A1 revised & repurposed

8/18/2019 A1 revised & repurposed

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Background Information

The observations for this Assignment Oneanalysis were taken place in different settings

to help determine the differences between a

Physician Assistant and a Registered Nurse.

For the first observation, I observed a video on

a Physician Assistant/YouTube blogger,

Lianne. This was a career chat video on how

she became a Physician Assistant and about

her profession being a PA. The second

observation was taken place at West Forsyth

Pain Management office where Amy Berry PA

was observed during her normal day at work

to help determine what a Physician Assistant

how a PA works during the day. Amy

graduated from Wake Forest University for

her bachelor’s degree and for PA School. For

the last observation Wendy Wrenn RN, my

mother, was observed. Wendy is a RegisteredNurse for Winston Salem Gynecology and

CareSouth Homecare but for this observation,

she was observed at Winston Salem

Gynecology. Observing these different

settings not only were to distinguish how a

different settings work but, to distinguish how

a Registered Nurse and Physician Assistant are

different from each other.

N O T E

The health field consists of numerous

occupations and I myself want toenter the health field in the near

future as well. For the longest time I

have wanted to become a Physician

Assistant, and I still want to be. Since

there are many different occupations

in the health field, comparing betwee

a Physician Assistant and a

Registered Nurse will interpret how

different occupations within the same

ield have di erent res onsibilities.

Actresses

Actors are people who are apart of a figured world. The

people I observed for the observations are the actors

within the figured world of the healthcare field. These

actors were chosen for the observations because they

represent the figured world of healthcare occupations.


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Lianne:

Lianne is an Urgent Care

Physician Assistant in

North Carolina. She

graduated from UNC

Chapel Hill in 2004 with

a Bachelors of Science in

Radiologic Experience

and graduated from PA

School in 2008 from

Duke University. Lianne

does a good job at

explaining the

requirement’s needed for

PA school and giving a

gist of what Physician

Assistant’s do.

Amy Berry, PA-C:

Amy is a Physician

Assistant for West

Forsyth Pain

Management Center who

graduated from Wake

Forest University. Shegraduated in the top of

her class at Wake when

she received her

bachelors and in PA

School. Amy used to be a

PA in at a Breast Cancer

Center but now works

with at a pain

management facility. Shewas observed during her

normal day at work to

help distinguish exactly

what a PhysicianAssistant does.

Wendy Wrenn, RN:

Wendy is a Registered

Nurse for CareSouth

Homecare and Winston-

Salem Gynecology. She

graduated from Forsyth

Technical CommunityCollege with her

Registered Nursing

degree in 1997. For this

observation, she was

observed at Winston

Salem Gynecology. It

was important to observe

Wendy to help classify

what a Registered Nursein comparison to a

Physician Assistant

Artifacts

These are items that are asignificant part to the

actresses listed abovewhich are apart of the

figured world of thehealthcare field.

Stethoscope:

In order to be a PA or an RN,one must have specific medical

tools to help determine theirvitals. A stethoscope is used to

determine one’s heart rate. APhysician Assistant or a

Registered Nurse will alwayshave this significant artifact

with them at all times

Planner: This is also a significant artifact of

a Physician Assistant and aRegistered Nurse. A planner is ver

helpful to keep track of patientsthroughout the day and to have a to

do list to make sure either profession doesn’t forget anything

important for their patients or work

Observation One

Note: For this observation, I observed a 22 minutes long career chat

YouTube video about Lianne and her experience becoming a Physician

Assistant. She also did a question and answer section where she

answered questions from her social media about PA’s, PA School, or

ust acts about her ex erience becomin and bein a PA.


