Nursing or PA

[shupagirl]

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I need some help deciding by this week.
I applied to two schools. One is a nursing program (accelerated MSN route) and another one is a PA program (certificate option). I was offered admission to the nursing program which I must let them know by this week or the PA program, which I went in for interview and found out I am missing 2 prereqs that I must take over the summer (therefore the application is under provisional status).

I don't want to make the wrong decision and I've been reading forums to hear from the PAs, the nurses, and the applicants like myself about what they think and I am still confused. One thread makes me lean towards PA and another thread makes me lean towards nursing.

Here are the major pros and the cons that's making my decision harder.😕

PA
pro: finish in 2 years. cheaper tuition. Do not have to move away from my current residence. I like the medical model learning. The flexibility of exploring different specialty.
con: certificate option. I am somewhat hesistant if it might get in the way later because alot of programs offer masters now.

Nursing
pro: accel. masters degree program, where I will be able to sit in for NCLEX by next year and get my masters in 2 1/2 years.
con: have to move to another state, longer program, tuition is higher, I have to study additional 2 years to become NP. (ultimate goal)

What I really want to do is whether I become PA or Nurse is to practice in ER for couple years, and learn ALOT then go to a specific specialty I find my interest in. Currently I work in the back office of a clinic doing routine medical hx, and chart work, but I would like to treat instead of filling out paperwork 75% of the time.

So to sum it up, I was already granted acceptance to MSN program that I must respond by this week and start by June, OR I am under provisional acceptance to PA program where I must complete 2 more classes during summer then provide them with documentation by end of July for admission in September. The admission is not guaranteed for PA program because they have limited seat, and so far I've contacted the Interviewer (Dr.) and admission personnels and they told me to take those classes to improve my chance of being accepted. I am scared if I take it, and not accepted.🙁

Please let me know from your experience what I can do in this case. I know it ultimately depends on your passion BUT I am really confused at this point. I want to start by this year, because I don't want to waste anymore time.

 

[deleted6669]

a few thoughts....
nursing and pa are very different careers and mindsets. figure out which you want, don't leave it up to the random chance of which accepts you.
if you want to practice em you will have a better chance of doing this as a pa as there are MANY more pa than np em jobs. pa's have most of the specialty and hospital based job slots out there. pa's also have a particularly close association with acep(the american college of emergency medicine physician group). the national em pa conference a few weeks ago was very similar to this yrs acep conference as we had many of the same speakers, etc in fact the president of acep was the key note speaker. pa's serve on several acep committees. the president of the pa national organization(sempa) writes articles in the md em residents journal, etc, etc
np's have more peds/im/fp outpt job opportunities.this is due in large part to the differences in the clinical yr. pa's focus on medicine and hospital based specialties while np programs are usually mostly outpt based, especially the fnp programs which have no surgical component( a required part of every pa program). typical pa clinical time is over 2000 hrs covering multiple specialties while np programs run 500-800 hrs covering a limited # of specialties..
there are many postgrad bs and ms programs for pa's so having a certificate isn't a problem as you can add on credentials later part time while working full time and most likely get your employer to pay for it out of cme.
see www.sempa.org for the pa em organization
see www.physicianassistant.net for a pa specific forum
see www.appap.org for optional postgrad pa residencies....not an option as an np.....

ps: emergency medicine IS a "specific specialty".....

 

[shupagirl]

thank u for the response. I really appreciate any input. My plan is to go into em for couple years....I figured I can get most out of starting in em....where everything seem to be at fast pace...and maybe if I find interest in another field...go on from there. One more day left till I decide which career path to take.....

 

[RAMPA]

thank u for the response. I really appreciate any input. My plan is to go into em for couple years....I figured I can get most out of starting in em....where everything seem to be at fast pace...and maybe if I find interest in another field...go on from there. One more day left till I decide which career path to take.....

then being a PA would give you the most flexibility.

