A Nurse Practitioner (NP) is a valuable and necessary career in the health care profession. It is a profession that falls under the Advanced Practice Registered Nurse (APRN) umbrella which earns an additional license through furthering of education in a distinct specialty area of practice. This career has evolved over the years but continuing patient education and barriers to practice are still an ongoing issue for the NP. Another profession that is very similar to the NP is a Physician Assistant (PA). All though they are very focused on patient care, they have a few different characteristics from the NP that make them a separate profession in the health care industry. The purpose of this paper is to identify a few differences between the Physician Assistant and the Nurse Practitioner. Also, to explain why a NP should be allowed to practice to their fullest extent of their role and the removal of the barriers that interfere with their practice. In addition, this document will also demonstrate the legal signature of the NP in the state of Louisiana.
Nurse Practitioner vs. Physician Assistant
A Nurse Practitioner and a Physician Assistant are two different types of healthcare providers with a common goal which is to medically assist a patient. Even though their function is very similar, the differences between their scope of practice, education, and independence of practice are very relevant. Physician Assistants practices medicine under the supervision of a physician, never independently, as far as the law is concerned (Buppert, 2015). PAs include in descriptions of their duties taking medical histories, performing physical examinations, ordering and interpreting laboratory tests, diagnosing and treating illnesses, assisting at surgery, prescribing and/or dispensing medication, and counseling patients (Buppert, 2015). The scope of a Physician Assistant practice corresponds with a supervising physician’s practice, with the understanding that the supervising physician will handle the more complicated medical cases (Buppert, 2015). Nurse Practitioners are nurses with a broadened scope of practice and depending in their state of practice, they do not have to have medical physician supervision like the Physician Assistant. The NPs scope of practice duties will include all of the same duties mentioned above for the PA with the exception of assisting in surgery.
PAs are trained from the medical model. They focus on the pathology of the problem and how to find a cure or a solution to the disease. This medical model training is diseased centered. Unlike the NP, that is trained under the nursing model which focuses on the patient as a whole. This type of model is considered patient centered. The work experience as a NP differs from a PA. The NP can practice in hospitals, clinics, schools, and skilled nursing facilities. They are also able to establish independent clinics or work at practitioner-run clinics. A Physician Assistant works with surgeons, physicians, physician’s clinic offices or hospitals. Unlike NP, PAs are not able to establish independent practice of their own due to the requirement of only allowed practice under the supervision of a physician.
NP and PA can specialize in a number of areas. Even though PA programs focus on general medical practice, they often specialize by area of medicine or practice settings including emergency medicine, surgery or orthopedics. The NP program focuses on education for patient population group. For example, family and individual across the lifespan, pediatric, adult and geriatric, women’s health, neonatology or mental health. A Nurse Practitioner can also further his or her education according to practice settings and disease type. The PA must attend graduate school and obtain a master’s degree in either Physician Assistant Studies, Health Science, or Medical Science. The NP has to attend an Advanced Practice program and receive either a Master of Science in Nursing or a Doctor of Nursing Practice. Both NP and PA are able to diagnose patients, treat diseases, and prescribe medications. The difference with medication prescription is that the PA has to prescribe under a physician license. Unlike the NP, they can actually apply for independent prescriptive authority at state level in which can vary by different states. In other words, the NP can independently prescribe medication without the need of a standard care agreement with a physician.
Barriers and NPs ability to practice.
The Future of Nursing notes that although Advanced Practice Registered Nurses are highly trained and able to provide a variety of services, they are prevented from doing so because of barriers including state laws, federal policies, outdated insurance reimbursement models, and institutional practices and culture (IOM, 2011). State laws, legislation, and regulations have been barriers to the NP field due to the similarity of the physician scope of practice. One of these regulations is the requirement of physician supervision of the NP practice. Over the years, this regulation has been overturned in some states in which NP may practice without physician supervision. Federal policies are also considered barriers for NP during their practice and safe care for patients. For example, NPs are now the largest type of healthcare providers delivering home care and cover the largest geographical service area (Yao, Rose, LeBaron, Camacho, and Boling, 2017), federal policies still require physicians to sign NP orders in order for them to be valid (Poghosyan, 2018). This is considered a barrier for NP since it does not allow them to order or even provide home health care in spite the fact that they personally deliver care to patients. Culture is also considered a barrier for the NP. Patients believe that only physicians are entitled to diagnose the ill. These views are highly held by different cultures and causes a barrier on the scope of practice of the NP. This is linked from a lack of information about the education and training of the NP. Physicians are now educating the patients regarding the scope of practice of the NP. They are hiring NPs and follow up appointments for the patients are directed to be seen by the NP.
All NPs are registered nurses with education beyond the basic requirements for registered nurse licensure (Buppert, 2015). The Future of Nursing recommends that APRN should be able to practice to the full extent of their education and training (IOM, 2011). The NP falls under the APRN category which means that the educational preparation is completed under a mastery level degree or a doctorate level degree. This enhancement of education, prepares the NP to practice to their fullest extent of their education. In order to become a NP, one must have the preparation and licensure requirement as mandated by the state in which the NP will practice. This is imperative for all health care professionals in order to optimize the efficiency and quality of services for patients.
Legal signature in Louisiana.
Every state has a board of nursing guidelines for interpreting scope of practice for APRN. In the state of Louisiana, you must hold a current and active Louisiana RN license. With the RN license, you are able to attend an accredited program of furthering your nursing education. The program can be either a Mastery level or a Doctorate level program. Once these steps are completed, you have also obtained the APRN license credential. The APRN license will be provided in the specific advanced practice role in which you plan to practice. The next step is to become certified in the specific advanced practice role of your choice. The advanced practice role of my choice is Family Nurse Practitioner. I am currently enrolled in the Doctorate program of the Nurse Practitioner at Loyola University of New Orleans. Upon the completion of my studies and certifications, my credentials should be as follows:
Yahaira Rodriguez, DNP, APRN, FNP-BC or Yahaira Rodriguez, DNP, APRN, FNP-C. The difference between the initials C and BC depends on the entity in which my certification is awarded.
Conclusion
The path to becoming a nurse practitioner can be a lengthy but satisfying journey. This career will encounter several hurdles with the fact that barriers are still lingering around regarding the scope of practice of this profession. One fact about NP is that the main focus is the care of patient. As the concept was envisioned, NPs would make not only nursing diagnoses but also medical diagnoses (Buppert, 2015). Further, they would treat patients with medical therapeutics, ordering pharmacotherapeutics and other treatments (Buppert, 2015). This is the reason that a broader scope of practice had to be developed for the legal scope of nursing practice.

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