Whats the difference?

[PharmDr.]

I know PA's practice the"medical" model and NP's practice the "nursing" model but don't they practice in the same way? I really need to clear this up as this is all I ever hear about on these forums. Don't NP do rounds, diagnose, and write scripts just like PA's? I work at CVS pharmacy as a tech and everyday I see a couple scripts written by either a NP or PA and most of the time if it is a clinic or private practice they both will be listed on the script for reference. Sometimes a ER NP will have their name listed by themselves on the script and just the department and hospital they work at. Is it that NPs still perform RN duties like cleaning up their crap and vomit and giving them showers and such and staying bedside or do they do their job like a Dr. would? Im so confused right now.

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[Febrifuge]

No, the job duties are similar. I think it's more a case of, the NP spent the first x number of years of his/her training in the 'nursing model' of education, and the approach to care that goes with that, while the PA never had that and has gained all their education in the 'medical model.'

It gets more confusing when a nurse goes on to practice after completing PA school. In fact, if such a person could comment, we'd pretty much have our answer, right?

 

[hospPA]

No, the job duties are similar. I think it's more a case of, the NP spent the first x number of years of his/her training in the 'nursing model' of education, and the approach to care that goes with that, while the PA never had that and has gained all their education in the 'medical model.'

It gets more confusing when a nurse goes on to practice after completing PA school. In fact, if such a person could comment, we'd pretty much have our answer, right?

I am a bachelor's trained RN who went to PA school and not NP school. I think the nursing model teaches a person how to care for the social aspects of a person more than the medical model does. For that, it was helpful. All through nursing school, I wondered what the heck this nursing diagnosis stuff was. I never found a use for it. I really think it is only so that the nursing profession can continue to strive for independence from physicians, which is scary. There is no other logical reason. All through nursing school I wondered why we did this nursing diagnosis crap (and it is crap) rather than calling it what it was. Sore throat is sore throat not alteration in pain perceptions related to bacterial invasion or something like that. Most nurses think it's crap too, don't kid yourself.

The reason I went to PA school instead of NP school is the training. Yes, the medical model is most of it, but the intensity and coverage of material is also a great part. Didactic study was in basic sciences including gross anatomy with full disection along with courses in each of the medical subspecialties. Clinical training was one full year (summers included) full time +, generally covering about 2500 hours. NP training (at least the schools I looked at) involves part time clinicals (like 3d/week) amounting to about 500 or so hours total. Many nurses will say that their previous nursing experience prepares you so that you need less clinical time. That is total bogus. How is hanging cefazolin and determining the proper drip rate the same as diagnosing cellulitis and making sure it's not fasciitis and knowing how each occurs? It's not the same. I am not knocking nursing experience as it has helped me, but it is not a substitute for rigorous training in medical science. Also, NP's are practicing medicine regardless of what they call it. They do the same job and are usually (at least should be) supervised by docs (they call it collaborative care ).

I like NP's and work with many good ones. I just have a problem with learning nursing (not medicine) for such a short time, and then being expected to practice medicine (and nursing I suppose) independently right after. It doesn't seem to compute. After some years of experience, most NP's and PA's are on a level playing field. The difference is in the training and ability to practice right out of school. I realize I am generalizing here, as there are always outlyers.

Pat

 

[niko327]

I know PA's practice the"medical" model and NP's practice the "nursing" model but don't they practice in the same way? I really need to clear this up as this is all I ever hear about on these forums. Don't NP do rounds, diagnose, and write scripts just like PA's? I work at CVS pharmacy as a tech and everyday I see a couple scripts written by either a NP or PA and most of the time if it is a clinic or private practice they both will be listed on the script for reference. Sometimes a ER NP will have their name listed by themselves on the script and just the department and hospital they work at. Is it that NPs still perform RN duties like cleaning up their crap and vomit and giving them showers and such and staying bedside or do they do their job like a Dr. would? Im so confused right now.

