Nurse Practitioner Versus Physician Assistant

Nurse Practitioner Versus Physician Assistant

Christine E. Freda

The 21st century has now approached us, and the demands on the nephrologist are escalating. It has been predicted that the number of patients with end stage renal disease (ESRD) will continue to rise at a rate of 7% per year (Ad Hoc Committee, 1997). This fact coupled with the limited number of physicians in nephrology fellowship programs suggests that the use of a mid-level health care provider, such as a nurse practitioner and physician assistant, can be expected to rise in order to meet the demands of this patient population.

Differences Between NP and PA

One might ask whether or not there is a difference between a nurse practitioner (NP) and a physician assistant (PA). Are they interchangeable or does one profession have more to offer? It is my belief that the nurse practitioner can offer more comprehensive care to their patients and is a more suitable choice in the care of chronically ill patient populations.

The educational preparation of the two professions differs. The American Academy of Nurse Practitioners has established a minimum standard of master’s level education for the NP, while the PA role has primarily been that of a bachelor’s level education. The master’s level preparation translates into a person who enters their role with more formal education and a more career-focused clinical path. This allows the NP to tailor his or her clinical experiences to their clinical area of specialty. This differs from the PA program, which requires clinical rotation through all specialties without regard to the specific career path after completion of the program.

The NP programs include those courses that will prepare one to assess, diagnose, and treat illness, similar to the focus of the medical model that has been adopted by the PA programs. However, the nursing foundation of NP programs also focuses on the human response to illness. Nurses are taught theory regarding human response to illness and health, as well as the mechanisms by which nurses can empower patients in order to ensure better patient outcomes. Nursing has long looked at treating not just the disease, but rather the patients. Nursing also views patients as part of a larger system, the family. Nursing interventions include the family.

Making the Decision to Use an NP

The relationship between the physician and the mid-level health care provider may influence the decision as to whether to use an NP or a PA. The physician acts in a supervisory role with the PA. The physician acts in a collaborative role with the NP which allows for a greater amount of autonomy for the NP. In the majority of states in the U.S., the NP is required to have a collaborative practice agreement with the physician, but in some states, the NP is able to practice independently. According to the Manpower Study, which surveyed nephrologists, more nephrologists worked with an NP (20.7%) than with a PA (8.9%) (Ad Hoc Committee, 1997). In addition, in 1998, a joint position paper was developed by the Renal Physicians Association (RPA), the American Society of Nephrology (ASN), and the American Nephrology Nurses’ Association (ANNA) to delineate what role the advanced practice nurse and NP will play in the care of the ESRD patient. The collaborative efforts of these organizations validate the role of the NP in nephrology.

A Valuable Addition to Multidisciplinary Team

The NP can be a valuable addition to a multidisciplinary team. This is especially true in the chronic ESRD population. The patient often has a physician, dietitian, social worker, and nurses working with them to coordinate their Care. The NP can help empower the patient through education, identification of coping mechanisms, and social support systems. The NP can have a strong role in disease prevention as well as in the treatment of acute illness and chronic medical problems. W.K. Bolton, a nephrologist from the University of Virginia, cited the NP as having an exceptional level of patient satisfaction, approval, respect, and trust (Bolton, 1998). The trust and approval of a patient is an excellent indicator of the potential impact that a provider can have on a patient’s outcome.

I believe that the NP has distinct advantages over the PA for the management of the ESRD population. They can help manage the patient through all areas and levels of care. The ability of the NP to serve as an educator, patient advocate, and member of a multidisciplinary care team is essential when managing people with a chronic illness. In addition, the NP’s focus on health maintenance and disease prevention can lead to more cost-effective, comprehensive care. I urge all NPs in the field of nephrology to examine their practice and conduct research that will further solidify their impact as a health care provider.

Readers are invited to contribute opinion essays for the Professional Issues department. Articles should cover topics of current interest to nephrology nurses. The Nephrology Nursing Journal encourages candid opinions. For specific guidelines, contact Paula Dutka, Department Editor, through the ANNA National Office; East Holly Avenue/Box 56; Pitman, NJ 08071-0056. The opinions and assertions contained herein are the private views of the contributors and do not necessarily reflect the views of the American Nephrology Nurses’ Association.


Ad Hoc Committee. (1997). Ad Hoc Committee on nephrology manpower needs: Estimating workforce and training requirements for nephrologists through the year 2010. Journal of the American Society of Nephrology, 8(Suppl. 19), 1-32.

Bolton, W.K. (1998). Nephrology nurse practitioners in a collaborative care model. American Journal of Kidney Disease, 31, 786-793.

Christine E. Freda, MS, RN, CANP, is an adult nurse practitioner, Outpatient Dialysis Center, Winthrop University Hospital, Mineola, NY.

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