Status and Titles

[857770]

I think my 20 years of search & rescue as a medic, my BS in emergency management, and my Masters in Public Health exceeds your proposed 4-5 years of RN coursework.

And I think the 4 year BS in Biology, chemistry, or other hard sciences that most of my classmates had is equivalent to your proposed RN education.

Those 13 months of rotations in PA programs are full time (plus) totations. 50-60 hour work weeks are normal, with some approaching 80 hours a week. Standard for total hours is 2500 during those 13 months.

Meanwhile the standard for NP education is only 500 hours.

I think my 20 years of search & rescue as a medic, my BS in emergency management, and my Masters in Public Health exceeds your proposed 4-5 years of RN coursework.

And I think the 4 year BS in Biology, chemistry, or other hard sciences that most of my classmates had is equivalent to your proposed RN education.

Those 13 months of rotations in PA programs are full time (plus) totations. 50-60 hour work weeks are normal, with some approaching 80 hours a week. Standard for total hours is 2500 during those 13 months.

Meanwhile the standard for NP education is only 500 hours.

These programs are not equivalent to nursing in terms of difficulty. Majors like chemistry and physics are very intense programs.

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[Boatswain2PA]

These programs are not equivalent to nursing in terms of difficulty. Majors like chemistry and physics are very intense programs.

You are entitled to your opinion. I watched my wife complete her BSN. I was impressed by the medical knowledge she acquired from her top-line private school...but it did not compare with level of difficulty in my MPH.

 

[W19]

Not all NP programs are online and I'd say most of the better ones find preceptors for students - like, for example,Vanderbilt which finds preceptors for its students. They aren't all "self-arranged". I do agree that some programs are lower quality but it does no one any favors to lump all NPs and NP programs in with the weak programs.

Some? How about most?

 

[precisiongraphic]

Some I'll agree with. Many, maybe, though you've presented no evidence. MOST - no. Most NP programs are not poor quality and most don't make the students find their own (allegedly low quality in that case) preceptors. You are a medical student and were a nurse but you have no proof, you're just spouting your opinion.

There are literally thousands of good programs, some not so good and some terrible. Same with NPs who have been licensed.

Some states require more than 500 hours to be licensed. I think all states should require 1000. Will that happen? I doubt it but the AMA needs to increase its lobbying to balance the ANA lobby.

Look, I'm not an RN or NP or MD and I have no ax to grind. I'm just an unbiased observer of university programs and graduate programs, both nursing and medical. I've taught at universities and I'm a seeker of knowledge. In my immediate family I have three MDs, two RNs, one NP and one MD student. I choose to be fair and unbiased. Show me stats that say than most NPs are poorly trained and I'll be convinced.

Some? How about most?

.

 

[W19]

Some I'll agree with. Many, maybe, though you've presented no evidence. MOST - no. Most NP programs are not poor quality and most don't make the students find their own (allegedly low quality in that case) preceptors. You are a medical student and were a nurse but you have no proof, you're just spouting your opinion.

There are literally thousands of good programs, some not so good and some terrible. Same with NPs who have been licensed.

Some states require more than 500 hours to be licensed. I think all states should require 1000. Will that happen? I doubt it but the AMA needs to increase its lobbying to balance the ANA lobby.

Look, I'm not an RN or NP or MD and I have no ax to grind. I'm just an unbiased observer of university programs and graduate programs, both nursing and medical. I've taught at universities and I'm a seeker of knowledge. In my immediate family I have three MDs, two RNs, one NP and one MD student. I choose to be fair and unbiased. Show me stats that say than most NPs are poorly trained and I'll be convinced..

I completed over > 2,000 clerkship hours as 3rd year med student. Now about to start 4th year... These hours involved (not limited to) seeing my OWN patients, writing progress notes, writing orders (that physicians have to evaluate and tell me why they think I am an idiot), interpreting Xray, CT scan, EKG and presenting these patients to an attending doc or a senior resident. Attend morning presentations with residents. Consult other services. Doing at least 2 presentations per rotations (6 rotations total). Taking a OSCE (Objective Structured Clinical Examination) and a HUGE shelf exam (110+ questions) from the National Board of Medical Examiner (aka NBME) at the end of every rotation etc... just to freaking get thru 3rd year!

This is surely (or probably) more than what most NP students have to do

Do you actually think I am qualified now to practice medicine independently?

You know what: I am not even at a top med school. The school I am at is probably at the bottom 20 of US MD schools..

After doing all that, I still have to take a step2 CK/CS, which is a repeat of all these stuff I did in 3rd year.

 

[precisiongraphic]

...

This is surely (or probably) more than what most NP students have to do

Do you actually think am qualified now to practice medicine independently?

