June 18, 2020 · 8 min read

What Are the Differences Between Physician Assistants and Nurse Practitioners?

The two jobs are very similar—but a number of things set them apart. Find out which one is right for you.

rob bhatt

Written and reported by:

Rob Bhatt

Contributing writer

male nurse palpates injured hand of male patient
male nurse looks at hand of male patient

Because their roles are similar, the jobs of physician assistants (PAs) and nurse practitioners (NPs) are often confused. But there are many things—from philosophy to salary to eligibility requirements—that set them apart.

PAs and NPs are both non-physician providers (NPPs) whose duties can include performing physical exams, treating patients, and prescribing medications, but that’s where the two jobs begin to diverge.

The differences between their respective approaches to care, the levels of specialization they allow, and the types of education they require are among the key factors that might make one field a better fit for you than the other.


What Do Physician Assistants and Nurse Practitioners Do?

Thanks to the rigorous education and training standards for each profession, today’s PAs and NPs are qualified to perform a wide range of primary- and acute-care tasks. In addition to the duties described above, it’s common for PAs to administer immunizations, set broken bones and close incisions during surgery. The nurse practitioner can also assist in ERs and ORs, and they often also order and analyze tests, treat patients with chronic conditions and manage patients’ overall health.

While PAs are trained in general medicine, NPs specialize in chosen areas of medicine or population groups, such as pediatrics, gerontology, women’s health, or mental health.

NPs tend to have more autonomy. Twenty-two states plus the District of Columbia allows them to work independently, under the oversight of the state’s nursing board. 

“This is a broad generalization, but you would typically find PAs in settings where they work directly with a specialist physician and often gain significant skill in technical or procedural tasks,” explains Leslie Flores, co-founder of Nelson | Flores Hospital Medicine Consultants, based in La Quinta, California. “NPs more often work in cognitive medical fields like family medicine, pediatrics and internal medicine. Also, NPs tend to be more specialized.”

At a Glance: PAs vs. NPs

Job duties:

Primary- and acute-care tasks of general medicine.

Philosophy:

Follows a disease-centered model, which focuses on identifying and treating a patient’s immediate ailment.

Workplace:

Medical offices, hospitals, outpatient care facilities.

Licensing/certification:

National certification and a license from a state medical or PA board.

Education:

Master’s degree from an accredited program, combining classroom instruction with about 2,000 hours of clinical rotations. Doctoral programs available.

Salary:

$112,410

Salary data: U.S. Bureau of Labor Statistics, 2019 Occupational Employment Statistics

Job duties:

Primary- and acute-care tasks within a certified specialty.

Philosophy:

Advanced nursing skills, with an emphasis on holistic patient-centered care.

Workplace:

Medical offices, hospitals, outpatient care facilities.

Licensing/certification:

Specialty certification and a license from a state nursing board.

Education:

Master’s degree from an accredited program, combining classroom instruction with about 1,000 hours of clinical training. Doctoral programs available.

Salary:

$111,840

Salary data: U.S. Bureau of Labor Statistics, 2019 Occupational Employment Statistics


Which Job is Right for You?

nurse shares a laugh with elderly patient in wheel chair

An NP career is a smart choice for those with a passion for any of the profession’s specialty areas. Among those already working in healthcare, RNs have a head start, by virtue of the admissions policies for NP educational programs.

And if you’re an aspiring NP who has not yet completed your undergraduate education, you’d be wise to start working toward a BSN as soon as possible.

The PA profession, on the other hand, is great for those who want to perform a broad range tasks and procedures, without committing to specialization. The PA profession also gives those already working in a number of different healthcare occupations an opportunity to take the next step in patient care.

As a rule, of the two professions, NPs tend to have more autonomy, which may make the nurse practitioner job more desirable for those who prefer to work on their own. Twenty-two states plus the District of Columbia grant NPs full-practice authority, which allows them to work independently, under the regulatory oversight of the state’s nursing board.

Elsewhere, NPs work in collaboration with healthcare organizations, or under their supervision. PAs almost always work under the supervision of a physician.

No matter which path you choose to follow, the good news is that you’re likely to find high demand for your services. As Flores puts it, “The coming physician shortage is real, and the healthcare system will continue to be pressed to become more financially efficient.

