Prepared by Public Sector Consultants Inc.
March 13, 2015
1
Comparison of Nurse Practitioners
and Physician Assistants in Michigan
Nurse Practitioners Physician Assistants
Background
Required background prior
to applying to program
Bachelor of Science in Nursing (BSN) and licensure as a registered
nurse (RN)
1
Bachelor’s degree
College coursework in basic and behavioral sciences is generally
required. Hands-on health care experience may also be required
(e.g., experience as a medical assistant, emergency medical
technician, registered nurse, surgical tech).
2
Education and Training
Minimum degree conferred
upon graduation
Master of Science in Nursing (MSN) with preparation as a nurse
practitioner in one or more of the following population focus areas:
3
Family/Individual Across Lifespan
Adult – Gerontology
Neonatal
Pediatrics
Women’s Health/Gender-Related
Psychiatric – Mental Health
Some nursing programs offer doctor of nursing practice (DNP)
degrees (in addition to or instead of MSN degrees).
Master of Science with preparation as a physician assistant (PA)
Education program
accrediting body
Commission on Collegiate Nursing Education (CCNE) or
Accreditation Commission for Education in Nursing (ACEN).
All nurse practitioner programs in Michigan are accredited by the
CCNE.
4
Accreditation Review Commission on Education for the Physician
Assistant (ARC-PA).
All PA programs in Michigan are accredited by ARC-PA.
5
Educators
Nurse practitioner faculty are responsible for the supervision and
evaluation of NP students’ clinical instruction. Didactic and clinical
instructors may be NPs or other licensed clinicians.
6
Didactic and clinical instructional faculty consist primarily of
practicing physicians and PAs. Other licensed health care providers
also provide instruction.
7
Philosophy/model
Nursing model
8
Besides health assessment, diagnosis, and treatment, NPs focus on
health promotion, disease prevention, health education, and
counseling.
Medical model
8
Disease-centered, emphasis on the biologic/pathologic aspects of
health, assessment, diagnosis, and treatment.
Submitted on March 27, 2017
by Assemblywoman Robin Titus
RE: AB115
Assembly Committee: Commerce and Labor
Exhibit: H Page 1 of 7 Date: 03/27/2017
Submitted by: Assemblywoman Robin L. Titus
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2
Comparison of Nurse Practitioners and Physician Assistants in Michigan
Nurse Practitioners
Physician Assistants
Didactic education training
and content
A minimum of 500 didactic training hours.
1,9
Core content for master’s nurse education:
10
Research
Policy, Organization, and Financing of Health Care
Ethics
Professional Role Development
Theoretical Foundations of Nursing Practice
Human Diversity and Social Issues
Health Promotion and Disease Prevention
In addition to the core curriculum for master’s nurse education, the
core advanced practice nurse curriculum includes:
11
physiology/pathophysiology, including general principles
that apply across the lifespan;
health/physical assessment, including assessment of all
human systems, advanced assessment techniques,
concepts, and approaches; and
pharmacology, including pharmacodynamics,
pharmacokinetics, and pharmacotherapeutics of all broad
categories of agents.
About 1,000 didactic training hours.
9
Instruction in:
7
Anatomy, physiology, pathophysiology, pharmacology and
pharmacotherapeutics, and the genetic and molecular
mechanisms of health and disease
Clinical medicine covering all organ systems
Effective exchange of information with patients
Patient evaluation, diagnosis, and management
Provision of clinical medical care across the life span
Social and behavioral sciences
Basic counseling and patient education skills
Medical literature research and evaluation
Health care delivery systems and health policy
Public health concepts
Patient safety and quality improvement
Medical ethics
Historical development and current trends in PA practice
Clinical education content
and training
A minimum of 500 clinical training hours in the NP’s population focus
area.
6
Additional didactic and clinical training hours are required for nurses
receiving training in more than one population focus area or a
specialty focus area (e.g., diabetes, oncology, palliative care).