You know what: I am not even at a top med school. The school I am at is probably at the bottom 20 of US MD schools..

After doing that, I still have to take a step2 CK/CS, which is a repeat of all these stuff I did in 3rd year.

So now we're talking about medical education? Tell me where I said that NP education was anywhere near that of medical students?

Medical students have very well-rounded, complete medical educations. MDs/DOs have the pinnacle of medical education and could conceivably practice any specialty.

NPs, on the other hand, have to master just one small portion of the medical spectrum and they complete less education as a result. PMHNPs do not learn to deliver babies; CNM/NPs don't master critical care; AGACNP do not master Pediatrics; PNPs don't become qualified to handle PMHNP duties. Yes, NP scope is less, their education is less but I would argue that most of the NPs practicing today are qualified in the areas that they are licensed.

My only point, originally to MadJack, was that one cannot argue that ALL or MOST NP students are poorly trained and/or unqualified.

Your arguments lack logic and are way off the subject that you attacked me for above. In any event, we will never come to an agreement on this unless you want to provide statistics saying that NPs are unqualified or that their educations are inadequate leading to their practice being unsafe and unsound.

 

[W19]

@precisiongraphic I think we are talking pass each other. I am not against NP practicing advanced nursing (whatever that means)... I am against the system producing substandard 'practitioners' and left them at the hands of physicians to train properly... and these same people later claim they can do an equal or even a better job than the people who do more to help them than the ANA

If every NP program were like the one at Vanderbilt University, we would not have this discussion now... The nursing organizations should standardize these programs, so even the worst one can meet the minimum requirement so their students can go out there and be teachable. The majority of NP programs are not good IMO. I am familiar with a NP program at state university in FL; these are programs that are supposed to be ok, and I was shocked to see how horrible their curriculum was. I took a class in that program toward getting my BSN.

 

[precisiongraphic]

@precisiongraphic I think we are talking past each other. I am not against NP practicing advanced nursing (whatever that means)... I am against the system producing substandard 'practitioners' and left it at the hands of physicians to train properly... and these same people later claim they can do an equal or even a better job than the people who do more to help them than the ANA

If every NP program were like the one at Vanderbilt University, we would not have this discussion now... The organization should standardize these programs, so even the worst one can meet the minimum requirement so their students can go out there and be teachable. The majority of NP programs are not good IMO. I am familiar with a NP program at state university in FL and these are programs that suppose to be ok, and I was shocked to see how horrible their curriculum was. I took a class in that program toward getting my BSN .

I agree with all of this. Funny, one of my friends just started their NP degree at Vandy today.

 

[Boatswain2PA]

So now we're talking about medical education? Tell me where I said that NP education was anywhere near that of medical students?

Medical students have very well-rounded, complete medical educations. MDs/DOs have the pinnacle of medical education and could conceivably practice any specialty.

NPs, on the other hand, have to master just one small portion of the medical spectrum and they complete less education as a result. PMHNPs do not learn to deliver babies; CNM/NPs don't master critical care; AGACNP do not master Pediatrics; PNPs don't become qualified to handle PMHNP duties. Yes, NP scope is less, their education is less but I would argue that most of the NPs practicing today are qualified in the areas that they are licensed.

My only point, originally to MadJack, was that one cannot argue that ALL or MOST NP students are poorly trained and/or unqualified.

Your arguments lack logic and are way off the subject that you attacked me for above. In any event, we will never come to an agreement on this unless you want to provide statistics saying that NPs are unqualified or that their educations are inadequate leading to their practice being unsafe and unsound.

Correct me if I'm wrong, but a FNP has near full scope, right? I work with a new FNP grad in a busy ED and we were talking about an EKG. She had NO CLUE about EKGs beyond reading the computer print-out. So I started showing her some things on this EKG, and she was CLUELESS about things like posterior STEMI, Sgarbossa criteria, etc. Initially I recommended she study something like Amal Matu's "EKG for the Emergency Physician." But further discussion she disclosed that the ONLY EDUCATION SHE EVER HAD ON EKGs was in her BSN program 10 years ago.

Her FNP, with near full scope of practice, never covered EKG reading at all. Same thing with reading x-rays. Same thing with surgical rotation. Or infectious disease. Or OB. Nuthin.

This is a terrific lady who will work very hard to overcome the huge deficiency in her NP education...but she just highlights how insufficient NP education can be.

Whether it is all, or most, or much, or many....these are subjective terms that will NEVER be studied accurately.

