Nurse practitioners and physician assistants: do you know the difference?

W I was a new graduate nurse working on a medicalsurgical unit, I assumed that Karen was a physician as she rounded and wrote patient care orders. Another nurse identified Karen as a nurse practitioner (NP) and opened my eyes to a whole new world of advanced nursing practice. I was curious to know more about NPs and physician assistants (PAs), whom I also saw in patient care. Was it legal for them to write orders and prescriptions? My interest prompted a debate during lunch about what nurse practitioners and physician assistants could and could not do legally, and what their educational background and qualifications were. I was not the only one who couldn’t identify the difference between them. Staff nurses should be able to distinguish their practice, privileges, and limitations. Health care delivery in the United States has changed dramatically in the last few decades. The introduction of non-physician clinicians began in the 1960s with NPs and PAs filling some of the traditional physician roles (Hooker, 2006). Because of gaps in the distribution of physicians and services in the rural and inner city geographic regions, the roles were created originally to enhance and extend the medical care provided to patients by a professional who could function as an extension of a physician (Hooker & Berlin, 2002). These providers would have approximately one-half the education time of the physician, but would provide quality care under the supervision of a physician. They also saw a comparable number of patients at a significantly lower salary, thereby making them more cost effective (Hooker, 2006). Due to the rising costs of health care, viable costconscious alternatives have become increasingly popular with hospitals, physician practices, and insurers. The popularity and acceptance of these providers has been rooted not only in the finances but also in positive patient satisfaction and clinical outcomes (Roblin, Becker, Adams, Howard, & Roberts, 2004). In 2004, 165,000 clinically active PAs and NPs accounted for approximately one-sixth of the medical workforce in the United States (Robert Graham Center, 2005). Their roles are not inter-changeable, with some fundamental differences in scope of practice, licensure, legal definition, and independence in practice. Nurse practitioners are all registered nurses who have graduated from an accredited school and have passed a certification exam (Hooker, 2006). Physician assistants have varied backgrounds and may not have any medical education or experience before starting training. They are educated using a traditional medical model to become physician extenders. Nurse practitioners are skilled in health care maintenance and disease prevention, not just disease diagnosis and treatment. An important difference is that NPs are allowed to practice autonomously in most states. Physician assistants are truly physician extenders because they practice under the license of a physician, never independently (Buppert, 2004).