What do you say to someone like this?

[quirkymedic]

I was having a conversation with one of my ER docs the other day, regarding how the general public still doesn't know what a PA is, even though we have been around for 40 years. He was saying that he has to tell people that a PA is like a NP, then they understand. We were both discussing how frustrating that is as a profession. That conversation isn't whats bothering me....

 

Out of the blue, one of the ER nurses came up to me and said "well, I have no respect for PA's. I am a licensed NP but I refuse to work at this hospital as an NP because they consider me a mid level. I am not a mid level. I can practice independently so that makes me higher than a PA" then she proceeds to tell me physician>NP>PA>nurses. As far as I know this nurse has ONLY practiced as an RN and has been at my hospital YEARS. Otherwise I have no issues with her, and she follows my orders without any problem. But now that this person has outed their view on PA's and her position on them, she has to make some smart a$$ comment every time she sits down next to me to chart. I refuse to get into any confrontation about it, Its not worth it to me to get involved in any drama. (I think if she is or ever was an NP, she received it 30+years ago).

 

I am new to the PA profession. Do I have a (wrong?/uninformed?) perception of what an NP is and can do or is she just being a pretentious a$$? My program just produced PA's, so we didn't really go into the whole np/pa debate in class. It is my understanding that we have fairly the same training if they are an FNP, but if they are an NP they are specialized in a particular area? I know they can practice independently, but then again, they have to wait 6 months to get their DEA while a PA can get theirs immediately... minor details to me. I thought we were all mid levels with just a few variations in the fine print. Not that I care, we are all supposed to have the same goal in mind... I'm moving on from this hospital anyway and only have a few weeks left. I just know that people are more familiar with the NP profession, but I would like to have a more informed answer I can give people like this....

[HMtoPA]

I get so tired of hearing about how NP's can practice independently. I heard that from nurses or wannabe NP's all the time when I was applying to PA school. Fact is, even in states where they can, most don't. So it's sort of a non-issue. Even physician-owned practices are getting rarer. I personally have no desire to run my own practice, so the bragging rights don't mean much to me. I realize "independence" means more than just having your own practice, but most of the PA's I've seen don't exactly have a Dr. breathing down their neck the whole time.

 

In any case, what's really crazy is that you're expected to believe that this lady is working as an RN because she's too proud to take a higher paying NP gig because they want to call her a mid-level? So she'd prefer to be what, a no-level? That makes no sense and I would have called her on it instantly. You're nicer than I. :)

[quirkymedic]

My thoughts exactly. I have no desire to practice independently, or I would have just gone to medical school and became a doctor. The sad part about her continuing to be an RN over an NP, is that with her years of experience as an RN and the Nursing union behind her, she makes WAY more per hour than I do. I was talking with one of the night nurses and they receive $6-8 more per hour with their night/weekend differential. I work nights and make $1 more an hour on night differential. They are union, we are not. So at night my brand new just graduated nurses make more per hour than I do.

[EMEDPA]

.

is she just being a pretentious a$$? .

yes.

you could mention to her that you will have over two thousand hrs of clinical exposure during school and ask her how many hundred hrs she had in her np program....and then tell her that even with a dnp an np is still a midlevel with less clinical training than a pa with a certificate and no degree.....you could also remind her that 50% of np's work as rn's because they can't find work as np's and >95% of pa's can find jobs as pa's.... why is that?...hmmmm

this never gets better...it's a big part of why we need the name change to physician associate. I, for one, am tired of not getting professional respect....I go out of my way to respect the nurses, techs, etc that I work with and yet we still have to deal with this crap from nurses, np's, and hospital administrators who can't look past the "assistant" in our title.....

I wouldn't put up with that crap. report her a$$ for creating an unfriendly work environment and get her FIRED. I have seen it happen....a bunch of nurses at a prior job refused legitimate orders from any pa and got canned.....

[EMEDPA]

sounds like new RNs fall into that category as well, just from looking at pay. maybe you better not say anything, then. they might actually be your bosses.

what?

are you trying to imply that rn's make more money than both pa's and np's? agency maybe but not regular staff. and if you look at locums pa pay it is significantly more than locums/travelling rn pay. I just turned down a per diem gig that pays 100/hr.

[HMtoPA]

"So at night my brand new just graduated nurses make more per hour than I do."

 

What?!? I get that the nurses have the backing of a union, but you're saying a brand-new BSN is making more than the PA's? You mean when you factor in OT or nights or whatever? I still would be pretty livid, and I think I would make a bit of a stink about it. But it sounds like you're on to greener pastures anyhow.

