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Assignment

One

Samantha Sealey, 2015, pg. 1

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 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 bachelors degree and for PA School. For the last observation Wendy Wrenn RN,
my mother, was observed. Wendy is a Registered Nurse 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.
Note: The health field consists of numerous occupations and I myself want to enter 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 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 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.
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 requirements needed for PA school and giving a gist of what
Physician Assistants 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 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.
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 College
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 Nurse in comparison to a Physician Assistant

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


observations were easy to follow and highly
detailed. Also, your relevant background information
was really useful to me as a reader; it helped orient me
as I was going through your observations. For the
third revision within the portfolio, here are some things
I want you to work on/revise:

Assignment One

Samantha Sealey, 2015, pg. 2

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. A
Physician 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 doesnt forget anything important
for 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 PAs, PA School, or just facts about her experience becoming and being a PA.
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 didnt 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 didnt want to become a doctor either. She then began researching
different 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 Dukes
Physician Assistant School in 2006 and graduated in 2008. Dukes 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 didnt 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 PAs 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
shadowing hours. These patient care and shadowing hours are required but the amount
may vary between each PA school.

Comment [SS2]: Adding slideshow images or


perhaps clips from the show within the revised
portfolio version of this assignment will be immensely
helpful for readers to visualize. Consider even
importing the video the you observed from YouTube in
the portfolio so that readers can see for themselves
first hand what you observed.

Assignment One

Samantha Sealey, 2015, pg. 3

Liannes 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 arent 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 Liannes 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.
PAs 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 theyre taking, what its for, why theyre taking it, when to
take it, etc. PAs want patients to know the importance and responsibility of taking
control of their healthcare.
Liannes 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 doesnt 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, Amys 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 she does not get behind at work. All of the patients
records are on an EMR (electronic medical record) which is very helpful and less time
consuming for Amy to access her patients 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 patients 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 getting the right medication.

Assignment One

Samantha Sealey, 2015, pg. 4

The Morning Clinic: After all of this, Amys 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 patients 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't complete a
complicated 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 have
come in during the morning, signs off on more Rx refills, finishes her notes from the
previous patients, completes morning dictation, and addresses the supervising attending
of any other issues that may arise.
The Afternoon Clinic: After Amys lunch break, her afternoon clinic begins. The
afternoon clinic begins at 1pm and Amys 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 same
liability of a doctor. However, a physician assistant are usually not respected as much as
a doctor because people/patients tend to think a Physician Assistants are not wise since
they arent 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
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

Assignment One

Samantha Sealey, 2015, pg. 5

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 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 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, 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 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.
II. Interview
Note: For this interview, I interviewed Wendy Wrenn RN from the previous
observation. 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

Comment [SS3]: With the interview section, I know


you have given your readers a brief summary about
Wendy in the "actors" section, but I would like to see
you import some of that information in the interview
section as well.

Assignment One

Samantha Sealey, 2015, pg. 6

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 with honors. 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 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 document
and 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 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 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 physicians assistant, is
different 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 a
masters 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

Assignment One

Samantha Sealey, 2015, pg. 7

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 to
what will happen to RNs and PAs?
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 a
number than those great events. There have already been thousand 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.

Analyze

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. For my first
observation, I watched a video on YouTube about a womans journey becoming a
Physicians Assistant and she answers questions that were asked to her about a PA. This
video was really interesting because she explained thoroughly of what needs to be done
for PA school, how she got through her education, and advice for anyone wanting to
become a Physician Assistant. To be qualified for PA School one must have a specific
amount of clinical hours, shadowing hours, a bachelors 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 Assistants work under a Physician, they also have their
own patients. PAs prescribe medications, sign off on prescriptions, diagnose patients,
and completing appointments with patients. 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. For example, throughout Amys day at work she was writing prescriptions
pain medications, completing appointments with patients, and doing documentation. As
for Wendy, throughout her day, she is responsible for reviewing charts, lab results, taking
the patients weight, temperature, and vitals. Physician Assistants are of a higher
occupation than a Registered Nurse therefore, they are permitted to diagnose patients and
prescribe medications where RNs cannot.
Interests:
The similarities and differences between the occupations
The differences between becoming a PA and a RN
IV.

Chart

Search Terms
Becoming a Physician Assistant

Sources
Google Scholar- Ballweg, Ruth, et al. Physician
Assistant: a Guide to Clinical Practice: Expert ConsultOnline and Print. Elsevier Health Sciences, 2013.

Comment [SS4]: The analysis section reads more like


a summary of interests and what you learned. In
looking at the assignment sheet, this section required
you to write up a 250-word summary of the rules and
conventions for appropriate behavior within the site
you chose to observe. So, in this case, you would
need to talk about the specific rules and conventions
that a PA vs. RN follows. Think in terms of how much
time a PA may spend with a patient vs. the RN, who
asks the general questions about allergies, medicines,
etc.

Assignment One

Samantha Sealey, 2015, pg. 8

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 and


responsibilities

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


education in the United States." Academic Medicine 82.9
(2007): 882-887.

Registered Nurse Program and


responsibilities

Google Scholar- Dahlin, Constance. Advanced Practice


Palliative Nursing. Oxford University Press, 2016.

V. Proposal
In todays society of the healthcare field there are many important occupations taking
place, such as a Physician Assistant and a Registered Nurse. A Physician Assistant and a
Registered Nurse are two completely different health occupations but they are similar in a
few ways. The education between the two are very different, to become a PA one must
have their bachelors degree, and masters degree while attending PA school. To become
a RN one must have their associates degree while attending nursing school. Both of
these occupations require clinical and shadowing hours as mentioned in the analysis
above. A Physician Assistant and a Registered Nurse are two different occupations thus,
this paper will explore more specifically on how each occupation compare with one
another at work, their controversies, and financial distributions. I will also find and use a
specific field of interest to help determine the differences between the two occupations.

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


little unclear as to what you intend to research. Right
now, it reads as though you are doing a comparison
between a RN and a PA, and if so, I am wondering
how you might add to this conversation. Here's an
idea to consider: patient perception of a PA vs. RN. I
would be willing to bet that patients' perceptions are
rather interesting, and I wonder how a PA's advice
may be taken vs. an RN's advice. In thinking about
assignment two, you may consider proposing a study
that would measure patient expectation and
perception of PA vs. RN care. And, the good thing is,
the sources you have collected can certainly work for
this modified topic, so you wouldn't need to replace
them. If this is something you are interested in, we
need to work on revising the proposal. Even if you
aren't interested in this specific topic, we need to work
on revising the proposal so that it demonstrates
something you can actually research rather than
reporting of similarities and differences. I am happy to
help you with this if you are interested.