Hey PharmDr.
You are correct, PAs are trained under the medical model, and NPs are trained under the nursing model. Both professions received advanced training to diagnose, treat, prescribe, etc, and become qualified as midlevel healthcare providers. PAs receive this training much like a student physician would, and NPs get the training as an intense elaboration of their nursing education. So in theory you'd figure that there would be big differences in the way they treat patients, right? But no, there really isn't. The differences between the two professions are minor when seen through the lens of clinical practice. The question of superior knowledge base of one profession compared to the other has been debated in the past and is still an open issue. Being a PA student, I have my own opinions. The differences you do see seem to be political and administrative. The nursing lobby is very old and very powerful. Despite similar qualifications and similar practice scope, NPs are allowed to work independently and sometimes have better narcotic prescriptive priviledges. These differences have little or nothing to do with training, but are rather a reflection of a very powerful and influential lobby. By keeping themselves under their respective state nursing boards NPs are not subject to the state medical board. They can therefore work independently of doctors and dictate their scope of practice at will, this can be quite a nice advantage. It is interesting to note that I have not noticed any NPs in independent practice where I live. PAs on the other hand are subject to their state medical boards and thus work under a physician's license. This is not necessarily a bad thing either, this arrangement oftens fosters a close working relationship between the two professions. Some jobs will prefer a PA to work for them instead of an NP based on this relationship or based on the medical model training. Some jobs will prefer an NP based on their ability for independent practice. It really depends on what region you are working in. There are a few more differences and alot of little details but I hope this gives you a little better idea about the two professions.
PS: An NP working in the capacity of NP is usually not responsible for general nursing duties. A PA of course is not responsible for nursing duties either.

 

[C1976]

I agree with both of the last two posts. A lot of nursing is crap, but NP's have some definite advantages (I'm a NP student).
Whatever this magical "nursing model" is eludes me as it relates to practicing as a NP. The nursing process is assessment, diagnosis, planning, implementation and evaluation--and yes, that does apply. But all health care professionals do that whether they call it that or not. Nursing care plans are simply a way of drawing out what could be said in 15 words into 100 words. Utter crap, I agree.
It is my opinion that people could learn more in PA school than NP school...depending on who they are. I think PA school is a more foolproof way to get the training, but I think with dedication you can get the same knowledge out of NP school. I decided to become an NP for the advantage of working under my own license. It is also the case in some, but not all international organizations, that they accept NPs and not PAs (for humanitarian work) because of their ability to work autonomously, and since I want to go that route, I thought it was the best choice for me. When I was deciding which one to become (each option would have taken me the same amount of time), I also considered another advantage of being a NP--you are also a nurse. That means that if you ever need to pick up some cash, quick, you can get some contract work on the side. You can also take breaks and travel, easily go part-time to accomodate children or whatever you need to accomodate. Being a nurse, you have unlimited other options if you decide that, temporarily or permanently, you want to try something else. Main advantage for me? It also allows me to work part-time and pay for my grad school without financial difficulty. Good luck!

 

[zenman]

I am a bachelor's trained RN who went to PA school and not NP school. I think the nursing model teaches a person how to care for the social aspects of a person more than the medical model does. For that, it was helpful. All through nursing school, I wondered what the heck this nursing diagnosis stuff was. I never found a use for it. I really think it is only so that the nursing profession can continue to strive for independence from physicians, which is scary. There is no other logical reason. All through nursing school I wondered why we did this nursing diagnosis crap (and it is crap) rather than calling it what it was. Sore throat is sore throat not alteration in pain perceptions related to bacterial invasion or something like that. Most nurses think it's crap too, don't kid yourself.

All professions have a diagnostic system in place. My brother, an auto mechanic, also does some complex diagnosing. I really don't think that nursing diagnosis is geared toward "striving for independence from physicians" because we are already two different professions.

If you chew through this definition, you might be able to get what they failed to teach you in nursing school: A nursing diagnosis is "a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable" (NANDA, 1992 p. 5). Nursing diagnoses are concepts used to describe actual and potential health problems of clients. They describe clinical nursing practice in a uniform manner.

Medical diagnosis is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. They also allow MDs all over the world to communicate with each other.

Clinical training was one full year (summers included) full time +, generally covering about 2500 hours. NP training (at least the schools I looked at) involves part time clinicals (like 3d/week) amounting to about 500 or so hours total.

I agree that NPs should have more clinical in NP school.

I am not knocking nursing experience as it has helped me, but it is not a substitute for rigorous training in medical science.

Just for the record, medicine is not a "science;" it employs the sciences...some of which are already considered ancient by other sciences.

 

[ultracet]

It also appears that SOME medical professionals view the two differently. I know of an ER doctor who prefers PAs simply because they were trained by doctors and seem to "anticipate" what they want a little easier.

 

[hospPA]

All professions have a diagnostic system in place. My brother, an auto mechanic, also does some complex diagnosing. I really don't think that nursing diagnosis is geared toward "striving for independence from physicians" because we are already two different professions.

Two different professions, but not as different as you think, once we are out in the real world.

