What’s the difference? Physician Assistant vs Nurse Practitioner

Health care delivery has undergone significant changes in the last few decades. The need for cost-effective care skyrocketed along with the number of people living with chronic illness demanding access to care. At times it has been said that individuals trained as a Nurse Practitioner or a Physician Assistant are interchangeable as medical providers. While many hospital systems may hire Nurse Practitioners or Physician Assistants to fill similar roles, the training and licensure of each program prepares the clinician to practice in a different way. 

The Physician Assistant profession was created in the mid 1960’s to meet the growing demand for access to health care, specifically access to primary care providers. Duke University Medical Center offered the first official program training individuals to provide medical care as a Physician Assistant based on the “fast track” programming for individuals trained to provide medical care during World War II.

Nursing pioneers were up to similar work across the country in Colorado, as the first Nurse Practitioner program was developed in 1965 at The University of Colorado to meet the growing demand for primary care providers in that region of the country. Many of the early Nurse Practitioner’s were trained in certificate programs through hospital systems and universities before formal Master’s Programs were developed.

The foundational training of a Registered Nurse, including hours of clinical experience, sets the Nurse Practitioner apart from the track Physician Assistants take.

The primary differences in training for a Physician Assistant and a Nurse Practitioner is found within the names of each. A Physician Assistant is trained similarly to a physician, under the medical model after completing the following requirements:

  • Bachelors Degree (GPA above 3.0)
  • Program Pre-requisite courses 
  • GRE or MCAT (program specific)
  • 1 year clinical experience in a healthcare setting.

Once admitted, PA programs focus on a comprehensive general medical education in addition to the clinical experiences. Most PA programs are over 100 credit hours completed in 2 years. The different Master of Health Sciences curriculums provides PA students with depth of knowledge in the basic medical sciences and clinical medicine, as well as skills in administration and research.

PA programs today are Master’s level programs with both didactic and clinical experiences that prepare individuals to take the Physician Assistant National Certification Exam or “PANCE” exam, achieving the certification designation of PA-C and opportunity to move on to state licensure. PA Certifications in subspecialty areas are available including in Mental Health/Psychiatry, this is achieved by completing the PA Certificate of Added Qualifications (PA-CAQ) clinical experience and passing the exam.

What is important to remember is that both PA and APRN programs support clinical care that is evidence based and held to standards at the state licensure and national certification levels.

Nurse Practitioners are first and foremost nurses. They are trained in the nursing model to practice the art and science that is nursing. They are licensed to practice as an RN prior to continuing their education in Nursing to become an Advanced Practice Registered Nurse (APRN). Graduate level nursing programs require the following:

  • Bachelor of Science in Nursing (BSN) from an accredited program (GPA 3.0-4.0)
  • RN license in good standing with the state
  • GRE entrance exam 
  • 1-2 years Nursing Experience (programs vary)

Nurse Practitioners are trained at Master’s or Doctoral levels (depending on the program or specialty) as well as must sit for their specialty’s board certification exam and meet the licensure requirements for their state. Nurse Practitioner’s can sit for the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC) exam. Master of Science in Nursing programs can be completed in 18 months while Doctor of Nursing Programs and PhD Nursing programs are completed between 3 – 5 years depending on full or part time course work. These advanced nursing programs range from 70 – 100 credit hours. 

The Doctor of Nursing Practice is a Clinical Degree that prepares the Advance Practice Nurse to translate research evidence into nursing practice, understand and contribute to healthcare policy (including budgets, financial management, leadership theory), as well as cultivating practice expertise in their specialty. APRNs are independent licensed providers and required to sit for board certification in their specialty.

The role of the nurse practitioner can differ somewhat depending on the state in which the APRN is practicing. Certain states allow work to be completely independent, whereas others require them to work in a collaborative agreement with a Physician. The State of Florida requires APRN’s to practice with a collaborative agreement and general supervision from a physician or dentist. Nurse Practitioners are independent prescribers for non-controlled substances, after 2 years of practice experience in the State of FL APRN’s are eligible for their DEA License and prescriptive rights for both controlled and non-controlled substances.


