Tuesday, June 25, 2013

What's the difference between a Nurse Practitioner and a Physician's Assistant?


I was asked this question yesterday and it was actually a question on my comprehensive examination to 'pass' to graduate with my Master's Degree education at the University of South Carolina in Columbia, SC.  But, more important is why is this important?  It's important in knowing 'who' you are seeing as a provider.  There is so much controversy in healthcare these days you really need to know who your provider is when you walk in that door to see them.  I will start off with an explanation of the various fields by defining each one.

Nurse - there are so many 'types' of nurses it isn't even funny!  That 'nurse' they may be calling may not in fact even be a nurse.  It could be certified nursing assistant, a medical assistant, a LPN, an RN, a BSN, an NP, or a doctorate prepared nurse!  See what I mean now?  So, let's go through each of those.

  CNA - Certified Nursing Assistant is a one year program that teaches someone to do basic skills as an 'assistant' to the nurse.  They provide 'basic healthcare needs' such as bathing, ambulation, and general activities of daily living in a variety of settings under the direction of an LPN or RN.  More often they work in nursing homes, individual homes or hospitals.

CMA/MA - A Certified Medical Assistant is also a one year program that teaches someone to do basic office care skills for duties in a doctors office under the direction of an LPN or RN.  They can do phlebotomy, injections, and more depending on the setting and the guidelines set forth by the physician in the practice.  In some settings such as Community Health Care Clinics their duties may be limited or even in some states.

LPN/LVN - Licensed Practical/Vocational Nurse - A one to two year program (typically) that has more skills than that of an CNA/CMA but less than an RN.  They provide basic care at a range of levels under the direction of an RN.  With advance training they can even start IV's (intravenous fluids), assist with procedures, and do further duties under the direction of the physician.

RN - Registered Nurse - A two to four year program and has passed a licensing exam to be a registered nurse.  They have some of the greatest responsibility and are often in charge of other nursing staff.  They often assist in coordinating care, monitoring patients and more.  Many of these nurses can advance their degree's with a Bachelor's degree (BSN) and with further degree's (Master's degree or higher) can hold advanced practice as an CNS (Clinical Nursing Specialist), NP (Nurse Practitioner), CNM (Nurse Midwife) and even CRNA (Nurse Anesthetist).  Lastly is the PhD or ND (Doctor of Philosophy or Nursing Doctorate).  Most of those with advanced degrees are board certified in their area of specialty and there are numerous areas of specialty including family practice, pediatrics, women's health, psychiatry, geriatrics, emergency care, and more.  Advanced practice nurses are trained under the nursing model and are often autonomous in practice and do not need the physician on site to practice if they are in a state that requires physician collaboration.  Many states do not have physician collaboration requirements.  The areas are boundless!  Board Certification is required for Advanced Practice with continuing education to be renewed to continue licensure every five years.  Advanced Practice nurses can receive reimbursement for services and most have DEA (Drug Enforcement Administration) numbers to prescribe prescriptions when necessary (depending on the state).  Laws for Advance Practice vary from state to state.

PA - Physician's Assistant - Many states still have a Bachelor's degree requirement though that is changing to a Master's degree.  PA's work under the guidelines of a physician regardless of the state they work in.  Some states they can work without a physician on the premises, however it depends on the length of time in which they have been working and which state they are in.  They are trained under the medical model.  All PA's require physician supervision.  Continuing education and retesting for board certification is required every six years.  DEA numbers are that of the physician that they work for.  Laws for PA's also vary from state to state.  PA's also can work in a variety of settings including physician offices, emergency rooms, hospitals, and more.

So, major differences between a PA and NP - training/education, supervision, and autonomy.  Each is described above.  The choice is yours.

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