If you chew through this definition, you might be able to get what they failed to teach you in nursing school: A nursing diagnosis is "a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable" (NANDA, 1992 p. 5). Nursing diagnoses are concepts used to describe actual and potential health problems of clients. They describe clinical nursing practice in a uniform manner.

Using NANDA to substitute for medical diagnosis is garbage. Using NANDA to encompass more of the social aspect of a patient (not client). A good medical practitioner, be it MD/DO/NP/PA, looks at the whole person, including the social, family aspects. I would only argue that it is a lot of work writing this nursing diagnosis garbage, when it can be simplified. I would argue that it IS a way for nurses to try and differentiate themselves from other practitioners. There is really no other logical reason for it.
For the record, I could write those crap nursing diagnosis' as well as everyone. I had all of the prof's convinced I believed in it. That's OK because the high GPA helped me in getting into PA school.

Medical diagnosis is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. They also allow MDs all over the world to communicate with each other.

Yes. NP's and PA's also use medical diagnosis daily because it makes sense and is easy to interpret. Although medical diagnosis does not specifically address certain social and family issues, they are not ignored.

I agree that NPs should have more clinical in NP school.

Good. Most do.

Just for the record, medicine is not a "science;" it employs the sciences...some of which are already considered ancient by other sciences.

It is an art based on science in general. So, what would you call practice based on randomized, placebo controlled, double-blind trials as well as basic science studies. I call it evidenced based medicine. How is that not science?

Despite the banter, I think we actually agree on most points.
Regards,
Pat

 

[hospPA]

All professions have a diagnostic system in place. My brother, an auto mechanic, also does some complex diagnosing. I really don't think that nursing diagnosis is geared toward "striving for independence from physicians" because we are already two different professions.

If you chew through this definition, you might be able to get what they failed to teach you in nursing school: A nursing diagnosis is "a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable" (NANDA, 1992 p. 5). Nursing diagnoses are concepts used to describe actual and potential health problems of clients. They describe clinical nursing practice in a uniform manner.

Medical diagnosis is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. They also allow MDs all over the world to communicate with each other.



I agree that NPs should have more clinical in NP school.



Just for the record, medicine is not a "science;" it employs the sciences...some of which are already considered ancient by other sciences.

Medicine is an art based on science. OK, how would you define practice based on randomized, double blind, placebo controlled trials as well as basic science research? I call it evidenced based medicine. How is that not science?

Regards,
Pat

 

[zenman]

Medicine is an art based on science. OK, how would you define practice based on randomized, double blind, placebo controlled trials as well as basic science research? I call it evidenced based medicine. How is that not science?

Regards,
Pat

I don't think medicine is much of an art, although years ago it was more so. It's mostly by the numbers, assess, order labs, xrays and there's your answer. Then just do as the textbooks say. So it's mostly a lot of memorization of what to do depending on what your labs, xrays, etc. show. It's actually funny watching interns and residents. They go assess the patient, order stuff, go look in their books, reassess and order more stuff depending on what their books say. Now, if the electricity were to go out and you kept on practicing, then that would be an "art!"

Research... Here's where the problem lies; the people doing the research have an effect on the results, even in a double-blind study where, for example, no one knows who is getting a placebo or not. The patient knows that he or she is also in a drug study and probably hoping that they are getting the "real" drug. The doctor may also like certain patients and are hoping they get the real thing. That alone will change the results, as will the consciousness of the researchers. That we don't yet have a handle on. Many reversals of popular medical opinion occur; this happens of course, after many thousands of people have been treated according to these empirically effective treatments or drugs. Vioxx is the latest of many.

Statistics can never account for the effect of a particular therapy on an individual.

So, there is our evidenced based medicine.

 

[Freeeedom!]

I have had the utter displeasure of working (teaching) NP students and the relative pleasure of teaching PA students and from my vantage (a 3rd year resident)...the NP model is so disorganized in the learning approach , terribly lacking academic standards, and far far too short to gain the necessary broad knowledge to manage patients with confidence. The PA's I have seen, have a far more organized approach and just appear so much more "with it". Once again, from my vantage, the 2 NP programs in my city are an utter waste and do not train the students in any way shape or form in the academic degree that either PA's are taught or certainly medical students. Part time academics lead to part time understanding.
I realize this will not be a popular stance, but lately I have had it up to "here" with the NP students who "go through the motions" and couldn't decern a differential if it was painted on their foreheads.