 

[shupagirl]

Just spoke to a nurse of 20 years exp. in various care settings. She told me nurses have that flexibility as well...to choose which specialty I want to pursue. I know and have heard it's not as flexible as PAs but you still get that option. I got a different opinion from her....that nurses get hired more easily to work in em than the PAs. They would hire 1 or 2 PA in em compared to alot more nurses.
ALSO after I spoke to her, I came up with two more questions.
1. PAs are on call? I thought PAs have flexible schedule like nurses, but I heard they get are on call on wkends, esp. when docs are on leave or vacationing...etc.
2. Nurses with experience can climb up corp. latter....whereas PAs with experience can move up to...?
I heard PA is more instant gratification, but in the long run, nursing is better. Does everyone agree to this statement?

Thanks again for the response.

 

[2bdntist2]

Are you talking about a regular nurse vs a PA? There is no comparing the two. Two different careers and levels of responsibility. If you were talking about NP then maybe theres a comparison, but nursing vs. PA, no comparison. Nurses can work in different areas of specialty but they do just that, nurse. PA's on the other hand are clinicians, they treat patients. You can be a nurse in EM, you can be a nurse anywhere but like I said, the level of responsibility of the two careers is completely different.

quinn

 

[shupagirl]

Even if I was to pursue NP, I would still need to work a year or two as a RN before studying to become NP. I know they are totally different responsibility (nurses vs PA) but NP and PA seem to be quite similar. NP is more outpt and PA is more hospital based. However it would take me 2 years to sit in for PA certification exam whereas it would take me about about 6 years to get to NP level. To be honest, I like PAs better starting pay, but in the long run, I think PA will be a PA, but nursing will give me more options.

 

[2bdntist2]

Actually, PA 's work everywhere not always only in hospitals. There are alot that also work in clinics.Urgent care, FP, Derm, ob/gyn(mine is a PA), ER,ICU,Neurosurg,etc. I live in Mich and this is a very friendly PA state. I don't know about other states but PAs work in alot of different capacities here. Thats the beauty of being a PA, if you don't like one specialty, you can always go work in another. I'm not trying to convince you or sway you, just give you correct info, because ultimately the decision is yours. If you like the nursing way of doing things, be a nurse, if you like the medical way of doing things, be a PA. Either way, it's your decision, and what you'd be more comfortable doing.

Good decision making
quinn

 

[shupagirl]

I was really interested in the Ob/GYN PA. thanks for sharing your thoughts. 🙂

 

[TexPre-Med]

A nurse practitioner and physician's assistant are the SAME thing. Do the program that takes the least amount of time to complete. There is no advantage to either. Both can work anywhere and in any field. They are both great degrees. And by the way, a P.A. is a masters degree (at least in TX - should be everywhere). There is NO point in doing the nursing program if it takes extra years to be an NP.

 

[core0]

A nurse practitioner and physician's assistant are the SAME thing. Do the program that takes the least amount of time to complete. There is no advantage to either. Both can work anywhere and in any field. They are both great degrees. And by the way, a P.A. is a masters degree (at least in TX - should be everywhere). There is NO point in doing the nursing program if it takes extra years to be an NP.

You should probably study up on this a little more. PA school is competency based. There are programs that while all are taught at the graduate level give a variety of degrees because of location or education mission. PAs can graduate with a certificate, associates, bachelors or masters. However, they are all taught by the same blueprint and to the same standard.

NPs programs are degree based which means that all NPs are taught as masters prepared nurses (ignoring the whole DNP thing). The program that they enroll in is seen as an advance practice extension of basic nursing. These extensions are based upon nursing domains. There are a number of currently recognized domains (and several that are not recognized). Generally acute care, family practice, adult, peds, psych, womens health and oncology are the recognized nursing domains.

