Nurse practitioner versus physician assistant: differences in role, training, and standard of practice (2023)


Nurse practitioner versus physician assistant: differences in role, training, and standard of practice (1)

Welcome toPart 1 of our serieson a comparison of the Nurse Practitioner (NP) versus Physician Assistant (PA) profession in Canada with a focus on NP versus PA in Ontario.

Last updated 1 February 2019 By Anne Dang, medical assistant andClaudia Mariano, Nurse.

In this article:

  1. NP vs. PA: See the difference
  2. Defining the role of PAs and NPs
  3. Misconceptions about PA and NP
  4. A History of Protected Areas and National Parks in Ontario
  5. PA and NP training
  6. The nursing model versus the medical model
  7. Licensing and recertification for PAs and NPs

PA vs. NP Overview difference

Medical assistants:

  • Trained in a medical model
  • Bachelor's or Master's degree in PA studies
  • The regulation depends on the jurisdiction
  • Non-independent processor
  • Practice in all areas of medicine

Doctors Nurses:

  • Educated in nursing model and medical model
  • Bachelors in Nursing, followed by a Masters in NP studies
  • Verified health expert
  • Independent doctor
  • Practice in all areas of medicine

Definition of the role of medical assistants and nurses

What is a Physician Assistant?

Physician assistants (PAs) are highly skilled healthcare professionals trained in the medical model who practice medicine. They have completed a bachelor's or master's degree that may be related to medical school. PAs practice medicine under the supervision of a board-certified physician in a patient-centered health care team. PAs can work in any clinical setting to expand physician services, supplement existing services, and help improve patient access to health care.

  • PAs perform medical histories, physical examinations, order and interpret tests, perform diagnostic and therapeutic procedures, diagnose and treat illnesses, and educate patients about treatment options and provide preventive health counseling
  • PAs assist in surgeries, prescribe medications, and perform procedures within the scope of their training and experience as long as they are within their supervising physician's area of ​​expertise.
  • A PA's practice mirrors that of their supervisor
  • PAs work to expand physician services, but they are not independent physicians

What is a nurse?

A registered nurse (NP) is a registered nurse with many years of professional experience who has completed a master's degree in providing health care to patients.[1]. The nursing education is a master's level education. NPs also write a second licensure exam to practice as nurses.

NPs have a scope of practice that is broader than what they can do as registered nurses (RNs). NPs have additional powers, including diagnosing, admitting patients, treating and discharging patients from the hospital. NPs may also order diagnostic tests and lab tests. NPs can work independently without a supervising physician. In Canada, nurses can also prescribe all medications, including controlled substances and narcotics.

[1]NPAO. What is a nurse? Accessed February 1, 2019.

Misconceptions about physician assistants and nurses

Medical assistantsis oftenconfused about "doctor in training",administrative assistants/medical secretaries or other relevant staff because the title "assistant" is misleading. PAs are advanced practice providers who work like physicians, but do so in collaboration with/under the supervision of a physician.

A patient may see a PA without a physician visit or see a PA and MD in one visit, depending on settings, practice and workflow.

nurses -Some patients feel that you should see the doctor after the nurse has completed your assessment. As long as the condition or presentation is within the NP's scope of practice, knowledge, and judgment, NPs can see the patient without involving the physician. If it is outside their practice, the nurse will make the appropriate referral when it is outside their practice, just as a GP would.

History of Physician Assistants and Nurse Practitioners in Ontario

Medical assistantshas been in Ontario since 2007 since the inception of the Ontario Ministry of Health and Long-Term Care (MOHLTC) as partPA demonstration projectto assess the impact of PAs in Ontario by recruiting internal medicine graduate students (IMGs) and US-educated PAs. They havewith support from the Ontario Medical Associationsince their introduction to Ontario.

In 2008, McMaster University and the PA Consortium (University of Toronto Medicine, Northern Ontario School of Medicine and Michener Institute of Applied Health Sciences) launched two PA training programs.

Military trained assistants have been in the Canadian Forces for more than 50 years and are graduates of the Canadian Forces School of Medical Services in Borden, Ontario.