 

[zenman]

I realize this will not be a popular stance, but lately I have had it up to "here" with the NP students who "go through the motions" and couldn't decern a differential if it was painted on their foreheads.

Doesn't matter if it is not a popular stance. It is antedotal "experience" and therefore much more useful in this case than an empirical study comparing the training of NPs vs. PAs.

 

[aphistis]

Doesn't matter if it is not a popular stance. It is antedotal "experience" and therefore much more useful in this case than an empirical study comparing the training of NPs vs. PAs.

"Antedotal," eh?

 

[hospPA]

I have had the utter displeasure of working (teaching) NP students and the relative pleasure of teaching PA students and from my vantage (a 3rd year resident)...the NP model is so disorganized in the learning approach , terribly lacking academic standards, and far far too short to gain the necessary broad knowledge to manage patients with confidence. The PA's I have seen, have a far more organized approach and just appear so much more "with it". Once again, from my vantage, the 2 NP programs in my city are an utter waste and do not train the students in any way shape or form in the academic degree that either PA's are taught or certainly medical students. Part time academics lead to part time understanding.
I realize this will not be a popular stance, but lately I have had it up to "here" with the NP students who "go through the motions" and couldn't decern a differential if it was painted on their foreheads.

I appreciate hearing from you and are glad you like teaching PA students. I do as well and agree with nearly everything you said. The part time academics thing is so true! I would argue that NP students who go through the "nursing crap" motion like I did in undergrad and then take the time and put forth the effort to learn the REAL MEDICINE themselves can do just fine. The ones that do not realize that one cannot independently care for a sick patient using only nursing theory are way scary.

Huh, I don't know what antedotal experience is either? Is that taught in NP school? Maybe it is experience with antedotes? Like wilderness medicine?

Pat

 

[deleted6669]

I have had the same experience with np students...I'm a little biased being a pa, but when an np student has a one week long em rotation and the pa students do 6 weeks, who do you think learns more......

 

[zenman]

Huh, I don't know what antedotal experience is either? Is that taught in NP school? Maybe it is experience with antedotes? Like wilderness medicine?

Pat

Not "antidote." Subjective experiences... antedotal stories, antedotal experiences, antedotal observations, antedotal evidence, versus objective experiences, etc..

 

[Seaglass]

I think they were making fun of you because the word is "anecdote."

 

[zenman]

I think they were making fun of you because the word is "anecdote."

Ha, ha, they failed cause I'm a very cunning linguist!

 

[CVPA]

....ummm, I think your still missing the point there, Skippy. You might want to consult Websters and get back to us.....

 

[J Lucas]

What a goof...

 

[hospPA]

 

[zenman]

What a goof...

You poor guys. Even though I'm from the Republic of Texas and can use the language as I wish here's a quote for you so you can see how an M.D. used the word:

"This writer is currently working with other researchers to expedite much-needed trials. The mounting written and antedotal incidents of success using agents such as Gamma Globulin, Ampligen, Kutapressin, and Interferon give cause for sincere optimism in treating CFIDS patients. But research must be funded to find more agents and determine how they work in carefully controlled studies."

Now, can we get back on track. I bore easily!

 

[hospPA]

You poor guys. Even though I'm from the Republic of Texas and can use the language as I wish here's a quote for you so you can see how an M.D. used the word:

"This writer is currently working with other researchers to expedite much-needed trials. The mounting written and antedotal incidents of success using agents such as Gamma Globulin, Ampligen, Kutapressin, and Interferon give cause for sincere optimism in treating CFIDS patients. But research must be funded to find more agents and determine how they work in carefully controlled studies."

Now, can we get back on track. I bore easily!

OK. The good doctor also need to study his english. Antedotal is a word used to describe the effects of an antedote. Look it up. He is using this word incorrectly. The word that should be used is anecdotal. Type antedotal into a google search and you will see it used correctly in several medical studies. The following is the correct use of the word:

Preliminary experiences in antedotal effect in vivo and in vitro of 4-mercaptobenzenesulfonamide on arsenious anhydride poisoning

Now, lets get back to the issues. This is not to make fun, only to clear things up so other professionals do not begin to misuse this word. Good luck.
Pat

 

[zenman]

A linguistics professor at University of Texas says "that a more common syllable sequence drives out a less common type." Course this is just more Texas talk!

 

[hospPA]

A linguistics professor at University of Texas says "that a more common syllable sequence drives out a less common type." Course this is just more Texas talk!

God Bless Texas! Enough said. I will let this rest.

Pat