“Since NPs and PAs are both quicker to train and less expensive than physicians, there will be an increased reliance on them going forward. Not only are the job prospects hot, but most NPs and PAs will find their career choice to be very rewarding.”


What Are the Education Requirements for NPs and PAs?

Aspiring PAs and NPs both typically need a master’s degree from an accredited program, though doctoral programs are available for both professions. (There’s been buzz in the industry for years about requiring those who hold advanced nursing degrees—like NPs and PAs—to earn a doctorate degree instead of just a master’s degree. There’s been no decision made yet.) Many are drawn to the professions because they allow practitioners to take on roles similar to those performed by medical doctors—without multiple years of medical school.

In addition to classroom instruction, the programs include training in clinical settings (about 2,000 hours for PAs; 1,000 hours for NPs), and usually take two to three years to complete. But this is about where the similarities end.

Eligibility Requirements for NP and PA Studies

The most significant differences between the two professions begin with the eligibility requirements. Most NP schools only accept registered nurses (RNs) with a Bachelor of Science in Nursing (BSN), although some offer “bridge programs” for nurses with an associate’s degree or diploma.

The prerequisites for most PA programs include undergraduate courses in basic and behavioral sciences (think chemistry, physiology, anatomy, and others). Applicants typically also need between 500 and 1,000 hours of hands-on patient care experience, gained by working as a lab or emergency-room technician, paramedic, RN, certified nursing assistant (CNA), or other recognized occupation. (The requirements for patient-care hours and occupations vary by school.)

Programs Available for NP and PA Students

There are more than 250 accredited PA programs across the country, and they all typically progress from classroom instruction to clinical rotations focusing on the major areas of medicine, including family medicine, internal medicine, surgery and pediatrics.

By the time a program is finished, a student will have a deep understanding of medical knowledge, patient care, interpersonal communication skills, professionalism, and the other core competencies of the profession. Most programs culminate with a Master of Physician Assistant Studies (MPAS), but other degrees, including Master of Medical Science certified (MMSc) and Master of Science Physician Assistant (MSPA), are available.

Family nurse practitioner programs are among the most common, but gerontology, adult care, emergency medicine, and mental health are among the other options.

NP programs, on the other hand, are offered by specialty, such as family nurse practitioner, adult-gerontology acute care nurse practitioner, or pediatric primary care nurse practitioner. So, in addition to considering a school’s location and fees, you should also make sure it offers a program in your preferred concentration.

Family nurse practitioner programs are among the most common, but gerontology, adult care, emergency medicine, and mental health are among the other options, according to Sean DeGarmo, the director, APRN Initiatives at the American Nurses Credentialing Center. Most specialties are further segmented by a focus in primary care or acute care, DeGarmo says. Including the ANCC, there are five organizations that offer national certification for nurse practitioners. Overall, approximately 400 institutions offer accredited NP programs, and the most common degrees are Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP).


Can I Study to Be an NP or PA Online?

computer and lamp on desk

Most NP programs are now also offered online, either partially (72%) or completely (13%), says Robert Rosseter, chief communications officer for the American Association of Colleges of Nursing.

Online and hybrid programs typically combine virtual classes with clinical training in approved facilities in or near students’ hometowns. But even completely online programs usually require two to three campus visits for immersive on-site education and training.

In contrast, distance learning is still rare among PA programs. However, as a possible sign of things to come, Yale School of Medicine introduced its online PA program in 2018, making its MMSc the university’s first degree offered through an online program.


How Do Physician Assistants and Nurse Practitioners Get Certified?

After completing their educational program, PAs need to pass the Physician Assistant National Certification Exam (PANCE) and apply for a state license. As you gain additional skills, you can seek a certificate of added qualification (CAQ), but these are only available for seven specialties, including emergency medicine, pediatrics and psychiatry. CAQs are optional, but all PAs need to complete 100 hours of continuing medical education every two years and pass a recertification exam every 10 years.

NPs will need to pass the certification exam for their chosen specialty and apply for an advanced practice license from their state’s nursing board upon completion of the NP program. To maintain certification, NPs typically need to complete 1,000 clinical work hours and 100 hours of continuing education in their specialty every five years. Post-masters (and post-doctoral) programs, which usually require about a year of study and clinical training, are available for those seeking certification in a sub-specialty.