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4:15 minutes: Lianne is an Air Force wife, mom, Physician Assistant, a YouTube

blogger, and is actually lives in North Carolina. She graduated from UNC Chapel Hill

in 2004 with a Bachelor of Science in Radiologic Experience and became an x-ray

tech. Lianne was a x-ray tech for a little over a year before she realized she didn’t want

to be an x-ray tech for the rest of her life so, she went back to school. Lianne decided

she wanted to go to med school so; she took prerequisite classes at UNC Chapel Hill

and bought an MCAT prep book. When taking her MCAT test for med-school, Lianne

realized then she didn’t want to become a doctor either. She then began researchingdifferent occupations and came across a Physician Assistant. From then she started

shadowing one of her colleagues at the ER where she worked. Once Lianne finished

her prerequisites she applied to three PA schools: Duke University, George

Washington University, and Wake Forest University. She got denied from GWU,

waitlisted from WFU, and then she became accepted to Duke University. Lianne

started Duke’s Physician Assistant School in 2006 and graduated in 2008. Duke’s PA

program is 24 months long but, other program could be anywhere from 2-3 years long.

Once Lianne graduated, she first worked as a PA in orthopedic surgery in Virginia but

then had to move to Texas because her husband is in the Air Force. In Texas, she

worked in pain management but didn’t really like it all that much. Lianne and herfamily moved back to North Carolina where she is now an Urgent Care PA in a local

hospital.

13:00 minutes: From this point on, Lianne answered questions that she

received on social media about PA’s or PA school. PA schools definitely

look at everything about each person that applies, more than just their

GPA. They are interested in a well-rounded person with an above averageGPA and the required amount of clinical hours and shadowing hours.

These patient care and shadowing hours are required but the amount may

vary between each PA school.

Lianne’s favorite thing about being a Physician Assistant is that it

definitely gives her a good balance of work and her personal life. She

works 40 hours every week and is home by a certain time everyday and

that she is allowed to do overtime if she wants to as well. Her least

favorite thing is having some patients not trust a Physician Assistant

verses a Doctor. Some patients aren’t aware that a PA works under a

Physician and if any questions occur then the PA can always go to the

Physician for help.

Before doing her prerequisite classes, Lianne had a cumulative GPA of a

3.3. While doing her prerequisites Lianne became very focused and

improved her cumulative GPA to a 3.6 along with completing her clinical

and shadowing hours. There are multiple ways to get clinical hours, one

could become a CAN or an EMT, etc. With Lianne’s job as an x-ray tech,

Chapel Hill counted those working hours as clinical hours.


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22:00 minutes: The goals of a Physician Assistant are to help

sublimate what Doctors do. PA’s get more time with

patients, explaining their diagnosis, their different treatment

options, and inform patients the importance of taking control

of their health care. They also explain what medication

they’re taking, what it’s for, why they’re taking it, when to

take it, etc. PA’s want patients to know the importance andresponsibility of taking control of their healthcare.

Lianne’s PA school definitely prepared her for the job but,

so does every other PA school. Just because one college

name is more known than others doesn’t mean your

education will be any different to become a Physician

Assistant.

Lianne is currently working in urgent care and says it is a

good mixture between procedures, acute and primary care.

There are tons of different fields one can go into to become a

PA, just choose the field that is best for you.

Observation Two

Note: This observation was taken place at West Forsyth Pain Management

Center where Amy G. Berry, PA-C was observed of her normal routine day at

work. Before the breakdown begins, Amy’s day is basically set up into two parts,

a "morning clinic" and an "afternoon clinic".

Arrival: At the beginning of everyday day, Amy always checks her email for

work to see if there were any important emails for patients or the physician. She

then prints off a copy of her schedule, which, this is what she does personally.

She has the original copy on her computer, but has found it to be better and easier

for her to have it in black-and-white versus looking at the computer. She also

makes notes on her schedule and checks off everything she has completed so shedoes not get behind at work. All of the patient’s records are on an EMR

(electronic medical record) which is very helpful and less time consuming for

Amy to access her patient’s documents when they come in for appointments.