6
Nurse practitioners would also have received clinical training when
earning a BSN prior to entry into an NP program.
More than 2,000 clinical training hours.
2,9
Clinical rotations are required in each of the following disciplines:
7
Family medicine
Internal medicine
General surgery
Pediatrics
Obstetrics and gynecology
Behavioral and mental health care
Rotations are required in inpatient, outpatient, emergency
department, and operating room settings. Clinical rotations must
expose physician assistant students to patients seeking medical
care across the life span, women’s health care; care for conditions
requiring surgical management, and care for behavioral and mental
health conditions.
7
Length of training
One to three academic years depending on the program.
12
Typical programs are 26 months (three academic years).
2
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March 13, 2015
3
Comparison of Nurse Practitioners and Physician Assistants in Michigan
Nurse Practitioners
Physician Assistants
Certification
Michigan requires NP certification.
Certification is conferred upon graduation from an accredited NP
program and passage of a certification exam offered by a national
certifying agency.
There are two major national certifying agencies:
American Association of Nurse Practitioners (AANP)
American Nurses Credentialing Center (ANCC)
Additional certifying agencies approved by the Michigan Board of
Nursing are:
13
Pediatric Nursing Certification Board (PNCB)
National Certification Corporation (NCC)
Oncology Nursing Certification Corporation (ONCC)
Michigan requires PA certification.
Certification is conferred upon graduation from an accredited PA
program and passage of the Physician Assistant National Certifying
Exam (PANCE), which is conducted and scored by the National
Commission on Certification of Physician Assistants (NCCPA).
14
PAs may seek a Certificate of Added Qualifications (CAQ) as
recognition of specialty experience. CAQs are offered in seven
specialties:
15
Cardiovascular and thoracic surgery
Emergency medicine
Hospital medicine
Nephrology
Orthopaedic surgery
Pediatrics
Psychiatry
Obtaining a CAQ in one of these specialties requires 2,000 to 4,000
hours of PA practice in the specialty area plus 150 hours of
continuing medical education credits focused on the specialty
area.
15
To maintain certification
The AANP and ANCC require re-certification every five years.
Recertification requires:
sitting for the appropriate examination (dependent on area
of focus), or
75 contact hours of continuing education relevant to the
NP’s role and population focus and completion of a
minimum of 1,000 hours of clinical practice as an NP in the
NP’s population focus in the five years (60 months) prior to
application. The ANCC requires that 25 of the CE contact
hours be in pharmacotherapeutics.
16,17
The ONCC requires recertification every four years. Recertification
requires 1,000 hours practice as a nurse practitioner in adult
oncology within the four years (48 months) prior to application.
18
The NCC requires recertification every three years through
continuing education specified in a personalized plan based on a
Continuing Competency Specialty Assessment. Required CE hours
range from 15 to 50.
19
The PNCB requires annual recertification through documentation of
As of 2014, the NCCPA requires recertification every ten years.
Recertification includes five two-year cycles in which PAs must
complete and log 100 continuing medical education (CME) hours
and passage of the Physician Assistant National Recertifying Exam
at the end of the ten-year period. During each two-year cycle, PAs
must earn 20 CME credits through self-assessment and/or
performance improvement activities.
24
The changes to recertification requirements were made to reflect the
recertification criteria for physicians mandated by the American
Board of Medical Specialties.
25
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4
Comparison of Nurse Practitioners and Physician Assistants in Michigan
Nurse Practitioners
Physician Assistants
15 CE contact hours or equivalent activities. The PNCB also
requires NPs to complete four required activities called Pediatric
Updates within a seven-year cycle.
20,21,22,23
Each certifying agency requires nurses to have an active,
unencumbered license.
Legal Standing in
Michigan
Regulatory authority
Board of Nursing
26
Task Force on Physician’s Assistants
26
Licensure
Licensed as an RN through the Michigan Board of Nursing. Certified
nurse practitioners apply for specialty certification as a nurse
practitioner.