Learn more about the history of PAsin Canada on the CAPA website.

Nurseshas a 40-year history of operating in Ontario (since the 1970s). They were early pioneers in expanding the RN role to remote communities in Ontario. The nursing profession began in community health centers (CHCs), beginning with registered nurses working with an expanded scope to serve the needs of patients in rural areas. Although they weren't called NPs at the time, the work these RNs did is similar to what NPs do today.

There are 3,300 national parks in Ontario per Feb 1, 2019. There are currently more than 4,000 national parks in Canada.

Learn more about their historyon the NPAO website.

Training of medical assistants and nurses

Medical assistants:To become a PA you must complete at least 2-4 years of undergraduate study (with some "recommended" courses), a minimum GPA and if you are interested in the PA Consortium (University of Toronto, NOSM and Michener) then you must have910 hours of healthcare experience(which is not a requirement for all PA schools, but there are many examples of PAs who had prior healthcare experience before becoming a PA). You also need oneGPA of 2.7-3.0 or higheron the OMSAS scale. You do not need a bachelor's degree in science to apply for the program. Nurses can also apply to become a PA.

  • In Ontario there istwo schoolsthat offer PA degrees, both are bachelor's degrees in PA studies. Manitoba's PA program offers a B.Sc.
  • Education is based onmedicalmodel
  • The duration of the training is 24 months. The first 12 months include basic medical fundamentals and the second year includes clinical rotations in various areas of medicine. You can't skip any aspect of this workout, and that's trueindependentyour experience or background.
  • PA training is not scalable. After PAs graduate, they are open to practice in any area of ​​medicine (whether surgical, general, or non-surgical specialties).

Nursesmust first complete a bachelor's degree in nursing and then apply for a master's degree in nursing. NP programs are competitive and requirements vary between different programs. An example of what they may need includes: at least 2 years of direct RN nursing experience in the last five years (3640 hours) with a GPA of B or higher in an undergraduate nursing program.

  • There are three different specialty degrees (primary health care, adult and pediatric) with different universities offering different programs (NP-PHC, NP-adult, NP-pediatric).
  • They are theremany schools in Ontariothat offer a NP primary health care program, enrollment requirements vary from school to school. At the time of writing, they include: Lakehead University, Laurentian University, McMaster University, Queen's University (satellite location: Trent University), Ryerson University, University of Ottawa, University of Western Ontario, University of Windsor and York University.
    • 9 of these schools offer NP-PHC (Nurse Practitioner – Primary Health Care) as a joint education, so you get the same education if you enroll in this major regardless of which university you attend.
    • The University of Toronto is an exception as it has its own NP-PHC / Primary Care program which they call the Global Health Program.
    • The University of Toronto also has NP-Adult and NP-Pediatrics certifications, leading to NP jobs primarily in the hospital setting.
  • The education is based on the current model and the medical model.You can learn more about the course material here.
  • The study lasts 2 consecutive years. Training includes hands-on practice, clinical practice and classroom work.
    • I Ontario, NP-PHCis a hybrid program with some courses taken online and required for weekly on-site sessions.
    • ToUniversity of Toronto PA-program, NP-PHCis essentially online, but students must be in the Toronto area for 1-2 weeks at least twice a year for more intensive parts of the curriculum.

The nursing model versus the medical model

Medical assistants and doctors learn from the medical model,or what is traditionally considered the “disease” model of learning medicine. This includes approaching the disease from the standpoint of basic anatomy and physiology, pathophysiology, pathology, pharmacology, epidemiology, etiology, research, clinical presentation, and treatment.

To explain the medical model, we must first look at a little history to understand where this model comes from. "The old medical model" as described by a psychiatristDr. George Engel i 1977, a disease-centered model that describes disease as the result of abnormal biological function (deviations from normal anatomy, physiology, and molecular biology)[2]. Restoration of normal function depended on the physician correcting the abnormality.

Jonathan Fuller in a 2017 paper titled “A new medical model: a new challenge for biomedicine”, describes a newer medical model that integrates chronic disease prevention and the use of evidence-based medicine. And evidence-based medicine refers to clinical research, epidemiological evidence. The goal of the new medical model is "treatment, prevention or management of disease".

