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Assignment One

February 13, 2016

Physician Assistant vs. Registered Nurse

Relevant Background Information: The observations for this Assignment One analysis

were taken place in different settings to help determine the differences between aPhysician 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 secondobservation was taken place at West Forsyth Pain Management office where Amy BerryPA 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 Universityfor her bachelor’s degree and for PA School. For the last observation Wendy Wrenn RN,

my mother, was observed. Wendy is a Registered Nurse for Winston Salem Gynecologyand CareSouth Homecare but for this observation, she was observed at Winston Salem

Gynecology. Observing these different settings not only were to distinguish how adifferent settings work but, to distinguish how a Registered Nurse and Physician

Assistant are different from each other.

Note: The health field consists of numerous occupations and I myself want to enter thehealth 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 inthe health field, comparing between a Physician Assistant and a Registered Nurse will

interpret how different occupations within the same field have different responsibilities.

Actresses: Actors are people who are apart of a figured world. The people I observed forthe 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 ofhealthcare occupations.

Lianne: Lianne is an Urgent Care Physician Assistant in North Carolina. Shegraduated 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 agood 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. She graduated in thetop 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.She was observed during her normal day at work to help distinguish exactly what a

Physician Assistant does.Wendy Wrenn, RN: Wendy is a Registered Nurse for CareSouth Homecare and

Winston-Salem Gynecology. She graduated from Forsyth Technical Community Collegewith 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 aRegistered Nurse in comparison to a Physician Assistant

Comment [SS1]: Great start to this assignment; y

observations were easy to follow and highlydetailed. Also, your relevant background informat

was really useful to me as a reader; it helped orien

as I was going through your observations. For the

third revision within the portfolio, here are some th

I want you to work on/revise:


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Artifacts: These are items that are a significant part to the actresses listed above which

are apart of the figured world of the healthcare field.Stethoscope: In order to be a PA or an RN, one must have specific medical tools

to help determine their vitals. A stethoscope is used to determine ones heart rate. APhysician Assistant or a Registered Nurse will always have this significant artifact with

them at all times Planner: This is also is a significant artifact of a Physician Assistant and a

Registered Nurse. A planner is very helpful to keep track of patients throughout the day

and to have a to do list to make sure either profession doesn’t forget anything importantfor their patients or work.

I. Observations

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 just facts about her experience becoming and being a PA.

Here is the link to the video: https://youtu.be/IaDLrJMFKdA

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 in2004 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 bean 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 fromWFU, 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 24months 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 tomove 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 her family 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 average GPA and the required amount of clinical hours and

Comment [SS2]: Adding slideshow images or

perhaps clips from the show within the revised

portfolio version of this assignment will be immens

helpful for readers to visualize. Consider even

importing the video the you observed from YouTu

the portfolio so that readers can see for themselve

first hand what you observed.


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shadowing hours. These patient care and shadowing hours are required but the amountmay vary between each PA school.

Lianne’s favorite thing about being a Physician Assistant is that it definitely gives her agood 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 anyquestions 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 GPAto a 3.6 along with completing her clinical and shadowing hours. There are multiple waysto 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.

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. Theyalso 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 and responsibility of takingcontrol of their healthcare.

Lianne’s PA school definitely prepared her for the job but, so does every other PAschool. 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 copyof 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-whiteversus looking at the computer. She also makes notes on her schedule and checks off

everything she has completed so she does not get behind at work. All of the patient’srecords 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 forappointments. 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 sometype 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 alsocalls back any patient that left messages from the previous day or weekend. While doing


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this she checks their EMR to make sure the patient is getting the right medication.

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 heretoday, asks about any major changes since their previous appointment, and does any

medication reconciliation. Once Amy goes in with the patient, she first introduces herselfas 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 aretaking and the effectiveness. If there are issues with the medications for their painmanagement 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 herdocumentation 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 youcan 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't complete acomplicated patients 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 her lunch she looks at messages that havecome 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 attendingof 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 afternoonclinic 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, thisis 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 thehospital 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 same

liability of a doctor. However, a physician assistant are usually not respected as much asa 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 between a PA and a RN is that both have to work under an actual

Physician.

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


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work she picks up the copy of the day's schedule and writes mini notes just like Amydoes. 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 thereceptionist 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 otherreports with Doctor. Finally, the first patient is 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 resultsso he/she does not have to search for them. If the patient is here for a routine exam/papsmear 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 obtainedwith 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 timesthroughout 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, she sometimes calls other patients back so she does not have so many to call at the end of the day.

End of day: At the days 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 thespecimens 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 toleave so; she then sets the alarm and locks the door when heading out.

