RHC81 Posted January 3, 2012 Share Posted January 3, 2012 Can someone explain what the difference is between the medical model of training/practice that PAs follow and the nursing model? I was over on allnurses, researching this question, and the answers were vague, at best. The general response was that MDs and PAs follow a disease-first model, without really accounting for the whole needs of the patient (lifestyle teaching, cultural considerations, etc.). Nursing, according to them, accounts for the whole person, not just the disease/condition. They termed nursing to be holistic practice. However, do these definitions really bear out in the real world? And, if so, what constitutes "holistic" in the nursing model and how would that differ from the approach a PA would have? At work and as a patient, I've seen that there are differences in the practice methods of MDs/PAs and nurses, but I'm not sure I could verbalize exactly what those are. That said, my initial impression is that the above definition is too simplistic. Your thoughts? Link to comment Share on other sites More sharing options...
mktalon Posted January 4, 2012 Share Posted January 4, 2012 I would love somebody to clarify this as well. I understand the philosophical difference that is being stated, but do NPs practice that much differently than PAs and MDs? I have yet to quantify a noticeable difference when working beside both. Any input anybody? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 4, 2012 Moderator Share Posted January 4, 2012 do NPs practice that much differently than PAs and MDs? I have yet to quantify a noticeable difference when working beside both. Any input anybody? np's practice medicine(albeit with less clinical training than pa's or physicians). they just like to call it "advanced nursing" so they aren't regulated by the medical board. a pa and an np working side by side do the same things in the same ways. Link to comment Share on other sites More sharing options...
HopefulPA Posted January 4, 2012 Share Posted January 4, 2012 I have only worked with a few NPs. I can tell you one experience I had. The NP had just got done seeing the patient and I went in the room to see if she needed any help. I ask her what is going on with the patient and she starts going on about the stage 2 decub on his heel, I interrupt her and ask has his breathing been like this the whole time she has been doing his H & P she said yes but she was really concerned about the decub. I said well I am concerned about his labored using accessary muscles breathing going into respiratory failure! His resp ~30-35 min. Audible wheezing and she is all worried about his decub?!? Even when I am calling for an ABG, O2, CXR, Solu-medrol, labs she is asking the nurse about lift boots. Seriously! I wanted to shout if he stops breathing we won't need to worry about a stage 2 decub. Guess I wasn't treating the "whole" pt. Now this was only 1 experience but with this same NP she kept focusing on these minute details in treating the pt and I just kept shaking my head and saying I am not saying ignore that but you gotta prioritize what will kill the patient the quickest! I am sure there are NPs out there that provide great care! This was the only NP I worked with for a while and she even admitted she was in way over her head dealing with hospitalized pts and her clinicals (all 500 hours) did not prepare her to care for hospitalized pts. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 4, 2012 Moderator Share Posted January 4, 2012 her clinicals (all 500 hours) did not prepare her to care for hospitalized pts. yup this is where experience comes in...it's all about the big picture..."looks good from door" yes or no.... Link to comment Share on other sites More sharing options...
cinntsp Posted January 4, 2012 Share Posted January 4, 2012 I had a really interesting phone convo at work a couple of weeks ago... Caller: Hi, I'm trying to order some tests to check a patient's thyroid but need to know what tests to order. Me: Hmm...do you mean the test codes? Caller: No, I need to know what tests to order to check a patient's thyroid. Me: ??? Well, that's something for the clinician to decide. Caller: The nurse practitioner told me to call and ask what tests she needs to order. Me: Uhhh, I can tell you what thyroid-related tests we run here but I can't tell you what you need to order. Caller: So how do I find out? I wanted to tell her to tell the NP to get a phone app/textbook/google but I suggested she ask her SP or a colleague instead. Link to comment Share on other sites More sharing options...