 

[pamac]

NP school is lacking behind PA school as a general rule, and being in NP school with a biology degree and anther advanced science degree behind my nursing degrees demonstrate the areas where they are lacking are a bit more clear for me than probably most other nurses that took the "nursing" biology survey classes. I'm not sure how much stock I would put in an n=1 cherry picked case you put out there because I think I know a few new grad PA's who would have to punt on quite a few topics. X-rays? I'm not sure I want a PA or even a non radiologist physician reading an X-ray that is any more complicated than something that can be easily deciphered. I'm sure your patients would appreciate you not playing radiologist with just your PA education as well unless its for something easy. When I work in the ED with new PAs, I've seen them heading to the physician to get some input as often as the new NP's, especially to cover their backs. I'm just not feeling it when you throw out your cardiology pimpings of NP's, because its tough for me to get a new or even slightly new PA to make a tough call in an ER on their own. Its not really hard to stump someone new and make them feel like there is a lot they don't know, including new PA's, new NP's, new nurses, new residents.... etc. I'll be the first to admit that I feel a bit more comfortable with a new PA than a new NP, especially since I've run in to at least a couple NP's that brought more confidence with them to being an NP based on their experience as RN's, which in both cases that come to mind to me had nothing to do with RN knowlege, and really needed them thinking as a humble new provider willing to punt.

But honestly, even as an RN, simply reading the printout vs deciphering it is universally regarded as not doing your job. If you don't know how to do it as an RN (which would out a critical care nurse as non competent and needing education), then you wouldn't walk in to the physician with the printout and proclaim a condition based on what the EKG machine said at the top. I've seen it done and caught by a charge, and witnessed the subsequent remediation with an EKG class to get them up to speed on at least the big stuff. So you are saying that an NP provider working next to you in your ER is running around getting pimped by you and discovered to have been doing that the whole time? She's working in the ER... did she think that she wouldn't need to deal with interpretation of EKG's? That whole scenario is a little bit too much for me to take in if its accurate. I guess you better get her fired so people can be safe there.

 

[pamac]

To find out how highly regarded physicians think of PA's, one doesn't have to go far on here. The way you present it, there is universal regard that MD>PA>>>>>>>>>NP>> RN. The truth is the perception among MD's who even care to have the topic cross their minds often see it like this: MD>>>>>>>>>PA>NP>>>RN, or even more shocking: MD>>>>>>>>>>>>>>"midlevel whatever">>>>>RN, with the latter being the predominant view, especially among specialties. You aren't any more part of the cool kids club to them than the NPs. Its probably worse in the big picture because there are no states with independent practice for PA's. The NP's may be nerds, but you ain't the jocks, and the nerds have their own table to eat at.

 

[Boatswain2PA]

It's not "NP school is lacking behind PA school as a general rule". The BEST NP/DNP program is far, far, far behind the WORST PA program when it comes to preparing someone to practice medicine (semantics aside, that's what we do).

No, I was not "pimping" her. She came to me and asked a question which led to a discussion, which led to the revelation that she never read an EKG in her entire DNP program.

....MD>PA>>>>>>>>>NP>> RN. The truth is the perception among MD's who even care to have the topic cross their minds often see it like this: MD>>>>>>>>>PA>NP>>>RN.......The NP's may be nerds, but you ain't the jocks, and the nerds have their own table to eat at.

Speaking of quality of education ONLY (not competency of provider after schooling), you should put he PA about halfway between the MD and NP. I think most MDs, PAs, and the good NPs know that. Of course, after the PA/NP begins practicing their competence is more based on their personal attributes, dedication to learning their profession, etc. The NP I referred to earlier is going to be a terrific provider some day because she knows her NP education was a joke, so she is working hard now to learn how to practice medicine.

I'm certainly not insinuating we're the jocks running the school. Unfortunately the nerds only have their own table to eat at because their union masters run the school, not from any kind of inherent quality.

 

[pamac]

You are saying that a DNP took a job in an ER, and isn't interpreting EKG's correctly (not interpreting them at all and just acting like she is), and yet she is not fired? You are sitting there watching that, and use your PA judgement to state with authority that she will one day be a good provider if she works really hard like a fresh new PA with no health care experience? And the new grad 22 year old PA is going to dance circles around her if you hire one? I just haven't see that type of thing go down, and I've spent plenty of time working with PA's and NP's, new and experienced.

Not really feeling this n=1 this time. She's not even covering the basics of what her job would be if that's the case. Your ER must be pretty terrible. That's terrifyingly bad if its true, and nobody is stepping in to relieve her of her duties until she gains competency?

I'm not convinced new grad PA's are essentially 100% better (or more) than new grad NP's. I don't think anyone else would be convinced of that either.

 

[Boatswain2PA]

You are saying that a DNP took a job in an ER, and isn't interpreting EKG's correctly (not interpreting them at all and just acting like she is), and yet she is not fired? You are sitting there watching that, and use your PA judgement to state with authority that she will one day be a good provider if she works really hard like a fresh new PA with no health care experience? And the new grad 22 year old PA is going to dance circles around her if you hire one? I just haven't see that type of thing go down, and I've spent plenty of time working with PA's and NP's, new and experienced.