Before Amy has her first patient she looks at the information that were left on her

desk. Since this is a pain management center, the majority of patient’s have some

type of pain medication. For them to receive these prescriptions, Amy must sign

off on the Rx's (prescriptions) reports, prior authorizations for medications, or

referrals. She also calls back any patient that left messages from the previous day

or weekend. While doing this she checks their EMR to make sure the patient is


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The Morning Clinic: After all of this, Amy’s day finally begins at 8:15am

with her first patient. When the patient comes in, the nurse always sees

them first. The nurse gathers the patient’s vital signs, asks a summary of

what's going on and why he/she are here today, asks about any major

changes since their previous appointment, and does any medication

reconciliation. Once Amy goes in with the patient, she first introduces

herself as if it is a new patient, or if it is a returning patient she greets them

and ask how they are doing. She then goes over a complete review of the body systems. Troubleshoots any problems that may have been occurring,

and goes back over the medications that they are taking and the

effectiveness. If there are issues with the medications for their pain

management she then decides on what treatment change is needed or

consults with the supervising physician. During a patient's visit she tries

very hard to either do her documentation completely or make many notes

on each patient so at the end of the day she can have information for the

legal record. A quote from Amy, “There is no way you can see 20 plus

patients and want to document at the end of the day”. Making mini notes

gives her the key words to help her remember each patient if she doesn'tcomplete a complicated patient’s documentation. This entire process is

repeated with each patient.

Lunch break: During the lunch

break, Amy does actually get to eat

lunch. However, most days she does

not leave the office. During herlunch she looks at messages that

have come in during the morning,

signs off on more Rx refills, finishes

her notes from the previous

patient’s, completes morning

dictation, and addresses the

supervising attending of any other

issues that may arise.

The Afternoon Clinic: After Amy’s lunch break,

her afternoon clinic begins. The afternoon clinic

begins at 1pm and Amy’s first patient is seen by

1:15pm. The afternoon clinic is basically a repeat

of the morning clinic. She rarely ever leaves any

dictation of notes until the next day. Because,

depending upon the area of healthcare you work

in, this is an essential. Before working with the

Pain Management facility, Amy worked with

breast cancer patients, and said you never knew

when they would have to go to the hospital in the

middle of the night. With that, all medication

changes or changed treatment plans had to be

current incase of emergency situations. All health

care of patients come down to what you are

responsible for. A physician assistant has the sameliability of a doctor. However, a physician

assistant is usually not respected as much as a

doctor because people/patients tend to think a

Physician Assistant’s are not wise since they

aren’t a Doctor when actually they are very smart.

Observation Three

Note: For this observation, Wendy Wrenn,

RN was observed during her normal day

of work at the Winston-Salem

Gynecology. Wendy graduated from

Forsyth Tech Community College in 1997

and has been a Registered Nurse for

almost 19 years. One thing similar betweena PA and a RN is that both have to work


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Arrival: Wendy arrives to the office around 8am to begin her day. Once she arrives

at work she picks up the copy of the day's schedule and writes mini notes just like

Amy does. One difference is that they do not have an EMR/ electronic medical

record like Amy does at her work. She then listens to the voicemails or reads

emails from the receptionist and jots down important information from those

messages and reviews the messages with the physician, if needed. After this,

Wendy goes over lab results and other reports with Doctor. Finally, the first patientis at 8:30 am.

First patient: Before patient is brought back, Wendy reviews the patient's

chart checking the last time a pap smear, bone density, labs, and

mammogram were done with the patient and writes down the results so it's

easy for the doctor to glance in one place for the results so he/she does not

have to search for them. If the patient is here for a routine exam/pap smear

and breast exam, Wendy then fills out the lab request for the pap smear to be sent. She then gets the patient back to go in a room where she takes

their height, weight, BMI, and blood pressure. Wendy also reviews over

their medications and reconcile any changes since the previous

appointment. She asks a brief summary of any issues or problems that they

are having, if any, and instruct the patient on using the restroom to empty

their bladder before their examination with the Doctor. If the patient is

here for a problem visit or talk, she gets the patient back and discusses

what exactly is going on with them and instruct them accordingly. Wendy

then reviews the information obtained with the physician and then help

assists the doctor with the patient. Nurses assist the physician with any procedure: from Pap smears, endometrial biopsies, colposcopies, breast

exams, STD testing, placement of IUD's, and other various procedures.