[EMEDPA]

often pa's get production and retirement incentives that far outweigh a difference of a few dollars/hr in pay. many em groups give pa's 10-30/hr in production on top of base salary and 25% of yearly salary as retirement at the end of the yr. that adds up pretty quickly if you consider 35K/yr in bonuses and 25k/yr in retirement.

[HopefulPA]

Try "Gee I can understand why your upset, I'd be pissed too if I went to NP school and graduated and couldn't find a job."

 

In general the hospital systems around here don't hire NPs in Inpt IM, ER or surgery. The NPs that work in other areas of the hospital have a SP just like me :-) !!!

[EMEDPA]

Try "Gee I can understand why your upset, I'd be pissed too if I went to NP school and graduated and couldn't find a job."

 

In general the hospital systems around here don't hire NPs in Inpt IM, ER or surgery. The NPs that work in other areas of the hospital have a SP just like me :-) !!!

yup, same deal here. all the em, hospitalist, surgery, ortho, cardiology, fp residency and critical care jobs go to pa's. all the psych/nicu jobs go to np's.

[EMEDPA]

I have no problem with a seasoned rn making more than a new grad pa. in fact at my first job the charge nurse( a great guy who taught me a lot) made a base salary 6k/yr more than me. I had no problem with that. he had been an rn for 25+ yrs and paid his dues. when the rn is at the top of their pay scale and the pa is at the bottom of theirs situations like this exist. ditto high end paramedic making more than entry level rn(senior medics in my area make 65k/yr with no overtime and entry level rn's make around 60 with no overtime). you see overlap like that with high end pa salaries and low end doc salaries as well. at my last job( I was there for 14 yrs) I had maxed out the(union) salary scale and made more more than the new grad fp docs who worked in the dept. by about 10k/yr.

after 5 yrs or so most pa's should be making more than all rn's who are not administrators.

[quirkymedic]

Unfortunately I am in a rural, very depressed area where honestly, 80% of our pt's are either medi-cal or uninsured. I was hired as a hospital employee, new grad pa at step 5 out of about 12 on the pay scale. I expect low pay as a new grad. Nurses, even the new hires make the same per hour as I do. Top that off with the $6-8 night differential and voila! they make more than me. I do not have retirement. I do not have benefits outside of our hospital (although I am 100% covered if the hospital and/or the hospital owned clinic treats me) but I am screwed if I need a cardiac cath which our hospital doesn't have... one of our hosptialist pa's who has 30+ years experience is maxed out in pay at $54/hr. That is about median nurse pay here. So, I am moving on. Got great experience, learned a ton, but I am no spring chicken and retirement is what I am needing. That is more important to me than hourly pay.

[ventana]

I have some problem with a RN making more then anything but a new grad PA - RN's at my local hosp make over 105k at top of scale for a m-f 9-5 job - if they do shift work they get more

 

I was a 5+yr PA running an interventional radiology suite doing invasive procedures all day and most the nurses made far more then I dod - finally got to 105 with a huge amount of arm twisting that ended up not being worth it and moved on.

 

RN are politically connected and have a HUGE influence - if you research the # of RN's that have completed a NP program and compare this to the number actually working as NP's it is amazing. A very very small actually go on to practice as NP - partly due to the pay cut they would likely have to take to come off the union supported wages, and the fact that (i think) the RN's realize they either can't, or don't want to, take on the role of provider and be the decision maker.

 

I have worked with a few RN's that were NP educated and a few were okay but a few needed to be called on their constant power struggle with me - usually I could accomplish this with simple education about my working differential, why i was ordering that study or lab, what I was trying to prove or disprove and asking if they had any other thoughts - 9/10 times they had not even realized what the real underlying thoughts were and sort of ate humble pie. Only once did I end up having to pull out the "if you have a problem with me or my decision making we should set up an appointment with the department director, your union boss and charge nurse" That was to a snotty soon to retire RN(np educated) that throught she ran the whole ER and that PA's slotted in well below her...... she never warmed up to me, but atleast she stopped actively undermining me and started to play like a team member....

[physasst]

You could also remind her that even in the states that allow NP's to practice independently, less than 2% actually do so. It's a complete non sequiter. Whatever....I usually don't bother with individual comments like that. You're likely not going to change their opinion and you'll waste a lot of time and effort trying to do so.

[EMEDPA]

yup, or the stat that the same % of np's and pa's actually own their own practice (5%). what I really like to mention is the local pa owned practice that has several docs, pa's and np's. yup, the pa is the np's boss.