Combined with the PA/MD assessment – ​​patient history, physical exam, additional tests, the doctor/PA can diagnose the underlying problem and correct the dysfunction with a treatment plan (which may include various treatment modalities – patient education, counseling, treatment) process, medication, encouraging lifestyle changes , topical or oral medications, injections, etc.)

Medical and PA programs today have moved toward interdisciplinary patient-centered care and away from physician paternalism.

[2]EngelGL The need for a new medical model: a challenge for biomedicine Science1977;196:129-36

Nurseslearning in the nursing model and the medical model. The nursing model is the basis for holistic, integrated care for the individual. There is a biopsychosocial approach that looks at patients' needs across the spectrum – from cradle to grave, regardless of diagnosis. And by first training as a nurse, NPs focus on those patient needs, not just the average diagnosis.

After completing the nursing education, students begin to focus on the investigation, diagnosis and treatment of disease, with some of the basic medical foundations, but with a focus on nursing.

Licensing and recertification for physician assistants and nurses

Medical assistantsis qualified forwrite the license testafter they complete their PA certification. From there they mustmeet the annual minimum requirementsContinuing Professional Development (CPD) points in the form of hours spent on courses, conferences, postgraduate work, magazine reading and more.

Because PAs are Canadian Certified Physician Assistants (CCPAs), they do not need to take the recertification exam.

For nursesOnce you are certified, you do not need to take the recertification exam. In the province of Ontario, NPs havemandatory quality assurance (QA)Programs we must do annual QA in accordance with regulatory programs. Each province will have its own QA program. In Ontario, every statutory health faculty is required to have a quality assurance process. In Ontario, the CNO has one that NPs must attend once a year, and for some it may include an OSCE.

The CNO is part of the QA program. PEs are expected to complete a learning plan each year and in the process identify areas where they need to expand their knowledge and skills. And on the basis of their learning participate in continuing education activities.

The CNO requires nurses to maintain contact with patients in the clinical setting in order to maintain their license.

See all NP vs PA articles


This article was created in collaboration between Anna and Claudia:

Annais a Canadian licensed physician assistant practicing orthopedic surgery and physical medicine and rehabilitation in Ontario. She is the founder and author of A longtime blogger and web graphic artist, she enjoys using social media and technology as a means to advance medical education and the PA profession.

Claudia Marianoshe graduated from the University of Toronto in 1986 with a degree in nursing. After working in medical-surgical nursing and public health care, she returned to U of T and earned her Master of Science in Nursing in 1992.

In 1999, she graduated from the Primary Care Nurse Practitioner Program, also at U of T. She has since embraced primary care and chronic disease management, working at the East End Community Health Center in Toronto for 10 years, and the last 10 years on the West Durham Health family practice team in Pickering. Claudia is a certified diabetes educator and is certified in intensive smoking cessation intervention. He is also a trainer of the Ottawa model for smoking cessation. Her clinical practice is largely focused on health promotion and self-treatment of chronic diseases.

Claudia is past president of the Nurses Association of Ontario and current board member of NPAO, past board member of the Family Health Teams Association of Ontario, current adjunct professor at the University of Toronto's Lawrence S. Bloomberg School of Nursing and author/editor''No one left behind: How nurses are changing Canada's health care system’.

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Nurse practitioner versus physician assistant: differences in role, training, and standard of practice? ›

Physician assistants train using the medical model, similar to physicians, which means they focus on the testing, diagnosis, and treatment of the disease that the patient has. Nurse practitioners train on the nursing model, which means they focus on the testing, diagnosis, and treatment of the patient with the disease.

What is the difference in training between a PA and NP How are their roles in delivering care similar and different? ›

2. Training and Education. Nurse practitioners and physician assistants both undergo extensive clinical training and education, both in medicine and in important soft skills. Primarily, NPs adhere to a patient-focused nursing model, whereas PAs follow a disease-centered (medical) model of practice.

Does a PA have more training than an RN? ›

PA: As physician assistants perform many of the same duties as doctors, they are required to obtain more education and training than compared to most RNs. Additionally, most PA programs require many hours of healthcare experience to be admitted.

