfromthisidiotPA” posts. Anecdotes are just that. Evidence and outcomes is another.

 

The question is whether a trained and competent NP or PA, applying for a job, should be discriminated on the basis of their credential for a specialty which 1) they were trained and 2) has a track record of presence of that credential?

[JBNP]

I very much resent the NP/PA designation, because it blurs the line between what we are, what we do, and how we are educated. I suppose the logic behind using NP/PA as interchangeably is that we are both "midlevels," but even that isn't entirely accurate. Some NP's are midlevels, but some are out there practicing on their own and are not legally, or in practice, "midlevels." NP's practice advanced practice nursing; PA's do not. Therefore, using the NP -slash- PA designation is something entirely different using, say, "MD/DO."

 

The other thing that gets my goat about NP/PA is that this deliberate blurring of the lines between our brands is something that benefits NP's and degrades PA's. There was a recent editorial in PA Professional about maintaining our PA brand image, which I entirely agreed with. By saying we are synonymous with NP's just because we are both "midlevel providers" we are diluting our brand. No, we need to insist that we are a different breed than the NP's (let them do their own thing) and promote our unique image to the public more aggressively. 

 

A lot of the NP/PA debate I encountered puzzled me until I went to an AAPA conference and talked about the issue with PA's from NP-predominant states. I live in a very PA friendly state with a half a dozen well established PA schools (Michigan) where the PA/NP debate is essentially a non-issue. It is widely accepted that PA's have a superior education and are generally highly regarded by patients and doctors alike. I recently started my first job out of school in ER and I have never once encountered a patient who was unaware of my role or uncomfortable with seeing me. Actually I can think of ONE patient that asked not to see me and it was a narc seeker. 

 

Having attended a school with an FNP and a CRNA program, I witnessed the FNP education first hand, and let me just state the plain truth of the matter: the curriculum consisted of large amounts of fluff. There wasn't much of anything approaching scientific or academic rigor in the education. The PA school I attended routinely weeded out poorly performing students every semester - not true of the NP's. PA school pushed me to the edge of my academic ability, while the NP students seemed to float through goofy nursing theory courses. Now, the practice of medicine has been a scientific endeavor for oh, a couple centuries now, and with the sheer complexity and scope of modern medicine it is a bit shall I say - delusional - that you can take a few fluff courses and be ready to practice medicine on your own. Any NP who readily concedes that PA's have a more "science based curriculum" is actually conceding that PA's have more of a medical education. There aren't two flavors medicine, one that is science based, and one that is somehow less scientific.

 

My ED routinely receives patients referred to us by local NP's who have so mismanaged their patients they end up getting dumped on us. Each time, it seems to come down to the same problems: lack of an understanding of basic medical science and failure to consider a broad differential. Once, I saw a teenaged patient from an NP clinic sent to us for supposed 'Hypotension," (whose BP was actually normal for his age) who had been told to eat more salt. He presented to the ED because he said that despite eating large amounts of salt, his blood pressure was still low when he measured it at the Wal Mart.

 

Insane and frightening are words that come to mind. Here, we have not only a failure to recognize normal age appropriate vital signs, but also a total lack of understanding of the physiological mechanisms regulating blood pressure and sodium concentration. 

 

Oh but wait, they are practicing advanced practice nursing, which is WHAT exactly? I have yet to see a convincing argument that advanced practice nursing is anything but a legal loophole. There is an old fashioned term for someone who attempts to practice medicine without the requisite training: QUACK. Yes, I'm sorry to say this but a lot of the NP's practicing Advanced Practice Nursing without supervision, are in reality, Quacks, whom I would never trust to see any of my loved ones. (Not the case with NP's who practice with supervision).

 

I realize this was a rather harsh diatribe, but I am someone who believes in looking at things clearly and unsentimentally. Before anyone accuses me of trying to degrade the NP profession in the interest of vanity I will readily concede THIS WAS NOT THE CASE WITH CRNA's. After school, I volunteered as an anatomy TA teaching CRNA's and PA's. The CRNA's excelled at it, a course that (along with pharmacology) was not required of the FNP's.

 

Wow! Your resentment of the NP profession is quite entertaining. The reality is that NP and PA are much more similar than different. The differences seem to lie only in education, some state specific regulations, and personal preference. I happen to work with an MD that favors NPs while other MDs favor PAs. My hospital hires both. Again I have not seen any research that suggests a difference in outcomes by NP vs PA providers. Anecdotal evidence should not be presented as fact. Turf wars have always existed to some extent in medicine (MD vs DO, OD vs MD, EMT vs RN, NP vs PA, etc) and do not seem to further any one cause. I would suggest that the whatever the future of NP/PA profession likely it lies along the same mutual path. 

 

I have already commented on my belief that the academic rigor of NP education programs overall should be improved. However, these vary significantly according to nursing schools. Some programs are quite rigorous. I can think of one program that still grants both PA/NP simultaneously.

 

Also, I don't know any nurse practitioners who claim to be practicing "advanced nursing" the reality is that we are all medical providers. The "advanced practice nursing" is likely the jargon created by the nursing leadership to lobby for practice separation from physicians. I personally believe that this does my profession a disservice as we should be moving forward with our medical colleagues. 

 

I practice in a state that has identical practice standards of NP/PA in terms of physician supervision. I have only known one NP that opened an independent primary care practice and likewise a PA that opened an urgent care. Both were successful and had a good reputation in the community. My understanding is that independent practice is still rare even in states that it is allowed. Again, I think that the merits and outcomes of each provider should be judged independently and to generalize all as "quacks" is inflammatory. In primary care, I expect that the NP or PA that has been practicing in a supervised capacity for 10-20+ years likely has the experience to justify safe and independent practice and probably can identify the need to refer to a specialist when appropriate. That said, I personally would have no desire to independently practice and am quite comfortable with my state model. 

 

The original question was regarding interchangeability in hiring an NP or PA. I still believe that in most cases any differences in education will likely be negated by professional experience and all candidates should be looked at individually. Generalizations are harmful to both PA and NP candidates. If an NP/PA apply for a position their experience should carry more weight in a hiring decision than professional bias. So for example, I would argue that a PA with a critical care residency would be a better candidate for an ICU position than a new grad FNP. On the other hand, an RN that had 10 years ICU experience before going back to school to obtain certification as an acute care nurse practitioner and then had 5 years ICU experience as an NP would be more qualified for the same position when compared to a new grad PA. 

[JBNP]

...I realize this was a rather harsh diatribe, but I am someone who believes in looking at things clearly and unsentimentally. Before anyone accuses me of trying to degrade the NP profession in the interest of vanity I will readily concede THIS WAS NOT THE CASE WITH CRNA's. After school, I volunteered as an anatomy TA teaching CRNA's and PA's. The CRNA's excelled at it, a course that (along with pharmacology) was not required of the FNP's.

 

By the way...CRNA is not a nurse practitioner. That would be like me suggesting that an AA is the same as a PA. 

 

The 4 areas of that "advanced nursing practice" you mentioned are: NP, CRNA, CNM, and CNS and all are different with unique educational programs and specialty focus.