Any PA student or practicing PA has undoubtedly been asked the question, “What is the difference between a PA and a nurse practitioner (NP)?” There is no easy way to respond because what a PA or an NP does varies by state, specialty, and individual practice. The AAPA Public Relations Committee decided to handle such a question with a list of helpful resources. Our intent was not to make PAs experts on the NP profession but rather to inform PAs on where to find accurate information. In May, we presented the information at the AAPA Annual Conference in San Francisco; this editorial, along with the accompanying sidebar, available on the Web, offers an overview of what we learned.
PAs, working with a variety of health professionals, must understand the roles of all members of the team. Both PAs and NPs provide patient care, preventive care, and health promotion. However, as one NP writer put it, “Although NPs and PAs do similar things, we do these things in our own way, with a unique philosophy.”1
Loretta Ford, RN, EdD, considered the “mother” of the NP profession, has said, “Although confusion still exists, the NP role is not a medical one—we are not physician assistants or extenders, nor do we offer medical services at the MD's command.”2
So what is the difference between PAs and NPs? The basic differences lie in the areas of education, regulation, and the relationship with physicians.
Education
There are more than 300 NP programs; within those programs there are specialty tracks such as family health, pediatric health, and adult health.3 It is the policy of the American College of Nurse Practitioners that “nurse practitioner education must be specific to an area of practice” of nursing.4 While NPs are trained in a specialty area, they may choose to work in a related subspecialty field. For example, an NP could be certified as an adult health NP or a family health NP. However, with on-the-job clinical training and continuing education, the NP's area of expertise could be nephrology.5 A recent addition to NP education is the Doctor of Nursing Practice (DNP) degree, which stresses clinical practice and leadership growth. The American Association of Colleges of Nursing's Web site lists 22 active DNP programs.6
In the PA profession, there are 136 accredited PA programs, and 75% award a master's degree.7 All students receive a general medical education, and all programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant.8 PA education focuses on the competency of the graduate to practice medicine rather than on the degree awarded.
Regulation
The nursing literature defines NP regulation in two ways: in some states, the Board of Nursing has sole authority, and in others, physician involvement is necessary for practice. In 45 states and the District of Columbia, the Board of Nursing has sole authority in determining scope of practice for NPs; in five states, the authority is shared with the Board of Medicine. However, in 37 states, physician involvement is required in order for the NP to practice to the fullest extent, such as prescribing medications. 9 In 2005, 43 states and the District of Columbia required NPs to be nationally certified by one of four different bodies for purposes of licensure.10
In all 50 states, DC, and the US territories, PAs work with physician supervision. PAs are licensed by the state medical licensing board, the PA-specific component of the medical board, or a separate PA board.11 All states and the District of Columbia require PAs to pass the Physician Assistant National Certification Examination administered by the National Commission on Certification of Physician Assistants as a condition for licensure.12