What are the differences in nurse practitioner training and scope of practice in the US and UK? ›

In the US, the role of the nurse practitioner is long established. In the UK, the role is not as well developed and there is neither a separate registry nor a recordable qualification to recognise NPs on the Nursing and Midwifery Council register.

Does an NP have more autonomy than a PA? ›

NP vs PA: Autonomy

Overall, nurse practitioners have more autonomy than physician assistants. PAs typically work under the supervision of a physician, but the level of supervision can vary by state.

How is your role as a nurse practitioner different than when you working as a staff nurse? ›

Roles and Responsibilities

Although both registered nurses and nurse practitioners focus on patient observation and care, the largest difference between the two roles is that NPs are permitted to prescribe treatments, order tests, and diagnose patients—duties normally performed by physicians—whereas RNs are not.

What is the role of a nurse practitioner vs a physician? ›

A primary difference between physicians and NPs is the fact that all doctors can prescribe medication to patients as a part of their duties. Nurse practitioners also prescribe medicine, but in some states they must be directly overseen by a doctor or physician in order to do so.

Why choose NP over PA? ›

Meanwhile, nurse practitioners typically train in a specialty area based on patient population (e.g., pediatrics or OB/GYN). As a result, NPs have more practice freedom than PAs in many states but less flexibility when moving between practice areas. PAs do not need additional education to switch specialties.

Is NP or PA school more competitive? ›

While premeds don't need 1,000 hours of direct patient experience, they do need to put in several hundreds of hours across multiple extracurriculars including clinical experience, research, volunteering, leadership, and others. NP school is the least competitive of the three and it has the loosest requirements.

Why I chose nursing over PA? ›

Both paths have their advantages, but the benefits of opting for a nursing degree over a PA degree include having job opportunities with an undergraduate degree, focusing on patient care over diagnosis and treatment and enjoying more new job opportunities and a higher salary with a master's degree.

What is the difference between nursing scope of practice and standard of practice? ›

Scope of Practice defines the boundaries of the practitioner's license. While Standards are authoritative statements that describe the level of care or performance common to the profession of nursing and are used to judge the quality of nursing practice.

What are the 4 pillars of ACP? ›

ACPs are deployed across all healthcare settings and work at a level of advanced clinical practice that pulls together the four ACP pillars of clinical practice, leadership and management, education and research.

What are the roles of a nurse practitioner? ›

Professional Role

NPs provide a wide range of health care services, including the diagnosis and management of acute, chronic and complex health problems; health promotion; disease prevention; health education; and counseling to individuals, families, groups and communities.

Which PA specialty has the most autonomy? ›

General Internal Medicine

Working in this discipline, PAs assist physicians in disease prevention, diagnosis, and treatment. These PAs work closely with patients and enjoy a great deal of autonomy in their work.

Are PAs and NPs interchangeable? ›

Physician assistants and nurse practitioners are not interchangeable.

Is PA a full practice state for NPs? ›

In Pennsylvania, an NP cannot practice without physician supervision, and the state limits the range of medicines they can prescribe. This is called restricted practice, short of full practice authority.

In what ways can an APRN distinguish his or her role from other nursing roles and medical counterparts why might this be important? ›

However, APRNs have specialized training and knowledge to make medical decisions that RNs may not have the training or experience to make. Their role also focuses more on analyzing patient data to determine plans of care, while RNs focus on implementing these plans of care.

Is a PA higher than a NP? ›

Is NP higher than PA? Neither profession ranks "higher" than the other. Both NPs and PAs work in the healthcare field but with different qualifications, educational backgrounds, and responsibilities. They also work in different specialties.

What are the pros and cons of a nurse practitioner vs doctor? ›

A nurse practitioner has the advantage of more time with patients, and is also able to provide a different level of care. Doctors are focused on diagnostics and specific types of treatment, whereas nurses spend more time delving into prevention and a wider range of holistic and wellness based treatments and therapies.