You can argue differences in educational philosophy, but the real difference between the two professions is scope of practice. PAs always work in a collaborative manner with a physician. Because of this, their scope of practice is defined by that of the physician. There is no independent scope of practice. The NP may or may not work in a collaborative relationship with a physician. Because of this their scope of practice is defined by the state BON, their educational preparation as an NP and their type of certification. While some states are more strict on how they interpret the certification, generally all state NP practice acts are written this way.

The other substantial difference is which practitioner is used and in what manner. There are wide regional variations in the use of both NPs and PAs. In general you will see very few NPs in surgery. There are currently more NPs in primary care but like PAs there seems to be an increase in the number doing specialty care. PAs are currently divided roughly 1/3 primary care, 1/3 surgery and 1/3 specialty care. NP numbers are more difficult to measure but are probably about 60% primary care 40% specialty care. As the poster above noted moving within the PA profession is relatively easy and merely requires finding a job and physician in the field that you choose.

David Carpenter, PA-C

 

[shupagirl]

PAs can graduate with a certificate, associates, bachelors or masters. However, they are all taught by the same blueprint and to the same standard.

The program I applied for is certificate option, however they also offer bachelor option. I already have a bachelor degree so I decided to go with certificate, but would 2nd bachelor in PA be better for me?
I am really leaning towards PA now. Thank you everyone for your comments.

 

[core0]

The program I applied for is certificate option, however they also offer bachelor option. I already have a bachelor degree so I decided to go with certificate, but would 2nd bachelor in PA be better for me?
I am really leaning towards PA now. Thank you everyone for your comments.

A bachelors may offer you more financial aid options. The best of all worlds is to see if they also offer a distance masters through another institution. Saint Francis offers a masters for many certificate programs.

David Carpenter, PA-C

 

[julie walker]

Being a nurse, one has the potential to earn more than a PA. Think about it.

 

[primadonna22274]

In some cases sad but true.
There are places that are so short of nurses they're paid a very high hourly rate. My mother is a traveling critical care nurse and usually commands $50/hr. OTOH she does not have paid benefits and doesn't really need them since my dad has state health, retirement etc. Nursing was also a "second career" for her after mothering for 25 years so she likes just going to work and making money and going home.
There are plenty of PA jobs that pay very well though too. I've never had one of them unfortunately but I've never been paid too poorly as a PA either.
And please, don't believe the drivel that PA and NP are "exactly the same". We're not. Thanks to David Carpenter as always for clearing that point.

Being a nurse, one has the potential to earn more than a PA. Think about it.

 

[core0]

Being a nurse, one has the potential to earn more than a PA. Think about it.

RN Median Hourly Rate by State (2006)*

* California: $31.88
* Florida: $23.26
* Georgia: $23.83
* Illinois: $25.00
* Pennsylvania: $25.00
* Tennessee: $22.25
* Texas: $25.00

Additionally, according to 2004 data from the Bureau of Labor Statistics, registered nurses earned an average of $52,330 per year. The middle 50 percent averaged between $43,370 and $63,360. The bottom 10 percent earned under $37,300, while the top 10 percent made more than $74,760.


INCOME — Results of the 2007 AAPA Physician Assistant Census Survey indicate that the mean total income from primary employer for PAs who are not self-employed and who work at least 32 hours per week for their primary employer is $86,214 (standard deviation $21,901); the median is $82,223. The comparable mean for PAs who have been in clinical practice for less than one year is $73,013 (standard deviation $13,015); the median is $71,825.

2004 data for comparison:
The median total annual income from primary employer for respondents who work at least 32 hours per week for their primary employer and who are not self-employed is $74,264; the mean is $78,257. The comparable figures for respondents who graduated in 2003 are $64,536 and $65,641, respectively.

I'll let you do the math

David Carpenter, PA-C

 

[shupagirl]

Thank you everyone for your comments. I love both nursing and PA profession, but I can just choose one. 😀

 

[bryanboling5]

Being a nurse, one has the potential to earn more than a PA. Think about it.