II. 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.

Comment [SS3]: With the interview section, I knoyou have given your readers a brief summary abou

Wendy in the "actors" section, but I would like to s

you import some of that information in the intervie

section as well.


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1. Since you have been a Registered Nurse for almost 19 years, have you everregretted 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 Ialways 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 andlisten 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 oneyear of the program, and thought I couldn't do it. Once again, I stopped school. Aftera 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. Itwas hard, and my last semester I became pregnant. This time, I wasn't giving up. In

May 1997, I graduated with honors. A few weeks later, I sat for my nursing boardsand 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 nurseanesthetist 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 beone them.”

2. What have been some things you struggled with to become a nurse and while

working as a nurse?“The politics that surround nursing and the entire health care field are struggle for us

all. When you have people behind a desk telling you what all you have to documentand all the questions you have to answer, it can take away from the personal,

empathetic experience with the patient. In nursing and other health care professions,there will be things that are heart breaking as well as heart lifting. I have numerous

stories of those types of examples. They are the reason I stay in the nursing 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 somethingthat 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 machines.”

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, isdifferent in that a physician assistant has an undergraduate degree, four years, of

either a BS or a BA degree, then applies to a PA program where they graduate with amasters degree and are eligible to sit for their certification boards as a Physician


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Assistant (PA-C). In nursing, you can sit for your North Carolina state boards aftercompleting either a two year accredited nursing program, which is known as an

Associate Degree Nurse (ADN) or a four year nursing program, known as aBachelors of Science in Nursing (BSN). Only after graduating school and passing

state boards can you work as a registered nurse.”

5. As for the upcoming future in the health field, do you have any predictions as towhat will happen to RN’s and PA’s?

“The future of health care as a whole is not stable. I have seen many fantastic

advances in treatments for patients. However, I have seen more patients treated as ‘anumber’ 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.”

III.

Analysis

Throughout this assignment I am comparing the differences between a PhysicianAssistant 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 forPA School one must have a specific amount of clinical hours, shadowing hours, a

bachelor’s degree with the correct prerequisite classes, and a certain GPA. Fromobserving 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’swork 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. Byinterviewing 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 areresponsible for reviewing charts, lab results, taking the patients weight, temperature, and

vitals. RN’s also spend more time with their patients than a PA or doctor. Also, registerednurses 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 clinicalexperience 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, thisis 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 arerequired to tell the patient to ask their healthcare provider to receive a diagnosis.

Interests:

The similarities and differences between the occupations

The differences between becoming a PA and a RN

IV.

Chart

Comment [SS4]: The analysis section reads mor

a summary of interests and what you learned. In

looking at the assignment sheet, this section requ

you to write up a 250-word summary of the rules aconventions for appropriate behavior within the sit

you chose to observe. So, in this case, you would

need to talk about the specific rules and conventio

that a PA vs. RN follows. Think in terms of how m

time a PA may spend with a patient vs. the RN, wh

asks the general questions about allergies, medici

etc.


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Search Terms Sources

Becoming a Physician Assistant Google Scholar- Ballweg, Ruth, et al. Physician

Assistant: a Guide to Clinical Practice: Expert Consult-Online and Print . Elsevier Health Sciences, 2013.

Becoming a Registered Nurse UNCC Library Database- Starr, K, and VM Conley."Becoming A Registered Nurse: The Nurse Extern

Experience." Journal Of Continuing Education In Nursing 37.2 (2006): 86-92 7p. CINAHL Plus with Full

Text . Web. 29 Feb. 2016.

Physician Assistant Program andresponsibilities

Google Scholar- Jones, P. Eugene. "Physician assistanteducation 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.

V. 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 arealso different. Both occupations have their own patients and are allowed to diagnose and

treat their 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 patientswho 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 oftheir healthcare provider that I am going to discover about as well.

Comment [SS5]: Looking at the proposal, I am s

little unclear as to what you intend to research. R

now, it reads as though you are doing a compariso

between a RN and a PA, and if so, I am wondering

how you might add to this conversation. Here's a

idea to consider: patient perception of a PA vs. RNwould be willing to bet that patients' perceptions a

rather interesting, and I wonder how a PA's advice

may be taken vs. an RN's advice. In thinking abo

assignment two, you may consider proposing a st

that would measure patient expectation and

perception of PA vs. RN care. And, the good thin

the sources you have collected can certainly work

this modified topic, so you wouldn't need to replacthem. If this is something you are interested in, w

need to work on revising the proposal. Even if you

aren't interested in this specific topic, we need to

on revising the proposal so that it demonstrates

something you can actually research rather than

reporting of similarities and differences. I am happ

help you with this if you are interested.

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