This is done by protocol and is illegal not to have a Nurse in the room

during the examination. After the examination is complete and patient

exits the room, Wendy is then responsible for cleaning the room and all of

instruments. This repeats itself numerous times throughout the day.

Lunch Break: At

Winston-Salem

Gynecology, they

have a short 30-

minute lunch break,

but Wendy does not

leave the office. In

between patients, sh

sometimes calls

other patients backso she does not have

so many to call at th

end of the day.

End of day: At the day’s end, Wendy restocks and cleans the rooms. She

washes all instruments and put them in the autoclave to sterilize the

instruments. She puts all of the specimens out to be picked up by the lab

courier the following day. Lastly, she calls all of the patients back from the

voicemails or messages than were left from the front desk, calls in refills

on prescriptions, calls patients with their report results, and fills out prior

authorization for medications and surgery patients. Usually, Wendy is the

last one to leave so; she then sets the alarm and locks the door when

heading out.


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Interview

Note: For this interview, I interviewed Wendy Wrenn RN from the previous

observation. Wendy Wrenn RN, has been a registered nurse for about 19 years and

she is also my mother. She works at CareSouth Homecare and Winston-Salem

Gynecology. For our interview, I was not able to meet her in person, so I emailed

Wendy these five questions and she emailed me back her responses.

1. Since you have been a Registered Nurse for almost 19 years,

have you ever regretted going to nursing school verse any

other health occupation? If so or if not, why?

“I decided to go into nursing when I was young. From the time I

was a little girl, I was told how caring and compassionate I was.

My aunt is a Registered Nurse and I always looked up to her. She

became a nurse after my mother, her sister, was killed in an

automobile accident. As my aunt went through nursing school and

I watched and listen to her, I then decided I would go to college to

become a nurse. In 1989, I applied to the Associate Degree

Nursing (ADN) program at Forsyth Technical Community

College. I was accepted and began the following spring. I

completed one year of the program, and thought I couldn't do it.

Once again, I stopped school. After a few years of maturing and

working, I decided I was going to finish what I started. I basically

worked full time between a job at Baptist hospital and a shop in

the mall. It was hard, and my last semester I became pregnant.

This time, I wasn't giving up. In May 1997, I graduated withhonors. A few weeks later, I sat for my nursing boards and

passed. A few weeks later I received my license as a Registered

Nurse; and a few months after, I became a mother. I have never

regretted either, nor have I wanted to be in any other profession. I

gain joy from both my professional and personal jobs. If I had

stayed in school from the beginning, I may have gone on into the

nurse anesthetist program or advanced my degree to teach.

Instead, I chose to raise my daughter. I may have some regrets in

this life, but nursing and motherhood will not be one them.”

2. What have been som

things you struggled

with to become a nu

and while working a

nurse?

“The politics that surrou

nursing and the entire

health care field are

struggle for us all. Whe

you have people behind

desk telling you what a

you have to document a

all the questions you ha

to answer, it can take aw

from the personal,

empathetic experience w

the patient. In nursing a

other health care professions, there will b

things that are heart

breaking as well as hear

lifting. I have numerous

stories of those types of

examples. They are the

reason I stay in the nurs

profession.”

3. What is some advice you would give someone that wants to enter the

field?

“Advice. Make sure you are going into the nursing profession because it is

something that you have a passion for, and not just to make a good living.

Being a good nurse is not just being book smart and collecting a decent

paycheck. It is part of your heart. You must have compassion, empathy,

and patience. You are dealing with human beings, not papers or


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4. In terms of education and schooling, how

would you compare becoming a Registered

Nurse to becoming a Physician Assistant?

“The education for becoming a registered nurse

versus a physician assistant, is different in that a

physician assistant has an undergraduate degree,

four years, of either a BS or a BA degree, thenapplies to a PA program where they graduate with

a master’s degree and are eligible to sit for their

certification boards as a Physician Assistant (PA-

C). In nursing, you can sit for your North Carolina

state boards after completing either a two year

accredited nursing program, which is known as an

Associate Degree Nurse (ADN) or a four year

nursing program, known as a Bachelors of Science

in Nursing (BSN). Only after graduating school

and passing state boards can you work as aregistered nurse.”