Are doctors being replaced by nurse practitioners? ›

With a shortage of primary care physicians leaving more than 90 million people without access to primary care, according to the Health Resources & Services Administration, it is not surprising that NPs and PAs are filling the gap and being sought to do so.

Do doctors respect nurse practitioners? ›

In addition, 87% of physicians said their working relationship with NPs was "good to very good," and 92% of NPs said the same about their working relationship with physicians.

What is the difference between a physician and a nurse? ›

Doctor: What's the Difference? While both doctors and nurses hold patient-facing roles in the healthcare field, their level of responsibility differs. For example: Doctors observe symptoms and form diagnoses, whereas nurses inform doctors by gathering and reporting critical information.

Is PA school harder than nursing school? ›

Yes, in general, physician assistant school is harder than nursing school.

What is the hardest part of nurse practitioner school? ›

Following are the 10 biggest challenges you will face as a nurse practitioner student and ways to overcome them.
  • Clinical hour requirement. ...
  • Clinical Placements. ...
  • Certification Exam. ...
  • Demanding and complex schedule. ...
  • Continuing to work full time. ...
  • Coursework. ...
  • Specialization. ...
  • Graduate Requirements.

Is getting into PA school harder than med school? ›

Medical schools do not have such stringent clinical experience requirements, making them less competitive in this respect. PA school admission may be less competitive from a standardized exam standpoint, as PA schools don't require the MCAT.

What is the hardest thing about PA school? ›

Many students report that pharmacology and the human sciences are the hardest classes in PA school.

Should I major in nursing if I want to be a PA? ›

Education: Most PA schools require applicants to have at least a bachelor's degree. If you haven't earned a bachelor's degree in nursing, you should pursue this qualification before applying to PA school.

What is the average nurse in PA? ›

Salaries by years of experience in Pennsylvania
Years of experiencePer hour
1 to 2 years$43.54
3 to 5 years$45.70
6 to 9 years$47.35
More than 10 years$52.94
1 more row

Should I be an RN before a PA? ›

PA programs generally require applicants to have a few years of healthcare experience. So, many aspiring PAs assume they must be nurses to be eligible to enroll in physician assistant programs. This is not the case. Furthermore, applicants have several options for meeting the experience requirements for PA programs.

What are the 6 standards of nursing practice? ›

Standards of Practice The Standards of Practice describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The nursing process includes the components of assessment, diagnosis, out- comes identification, planning, implementation, and evaluation.

What is the difference between a practice standard and a practice guideline? ›

Practice standards are authoritative, whereas practice guidelines are recommendations. Consensus statements and position papers serve mainly as information sources; their recommendations aren't binding.

What is the difference between standards of care and standards of practice? ›

The “standard of practice” may or may not rise to the minimum level of care required by a given activity. Tradition, misunderstanding, economics and lack of knowledge may lead to a “standard of practice” which falls short of the standard of care.

What competencies does an ACP need? ›

Those working at ACP level will have skills in research, audit, quality improvement, leadership and management. They will be able to share knowledge and facilitate the development of junior colleagues and peers.

What is ACP framework? ›

The ACP Framework provides a structure for cybersecurity competencies in automotive.

What is the role of the ACP in leadership? ›

The ACP is tasked with operating at an autonomous advanced level across the four pillars of education, leadership, research and clinical practice, and to be competent in the core capabilities for each pillar.

What is the role of a nurse practitioner in end of life care? ›

Nurse practitioners in hospice are a conduit for a patient's ever-changing medical information, helping ensure each person is able to get the care they need, when they need it. They bring a high level of medical knowledge, communication skills, and compassion to their work.

What power does a nurse practitioner have? ›

FULL: NPs can prescribe, diagnose, and treat patients without physician oversight. Nurse practitioners who operate in full-practice states are also allowed to establish and operate their own independent practices in the same way physicians do.

What do you most look forward to in your new role as an NP? ›

NPs can look forward to innovative hybrid roles that place them at the center of patient care throughout the care continuum. Advanced education, complex skill development, and higher patient care responsibilities translate into higher salaries for NPs than their RN counterparts.