Michigander Posted January 4, 2012 Share Posted January 4, 2012 I have mostly worked with NPs and am now in PA school but have never been to nursing school. I have also read all those "discussions"/wars on allnurses.com and am not totally clear on the difference. On the associates and bachelors nursing levels, I know they use "nursing care plans" where they give nursing diagnoses such as "altered coping mechanism related to..." (i.e. depression) or "alteration in breathing related to..." (i.e. COPD) but they do not give medical diagnoses, as appropriate for that level. There are a lot of practical differences between NP and PA training as other people said. The NPs I worked with had no idea what I was talking about when I asked questions about my first semester classes so I gave up asking them for help. I also remember lots of discussion about which drugs were metabolized through the CYP P450 system. I was disappointed to find out that 95% of drugs are, they never discussed specific enzymes, just used the blanket term P450 that I thought sounded very impressive. But, the few NPs on surgical service do the same things (line removal, manage meds, H&Ps, etc) as the PAs. Same for the internal medicine and hospitalist services. As for a difference in philosophy, I think there is more discussion of patient and family coping when learning about different diseases whereas PAs learn the disease, patho, differential, treatment, etc. I was a social worker in my last job and the NPs would often tell me that they feel confident as a social worker because they took a class in therapeutic communication (I guess I wasted that masters degree). So maybe they have are referring to classes like that to cite "holistic" training? Link to comment Share on other sites More sharing options...
Acebecker Posted January 4, 2012 Share Posted January 4, 2012 The definition that you have given is about as good as it gets, but it plays out in different ways for different NPs as you can see above. My own experiences with NPs is varied - I work with 1 NP who is as good as any provider I have ever worked with (aside from the Hospitalist docs I trained with). But the other two NPs are like those above - I had one ask meme yesterday about a piece of tissue sticking up from the back of a child's throat. I replied, "Is it pink and kind of comes to a point? Yeah, that's the epiglottis." I can understand her concern - it looks funny and you can't see it on everyone. It was just odd. This is the same NP that I taught EKG reading to when I was a student after she'd been in practice for a year. All of this is just to illustrate that the nursing model focuses less on the fundamentals of medicine (I.e. Anatomy, basic clinical skills) and more on nursing theory. Some nurses make great strides with this training, while others graduate and aren't really ready for practicing medicine without a LOT of backup. This occurs with PAs too, but much less commonly if the candidate has had significant clinical experience (and alll NPs were practicing RNs first). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 4, 2012 Moderator Share Posted January 4, 2012 and alll NPs were practicing RNs first unless they did direct entry. bs in history to np in 3 yrs including 1 yr to become an rn. only "practice time" is clinicals in school. Link to comment Share on other sites More sharing options...
duchesskre Posted January 4, 2012 Share Posted January 4, 2012 unless they did direct entry. bs in history to np in 3 yrs including 1 yr to become an rn. only "practice time" is clinicals in school. Many states have NP bridge programs where if you have a masters in another field you can bridge into an NP program and become an NP in 3 years without being an RN first (and not just a practicing one....one at all). I know this cause I have my msw and looked into it before deciding on the PA route....... Link to comment Share on other sites More sharing options...
Acebecker Posted January 5, 2012 Share Posted January 5, 2012 Many states have NP bridge programs where if you have a masters in another field you can bridge into an NP program and become an NP in 3 years without being an RN first (and not just a practicing one....one at all). I know this cause I have my msw and looked into it before deciding on the PA route....... This is scary. Very scary. I am hard pressed to get on board with PA programs that do not require experience - the didactic and clinical years are just sufficient to turn these folks into good PAs. Now, shorten the clinical year to 1/3 of what it used to be, and let the students go to school part time for their didactics and that is what these direct entry NP programs are essentially doing - both products have the same ability to Dx, Rx, and Tx patients. That is a scary recipe. Andrew Link to comment Share on other sites More sharing options...
crobe Posted January 6, 2012 Share Posted January 6, 2012 I have a great respect for nurses, as my mother is one in a busy city ER. She defines her role as keeping patients alive. Through what I saw as a volunteer, I found this to be correct. Nurses are responsible for holistic care because not only do they they take care of their basic functions (cleaning and feeding), but they also are responsible for administering medicine, and keeping an eye out for the overall health of the patient. However, she is also very suspicious of ETP NP students because she has encountered similar experiences like the ones relayed above. Side note: Interestingly enough, in her ER, nurses used to work triage but now the PAs do it all day long. Link to comment Share on other sites More sharing options...
winterallsummer Posted January 6, 2012 Share Posted January 6, 2012 Don't knock NPs just because of a few bad experiences. I had a issue and after seeing a doctor that lacked two things entirely: self awareness and awareness of others - I went to see a NP. Excellent care, in fact, I have never been given so much attention from a health care provider, EVER. Just like there are bad NPs there are bad MDs, PAs, DOs, etc. In the end we are all on the same team, right. As far as nursing vs med model, yes the nursing is "person focused" and medical is "disease focused". However, as we all have I'm sure, I've known PAs who work from the medical model yet are excellent at attending the entire person, and NPs who work from the nursing model and are completely oblivious to anything outside of how to address one problem and get the patient out the door. My 2 cents. Link to comment Share on other sites More sharing options...
