A Registered Nurse is a healthcare professional who cares for patients in hospitals, schools, correctional facilities and other health care settings. RNs also work in public health and research. You can find them in all departments of the hospital and physician’s office – family medicine, paediatrics, psychiatry, ICU, and operating room. To become a Registered Nurse, you must complete a Bachelor of Science in Nursing (university level). RNs take histories and physicals, take & monitor vital signs and perform basic physical exams. They also monitor the results of treatments. They are involved in patient education and counselling, as well as nursing treatment plans.
Nurse Practitioners are RNs with advanced education and training within a specialty. RNs and NPs are not interchangeable in terms of jobs and training. RNs and PAs are also not interchangeable. In fact, NPs are more similar to PAs than they are to RNs.
RNs play an important role in health care. Should the RN wish to advance their training and become more autonomous in diagnosing, ordering investigations, initiating treatment plans, and prescribing, they may further their education. They can opt to become an NP (1-2 years), PA (2 years) or go to medical school, become an MD (6+ years) or other health careers.
Registered Nurses can (and often do!) become Physician Assistants (PAs). What’s unique about Registered Nurses is that they have the option of pursuing a career as either a Nurse Practitioner, or Physician Assistant. There are many examples of Registered Nurses who work in various specialties and health care settings that opt to pursue the PA profession.
Why would an Registered Nurse select to pursue PA over NP (and vice versa)? Although there are several similarities between job duties and scope of practice. In the eyes of some employers PAs and NPs are interchangeable. However when deciding between which to pursue there are several important differences in education, philosophy and areas of work. Whether an RN chooses to pursue PA vs NP also depends on their personal values, and long-term goals.
Can a Registered Practical Nurse (RPN) become a PA? Yes, however, RPN is a college level degree, and all PA programs require university level courses as part of their requirements
Major reasons an RN may choose PA vs NP:
- Education and Philosophy of Care:
- Nurse Practitioners are based off of the Medical/Nursing Model. This focuses on “using a Biopsychosocial centered, with emphasis on disease adaptation, health promotion, wellness, treatment, and prevention.” (Source: https://umanitoba.ca/faculties/health_sciences/medicine/media/A_COMPARISON_OF_PA__NP_May_2012_(2).pdf)
- Physician Assistants learn under the same medical model as physicians. 1st year of PA school is similar to the 1st and 2nd year of medical school which is didactic, classroom learning. 2nd year PA school is clinical rotations, where PAs have the same responsibilities as 3rd and 4th year medical students (clinical clerks) during rotations.
- Practice: Both may work autonomously and can function as a patient’s primary care provider. For instance, a patient may see a PA or NP instead of the physician at a family practice.
- Nurse Practitioners can work under physician supervision or run their own clinics (NP-led clinics)
- Physician Assistants can see patients autonomously, but work under “supervision” of a physician. Supervision can be direct or indirect depending on the practice type, and PA experience. PAs do not run their own clinics in Canada.
- Nurse Practitioners: community care/family medicine (CHCs, family health team, physician offices, patient homes), long-term care (nursing homes), hospitals (adult medicine, outpatient, ER) and in NP-led clinics. The specialties in Ontario are: NP-Adult, NP-Paediatric, NP-Primary Health Care, and NP-Anesthesia.
- Physician Assistants: PAs train and graduate as generalists, from which they can work in any area of medicine. The most common specialties include Family Medicine, Emergency Medicine, Internal Medicine, Orthopaedic Surgery, Oncology, Neurosurgery, and more. PAs can also first assist in surgery.
Having an undergraduate degree as an RN provides several advantages:
- You have direct patient care experience that was part of your education, and therefore have met the health care experience hours as required by University of Toronto’s PA Consortium Program.
- If you are an RN that works as a Physician Assistant – you have access to two job markets – that is working as a Registered Nurse and as a Physician Assistant.
- If you would like more autonomy working as a primary care provider, diagnosing, and having more management over initiating treatment you can go through the PA or NP route. However, you can apply to PA straight out of your BScN program (given you meet other course requirements, minimum GPA, etc.), whereas in NP you have to gain minimum 2-3 years for some programs of clinical experience prior to applying to the Nurse Practitioner program. This requirement varies across provinces.
Nurse Practitioners vs Physician Assistants
How similar are NPs and PAs?
- PAs and NPs assess, diagnose and manage patients. PAs and NPs order investigations, and prescribe medications (may vary by jurisdictions, cannot prescribed controlled substances). PAs and NPs may also function as the primary care provider for a patient.
- NPs and PAs can order investigations, write prescriptions, diagnose and initiate a treatment plan (write orders) whether through medical directives or other legislation. They can admit, treat and discharge patients from hospital.
- Note: In Ontario Ontario Government approved changes to the Nursing Act permitting qualified RNs to prescribe medications to a list, and communicate a diagnosis for purpose of prescribing medications. http://www.cno.org/en/news/2017/june-2017/cno-to-start-work-on-rn-prescribing/
- In the United States there are some job postings where PAs and NPs are interchangeable “PA or NP for hire at X” practice.
Google “I’m an RN and I choose PA [or NP]” and you can quickly read personal experiences as to why an RN chose NP vs PA (and vice versa). Sometimes it is a desire to learn in the medical model, or preferring one philosophy of care over another. Other times its related to job market, and job opportunities.
When I was in my 2nd year of PA school working as a clinical clerk in my family medicine rotation, the community health centre had both PAs and NPs working at the clinic. I spent most of my time working with the PA, however, the NP took me under her wing for several shifts. I quickly saw the PA and NP performed the same tasks, saw their own list of patients, both performed well baby exams, routine physicals/PAP smears, managed chronic conditions like Diabetes, and prescribed medications. Both the PA and NP frequently facilitated referrals to specialists, diagnose patients, and would speak with the physicians on site should there be any issues or concerns. I understood that the funding for both of their positions came from different sources, and each had different education pathways. However, the relationship between the PA and NPs on site were collegial and professional – and both were happy to take on medical learners.
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