5. As for the upcoming future in the healt

field, do you have any predictions as to

what will happen to RN’s and PA’s?

“The future of health care as a whole is no

stable. I have seen many fantastic advance

in treatments for patients. However, I have

seen more patients treated as ‘a number’than those great events. There have already

been thousands of medical professionals

laid off from the two major health care

providers in our area, and there will be

more. The majority of nurses and physician

assistants are, and will continue to be

overworked in the future unless huge

changes are made. This is against all ethics

and is unsafe for the patients as well as the

health care providers.”

Analysis

Throughout this assignment I am comparing the differences between a Physician Assistant

and a Registered Nurse. This topic is an important interest to me because I am debating

whether or not I want to go to Nursing School or PA school. To be qualified for PA Schoolone must have a specific amount of clinical hours, shadowing hours, a bachelor’s degree with

the correct prerequisite classes, and a certain GPA. From observing Amy Berry, PA-C for my

second observation, I learned a gist of what it is like to work as a Physician Assistant and

they are capable of doing. Physician Assistant’s work under a Physician, they also have their

own patients. PA’s prescribe medications, sign off on prescriptions, diagnose patients, and

completing appointments with patients. PA’s also spend more time with their patients than a

doctor but, not as long as a registered nurse. The last observation and interview was with

Wendy Wrenn, RN. By interviewing and observing her, not only did I learn what a

Registered Nurse is capable of doing but I also learned some differences between a PA and a

RN. Registered nurses are responsible for reviewing charts, lab results, taking the patientsweight, temperature, and vitals. RN’s also spend more time with their patients than a PA or

doctor. Also, registered nurses do not require as much schooling as a PA. They must earn

their associates degree at the minimum while attending nursing school. Both occupations

require clinical experience and shadowing but, physician assistants are of a higher occupation

than a registered nurse therefore. This is because PA’s require more educations than a RN,

this is what gives them to diagnose patients and prescribe medications where RN’s cannot.

Registered nurses are allowed to make judgment calls but they cannot diagnose. They are

required to tell the patient to ask their healthcare provider to receive a diagnosis.


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Search Terms Sources

Becoming aPhysician Assistant

Google Scholar- Ballweg, Ruth, et al. Physician Assistant: a Guide to Clinical

Practice: Expert Consult-Online and Print .Elsevier Health Sciences, 2013.

Becoming aRegistered Nurse

UNCC Library Database- Starr, K, and VMConley. "Becoming A Registered Nurse:

The Nurse Extern Experience." Journal OfContinuing Education In Nursing 37.2

(2006): 86-92 7p. CINAHL Plus with FullText . Web. 29 Feb. 2016.

Physician AssistantProgram and

responsibilities

Google Scholar- Jones, P. Eugene."Physician assistant education in the United

States." Academic Medicine 82.9 (2007):882-887.

Registered Nurse

Program andresponsibilities

Google Scholar- Dahlin, Constance.

Advanced Practice Palliative Nursing .Oxford University Press, 2016.

Interests:

The similarities and

differences between

the occupations

The differences between becoming a

PA and a RN

Chart

Proposal

In today’s society of the healthcare field there are many important

occupations taking place, such as a doctor, physician assistant, nurse

practitioner, and a registered nurse. A physician assistant and a nurse

practitioner are very similar in their abilities but they are also different. Both

occupations have their own patients and are allowed to diagnose and treattheir patients, prescribe medications, and other basic things a doctor can do.

A nurse practitioner is basically an overall advanced registered nurse. There

some things a doctor can do than a PA or NP cannot do and when going to

the health clinic, there are patients who tend to think less of a PA or NP

compared to a doctor because of this. There are also discriminations and

ethical disparities and other factors that change a patient’s view of their

healthcare provider that I am going to discover about as well.

A1 revised & repurposed

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