Elizabeth Winings, DNP, APRN, PMHNP-BC

At the Retreat PVB we have Elizabeth Winings, DNP, APRN as our Director of Nursing. She is ANCC board certified as a Family Psychiatric Mental Health Nurse Practitioner. After completing her Bachelors of Science in Nursing at The University of Florida in 2011 and a 1-year surgical nurse residency program through the VA Hospital in Gainesville, FL she transitioned to community based care as an emergency room nurse for 2 years. These experiences inspired her to pursue advanced training in mental health and nutrition. She completed her Masters of Science in Nursing at the University of Florida in 2013 and began practicing as a Psychiatric Nurse Practitioner in Jacksonville in the spring of 2014, initially at The UF Health Department of Psychiatry in their outpatient adult, child and adolescent clinic. She transitioned to join the team at Nemours Specialty Clinic in the fall of 2015 where she was able further specialize in the care of children and adolescents in the outpatient setting as well as on the inpatient Behavioral Health Unit at Wolfson Children’s Hospital. While working as a Nurse Practitioner, Dr. Winings continued her education as well as specialized in Plant Based Nutrition through Cornell University and completed a 300 hour internship in Lifestyle Medicine at The True North Health Center in Santa Rosa, CA. She completed her Doctor of Nursing Practice through UF in 2016. Dr. Winings grew up in Jacksonville and is honored to bring her passion for nursing, wellness, and mental health to the community of Ponte Vedra Beach and surrounding areas. Come experience the personalized care of a Nurse Practitioner at The Retreat at Ponte Vedra Beach!

Psychology vs. Psychiatry

What type of healthcare professional should you seek when you have mental health concerns? Should you look for a psychiatrist or a psychologist? For many people, the answer to this question is a difficult one. Unless you are in the medical field or know someone who is, there’s a good chance you don’t know the difference between the two. We thought it would be great to highlight the differences between these two specialties for families looking for mental health care.

Before we compare and contrast the two professions, we should acknowledge the fact that you are seeking help, which is the most essential step in treating any issues you might have.

Psychologists and psychiatrists share a common goal to help people feel better.

Both are typically trained to practice psychotherapy — talking with patients about what is bothering them. The differences in background and training leads to various approaches to addressing mental health needs. Each clinician’s aim is to provide you with the means to manage the issues in your everyday life by talking through challenges and discovering solutions.

Here are the main differences between psychiatrists and psychologists:

  • Psychiatrists are Medical Doctors (MDs) who’ve graduated from a 4-year medical school after completing a 4-year-college degree. They complete an additional 4-years of Medical Specialty Residency. They are trained to diagnose and treat individuals with mental health disorders. This is a total 12 years of training. Psychiatrists who sub-specialize go on to complete 1 – 2 years of Fellowship Training in areas such as Child Psychiatry, Addiction, Geriatric Psychiatry, Consult-Liaison Psychiatry, and Forensic Psychiatry.
  • Psychologists, on the other hand, are not medical doctors. They’ve earned a doctoral degree such as a P.hD. in related areas or Psy.D. in a selected area of psychology, which focuses on the study of personality development, the history of psychological problems, and the science of psychological research.

Therefore, the two are prepared to diagnose and treat their patients differently.

Psychiatrists—being trained medical doctors—have the authority to write prescriptions for medication while psychologists, in most states, do not. Many Psychiatrists, in the era of managed care, spend the majority of their time on medication management. Traditionally, psychiatrist received training in psychotherapy, also. Psychologists spend most of their time either performing psychological testing or conducting psychotherapy to treat patients.

Psychotherapy—or “talk therapy,” as it is sometimes referred to—can “help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing,” according to the American Psychiatric Association.

Coming from the medical background, psychiatrists typically consider your genetic, biological, and medical history. Psychiatrists are uniquely trained to formulate a possible diagnoses and rule out causes of mental disorders due to other medical issues. People experiencing a significant impact on the body—and daily life activities from mental illness are well served by a psychiatrist. Psychiatrists are trained to listen for the signs and symptoms of particular neurochemical alterations, just the way a conductor can pick out the contribution of the violin amongst the symphony.

The field of mental health eliminates the division between the mind-body connection. So a person who is suffering can benefit from both a psychologist and/or a psychiatrist who often work together to treat patients.

At The Retreat at Ponte Vedra Beach, our psychiatrist is Theresa Randazzo-Burton, MD, who provides exceptional personalized psychiatric care.

Dr. Theresa Randazzo-Burton

Dr. Burton, is a Board-Certified Adult and Child and Adolescent Psychiatrist, who finished her training at UMASS in 2008. She completed years of supervision in individual, group, and family therapy. Her training and experience in cognitive behavioral therapy and psychodynamic psychotherapy sets her practice apart from most contemporary psychiatrists. While practicing from 2008 until 2014 at Presbyterian Hospital in Charlotte, NC on a 60-bed psychiatric unit (for ages 7 and up), she honed her psychopharmacology skills treating patients requiring the highest levels of care. Moving to the Jacksonville area in 2014, she joined the fantastic team of doctors at Nemours Specialty Clinic, most frequently overseeing the Psychiatric Care for Children on the Behavioral Health Unit at Wolfson Children’s Hospital. As a resident and a parent in Ponte Vedra Beach, Dr. Burton is dedicated to bringing her passion for psychiatric care to this community at The Retreat PVB.