Typically, if a PA/NP is making less than a staff nurse, they're working less and more desirable hours as well. Most nurse who are making a ton are working overtime and nights/weekends.

Beyond that, nursing (staff nurse, not NP) and PA are totally different jobs. Don't choose based on who makes more.

 

[TexPre-Med]

Being a nurse, one has the potential to earn more than a PA. Think about it.

Ignorant comment. We are in America. Anyone has the "potential" to earn more than others. I know nurses practitioners that make more than doctors. I know P.A.'s that bank. It all depends on the practice and how talented you are.

To those speaking on the P.A. degree. This is from U.S. News - 2007:
Training
Requirements have been ratcheted up. Today, the typical student admitted to the three-year training program has a pre-med bachelor's degree, plus a few years of experience as a nurse, paramedic, or emergency medical technician.

Money Magazine 2008 ranks P.A. as the #1 job in healthcare, and the #5 job in the nation based on income, flexibility, stress, creativity, and difficulty.

If you are deciding between being a nurse or P.A., the answer is P.A. There is no arguement. P.A.'s will on "average" make more, work fewer hours, more autonomy, etc. If you are deciding between an NP or a P.A. degree, go with whatever route is the cheapest/cost-efficient. A NP/PA will make roughly equal income in similar fields/locations with the same benefits.

If you started the nursing route/completed it, consider being a nurse anesthetist or NP.

These are just the facts people. Disclaimer: I am not bashing any degree. Everyone has their place in the medical field.

 

[TexPre-Med]

You should probably study up on this a little more. PA school is competency based. There are programs that while all are taught at the graduate level give a variety of degrees because of location or education mission. PAs can graduate with a certificate, associates, bachelors or masters. However, they are all taught by the same blueprint and to the same standard.

NPs programs are degree based which means that all NPs are taught as masters prepared nurses (ignoring the whole DNP thing). The program that they enroll in is seen as an advance practice extension of basic nursing. These extensions are based upon nursing domains. There are a number of currently recognized domains (and several that are not recognized). Generally acute care, family practice, adult, peds, psych, womens health and oncology are the recognized nursing domains.

You can argue differences in educational philosophy, but the real difference between the two professions is scope of practice. PAs always work in a collaborative manner with a physician. Because of this, their scope of practice is defined by that of the physician. There is no independent scope of practice. The NP may or may not work in a collaborative relationship with a physician. Because of this their scope of practice is defined by the state BON, their educational preparation as an NP and their type of certification. While some states are more strict on how they interpret the certification, generally all state NP practice acts are written this way.

The other substantial difference is which practitioner is used and in what manner. There are wide regional variations in the use of both NPs and PAs. In general you will see very few NPs in surgery. There are currently more NPs in primary care but like PAs there seems to be an increase in the number doing specialty care. PAs are currently divided roughly 1/3 primary care, 1/3 surgery and 1/3 specialty care. NP numbers are more difficult to measure but are probably about 60% primary care 40% specialty care. As the poster above noted moving within the PA profession is relatively easy and merely requires finding a job and physician in the field that you choose.

David Carpenter, PA-C

AAPA Website
"The typical PA program is 24-32 months long and requires at least four years of college and some health care experience prior to admission. The majority of students have a BA/BS degree and prior health care experience before admission to a PA program.

While all programs recognize the professional component of PA education with a document of completion for the professional credential (PA), 78 percent of the programs award a master’s degree. [111 award master’s degrees, 21 award bachelor’s degree, 3 award associate degrees, and 5 award certificates."

Obviously the majority and trend are towards a masters, but yes you can do it a few ways.

Your statistics on the PA vs NP workforce - do you have a reference? Is this just a guess?

 

[core0]

AAPA Website
"The typical PA program is 24-32 months long and requires at least four years of college and some health care experience prior to admission. The majority of students have a BA/BS degree and prior health care experience before admission to a PA program.