Not really feeling this n=1 this time. She's not even covering the basics of what her job would be if that's the case. Your ER must be pretty terrible. That's terrifyingly bad if its true, and nobody is stepping in to relieve her of her duties until she gains competency?

I'm not convinced new grad PA's are essentially 100% better (or more) than new grad NP's. I don't think anyone else would be convinced of that either.

You are putting things in all 3 paragraphs that I never said.

In this shop there is 24/7 coverage of board certified emergency physicians (EP), and ED policy is for the EP to sign off on all ekgs. This means a lot of midlevels there don't even look at them, just throw them on the EP desk. She took the initiative and looked at it, but didn't understand the fundamental of what the EKG was reading.

Yes, a 22 yo new grad PA will know these fundamentals. Every. Single. One. Of. Them. EKG fundamentals are taught in EVERY PA program, and tested on the national certification exam. That's not an n=1, that's every single PA graduate in the country.

Lastly, I never said every new PA grad is better than every new NP grad. I said the worst PA education far exceeds the best NP education when it comes to preparing for the practice of medicine.

 

[pamac]

So that gal made it through several years as a nurse without picking up EKG skills, then made it through a DNP program without picking them up, then decided that she'd be perfect to take a job in an ED without having any skill whatsoever in EKG interpretation, (as if she would know that the physicians don't trust you guys to interpret them anyway, and that would be her lucky break)? But according to you, someday she will be a great provider as long as she realizes how bad her nursing education stinks, and she throws herself into relearning everything there is to know to about being an advanced practice provider? This is a story about a DNP graduate who supposedly does not know that she would have to regularly utilize a piece of basic diagnostic technology that measures the electrical activity of the heart to help her evaluate heart conditions in an emergent setting, conditions that are the leading cause of death in the United States.... She didn't know a thing about that?

Like you said, lucky for her the physicians keep you guys on a short leash and don't trust you to make calls based on what you see on the EKGs even with the awesome PA skills you and the new grad PAs possess. I imagine that's the policy on films too. Sounds like they see the scale as MD/DO>>>>>>>>any given midlevel> nurse, just like I suspected.

You do realize that NPs (and RNs) take exams that ask questions about EKGs and the interpretation therof, right?

 

[pamac]

I'm not trying to be a tool here, but I'm really having a hard time with that story on many different levels. At this point it's well established that you have a chip on your shoulder about nurses, but the stars would have to align perfectly for me to find a DNP in an ED setting that was clueless about to that extent about EKGs. That fell perfectly into your lap as a constant critic of most things NP (except, bless their hearts, the NPs who realize they don't know as much as PAs do and work so hard to fix it).

 

[Boatswain2PA]

Most large EDS keep mid-levels on pretty short leashes. In this shop all EKG'S are read by the EP, who also handle all codes, trauma, intubations, sedations, and I'm sure other stuff. We have 24/7 radiology overread.

I only work about 1 shift a month there. Most places I work I'm single coverage and do all of that myself (generally always have rads overread).

This is a brand new DNP graduate who, after asking me to look at sn EKG because EP was busy, disclosed that her FNP/DNP program didn't give a single class on EKGs.

The level of EKG knowledge that is expected of an RN is about consistent with ACLS and is more about knowing the rhythm strip versus reading an EKG.

I don't have a chip on my shoulders regarding nurses (I'm married to a BSN/RN), or NPs. I do think NP education is full of fluff courses heavy on writing leadership papers and wayyy too light on medicine.

As such, it's ridiculous for a DNP to introduce themselves to a patient as "Doctor".

 

[762513]

Most large EDS keep mid-levels on pretty short leashes. In this shop all EKG'S are read by the EP, who also handle all codes, trauma, intubations, sedations, and I'm sure other stuff. We have 24/7 radiology overread.

I only work about 1 shift a month there. Most places I work I'm single coverage and do all of that myself (generally always have rads overread).

This is a brand new DNP graduate who, after asking me to look at sn EKG because EP was busy, disclosed that her FNP/DNP program didn't give a single class on EKGs.

The level of EKG knowledge that is expected of an RN is about consistent with ACLS and is more about knowing the rhythm strip versus reading an EKG.

I don't have a chip on my shoulders regarding nurses (I'm married to a BSN/RN), or NPs. I do think NP education is full of fluff courses heavy on writing leadership papers and wayyy too light on medicine.

As such, it's ridiculous for a DNP to introduce themselves to a patient as "Doctor".

Gas lighting to a T.