Dr. Burton has created a welcoming office for her clients

The Retreat at Ponte Vedra Beach is a Child Psychiatry and Family Wellness Center for those looking for mental health care for themselves or their children in a comfortable and relaxed setting. We don’t look like any doctors office you have ever seen. Experience the difference individualized care in a stigma-free environment can make in your life. You can read more about our entire team on our website: click here

Beach Tree - Sunset

World Suicide Prevention Day




Join me, today and everyday, in the fight to prevent suicide. The battle is here in our community and we all need to reach out to those who are suffering with life threatening emotional pain. Suicidal thoughts should never be dismissed or minimized. They always represent a treatable condition. Any emergency room in the country can direct someone to the care they need. If you are worried about someone, speak up, get help, don’t wait. Let’s get rid of stigma and become beacons of hope.

Dr. Burton-Dr. Burton

The American Academy of Child and Adolescent Psychiatry Suicide Resource Center has valuable information for families: ACCAP Family and Youth Resources

Family on Bench

Stop Bullying

Let’s Put an End to Bullying

Kids in the US attend school for 180 days a year!  Half of our childrens’ waking hours from Monday to Friday are spent in classrooms with peers and teachers.  We hope, watch, and wait to see if the people who share our son’s or daughter’s time are going to think he/she is as wonderful as we do! The Retreat at Ponte Vedra Beach believes that children and teens need a safe and supportive educational environment to achieve their academic potential.  We are beginning a series of blog posts to help arm parents, kids, and educators in our community with tools to prevent, recognize, intervene and bounce back from bullying.

STop Bullying Colorful Hand

This week we look to for evidence based steps in preventing bullying. Kids take their cues from the adults in their life about how to view bullying.  Parents, teachers, coaches, and administrators serve a vital role in setting the scene at school. We are going to walk through the these prevention guidelines week by week and then move on to intervention and recovery.

Preventions and What You Can Do:

  • Talk about what bullying is and give some examples.  Tell kids bullying is not tolerated on or off campus and the everyone has a role in preventing it.  Make sure kids know who they can go to at school to report something they see happening and that they can make an anonymous report.  Take a look below for our first expanded discussion.
  • Talk to your child’s school about how they prevent bullying and ask if they have a campaign or curriculum they offer specific grade-levels  struggling with bullying concerns.
  • If your child has already been involved with bullying, talk with a specialist about building resilience. It is important for kids to unlearn the bully or victim role before starting a new grade or school to keep the pattern from continuing.
  • Check in with kids periodically.  Listen to their experiences about making and keeping friends. Ask about school.  Understand their concerns about fitting-in, being well-liked, and having a place at school they feel accepted.
  • Foster Interests and Hobbies. Special activities can boost confidence, help kids find like-minded friends, and protect them from bullying behavior.
  • Be a good role model!  Kids learn from observing social behavior.  When they see how parents treat one another, principals treat teachers, and coaches treat the opposing team, they are crafting scripts for life.  Examples of adults and peers treating each other with kindness and respect are the best weapon we have against bullying.

Bullying: Know it when you see it!

Children who are able to identify bullying can learn to stand up for themselves and others.  Kids often need grown-ups to help them talk about difficult or embarrassing topics. They also need adults to give them the space and permission to talk.  When they have this, they can safely respond to bullying and get help.

  • Step 1: Help your child identify bullying when it happens.  Ask them to tell you about bullying or if they have seen it at school or on TV.  Physical bullying like pushing, stealing, tripping, threatening with weapons, and acts of intimidation happens on school campuses everyday. However, bullying is often more subtle than pulling someone’s hair or taking their lunch money.  It is often a very personal and shameful. See if your child can identify name calling, rumor spreading, turning peers against someone, pointing and laughing, and intentionally making it unpopular to like someone as bullying.
  • Step 2: Help your child identify trusted adults at school, at home, at camp, and any other place they spend time.  Don’t take for granted that they know who to talk to or that you want them to speak-up. Kids, particularly if they are dealing with a bit of depression or anxiety, can erroneously believe that their problems are not important enough to share.
  • Step 3: Let your child know that it is brave to speak-up about bullying.  Help them step away from the stigma. It takes a lot of courage for a kid to admit to an adult that they are being bullied!  Secretly they may fear that an adult or parent won’t take them seriously or will view them as weak. Their worst fear is that the adult will agree with the things the bully has said or done. In my experience, this is the largest barrier to kids reporting bullying to their parents.
  • Step 4: Tell you child that no one is allowed to hurt them, just as they are not permitted to hurt anyone else.  Let them know that they deserve to be treated with dignity and that the adults at school and in the community believe this also.  Adults will take steps to address when bullying is identified. Most importantly, tell your child that if they inform you of bullying, you will NEVER MAKE THEM SIT DOWN WITH THE BULLY TO TALK IT OUT.  This does not help and is not recommended.  Bullying prevention is accomplished through the bystander effect: when enough kids believe they deserve to go to a school where everyone feels safe and accepted, they will stand-up for that belief.  Building this culture into educational settings, athletic programs, extracurricular activities, and our homes is the treatment for bullying problems in a community.
  • Step 5: Remember that parents are not expected to have all the answers to challenges children face.  Give comfort, support, and advice, even if you can’t solve the problem directly. Children are not always looking for solutions, in fact jumping to problem solving before understanding their experience can be invalidating.  Let them know what they feel makes sense.  Ask them what they think would help–problem solve together.
  • Step 6: Give tips, like using humor and saying “stop” directly and confidently, if they find themselves in the middle of a bullying situation.  If it’s something more complicated or dangerous, find strategies for staying safe, such as staying near adults or groups of other kids.Talk about what to do if those actions don’t work.