While all programs recognize the professional component of PA education with a document of completion for the professional credential (PA), 78 percent of the programs award a master’s degree. [111 award master’s degrees, 21 award bachelor’s degree, 3 award associate degrees, and 5 award certificates."

Obviously the majority and trend are towards a masters, but yes you can do it a few ways.

Your statistics on the PA vs NP workforce - do you have a reference? Is this just a guess?

The trend is definitely toward a masters, but there have been recent programs at the community college level. Some of these programs excel at providing PAs for primary care and undeserved areas.

For the PA data you have to cull it from here:
http://www.aapa.org/research/07census-content.html#sec03
Table 3.7.
The NP data is much harder to come by. There is some data at advance for NP but its fairly limited. The best article is the one by Hooker and company:
ftp://ftp.hrsa.gov/bhpr/workforce/scope1992-2000.pdf
It discusses the movement by NPs and PAs toward specialty care but does not quantify it. The movement toward specialty care has accelerated in the PA world. Really hard to say in the NP world, but the increase in the number of ACNP graduates seems to indicate similar results.

David Carpenter, PA-C

 

[Xigris79]

Typically, if a PA/NP is making less than a staff nurse, they're working less and more desirable hours as well. Most nurse who are making a ton are working overtime and nights/weekends.

Not in all cases. I am an ICU nurse and work for an agency making $95,000/yr. I work M-F 7a-3p, 40hrs/wk. If I should decide to pick up OT, which is optional, I make $101/hr. In some ICU's I have worked in PA's and NP's cover for the docs at night. They work terrible hours (24hr shifts!) and make about $20K less than me, the staff nurse.

Knowing what I know now, if I could go back before I became a nurse and choose between NP and PA I would choose PA. PA's have the optional of doing a residency. Also, from what I have heard from NP's who work in acute care, is that their 10-20yrs of experience as an RN in acute care first is what got them thier jobs.

 

[shupagirl]

Not in all cases. I am an ICU nurse and work for an agency making $95,000/yr. I work M-F 7a-3p, 40hrs/wk. If I should decide to pick up OT, which is optional, I make $101/hr. In some ICU's I have worked in PA's and NP's cover for the docs at night. They work terrible hours (24hr shifts!) and make about $20K less than me, the staff nurse.

Knowing what I know now, if I could go back before I became a nurse and choose between NP and PA I would choose PA. PA's have the optional of doing a residency. Also, from what I have heard from NP's who work in acute care, is that their 10-20yrs of experience as an RN in acute care first is what got them thier jobs.

I have heard that acute care is the way to go when you are a RN trying to pursue to become a NP.

Xigris: I want to know why would you rather be a PA over NP when you seem to be doing so well? (great schedule + pay)? almost a six figure income is great. If you dont mind me asking how long were you a nurse in the ICU?

Thanks everyone for your input! 🙂

 

[Xigris79]

shupagirl,
I like the PA cirriculum/medical model better than the NP. Also, YOu can do a residency as a PA. This is just my preference though. To answer your question of why I want to be PA over and NP when I am doing so well (financially) as an RN it would be that I am not planning on pursuing either. Money isn't everything. Big suggestion though, if you plan on pursuing nursing I would HIGHLY suggest shadowing a nurse in the acute care setting. I wish I had. I did ER for 2 yrs and ICU for 2.5 and counting. Good Luck 🙂

 

[foreverLaur]

I don't know if anyone directly mentioned this.. but...

As a PA you can work in EM for a few years and then if you decide to have a family and work less, you can switch to derm and work part time.

As an NP, you have to go back to school for 1 year to switch specialties like that.

 

[njbmd]

Do not choose any health care profession based on money. Choose your profession based on what you want to do. This goes for medicine, physician assistant, nursing or whatever. If you hate your work, you become dangerous and you generally won't enjoy any financial compensation no matter how great. Working just for a paycheck is pretty boring with high burnout.