Joelseff Posted January 6, 2012 Share Posted January 6, 2012 @crobe: Working triage is every PA'S dream job.... Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 6, 2012 Moderator Share Posted January 6, 2012 @crobe: Working triage is every PA'S dream job.... Sent from my myTouch_4G_Slide using Tapatalk if you define nightmares as dreams.... Link to comment Share on other sites More sharing options...
Joelseff Posted January 7, 2012 Share Posted January 7, 2012 Lol I was being facetious since crobe posted it as a good thing lol Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
crobe Posted January 7, 2012 Share Posted January 7, 2012 Lol I was being facetious since crobe posted it as a good thing lol Sent from my myTouch_4G_Slide using Tapatalk I never implied it was a good or bad thing. The PAs like the hours they work in triage but are often bored with the type of stuff they see, which I understand completely. The nurses would actually prefer to triage. Stating a fact doesn't imply that there's a feeling associated with it. Link to comment Share on other sites More sharing options...
Joelseff Posted January 7, 2012 Share Posted January 7, 2012 My apologies..it read as if u were impressed, perhaps I read too much into it...sorry, Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 7, 2012 Moderator Share Posted January 7, 2012 lol i was being facetious since crobe posted it as a good thing lol sent from my mytouch_4g_slide using tapatalk yup, me too. Link to comment Share on other sites More sharing options...
flyingsquirrel Posted January 7, 2012 Share Posted January 7, 2012 @crobe: Working triage is every PA'S dream In my hospital (busy level 1) it's a billing thing. By having every pt triaged by a PA/NP they can be billed for the visit whether they sign out AMA or not. Link to comment Share on other sites More sharing options...
Acebecker Posted January 7, 2012 Share Posted January 7, 2012 @ winterallsummer You are quite right - I don't mean to say that every NP is poorly trained and that they are all bad. I have the pleasure of working with a FNP who knows her stuff much better than most. Again I can only speak from my experience and from it I have gleaned that new NPs are not as well trained as new PAs. That said, I have known a PA who had been out of school for a year or so who was remarkably poor at her job. You are wise to point out that there are poor practitioners in any of the levels of medicine that we can identify. But when we compare PAs and NPs and when we compete with them for recognition and jobs, there are important distinctions that bear pointing out for the future of our profession and our new graduates. Andrew Link to comment Share on other sites More sharing options...
Just Steve Posted January 7, 2012 Share Posted January 7, 2012 "keeping them alive" strikes me strange. Supporting the patient with an overall improvement in their quality of life seems to be a more well rounded end goal. Anyone can stick a tube in every orifice and put you in a virtual suspended animation. That's easy (comparatively). I think the trick to quality medical care is patient satisfaction with the end result. Getting there via a nursing model versus a medical model is really patient dependent. Different people will respond in their own way to different care providers. Link to comment Share on other sites More sharing options...
greenmood Posted January 7, 2012 Share Posted January 7, 2012 In the context of a busy ER, a nurse saying that her job is to keep the patient alive doesn't strike me as strange at all, nor does it imply that she is unconcerned with the patient's quality of life or his satisfaction with her medical care. Link to comment Share on other sites More sharing options...
winterallsummer Posted January 7, 2012 Share Posted January 7, 2012 I gotcha Ace. Yeah my post was not directed towards you but more in general as some people here have a very negative attitude towards NPs. I do agree that PA training is ahead of NP (my humble opinion) but after so many years of practice I believe the line between the roles can become almost completely blurred. Link to comment Share on other sites More sharing options...
Just Steve Posted January 8, 2012 Share Posted January 8, 2012 In the context of a busy ER, a nurse saying that her job is to keep the patient alive doesn't strike me as strange at all, nor does it imply that she is unconcerned with the patient's quality of life or his satisfaction with her medical care. That is the nice thing about opinions...we all get to have our own. Link to comment Share on other sites More sharing options...
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