27
License and specialty certification must be renewed every two
years.
28,29
Licensed as a PA through the Task Force on Physician’s
Assistants.
30,31
License must be renewed every two years.
32
Delegation and supervision
of practice
Carry out medical functions under the delegation and supervision of
a licensed physician.
33,34
Practice nursing independently.
35
Practice medicine under the supervision of a licensed
physician.
36,37,38
Scope of practice definition
Because an NP is a licensed RN in Michigan, there is not a separate
written scope of practice for NPs in Michigan law.
27
Michigan law states that the “practice of nursing means the
systematic application of substantial specialized knowledge and
skill, derived from the biological, physical, and behavioral sciences
to the care, treatment, counsel, and health teaching of individuals
who…require assistance in the maintenance of health and the
prevention or management of illness, injury or disability.”
35
Anything beyond the RN scope of practice must be delegated and
supervised by a physician.
33
Practice medicine under the scope of practice of a supervising
licensed physician.
39
Prescription privileges
Delegated authority for both controlled and non-controlled
substances.
40
Delegated authority to prescribe controlled substances in schedules
3 through 5 without restrictions. Delegated authority to prescribe
controlled substances in schedule 2 with restrictions. Delegation for
prescription of controlled substances is renewed annually.
41
Apply for DEA registration under the DEA Midlevel Provider
Authorization rules.
Delegated authority for both controlled and non-controlled
substances. Delegated authority to prescribe controlled substances
in schedule 2 through 5 without restrictions.
39,40
Delegation for prescription of controlled substances is renewed bi-
annually.
42
Apply for DEA registration under the DEA Midlevel Provider
Authorization rules.
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5
Comparison of Nurse Practitioners and Physician Assistants in Michigan
End Notes
1. Study.com. Nurse Practitioner School Requirements and Prerequisites. Available: http://education-portal.com/nurse_practitioner_school_
requirements.html. (accessed 3/5/15).
2. American Academy of Physician Assistants (AAPA). Become a PA. Available: https://www.aapa.org/twocolumnmain.aspx?id=288&utm_source=
aapa.org&utm_medium=home_4buttonmenu&utm_campaign=BecomeaPA. (accessed 3/5/15)
3. APRN Consensus Work Group and the National Council of State Boards of nursing APRN Advisory Committee. Consensus Model for APRN
Regulation: Licensure, Accreditation, Certification & Education. July 7, 2008. APRN Joint Dialogue Group Report. Available:
http://www.aacn.nche.edu/education-resources/APRNReport.pdf. (accessed 3/6/15).
4. March 5, 2015. Internet search of all nurse practitioner programs in Michigan conducted by Public Sector Consultants Inc.
5. March 5, 2015. Internet search of all physician assistant programs in Michigan conducted by Public Sector Consultants Inc.
6. National Task Force on Quality Nurse Practitioner Education. Criteria for Evaluation of Nurse Practitioner Programs. Washington, DC : National
Organization of Nurse Practitioner Faculties, 2012. Available: http://www.aacn.nche.edu/education-resources/evalcriteria2012.pdf. (accessed
3/6/15).
7. Accreditation Review Commission on Education for the Physician Assistant Inc. (ARC-PA). Accreditation Standards for Physician Assistant
Education: Fourth Edition. Johns Creek, Georgia : ARC-PA, September 1, 2010. Available: http://arc-pa.org/documents/
Standards4theditionwithclarifyignchanges10.2011fnl.pdf. (accessed 3/6/15).
8. Practicing Clinicians Exchange. Do You Know the Differences Between NPs adn PAs? Available: http://www.practicingclinicians.com/cms/wb/
pages/nps_and_pas.php. (accessed 3/9/15).
9. Sechel Ventures. NP vs. PA. Nurse Practitioner Schools. Available: http://www.nursepractitionerschools.com/faq/np-vs-physician-assistant. (accessed
3/9/15).