Additional Resources: logo  National Anti Bullying Logo  Anti-Bullying Logo

Follow our Blog for more on this series.  We will visit these topics in more detail in weeks to come.  The Retreat at Ponte Vedra Beach will tackle the topics of cyberbullying, helping your child form a peer group, identifying bullying at home, bully proofing, bouncing back from bullying, and more.  Check with the Retreat at Ponte Vedra Beach this fall to join our Bouncing Back Group for kids to have experiencing bullying.

Children Running to Ocean

From Teacher to Tutor

After years of teaching, I am stepping away from the role of a formal classroom teacher and into the role of educator and tutor at The Well at Ponte Vedra Beach.  As I make this transition, I want to share with you what led me to teaching in the first place. As a teacher, I am always filing away the lessons I don’t want to forget.

I first discovered my love for education when I reluctantly took a job as a high school tutor.  What I found led me down an exciting path. When I first met the bashful 7th grade girl I would be paired with for 9 months of English tutoring, I honestly felt that getting her to score passing marks would be an Everest I couldn’t climb. Our first month of meetings consisted of her refusing to speak to me and averting her eyes every time I tried to engage her.  How could I be sure she was soaking in the material? I remembered my own English teacher telling me to build relationships first, and the content and knowledge would follow. I decided to make that my mantra. We set goals, we made stepwise changes, we learned her style and how to overcome her barriers.  Over time, we grew to know and trust each other. Eventually, she began making C’s, and then those C’s became B’s. I will never forget her face when she ran into our tutoring room, waving her latest test proudly in front of her. She had scored an 85 and a smiley face sticker. She finally understood the information we had been reviewing and retained it! It belonged to her now! She was thinking differently and could apply the material in different situations.  It was at then that I experienced what many veteran teachers refer to as the “light bulb moment.”

In the case of my first tutoring experience, the student’s achievement was a reflection of the profound difference it makes when we build personal relationships and individualize a lesson plan. Teaching a child how to learn, identifying their skills, translating the material into a language he or she understands best, and setting high but manageable goals is how I approach each student I tutor.  For example, my 7th grader hated reading out loud, but loved drawing on the whiteboard. So, once I learned this, she was willing to diagram sentences and illustrate different parts of speech all afternoon. She liked writing on the board so much more than in her workbook. At the Well at Ponte Vedra Beach we have the opportunity to learn our student’s learning styles and meet them where they are at.

This initial experience, paired with the immense love and respect I felt for my own teachers, helped me fall in love with the profession and commit my future to becoming the best teacher I could be. As an educator, I incorporate the same preparation and devotion whether I am teaching in a formal classroom or as a tutor working with students in a small group or individually.

I have learned that great teaching has everything to do with how we approach students. In a successful classroom, ideas and opinions are valued. When kids are able to express their feelings, they learn to respect and listen to others. This fosters a collaborative environment where everyone feels they serve a vital role and offer something important to the class.

In a typical American classroom it can be challenging to meet the needs of students equally. When a student has a different learning style or needs an alternate approach, the lesson is bound to curriculum and the majority learning style. Students who need outside help often reluctant to ask for it and when they do, may sacrifice leisure time and peer experiences.  Successful teachers know that students benefit not only from relying on him/her for information, but on each other, and the vast resources of the school and the community.

As the Director of Education for The Well at The Retreat at Ponte Vedra Beach, I am eager to work with students in both small group and individual settings. This allows for flexibility for a family to schedule academic support tailored to fit their student’s need. We believe that children benefit from having clear instruction, expectations with high but manageable goals, and the support of a caring adult. We provide this in addition to the knowledge and support they need to succeed academically.  Just as classrooms thrive on warmth and enthusiasm, the educational services at The Well seek to create a space free from feelings of helplessness, instilling students with confidence and capability they need to take on whatever their school day may hold.  I value the the opportunity to work closely with students in need of individualized attention, partner with parents, and come alongside the teachers in our community. At The Well at Ponte Vedra Beach we believe every student is capable of making great strides and achieving academic success.