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Why Aren’t You Becoming a Nurse Practitioner?

December 2, 2011 in Prospective PAs

Physician Assistant ED - nurse practitioner versus physician assistant
“Why aren’t you becoming a nurse practitioner?”

As a registered nurse (RN), pursuing a degree as a PA, I knew I would get different forms of this same question time and time again. To answer that question effectively, I’ve always first listed similarities between the PA profession and the nurse practitioner (NP) profession:

1)      Both get to work with patients.

2)      Both can order diagnostic tests and treatments.

3)      Both provide patient education and can do referrals as needed.

4)      Both have prescription rights (within state guidelines).

5)      Both can assist in surgery.

6)      Both are rewarding careers.

7)      And just as a laugh… I’m sure they both have lots of paperwork to do.

From what I understand, there are only a few differences between the way that an NP practices and the way that a PA practices; and for me as a personal decision- it’s the small differences that make PA the better “fit” for me.

1)      PAs are dependent practitioners. NPs are capable of being independent practitioners.

Being independent or dependent upon a physician’s license are different approaches to achieving the same goal: affordable, quality care for patients. I have always envisioned myself as working as part of a team and so the PA path resonated with me as teamwork is a fundamental facet of being a PA.  I don’t view being “dependent” as demeaning in any sense. PAs have a specific amount of autonomy and are able to provide competent care with good patient outcomes.

As an interesting side note, according to The Permanente Journal, patient satisfaction does not depend on the type of provider, but rather on communication and style. Click here to read the article.

 2)      PAs are able to work in different specialties without additional schooling. NPs must be certified for each chosen specialty they work in.

I have to admit that being able to work in different areas in healthcare is part of what attracted me to being an RN to begin with. When I was in nursing school I had clinical rotations in geriatrics, pediatrics, maternity, psychiatric, newborn, wound care, operating room, emergency room, post-anesthesia care units, intensive care units, cardiac units, medical/surgical, catheterization laboratory, dialysis, physical therapy rehabilitation, and more. It was exciting for me to know that if I wanted to take my career in a new direction, I could specialize in a different area of nursing.

Now that I’ve decided that I want to be capable of doing more for my patients, the PA route allows me the freedom of changing between specialties as long as my supervising physician is in the same area of expertise. (For example, if a PA was interested in working in dermatology, his or her supervising physician would need to be a dermatologist.) Of course I’m not intending to say that I plan on bouncing around from specialty to specialty every couple of years, but I do like to keep my options open. My current goal is to work in primary care after I complete PA school. I feel like there is a real need in this area. Besides the high demand for primary care providers, primary care is such a vital component to patient well-being. It is here where preventative measures can make all the difference in a patient’s quality of life.

 3)      PAs practice the medical model. NPs practice the nursing model.

As a nurse, I have been trained in the nursing model. This method is considered a holistic approach to treating the patient, not just the disease process. I feel very comfortable with this model and would now like to expand my understanding into the medical model. I believe I will be able to take concepts from both models to give my patients the best care possible.

These are my own personal reasons for choosing to be a PA rather than an NP. For others, they will find that the NP route is the better choice for them. And there will be some that will decide ultimately they could not be happy unless they were physicians. That is for each to decide, and only you will know why only one of these professions speak to you.  I would invite each of you to really research each of these respectable professions and find the best “fit” for you!

5 responses to Why Aren’t You Becoming a Nurse Practitioner?

  1. Great article! I do have one question and I seem to have this same question raised every time I read articles explaining the difference in professions. If PA’s can create independent practices in some states why then are they not considered independent practitioners?

    One more thing will you define in more detail “specific autonomy?”

  2. From what I understand, even a PA who owns his own practice must work under a physician’s license. So in this case, a PA would pay a physician to oversee as needed; thus the physician would act more like a consultant rather than leading supervisor.

    Regarding “specific autonomy”, a PA will see many and treat many of the same types of patients his supervising physician sees; however, a more complicated patient case will be directed to the physician due to the physician’s extensive training and knowledge.

    This is what I understand from my own research of the PA profession. Perhaps we could get further insight from a PA-C? Would any PA-Cs like to shed any light on these 2 topics?

  3. PAs have a significant degree of autonomy. The best description of the way they function is to say they practice medicine on a physician-led team. This is much more accurate than stating they practice under a supervising physician.

    Generally PAs are trusted to make the great majority of decisions on their own because their supervising physicians are confident that they know their limitations. Their degree of autonomy then is usually determined by their level of competency. For example, if I have excellent training and experience in treating diabetes, I would rarely ever have to communicate with my supervising physician when managing a patient’s diabetes. However, if I lack training and/or experience in a particular disease process, then I’m more likely to rely on my supervising physician.

    What happens in reality is that new grads are kept on a shorter leash. As they grow in knowledge, skills, and abilities, that leash gets longer and longer (their autonomy increases). PAs who have years of experience in a particular area (depending on the specialty) may only rarely consult with their supervising physician.

    It’s also not uncommon for physicians to rely on PAs to handle cases they may not be as comfortable with. I have a colleague PA who worked in Women’s Health for several years. She then switched specialties to Emergency Medicine. Guess who gets the call when there is a women’s health issue that walks in the door? Also, think about a PA who’s practiced Orthopedics for years who has switched to Family Medicine. Who do you think will be more competent in handling orthopedic problems in this situation, the PA or Family Medicine physician?

  4. Thank you! Thank you! Thank you!

    I’ve been trying to put into words why this is my choice after having been in nursing. And sadly “I just don’t want to be an NP.” doesn’t satisfy most people.

    I think the ability to change specialties is the biggest reason. I hope/plan to be an ED PA, but if one day I change my mind, I can!

    Thanks again for the great article!

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