How Do PA and NP Philosophies Differ?

The modern educational standards and training programs for both PAs and NPs were established in the mid-1960s, and their respective job titles reflect their traditions. The curriculum in PA schools was created by physicians and is modeled after medical schools, with a disease-centered approach to care, which places the focus of treatment on the ailment or injury.

Similar to advanced practice registered nurses (APRNs) (a designation also held by nurse anesthetists, nurse midwives, and other nursing positions that require a master’s or doctorate), NPs follow standards that are steeped in the holistic, patient-centered approach of nursing. In this approach, NPs consider factors such as a patient’s lifestyle and long-term health in developing treatment plans.


Where Do They Work?

The economics of healthcare has created demand for PAs and NPs in just about every healthcare setting. Americans are living longer, and as the population ages, the need for primary-care physicians keeps outpacing availability.

While NPs and PAs are well-paid, they tend to earn a little more than half as much as physicians. This makes both physician assistants and nurse practitioners attractive to healthcare administrators seeking cost-effective ways to add staff and treat more patients. That said, the lion’s share of jobs for both professions are in physicians’ offices and hospitals. According to the most recent figures from the U.S. Bureau of Labor Statistics (BLS):

  • 55% of PAs worked in physicians’ offices
  • 26% worked in state, local, or private hospitals
  • Of the remainder, 8% worked in outpatient care centers, such as HMO medical centers, kidney dialysis centers, outpatient mental health and substance abuse centers, and other non-hospitals offering outpatient care

The lion’s share of jobs for both NPs and PAs are in physicians’ offices and hospitals.

When it comes to NPs:

  • 47% worked in physicians’ offices
  • 27% in hospitals and 9% in outpatient care centers

Though BLS does not further separate the data by APRN profession, NPs represented nearly 95% of the APRN population.


What’s the Career Outlook?

The most recent BLS figures reports that there were 118,000 PAs compared to 189,100 NPs. The agency expects the number of PA jobs to increase 31% by 2028, while NP jobs are expected to grow 28%. Both rates are considered much faster than the average for all occupations.


How Much Do They Make?

The BLS also reports that the mean, or average, salary for physician assistants was $112,410 in 2019. In general, PA’s working in outpatient care centers out-earned peers in other workplaces, followed by those working in general medical and surgical hospitals, physicians’ offices, and other settings.

At $111,840, the average salary for NPs in 2019 was a just a touch less than that for PAs. Top earnings, in order of workplace, like PAs include outpatient care facilities, hospitals, and physicians’ offices.

But those working in the offices of other health professionals still did pretty well—all averaging six figures—as did those working at colleges, universities, and professional schools.

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October 8, 2019 · 3 min read

Balancing Work and Nursing School

Here are nine strategies to achieve balance between work, nursing school and life.

All Nursing Schools Staff

Most of us know all too well the challenges that go along with maintaining the vital balance between our job and life. Add to that mix the energy needed to continue your nursing studies, and you may find yourself in a non-stop juggling act.

If you have decided to go back to nursing school—for career advancement or personal achievement—consider these nine strategies for finding balance and enjoying life in the midst of this potentially chaotic, but exciting time.

1. Organize Your Space

Set up a place in your home dedicated to your studies, whether a desk in a home office or a card table and chair in the living room. Use it to house your computer, books, supplies and other materials essential to your nursing studies. Knowing you have a space reserved just for school work will improve your mindset…and your chances for nursing career success.

2. Rely on Some Non-Technical Scheduling Tools

Post a calendar on or near your desk and update it regularly with class dates, project deadlines and special events. Also, print a list of email addresses and phone numbers of nursing instructors, classmates and school personnel who can help you when you’re at home.

3. Prioritize Your Projects

Take time at the beginning of each week to list the nursing school projects and deadlines for that week, and allot time to work on these items each day. Tasks become less daunting if you break them up into smaller chunks that you work on for one or two hours a day instead of at the last minute.