Shadow a PA and shadow a nurse. Figure out which you like best and pursue the one you like best. The monetary rewards will come with a job well done that you enjoy. Otherwise, you will be searching for another career again. If being an NP is your ultimate goal, then you are not going to enjoy being a PA.

 

[shupagirl]

Dear
Forever... : I have considered that route before. Work in EM then get into specialty like dermatology with flexible hours 🙂 thanks

njbmd: Thank you! I am scheduled to shadow both nurse and PA in OR this coming tuesday. I figured being there in person talking to the experienced professionals would indeed be of great help.

Thanks everyone! You guys are great!

 

[fab4fan]

Do not choose any health care profession based on money. Choose your profession based on what you want to do. This goes for medicine, physician assistant, nursing or whatever. If you hate your work, you become dangerous and you generally won't enjoy any financial compensation no matter how great. Working just for a paycheck is pretty boring with high burnout.

Shadow a PA and shadow a nurse. Figure out which you like best and pursue the one you like best. The monetary rewards will come with a job well done that you enjoy. Otherwise, you will be searching for another career again. If being an NP is your ultimate goal, then you are not going to enjoy being a PA.

Probably the wisest advice of any offered thus far.

 

[bryanboling5]

Probably the wisest advice of any offered thus far.

For sure. I was just talking with a friend about this this afternoon. He works with several people whose only motivation for work is a paycheck and he said he couldn't understand how you'd keep going. He said, "for me, I need to know that I'm making a difference to a kid." (he's a special ed teacher)

"Do what you love and you'll never work a day in your life." -Some really smart guy

 

[SailorNurse]

Not in all cases. I am an ICU nurse and work for an agency making $95,000/yr. I work M-F 7a-3p, 40hrs/wk. If I should decide to pick up OT, which is optional, I make $101/hr. In some ICU's I have worked in PA's and NP's cover for the docs at night. They work terrible hours (24hr shifts!) and make about $20K less than me, the staff nurse.

Knowing what I know now, if I could go back before I became a nurse and choose between NP and PA I would choose PA. PA's have the optional of doing a residency. Also, from what I have heard from NP's who work in acute care, is that their 10-20yrs of experience as an RN in acute care first is what got them thier jobs.

But you are not a "staff nurse" you are an AGENCY nurse, not hospital staff.
Agency nurses (rent a nurse) earn more then the hospital staff RN's as you are not being paid benefits by the hospital since you are not hospital employees. The difference in hourly wages is due to the no benefits part, (No health insurance, no sick leave, 401K, workmans comp, no disability etc) that the hospital is not having to contribute. While the agency you work for may have similar benefits for those that work full time hours, other agencies may treat you as an independent contractor where you are responsible for all taxes owed to the government. I still pick up shifts as an agency nurse & PRN staff, have worked agency for 5 years in Phoenix.

To the OP, I would have to agree with Coreo (D. Carpenter, PA-C) but would like to add that how mid levels are utilized may depend on the geographical location and the individual facilities. Locally, the ER uses FNP's in the fast track area & recenlty a PA joined the group. As David pointed out, NP specialties are by domains, but IMO-Family Nurse Practitioner is the most marketable. You did not say which type of NP you are looking at. Acute Care NP is the newest & might be something for you to consider. Our local Advance Practice group includes both Pa's, NP's, CNM's, CRNA's,CNS, & educators.

When looking at salaries for NP's- it depends on the contract. It may be that while the base salary is low, the benefits may include bonuses such as profit sharing, paid travel & paid time off to attend conferences for required CEU's, the employer may also be paying for required licenses/Dea #'s etc and malpractice insurance. Typically (at least locally, NP's that have hospital privileges, take call, weekends ) & see patients at a clinic) make more then clinic only NP's.

I can tell you the one area where you will not make big bucks-teaching!!!! Hey but I've got the summer off!!!!