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Photo by James Schuck
In times past one visited the doctor and there was no confusion about who the doctor was and what to expect from him or her. Now, there is an amazing array of people working in most clinic and office settings. Who are they and what can you expect from them?
Medical Assistant, Nursing Assistant (NA), Certified Nursing Assistant (CNA) – These workers have several weeks of formal training or learn on the job. Their role is to take some initial information, measure your vital signs (blood pressure, temperature, pulse), and prepare you for the exam. They may be trained to draw blood or give injections. In some offices and clinics they answer the phone and make appointments. They cannot give you medical advice.
Licensed Vocational Nurses (LVN) are called licensed practical nurses (LPN) in most states. Typically they have one year of training focused mainly on nursing tasks such as medication administration, giving injections, and drawing blood. They are licensed by the state.
Registered Nurses (RN) in California typically attend a community college and obtain a 2-year associate of arts degree, though many have bachelor’s degrees. The RN learns the same nursing tasks as the LVN, but RN training adds more in-depth knowledge about the science behind the tasks. They are licensed by the state and can perform tasks outside of the normal scope of nursing practice under the supervision of a physician. You will not see too many RNs working in offices because most are employed as staff nurses in hospitals. When they do work in a hospital or clinic they are likely to be in a leadership position, such as clinic manager, or performing complex tasks requiring advanced skill and knowledge, such as administering chemotherapy.
Clinical Nurse Specialist (CNS) is a master’s prepared RN who works with patients and families performing consultation or specialized clinical care, such as diabetes management or chemotherapy administration. CNSs can be managers, conduct research, and teach classes for nurses as well as for patients and their families. In 40 states, excluding California, CNSs can write prescriptions.
Nurse Practitioners (NP) are registered nurses with additional education beyond that of the RN, usually in a masters degree program. They can diagnose and treat some medical conditions. Several studies comparing NP to physician care show no difference in outcomes. NPs work under their own licenses and in the state of California work under the Nurse Practice Act. Many are certified by a national board. NPs are able to prescribe medications, including opioids (strong pain medications). An NP can work independently although some activities need to be done under a physician’s supervision. The physician does not have to be present to supervise an NP but he or she must be available for consultation. They are sometimes called mid-level practitioners because their scope is between that of an RN and a physician.
Physician assistants (PA) are also considered mid-level practitioners. They work under the physician’s license but function essentially the same as NPs. They are able to perform physical examination, make diagnoses, and provide treatments, including prescribing medications. PAs are nationally certified but are not licensed by the state.
A couple of comments about this video. The PA states that PAs do rotations through all specialties of medicine whereas NPs specialize. NPs have RN training before they enter the NP program and to obtain an RN need to rotate through the major medical specialties. There are some specialties in NP education; however California does not recognize specialties. An NP or a PA is free to work in any medical specialty area but should never accept a position for which they do not have adequate education and experience.
Here are a few more helpful definitions:
Prescriber – any professional who is authorized to prescribe medications.
Primary care provider – professionals who assume health care over along period of time. In general this term means physician, nurse practitioner, or physician assistant.
Comments
PA's ARE licensed by the state in which they practice.
Thanks for the correction. Can a PA become licensed in another state easily? An RN has to apply to the Board fo Registered Nursing and fulfill the state requirements. Did you feel the YouTube on PAs was accurate?
How does someone with a RMA diploma get CNA certified??
PA's do rotations in all the major medical specialties as students learning medicine. They are typically done alongside medical students in their 3rd year of training; meaning PA's get the same type of clinical training in major specialties. We are supervised by attending MD's, just like med students.
NP's only do clinical rotations in one specific area; even in just an office setting with sometimes an NP as their teacher. As RN's, clinical rotations in medical specialties are on the level of a nursing student, and has nothing to do with the type of training and testing one does when doing a rotation on a medical level. They are taught by RN's are not involved in medical decision making
So yes there is a difference in the type of training NP's and PA's receive. PA's classically follow the medical model of training and again, do clinical rotations alongside 3rd year medical students and have the same expectations as med students when on the rotation. This is not the case for any N
Hi, Albert-
As an NP and an NP instructor I can tell you that it is not a correct statement to say that NPs only get training in one specific area. In my training I worked in family practice, rheumatology, urgent care, skilled nursing facility, adult day health, out patient women's clinic, etc. I also think you underestimate the role of the nurse. The nurse (and nursing student) are responsible for the patients' lives 24/7 in the hospital. Except for rounds, the physician team does not get involved unless the nurse calls.
Anyway, we could argue forever which type of training is better.
The important point is that many different practitioners can care for a person's medical needs. The correct practitioner is the one who can handle the particular patient's particular problem.
no question which training is better. Ask any patient if they would like to be seen by someone was trained like MD's and by MD's or someone who was trained by nurses and in the nursing model.
RN's, when being trained are supervised by RN's and have to answer to RN's. Is that really comparable to having to answer to attending physicians and make medical decisions for a patient? I really dont think so...
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