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.

N O T E:
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.

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

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.

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.

Wendy Wrenn, RN:

Wendy is a Registered
Nurse for CareSouth
Homecare and WinstonSalem 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

Planner:

This is also 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.

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

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

Washington University, and Wake Forest University. She got denied from GWU,
from WFU, and then she became accepted to Duke University. Lianne
waitlisted

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
pain management but didnt really like it all that much. Lianne and her
worked in

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.
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.

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

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 is 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.

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.

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 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.

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.

Lunch Break: At
Winston-Salem
Gynecology, they
have a short 30minute 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.

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.

2. What have been some

things you struggled
with to become a nurse
and while working as a
nurse?

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 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.

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.

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.

4. In terms of education and schooling, how

would you compare becoming a Registered
Nurse to becoming a Physician Assistant?

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 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, 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 (PAC). 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 a
registered nurse.

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 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 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. PAs 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 patients
weight, temperature, and vitals. RNs 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 PAs require more educations than a RN,
this is what gives them to diagnose patients and prescribe medications where RNs 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.

Chart
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.
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.

Becoming a
Registered Nurse

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.

Interests:
The similarities and
differences between
the occupations
The differences
between becoming a
PA and a RN

Proposal
In todays 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 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 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 patients view of their
healthcare provider that I am going to discover about as well.