10. American Association of Colleges of Nursing (AACN). The Essentials of Master's Education for Advanced Practice Nursing. Washington, DC :
AACN, 1996. Available: http://study.com/nurse_practitioner_school_requirements.html. (accessed 3/9/15).
11. Commission on Collegiate Nursing Education (CCNE). Standards for Accreditation of Baccalaureate and Graduate Nursing Programs. Washington,
DC : CCNE, 2013. Available: http://www.aacn.nche.edu/ccne-accreditation/Standards-Amended-2013.pdf. (accessed 3/8/15).
12. Study.com. How Long Does it Take to Become a Nurse Practitioner? Available: http://study.com/how_long_does_it_take_to_become_a_nurse_
practitioner.html. (accessed 3/9/15).
13. Mich. Admin. Code R 338.10404. Available: http://www7.dleg.state.mi.us/orr/Files/AdminCode/1152_2013-003LR_AdminCode.pdf. (accessed
3/10/15).
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Comparison of Nurse Practitioners and Physician Assistants in Michigan
14. Mich. Admin. Code R 338.6301. Available: http://www7.dleg.state.mi.us/orr/Files%5CAdminCode%5C1509_2015-012LR_AdminCode.pdf. (accessed
3/5/15).
15. National Commission on Certification of Physician Assistants (NCCPA). What do I need to take a CAQ? Johns Creek, Georgia : NCCPA. Available:
http://www.nccpa.net/Upload/PDFs/CAQ%20Requirement%20Table.pdf. (accessed 3/5/15).
16. American Nurses Credentialing Center (ANCC). 2014 Certification Renewal Requirements. American Nurses Association. Silver Spring, Maryland :
ANCC, 2014. Available: http://www.nursecredentialing.org/RenewalRequirements.aspx. (accessed 3/5/15).
17. American Association of Nurse Practitioners Certification Program (AANPCP). Candidate Handbook and Renewal of Certification Handbook. Austin,
Texas : AANPCP, 2015. Available: http://www.aanpcert.org/ptistore/resource/documents/2013%20CandidateRenewalHandbook%20-
Rev%2011%2025%202013%20forNCCA(FINAL).pdf. (accessed 3/5/15).
18. Oncology Nursing Certification Corporation (ONCC). Eligibility Criteria for Renewal Candidates. Available:
http://www.oncc.org/Eligibility/Renewal. (accessed 3/8/15).
19. The National Certification Corporation (NCC). Maintain Your Certification. Available: https://www.nccwebsite.org/Certification-maintenance.
(accessed 3/8/15).
20. Pediatric Nursing Certification Board (PNCB). Primary Care Recertification: Your Guide to Recertifying for 2015. Rockville, Maryland : PNCB.
Available: http://www.pncb.org/ptistore/control/resource/content/certs/PC_CPNP_Recert_Guide.pdf. (accessed 3/8/15).
21. ———. Acute Care Recertification: Your Guide to Recertifying for 2015. Rockville, Maryland : PNCB. Available:
http://www.pncb.org/ptistore/control/resource/content/certs/AC_CPNP_Recert_Guide.pdf. (accessed 3/8/15).
22. ———. Certified Pediatric Nurse: Your Guide to Recertifying for 2015. Rockville, Maryland : PNCB. Available:
http://www.pncb.org/ptistore/control/resource/content/certs/CPN_Recert_Guide.pdf. (accessed 3/8/15).
23. ———. Dual Acute Care & Primary Care Recertification: Your Guide to Recertifying for 2015. Rockville, Maryland : PNCB. Available:
http://www.pncb.org/ptistore/control/resource/content/certs/DUAL_CPNP_Recert_Guide.pdf. (accessed 3/8/15).
24. National Commission on Certification of Physician Assistants (NCCPA). Certification Maintenance. Available: http://www.nccpa.net/CertMain.
(accessed 3/8/15).