 

[Owlgal]

NP's learn all the "basics" in nursing school and during their RN career prior to going to on to an NP program. PA's have to learn everything, just walking in off the street. PA=Direct Entry NP program. And even most NP's aren't excited by the direct entry NP programs. Though, I will admit that PA's seem to be more along the line of an acute care NP rather than an FNP. Different focus.

My own prejudices would make me uncomfortable with having a PA as my "family doctor" while I'm very comfortable with a FNP. Assuming that both work in collaboration with a physician, of course.

Still. This is all anecdotal. I want to know what patient outcomes are.

 

[Boatswain2PA]

NP's learn all the "basics" in nursing school and during their RN career prior to going to on to an NP program. PA's have to learn everything, just walking in off the street. PA=Direct Entry NP program. And even most NP's aren't excited by the direct entry NP programs. Though, I will admit that PA's seem to be more along the line of an acute care NP rather than an FNP. Different focus.

My own prejudices would make me uncomfortable with having a PA as my "family doctor" while I'm very comfortable with a FNP. Assuming that both work in collaboration with a physician, of course.

Still. This is all anecdotal. I want to know what patient outcomes are.

NPs learn the basics of nursing in nursing school, and are exposed to a LOT during an RN career. However there is a huge difference in thought processes and required knowledge base between nursing and being a provider.

To say PA = direct entry NP program ignores the huge difference in structure and depth between the two types of programs. PA education far exceeds NP education in both didactic and experiential learning during clinical rotations. Anyone who compares the two will quickly recognize that.

There haven't been any good studies comparing patient outcomes between NPs, PAs, and MDs. There have been several studies that showed no differences, but they were very, very poorly done.

 

[762513]

NPs learn the basics of nursing in nursing school, and are exposed to a LOT during an RN career. However there is a huge difference in thought processes and required knowledge base between nursing and being a provider.

To say PA = direct entry NP program ignores the huge difference in structure and depth between the two types of programs. PA education far exceeds NP education in both didactic and experiential learning during clinical rotations. Anyone who compares the two will quickly recognize that.

There haven't been any good studies comparing patient outcomes between NPs, PAs, and MDs. There have been several studies that showed no differences, but they were very, very poorly done.

1- After my 100th or so patient intubated in the ICU and calling the physician to tell him I think there's a problem I'm pretty good on the subjective and objective signs of impending respiratory failure. I don't see a lot of 25 year old PA's getting that right.

2- Any level of evidence is better than your opinion. Like, for instance, this 2017 study representing 23,704 patient visits to 1139 practitioners in the U.S.
A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers. - PubMed - NCBI

 

[857770]

You are entitled to your opinion. I watched my wife complete her BSN. I was impressed by the medical knowledge she acquired from her top-line private school...but it did not compare with level of difficulty in my MPH.

My Bachelors degree in Physics was more hands down conceptually difficult than med school itself.

 

[Owlgal]

PA= Direct Entry NP. For those NP's who've gone the traditional route of obtaining their RN/BSN and practicing for at least a few years prior to moving on to an NP program; they have far more clinical and experiential knowledge about disease processes, abnormal labs/tests, medical procedures, terminology, pharmacology, and real-life acute medical situations than either the new PA or direct entry NP. Though, the direct entry NP does have the opportunity to work as an RN while completing their NP program (once they have their RN license), so they would be far ahead of the PA, who is receiving only structured clinical hours. We've all been through clinicals -- PAs aren't special in that.

Boatswain, I feel like saying, "Dude, just because you "watched" someone complete a degree program does not mean that you actually know what they studied or their clinical experiences. To claim that you know everything about nursing education because your spouse completed her BSN would be like saying that a doctor's husband knows everything she went through in medical school, just because they're married. It's kind of ridiculous. You'll get more credibility if you speak knowledgeably about what you *know* rather than conjecture. And the truth is, your wife is not an NP. So I'm wondering where your vast knowledge of Nurse Practitioner programs comes from? ... oh, you sat it on a biology class, once. I remember, now. Just for the record. I CLEP'd biology in college. Did not take it; not even the watered-down "nurses" version you claim they take. Of course, I've had several A&P classes, a couple micro-biology classes, 2-3 classes on body system assessments, 2-3 pathophysiology classes, 3 pharmacology classes, etc., etc. -- the point being that you have a very limited, personalized knowledge base and you seem to have a chip on your shoulder. Mix those two things together, and you start losing credibility when you make broad statements. That's all I'm saying."

 

[Boatswain2PA]

Every PA education program = 12-16 months of intense didactic broad-spectrum medical training with frequent testing, OSCEs, etc. Probably average 30 hours a week in class, plus a LOT of time studying. Then 12-16 months of intense rotations, including required rotations in surgery, FP, IM, peds, geriatrics, womens, behavioral, etc, with a minimum requirement of 2000 hours (with many completing 2500+ hours of rotations). And testing between each rotation. These programs are so intense that nobody can work full time while enrolled, and very very few students can even manage a PRN let alone part-time work schedule. Then, at the end, there is one standardized national certification exam that covers the entire breadth of medicine.