I don't know of any np owned practices that hire pa's. I guess we are just more open minded....:)

[unewillow]

Different perspective in that, I am okay with a RN occassionally making more than me (figuring in differentials and such) because they do all the crap that I would never want to do and they run their butts off during their shifts. When I'm asleep in my call room at night, they're up working. So the fast that several of our nurses make more than me even though I've been there going on 5 years, isn't something I get my dander up about.

 

That the hospital employed CNMs have better benefits than we do (ie: CME $$) however...that annoys the crap outta me.

[andersenpa]

To the OP....

I've come to realize that there's not much to be gained my getting antagonistic in these situations. As Mike said you probably won't change her mind. Some friendly education on how STRIKINGLY SIMILAR we are in real world clinical practice, despite coming from educational backgrounds which are worlds apart, is the way to go.

We're all in this together.

And NONE OF US are "mid-levels" or "MID" anything! We're professionals who practice medicine!

[quirkymedic]

We're all in this together.

And NONE OF US are "mid-levels" or "MID" anything! We're professionals who practice medicine!

 

Well said. I am absolutely positive I would be unable to change her mind. I just want to represent our profession well and give an educated (and perhaps a little snarky) response so I don't look like a beat dog with my tail between my legs the next time this happens... and I'm quite sure there will be a next time.

[andersenpa]

Well said. I am absolutely positive I would be unable to change her mind. I just want to represent our profession well and give an educated (and perhaps a little snarky) response so I don't look like a beat dog with my tail between my legs the next time this happens... and I'm quite sure there will be a next time.

 

I would remind myself that if I'm doing what I want to do, then what she is or isn't doing professionally is her problem. You're still a PA-C!

Despite her opinions the PA profession isn't going anywhere...and won't crumble and die based on how she feels about the terminology.

[brookspa]

no RN should make more than a PA at any level, in the same geographic area. No non anethesia RN should make more than a PA in the VAST majority of instances. If this is the case, you need a new ZIP code. just saying. and I have been of of those "high Paid" traveling nurses.

[ventana]

no RN should make more than a PA at any level, in the same geographic area. No non anethesia RN should make more than a PA in the VAST majority of instances. If this is the case, you need a new ZIP code. just saying. and I have been of of those "high Paid" traveling nurses.

 

disagree. .............

[andersenpa]

no RN should make more than a PA at any level, in the same geographic area. No non anethesia RN should make more than a PA in the VAST majority of instances. If this is the case, you need a new ZIP code. just saying. and I have been of of those "high Paid" traveling nurses.

 

Isn't this an anti-market sentiment? The local supply and demand should determine compensation, not degree/credentials.

this is no different than a doc saying that no PA should make any more than any physician at any level.

[HMtoPA]

Isn't this an anti-market sentiment? The local supply and demand should determine compensation, not degree/credentials.

this is no different than a doc saying that no PA should make any more than any physician at any level.

 

I get you on the free market thing, but what do you think of the notion that some new graduates (or even experienced PA's) are undervaluing themselves and not negotiating strongly enough for a higher salary? Just throwing the possibility out there - I'm just a PA-S with job security (courtesy of Uncle Sam), so I definitely don't have any experience in this arena.

I guess even if this is the case, it demonstrates market forces at work in that there aren't enough PA's holding the line for a higher salary - but still, you want to tell people not to work for peanuts because it ultimately hurts everybody. I guess that sort of borders on price-fixing, though. I don't know, I never took economics...

[Planteater]

IMO free market point does not work when unions are involved.....

[andersenpa]

It would only be price fixing if all PAs decided to sell their services at one rate.

There are regional influences and in areas with tons of programs and abundant PAs salaries will be undercut.

New grads are at a disadvantage all around and typically lowball in competitive areas.

 

These are all examples of market forced determining pay. Physician specialties are more astute at controlling graduate output based on needs, and maintaining salaries.

[myironlung]

little bit off topic but i work at a correctional facility and the medical staff (rn's, pa's, np's, lpn's) all wear blue scrubs and generally look the same. So of course all of the officers (and inmates) call me nurse, even after i have told them i am a pa. The officers rotate shifts a bunch and it's hard to remember who i've had to remind of the pa name calling thing, so at this point i've stopped making it a point to tell them (i also feel bad correcting them in front of the nurses because it makes it seem like i am better than the nurses). Just the other day we had an emergency and the officer was talking on the walkie talkie and was like "yeah its ok we have the nurses here now." It shouldn't bother me but it does and i feel bad that it does because i really do respect rn's and everything they do, they have helped me out so much in my career, but....i didn't go to nursing school! It should be an insult to nurses when they hear me being called a nurse in fact. I guess this is a little rant but the OP's situation just made me think about the level of provider/name calling thing. Alright that's all.