Does a PA or NP have more autonomy? ›

Nurse practitioners tend to specialize in fields, whereas PAs tend to have a more generalized education. NPs also tend to have more autonomy in 24 states, where they have full practice authority. PAs work interdependently with physicians.

Which PA specialty has the lowest burnout? ›

Certified PAs working in dermatology reported the lowest rate of burnout (20.3%).

What are the similarities between NPS and PAS? ›

Despite these differences, there are also many similarities between nurse practitioners and physician assistants. Both nurse practitioners and physician assistants will complete patient assessments, prescribe treatment and medications, and perform diagnostic tests to determine the health of their patients.

Can NPS perform Pap smears? ›

Things such as STD panels, pap smears and overall wellness exams can be performed by a nurse practitioner.

What states do PA have full practice authority? ›

The Best States for Full Practice Authority

Connecticut, Massachusetts, Michigan, Minnesota, North Carolina, North Dakota, Rhode Island, and Vermont meet all six of the AAPA's requirements, making these locations ideal for PAs looking to practice with some freedom.

What are the most restrictive NP states? ›

Restricted practice states: According to the AANP, restricted-practice states as of January 2020 were California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia.

What is the scope of practice for nurses in PA? ›

A Registered Nurse (RN) may:

diagnose* and treat patients' responses to diagnosed health problems; teach and counsel patients about their health; execute medical regimens as prescribed by licensed physicians, dentists, certified registered nurse practitioners, nurse midwives, physician assistants, and podiatrists; and.

What is the difference between nurse and physician assistant? ›

While registered nurses assist patients from a nursing approach, PAs assume a role more or less similar to that of physicians. This gives physician assistants a more direct role in administering tests, performing examinations, and prescribing medication.

What is the role of an NP in PA? ›

In Pennsylvania, nurse practitioners (NPs) may diagnose medical conditions, develop and implement treatment plans, order and perform diagnostic tests, and deliver other health care services, pursuant to a written collaborative agreement with a licensed physician.

Can a physician assistant perform the same procedures as a nurse practitioner? ›

Personalized medicine will be based on an individual's DNA. A physician assistant can perform the same procedures as a nurse practitioner.

What is the difference between a physician and a physician assistant? ›

An MD can work independently, while a PA must always work under the supervision of a doctor. PAs can't perform surgeries, but they can assist an MD during the procedure. However, an MD and a PA both can: Develop patient treatment plans.

What are the 4 roles of NP? ›

NPs are responsible to the public and adaptable to the dynamic changes in health care. As leaders in health care, NPs combine the roles of provider, mentor, educator, researcher, advocate and administrator.

Do nurse practitioners have full practice authority in Pennsylvania? ›

Full Practice: State law provides for nurse practitioners (NPs) to evaluate, diagnose, treat, and prescribe under the exclusive licensure authority of the state board of nursing.

What are the limitations of nurse practitioners in PA? ›

In Pennsylvania, an NP cannot practice without physician supervision, and the state limits the range of medicines they can prescribe. This is called restricted practice, short of full practice authority.

Can you have two specialties as a nurse practitioner? ›

NPs can obtain multiple degrees across multiple specialties, or they may choose to just focus on one area. Depending on your geographic region, knowledge about specialty NPs may be fairly uncommon, or a specialty certification may be the only way to get a job in a particular area.

Do medical assistants perform the same tasks as physician assistants? ›

The greatest differences between the two lie within the level of care that each can provide. Tasks like scheduling, clerical and billing tasks, signing patients in, and so on, are duties often required by medical assistants. Physician assistants focus more on patient care.

Is a physician assistant above a NP? ›

Is NP higher than PA? Neither profession ranks "higher" than the other. Both NPs and PAs work in the healthcare field but with different qualifications, educational backgrounds, and responsibilities. They also work in different specialties.

Do PAs know as much as doctors? ›

PAs can assess, diagnose and treat, so they must have as robust medical knowledge as a physician. PAs take a recertification exam every 10 years called the PANRE. Physicians in other specialties will often consult PAs to obtain medical advice.

What do you call a PA with a doctorate degree? ›

Today, we will explore another facet of higher education available to the physician assistant, the physician assistant PhD aka the physician assistant doctorate.


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