NP programs = 12 months of education, often on-line, with a heavy focus on leadership papers, nursing management theory, organizational management, with some good medical training thrown in as well, but severely lacking in comparison to any PA program. Then a required 500 hours of clinical rotations, often done at a single site, and often done just a few hours at a time. Testing at the end is variable, depending on what supposed "specialty" they are going into.

So no, in no way does any PA program equal a direct entry NP program.

Absolutely agree the best student for a PA or NP program is an experienced nurse, paramedic, or combat medic. The experience they bring to their educational path will make them FAR better providers than their less-experienced cohorts upon graduation.

I don't have a chip on my shoulder for nurses, or NPs. I just point out that NP education is not standardized, and is very weak in comparison to PA education, which is only a fraction of MD/DO education.

And so they shouldn't call themselves "doctor" in clinical settings.

 

[762513]

Every PA education program = 12-16 months of intense didactic broad-spectrum medical training with frequent testing, OSCEs, etc. Probably average 30 hours a week in class, plus a LOT of time studying. Then 12-16 months of intense rotations, including required rotations in surgery, FP, IM, peds, geriatrics, womens, behavioral, etc, with a minimum requirement of 2000 hours (with many completing 2500+ hours of rotations). And testing between each rotation. These programs are so intense that nobody can work full time while enrolled, and very very few students can even manage a PRN let alone part-time work schedule. Then, at the end, there is one standardized national certification exam that covers the entire breadth of medicine.

NP programs = 12 months of education, often on-line, with a heavy focus on leadership papers, nursing management theory, organizational management, with some good medical training thrown in as well, but severely lacking in comparison to any PA program. Then a required 500 hours of clinical rotations, often done at a single site, and often done just a few hours at a time. Testing at the end is variable, depending on what supposed "specialty" they are going into.

So no, in no way does any PA program equal a direct entry NP program.

Absolutely agree the best student for a PA or NP program is an experienced nurse, paramedic, or combat medic. The experience they bring to their educational path will make them FAR better providers than their less-experienced cohorts upon graduation.

I don't have a chip on my shoulder for nurses, or NPs. I just point out that NP education is not standardized, and is very weak in comparison to PA education, which is only a fraction of MD/DO education.

And so they shouldn't call themselves "doctor" in clinical settings.

NP is 12 months of education? You've lost credibility.

 

[pamac]

I wish I could find a 12 month NP program because I'd be done and making $150k per year starting as a PMHNP, instead of looking at almost 3 total years of NP school that I'm not through with.

These days your average PA applicant has significantly less HCE than an NP applicant. You occasionally see an RN in the PA ranks. I think paramedics are pretty rad, and have a good solid mindset to build on... Probably among the best in my opinion... But after they drop off their patient safely and alive, another phase of work begins that is more geared towards the actual work environment a physician extender PA will practice in. Combat medics that go into the villages or get off the ship to handle boat people... Ideal. Medics dealing only with issues of strapping 18-22 year olds in peak physical condition... Less than ideal because your average American patient is sporting 2 or 3 comorbidities (if they are lucky).

As for PA rotations being universally intense.... Tell that to the students hanging out in the break room studying for their exams instead of out in fast track. There's not much dictating that those clinical experiences are as intense as some say. They aren't residencies. I think they are actually a good way to train, and one of the strengths of PA education, especially since PAs were designed to be generalists, but get way overblown whenever someone brings them in to the conversation to denigrate NPs. I think an FNP would benefit from that kind of approach, but they weren't designed to be going in to surgery (unless they go back for a first assist cert), or to deliver babies (nurse midwives), or do psyche (PMHNP). We have acute care NPs, and adult gerontology NPs, and until recently, pediatric NPs, and neonatal NPs, and nurse anesthetists. PAs were designed to be blank slates so they could jump in under any type of physician and extend their reach under their supervision.

 

[Owlgal]

Every PA education program = 12-16 months of intense didactic broad-spectrum medical training with frequent testing, OSCEs, etc. Probably average 30 hours a week in class, plus a LOT of time studying. Then 12-16 months of intense rotations, including required rotations in surgery, FP, IM, peds, geriatrics, womens, behavioral, etc, with a minimum requirement of 2000 hours (with many completing 2500+ hours of rotations). And testing between each rotation. These programs are so intense that nobody can work full time while enrolled, and very very few students can even manage a PRN let alone part-time work schedule. Then, at the end, there is one standardized national certification exam that covers the entire breadth of medicine.