4. Expect Disruptions

Some weeks will be routine, but the unexpected will occur—at home, at work and at nursing school. In these cases, step back and reprioritize the rest of the week. Simply having a written plan that you can refer to for your next task can help you navigate around disruptions to your busy schedule.

5. Set a Realistic Schedule

When you schedule your nursing courses, consider everything else going on in your life. If work and family commitments allow time for one course a semester, don’t overburden yourself. You will end up resenting both school and life if you find yourself drowning night after night in coursework— and missing out on important events—when you could have set more realistic goals.

6. Communicate With Your Boss

Before you start nursing school, tell your manager of your plans, especially if you hope that your education will increase your chances for promotion or give you new opportunities at work. Employers might also offer tuition reimbursement and require your supervisor to approve your studies before you enroll.

7. Manage Your Stress

Your nursing education is important, but so is your health. Take time for deep breaths, exercise and fun. If you let school consume all of your free time—while work devours the rest—you may see your performance slide in both areas.

8. Focus on Your Nursing Career Goal

By going to nursing school, you have taken an important step forward in your life and career. At certain points, achieving balance between your education, work and life may take its toll. Remember the reason you started your education in the first place, and picture yourself completing your last class or receiving your nursing degree. The goals that motivated you to start school can serve as a great incentive to finish it.

9. Enjoy the Journey

Going to nursing school is challenging, liberating and self-affirming. You’ll meet new people, have unforgettable experiences, stretch yourself in ways you never imagined, and gain valuable insights into yourself. Take time to enjoy this special time. You’ll not only reap career rewards at the end, but will expand your horizons every step of the way.

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November 2, 2016 · 6 min read

Nurse Burnout? Learn How a Degree Can Help

Nurse burnout can happen to any nurse. Here’s how a degree can help you avoid the problem.

All Nursing Schools Staff

From doctors to patients, many people rely on nurses every day and night. While the job can be immensely rewarding, it can also be taxing. When nurses are frustrated, overworked or unsupported, this can be felt by both a medical institution’s staff and patients. As more people enter the health care system and the nursing shortage continues, it’s not uncommon for nurse burnout to occur (although it’s not a new concept).

Here’s a look at how nurses can prevent or remedy this problem.

How Nurse Burnout Can Happen

Nursing burnout, which usually happens gradually, doesn’t discriminate; it can happen to a new or seasoned nurse at any point in their career.

In many cases, nurse-to-patient ratio is a leading cause. According to the American Nurses Association:

nurse-burnout_statistics1

Nurse burnout, according to American Nurse Association: 1 in 3 nurses report inadequate staffing levels, 2 in 5 units are shorts-staffed, 54% report excessive workloads, 96 out of 100 nurses report fatigue at the beginning of their shift, half of nurses say they spend an insufficient amount of time with patients.

In these conditions, there is less time for patient/nurse education. In addition, patients can feel neglected and nurses feel they can’t provide enough quality care or participate in a team approach. Negativity breeds, tasks feel stagnant and daily satisfaction decreases.

Although some hospitals and other medical facilities work to keep nurse-to-patient ratios low, certain occurrences are unavoidable sometimes. Patient acuity—a determination of nurse staffing needs—changes or nurses may call out of work for family reasons or illness. These factors can make it difficult for an institution to accurately staff a shift, yet still leaves nurses overworked and stressed.

Combatting Nurse Burnout with Relaxation Techniques

nurse doing yoga to help nurse burnout

A nurse’s work environment won’t change, but fortunately, there are ways to manage stress in the workplace.

In May 2015, a study from the Ohio State University Wexner Medical Center released findings that nurses cut their stress by 40 percent using mindfulness techniques. Over the course of eight weeks, a group of nurses in a surgical intensive care unit participated in mindfulness exercises, yoga, meditation, music, and gentle stretching and saw significant improvement in their stress levels.

If you’re suffering from high levels of stress at work, consider implementing these methods into your day.

Nurse Burnout and Education

Education, both inside and outside the hospital, can play a key role in addressing burnout. However, as more medical facilities focus on lowering their ratios, educating nurses is often one of the first things to be pushed aside.

Experienced nurses also have another challenge. They become fatigued doing both their own job and training news nurses on a regular basis.