25. ———. FAQs. Certification Maintenance Process Changes. Available: http://www.nccpa.net/Faq#3. (accessed 3/13/15).
26. Michigan Department of Licensing and Regulatory Affairs. Boards for Professions Licensed/Registered/Regulated. Available:
http://www.michigan.gov/lara/0,4601,7-154-35299_63294_27529-50941--,00.html. (accessed 3/5/15).
27. MCL 333.17210. Available: http://www.legislature.mi.gov/(S(v5ekf31j12v3cq2umk21t30g))/documents/mcl/pdf/mcl-333-17210.pdf. (accessed
3/11/15).
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Comparison of Nurse Practitioners and Physician Assistants in Michigan
28. Mich. Admin. Code R 338.10405. Available: http://www7.dleg.state.mi.us/orr/Files/AdminCode/1152_2013-003LR_AdminCode.pdf.
(accessed 3/9/15).
29. Mich. Admin. Code R 338.10601. Available: http://www7.dleg.state.mi.us/orr/Files/AdminCode/1152_2013-003LR_AdminCode.pdf.
(accessed 3/9/15).
30. MCL 333.17062. Available: http://www.legislature.mi.gov/(S(gjdqwmyn1lwnsqrkb15sy4zq))/documents/mcl/pdf/mcl-333-17062.pdf.
(accessed 3/11/15).
31. MCL 333.17064. Available: http://www.legislature.mi.gov/(S(gjdqwmyn1lwnsqrkb15sy4zq))/documents/mcl/pdf/mcl-333-17064.pdf.
(accessed 3/11/15).
32. Mich. Admin. Code R 338.6311. Available: http://www7.dleg.state.mi.us/orr/Files/AdminCode/1509_2015-012LR_AdminCode.pdf. (accessed
3/9/15).
33. MCL 333.16104. Available: https://www.legislature.mi.gov/(S(j0job05aey0ln2vy0qwwnf5t))/documents/mcl/pdf/mcl-333-16104.pdf. (accessed
3/11/15).
34. MCL 333.16215. Available: http://www.legislature.mi.gov/(S(eb1mfr2pg0cdlnv3gubybtsx))/documents/mcl/pdf/mcl-333-16215.pdf. (accessed
3/9/15).
35. MCL 333.17201. Available: http://www.legislature.mi.gov/(S(4tg1c05lgoybsygdblr223kp))/documents/mcl/pdf/mcl-333-17201.pdf. (accessed 3/9/15).
36. MCL 333.17001. Available: https://www.legislature.mi.gov/(S(r30ddjpe142z434hfwsjhvvr))/documents/mcl/pdf/mcl-333-17001.pdf. (accessed
3/11/15).
37. MCL 333.16109. Available: http://www.legislature.mi.gov/(S(tkghw43p0og2coq2yoopks2c))/documents/mcl/pdf/mcl-333-16109.pdf. (accessed
3/11/15).
38. MCL 333.17049. Available: http://www.legislature.mi.gov/(S(aqzbn0ewzmx3ahhxrx4undix))/documents/mcl/pdf/mcl-333-17049.pdf.
(accessed 3/11/15).
39. MCL 333.17076. Available: http://www.legislature.mi.gov/(S(04bkejmygr2r1nlx1vqkcmhz))/documents/mcl/pdf/mcl-333-17076.pdf. (accessed
3/9/15).
40. Michigan Department of Licensing and Regulatory Affairs. MAPS [Michigan Automated Prescription System] Information for Prescribers and
Dispensing Practitioners. Available: http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_55478_55485---,00.html. (accessed
3/9/15).
41. Mich. Admin. Code R 338.108b. Available: http://www7.dleg.state.mi.us/WebORRGSA/1041_2012-036LR_AdminCode.pdf. (accessed 3/8/15).
42. Mich. Admin. Code R 338.108a. Available: http://www7.dleg.state.mi.us/WebORRGSA/1041_2012-036LR_AdminCode.pdf. (accessed 3/8/15).