NP programs = 12 months of education, often on-line, with a heavy focus on leadership papers, nursing management theory, organizational management, with some good medical training thrown in as well, but severely lacking in comparison to any PA program. Then a required 500 hours of clinical rotations, often done at a single site, and often done just a few hours at a time. Testing at the end is variable, depending on what supposed "specialty" they are going into.

So no, in no way does any PA program equal a direct entry NP program.

Absolutely agree the best student for a PA or NP program is an experienced nurse, paramedic, or combat medic. The experience they bring to their educational path will make them FAR better providers than their less-experienced cohorts upon graduation.

I don't have a chip on my shoulder for nurses, or NPs. I just point out that NP education is not standardized, and is very weak in comparison to PA education, which is only a fraction of MD/DO education.

And so they shouldn't call themselves "doctor" in clinical settings.

So. Here you go, making light of the 2-3 years that NPs spend in their program. And that doesn't make mention of the previous 4 years they spent getting that good ol' BSN. You just sound ridiculous. Honestly. Do you think that NPs aren't taking tests, logging clinical hours, and didactic? You sound absurd. I have 750+ clinical hours as a requirement for my clinical hours. Let's add that to the 1000+ that I already did in my BSN -- you know, the basics that you go through in the first 1.5 years of your PA program. You want to pretend that students enter PA programs with the same information and experience that a BSN has, and that is a fallacy. It's the BSN-->NP component that you seem to miss (dismiss). You do know that nurses are healthcare professionals, right? Responsible for the vast majority of care in acute settings and the one's on the frontline, catching those changes in condition, abnormal labs, and using well honed assessment skills to save lives? That's why they make so much with a bachelor's degree. And while their role is one where they are NOT making diagnoses, they probably know far more than a spankin' new PA about medications - side effects, regimens, and quite a bit about indications. After all, they're the one's used to getting the doctor on the phone to suggest they put the patient on any number of medications on a given day. There are only so many medications that are in routine use in any care environment. You do realize that by the time a nurse gets his BSN, he's already had a couple pathophysiology classes and a couple pharmacology classes? An experienced nurse has probably done a number of things that the new PA is congratulating himself for having "learned right along-side doctors". I'm assuming that once one has learned a skill, it doesn't really matter if they were standing right beside medical students or learning on the job as a nurse. Those patients I coded as a nurse, the IVs, PICC lines, casts, splints, etc., etc., -- I've thumped on chests, watched patients die, and had end of life talks in ICUs, cancer centers, and patient's homes. And that was just with a BSN. Let's get serious. The breath and scope of training and experience that an NP is likely to bring to the table far, far exceeds that of the typical PA. No wonder PA programs need to be so stringent; they're trying to cram both the basic and advanced training into one compact package.

Even with that, a DPN is an academic degree rather than a clinical degree. I wouldn't call myself "doctor" in the clinical setting, even if I would have it on my address labels for my Christmas cards. NP's aren't physicians. And PA's certainly aren't.

 

[precisiongraphic]

Boatswain, you're just dripping with condescension. I won't comment on PA's education, as I'm not an expert on that but your NP assertions are baseless and you have no evidence (only your opinion) to back up your claims.

Boatswain-NP programs = 12 months of education
ME- not true in all cases

Boatswain - often on-line, with a heavy focus on leadership papers, nursing management theory, organizational management, -
ME -not all true. Yes all programs have a component of these but the majority of classes are clinical classes geared to the specialty.

Boatswain - with some good medical training thrown in as well, but severely lacking in comparison to any PA program.
ME - Prove to me that it's "severely lacking". This is just your opinion.

Botswain - Then a required 500 hours of clinical rotations, often done at a single site, and often done just a few hours at a time.
Me: 500 is just the minimum - some states require more, some schools require more. Some students get more because they want more.

Boatswain - Testing at the end is variable, depending on what supposed "specialty" they are going into.
ME -Again, you are dripping with sarcasm regarding NPs specialties - why? Why do you not accept NPs as mid-levels equivalent to PAs and why don't you offer any proof of lesser education/training/status?

Boatswain -I don't have a chip on my shoulder for nurses, or NPs.
ME -Yes, sorry, you do in regards to NPs.

Boatswain - I just point out that NP education is not standardized, and is very weak in comparison to PA education, which is only a fraction of MD/DO education.
ME- No, Prove NP education is weak, which you haven't done.

And so they shouldn't call themselves "doctor" in clinical settings. - Me -agreed. One thing upon which we can absolutely agree. Neither PAs nor NPs should call themselves doctors (unless it's to get a better tee time or restaurant reservation and with an appropriate doctorate, same as with English PhD holders).