In school, you’ll find that delegation is a hot topic (the NCLEX-RN even has questions about it). Students are taught the importance of communicating clearly, but trust issues can hinder delegation in a real-life setting. Employers expect new nurses to hit the ground running, yet many new graduates are unclear about delegation guidelines in their workplace.

Staying up-to-date on nursing technology can also help decrease the risk for burnout. In some cases, older nurses with decades of knowledge and experience retire because the stress of using new computer charting systems is too much. This means the health care system often loses quality caregivers.

Some nurses say that if a medical facility is willing to provide the education needed to help nurses, both new and experienced, burnout could decrease.

Earning an Advanced Nursing Degree

Nurses often look to school as a way to avoid burnout. Many thrive knowing they’re working toward a larger accomplishment. And, with so many online degree options, nurses can earn a degree while working.

Since burnout and compassion fatigue can occur when a nurse feels disconnected, many RNs return to school to study a specialty they’re passionate about. With a specialized degree, nurses may find more job opportunities in a setting they’re happier in. A specialized nursing career can also mean a better work schedule and increased salary in some cases.

Examples of nurse specializations:

An advanced degree in nursing can help take you out of the frenetic environment of a hospital or large medical facility. RNs who go on to become nurse practitioners often open a private practice while nurse educators can be found in the classroom. Nurse administration roles put you behind the scenes where you’ll manage nursing personnel and oversee budgets and staffing. In fact, you could be responsible for ensuring your nurses don’t suffer from burnout.


Nursing Burnout or Compassion Fatigue?

young nurse dealing with nurse burnout and fatigue

Nurses can experience one or the other, or both. While nurse burnout is typically associated with the work environment, compassion fatigue tends to occur when a nurse doesn’t take care of their mental, physical and emotional well-being.

Compassion fatigue causes a nurse to become apathetic and tends to occur among nurses who commonly see death or chronic illnesses. There are steps a nurse can take to battle compassion fatigue—exercise, maintaining a healthy diet and connecting with friends—which help many happily continue in their career. However, if burnout is left to fester too long, it’s not uncommon for a nurse to leave the field altogether.

Avoiding Burnout: A Nurse’s Advice

An RN with more than a decade of experience offers this advice and encouragement to nurses:

  • Shadow lots of nurses in different departments and at different hospitals
  • Look at hospitals that provide education and try to maintain a ratio
  • Connect with coworkers; you’ll share many great experiences together
  • Focus on eating right, exercising and getting support

Remember, after your first year or two of nursing you can always try another unit or floor in the hospital.

Nursing and Self-Care

You spend all day taking care of others as a nurse, but what about yourself? By performing basic self-care tasks, you’ll feel better, have more energy and avoid burn out.

Eating Right

A 12-hour shift is a long time if you’re not eating right, or not eating at all. The good news is you don’t have to familiarize yourself with vending machine options. Many hospitals across the country have implemented wellness programs and revamped their cafeteria food options.

healthy_food

Although the primary goal for many facilities is to improve patient satisfaction, hospital staff can also benefit from the changes. Instead of processed meals, hospital foodservice companies are introducing more whole grains (quinoa burgers, anyone?) into their meals and utilizing an abundance of fresh vegetables and fruit.

After the Cleveland Clinic began offering healthier options, many staff members started losing weight. Sugary beverages were eliminated and fryers were replaced with ovens. Cooks now chop more fresh vegetables instead of opening canned goods. Meanwhile, New York City runs the “Healthy Hospital Food Initiative” which includes guidelines on ways hospitals can improve the nutritional content of their food.

If you don’t work in a medical facility with healthy options, you can pack easy-to-transport snacks and meals. Here are a few ideas:

  • Almonds
  • Easy-to-carry fruits (apples, peaches, oranges, and plums)
  • Hummus and cut vegetables
  • Plain yogurt mixed with raw nuts or fresh fruit
  • Sandwiches with lean meats, like turkey or chicken

Feeling fatigued? Nurses often rely on coffee for a caffeine boost, but go easy. Too much coffee can cause jittery feelings and a subsequent crash. Tiredness can also be caused by dehydration. Be sure you’re drinking plenty of water throughout your shift. Non-caffeinated herbal teas are another great option.

