Physician’s Assistant Versus RN: A Question of Autonomy
Posted by York RN on January 25, 2010
One of the primary differences between an RN and a PA (Physician’s Assistant) is an ability to act with autonomy.
Nursing is an autonomous practicing profession accountable primarily to the patient.
On the other hand, a “PA is a physician extender and not an independent practitioner” (source).
An extension of a physician’s expertise would be valuable in the Canadian health care system, especially in the context of a physician shortage, and in many ways, the PA allows the physician to be practicing in two places at once.
But there are inherent dangers to practicing medicine without the freedom of autonomy.
One of the roles of the RN is to challenge the physician, if needed, when an action is deemed unsafe or unfavorable to a patient.
If patient care is in question, the nurse is accountable to the patient. It is his or her professional responsibly to advocate for their patient, even if that means rejecting a physician’s order. The nurse functions in this manner without fear of disciplinary action from the physician.
Since the PA is directly accountable, an extension of, and under direct control of the physician, they potentially forfeit the ability disagree with and not act on a physician’s order.
If a PA decides not to follow an order that they question they potentially face disciplinary action from their managing physician.
Would this relationship of direct control sway the PA’s decision to refuse a bad order or action?
It would be better to see a PA’s take on a independent, autonomous practice, but then, they would not be much different from a nurse.
PAs are gradually being introduced into the Canadian Health Care system.
In Ontario, there is currently a two-year demonstration project where PA’s have been introduced into approximately 20 hospitals (source). The PAs are placed in areas where there are chronic staffing issues (source).
“Historically the PA’s role was developed within the Canadian Forces Health Services to provide a full spectrum of medical care. Civilian PAs are practicing in Manitoba and in Ontario where they have been integrated in the health care system since 2006″ (source).
PA’s conduct patient interviews, take medical histories, perform physical examinations, perform certain controlled acts delegated to them by a physician and provide counselling on preventative health care (source).