 

[762513]

Boatswain, you're just dripping with condescension. I won't comment on PA's education, as I'm not an expert on that but your NP assertions are baseless and you have no evidence (only your opinion) to back up your claims.

Boatswain-NP programs = 12 months of education
ME- not true in all cases

Boatswain - often on-line, with a heavy focus on leadership papers, nursing management theory, organizational management, -
ME -not all true. Yes all programs have a component of these but the majority of classes are clinical classes geared to the specialty.

Boatswain - with some good medical training thrown in as well, but severely lacking in comparison to any PA program.
ME - Prove to me that it's "severely lacking". This is just your opinion.

Botswain - Then a required 500 hours of clinical rotations, often done at a single site, and often done just a few hours at a time.
Me: 500 is just the minimum - some states require more, some schools require more. Some students get more because they want more.

Boatswain - Testing at the end is variable, depending on what supposed "specialty" they are going into.
ME -Again, you are dripping with sarcasm regarding NPs specialties - why? Why do you not accept NPs as mid-levels equivalent to PAs and why don't you offer any proof of lesser education/training/status?

Boatswain -I don't have a chip on my shoulder for nurses, or NPs.
ME -Yes, sorry, you do in regards to NPs.

Boatswain - I just point out that NP education is not standardized, and is very weak in comparison to PA education, which is only a fraction of MD/DO education.
ME- No, Prove NP education is weak, which you haven't done.

And so they shouldn't call themselves "doctor" in clinical settings. - Me -agreed. One thing upon which we can absolutely agree. Neither PAs nor NPs should call themselves doctors (unless it's to get a better tee time or restaurant reservation and with an appropriate doctorate, same as with English PhD holders).

This guy is a troll, has been so for years. Constantly starts flame wars against TOS. No moderator will moderate him. I can provide all the proof you need if asked.

 

[precisiongraphic]

This guy is a troll, has been so for years. Constantly starts flame wars against TOS. No moderator will moderate him. I can provide all the proof you need if asked.

OK, well I guess I should give up on getting him to see both sides of the argument.

 

[W19]

@Boatswain2PA is probably saying that NP curriculum is equivalent to a 12-month thing because of all the fluffs... That might be an accurate assessment.

 

[VA Hopeful Dr]

This guy is a troll, has been so for years. Constantly starts flame wars against TOS. No moderator will moderate him. I can provide all the proof you need if asked.

If by "troll" you mean "guy passionate about his career and training"...

 

[762513]

If by "troll" you mean "guy passionate about his career and training"...

lol good one. By troll I mean constantly demeaning the nursing profession and starting flame wars with a script that never changes but never a shred of evidence.

 

[pamac]

I don't think boatswain is a troll. That would make everyone at the PA forums a troll too, because he echoes almost exactly the same line they do about NPs, with the exception that he isn't big on the PA independence movement. But many of the posters there fancy themselves as cowboys who compensate for the profession's status as physician extender by seeking out roles that make them feel independent, like backwoods ER, and the like, where the facility will take what they can get by employing a PA instead of an expensive board certified MD or DO. Many actually might be some of the more motivated and traditional among their profession that is quickly becoming an entry level career for a lot of new PAs. The competition to get into a PA program is shutting out the folks with quality, traditional, HCE.

The condescending tone and preachiness of insisting NPs "just need to be aware of how they need to work s lot harder to make up for their poor training" (he said that long ago), is typical fare. The evidence that most physicians don't place as high of regard on PAs as PAs do is lost on him too. And physicians certainly don't, which is why there is at least 88 pages of letters by physicians submitted to Washington state in opposition to allowing PAs to complete an online 12 month program to then combine with 3 years of PA experience to be allowed to call themselves "Doctor" (of medical science... whisper the last part), and operate in primary care independent of supervision. But over at the PA forums, everyone is so excited to have a chance to become "independent" and "doctors" that you'd find yourself wondering if they still think NPs are out of line for seeking independence and instituting DNPs. Lots of PAs are now looking to do just that so they can supposedly join the club. So is that new doctorate going to come with a residency and clerkships like docs have? Are we going to call the folks possessing the new terminal degree PActors like we call the DNPs Noctors? Will the year of ONLINE classes be fluff, or hard sciences? Lot of hipocracy will be laid bare in Washington state and Tennessee when PAs start rushing to latch on the bandwagon they accused DNPs of sporting. Then it's "Doctor" embroidered on their long white coats, and correcting the staff if there isn't an honorific attached to their name. Online coursework will be cool again, and the lack of independence that they went into the PA career knowing they would be stuck with will be left behind. Maybe they will want the ability to supervise their fellow masters level PAs, or even NPs... Make some money off of it...lol.

 

[Makati2008]

Way off topic again. Closing.


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