Exercise

Running around caring for patients will burn calories, but nurses need more than that to stay well. Taking a few minutes to complete a few purposeful exercises not only revs up the metabolism, but has a mind-clearing and stress-reducing effect.

exercise_nurseburnout
  • Squats: Stand up straight with legs hip-width apart. Squat down as if you’re almost sitting in a chair and hold the position for 10 seconds. Be sure you’re not leaning forward, which can strain your knees. Return to standing position and repeat.
  • Take the stairs: Get a short cardio boost by climbing a few flights of stairs.
  • Shoulder shrugs: Keep a set of 2- or 5-lb weights in your desk or cabinet to perform these exercises. With weights in hand, slowly lift your shoulders and slowly lower back down.

Incorporating these tips into your daily nursing routine will help keep you alert, focused and ready to care for others.

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November 2, 2016 · 4 min read

Yes She Can! Single Mom Balances Work, Parenting, and Nursing Studies

Writer Liz Murtaugh Gillespie talks to Monica Zamora about juggling school, work, and parenthood.

All Nursing Schools Staff

Author’s title or background

Working parents juggle a lot. Single working parents juggle so much, they tire of answering the question everyone always asks: “How on earth do you do it all?”

Monica Zamora juggles so much, she barely has time to field such a question. She’s a nurse and single mom who went back to school in her early 40s, finished her bachelor’s degree in nursing, and is now studying for her master’s degree at the University of Washington, where she’s on track to graduate as an advanced registered nurse practitioner next spring.

She took the plunge at an extraordinarily difficult time. When she was five months pregnant with her youngest child, now 5, the girl’s father left without warning—no explanation, no good-bye. “I was terrified!” Monica said. “After I made it through the most difficult period, I began to realize that if I had the strength to go through that, at the age of 42, there was no reason that I couldn’t accomplish anything.”

I’ve learned about Monica’s Superwoman life in snippets…as we pick up or drop off our daughters at preschool and on the sidelines at birthday parties. I asked her to share some of the ins and outs of her crazy-at-times juggle, knowing it would inspire others – maybe enough to encourage some of you busy-as-all-get-out working parents to overcome your misgivings about going back to school.

Here are excerpts from an email exchange we had after months of trying to coordinate her impossibly packed schedule with mine:

What time do your days usually start and end?

5:30 a.m. I’m usually in bed by 10:30, but if I am behind on school I can sometimes make it until midnight.

What’s your work schedule?

I’m working 28 hours per week [Monday, Wednesday, Thursday and Sunday as a clinic nurse manager at the 1811 Eastlake Clinic, run by Harborview Medical Center and part of a housing program that provides health care and other support services to residents with chronic alcohol addiction; plus a clinic shift at Harborview].

What’s your class schedule?

It’s different every quarter. I have four classes this quarter and spend 10 hours in class total on Tuesdays and Thursdays, plus the 8-hour day at my clinical placement on Friday.

When do you study?

Between patients at work, on the couch in the evening while the family is watching TV and at family get-togethers in the middle of the chaos.

What motivated you to pursue your master’s degree?

In my current position, I work independently most of the time and so have learned a lot about providing primary care. Thanks to a wonderful MD who has become my mentor, I decided that the most logical thing to do was to become an ARNP.

How long will it take you to get your master’s?

One-and-a-half years of full-time study for my MSN.

What do you like about nursing?

I love the human connection. I get to hear such great stories from my patients and meet such an interesting array of people that I would never have met in almost any profession. I get to help people through difficult things and advocate for folks who would have no power behind their voices. It really is a privilege that I am constantly aware of, to be present with someone in an intimate time in their life or death, and it’s so rewarding to know that sometimes I make a big difference in their physical or emotional comfort.

What’s not to like?

I guess in the beginning the hours were difficult. It can be difficult to work within a budget- and rule-conscious system, but I feel like if you are good at what you do and passionate about serving the populations you care for, then you can create your own path and end up in positions that allow you to be creative and flexible.

How did you get past the fear that you wouldn’t have the time, money or energy to go back to school?

I just decided not to think about the energy required, and as for the expense, I would rather be in debt in order to have the education and career I want than to have extra money to spend on accumulating more things. It’s all a trade-off.

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