The title says it all. I was told today by a new grad ICU nurse that her preceptor (a graduating nurse practitioner) claims that the move to the DNP was in an effort to phase out PAs. Of course that's ridiculous and I stated as much but it's also infuriating and insulting to hear (especially since the other nurses there share the same view). I told her that PA education comes from a medical and not nursing background and is usually considered more rigorous than NP education. On the national average PAs make more (due to specialties) and are governed by a different board than nurses.

The new grad replied that NPs have more education due to obtaining a doctoral degree and are more widely used so it makes sense that they would be replacing PAs altogether. My main question is: how do you all (mainly asking PAs here) handle these sorts of rumors and accusations? I know I shouldn't be bothered by petty misconceptions but how can I not be annoyed at the very least when someone spews stuff like this and then defends it?

/rant over

Medical groups are still run by docs and who do you think they will hire?
A pa with an a.s. degree has twice the clinical hrs of a dnp.
sure, a dnp can open their own primary care practice but so can an np with an ms.
the dnp offers nothing except higher tuition and the ego stroking of saying you have a doctorate. as much as they would like to say it's a clinical degree it isn't. it's a management degree. basically a nursing mba.

Agreed. But for the record, I've never heard any nurses at any level say anything negative about PA's. Of course I could be living under a rock.

If anything, the DNP's will increase the interest in PA's.

Why?

Because DNP's have to spend more time and more tuition money to get their degrees, they obviously want more salary for their efforts. However, in the eyes of physicians, DNP's have no more clinical training than NP's and in most cases have even less clinical training than PA's. So why would a physician hire a DNP who costs more money but can't function any more than a PA/NP? It doesn't make sense logically or economically. It's simply cheaper and easier to hire PA/NP's than DNP's.

The conclusion you can draw from this is that the DNP's will price themselves out of the market unless they accept the same salary as PA's. If DNP's ask for more salary, interest in hriring PA's will soar.

Agreed. But for the record, I've never heard any nurses at any level say anything negative about PA's. Of course I could be living under a rock.

And, none of the NP's on this site have heard of any nurses at any level talk about demanding equal privilege and pay to physicians. And yet, we know it's happening.

The conclusion you can draw from this is that the DNP's will price themselves out of the market unless they accept the same salary as PA's. If DNP's ask for more salary, interest in hriring PA's will soar.

DNP's won't be hired by physicians. They'll be hired by nurse-run (or non-physician run, at any rate) clinics. I think, ultimately, DNP's will push PA's out because their stated goal is to take over primary care. Once physicians are out of primary care, who is going to supervise/sponsor PA's? The DNP's? :laugh:

dnp's can run their own clinics and work at minute clinics. if they want to be the quickie mart provider of choice they can have it.
most pa's work in specialties at this point something like 60:40. those jobs are run by physicians. pa's already own th midlevel specialty job market. np's are working themselves into a corner where they only do primary care and only in np run groups.
if it comes down to docs and pa's vs np's who do you think will win?

snip
DNP's won't be hired by physicians. They'll be hired by nurse-run (or non-physician run, at any rate) clinics. I think, ultimately, DNP's will push PA's out because their stated goal is to take over primary care. Once physicians are out of primary care, who is going to supervise/sponsor PA's? The DNP's? :laugh:

NPs don't want to do primary care any more than physician do for many of the same reasons. Right now Less than 30% of PAs are in primary care, 45% of NPs work in primary care (best data as of 2009). That number has gone down in the last five years. The primary reason just like for physician is money. A nurse can make more at the bedside than as a primary care NP. The hospital based NPs are usually based on the nursing salary and pay more. So no one is going to "take over" primary care until they fix the way that primary care is reimbursed. Then you will also see more physicians interested.

NPs don't want to do primary care any more than physician do for many of the same reasons. Right now Less than 30% of PAs are in primary care, 45% of NPs work in primary care (best data as of 2009). That number has gone down in the last five years. The primary reason just like for physician is money. A nurse can make more at the bedside than as a primary care NP. The hospital based NPs are usually based on the nursing salary and pay more. So no one is going to "take over" primary care until they fix the way that primary care is reimbursed. Then you will also see more physicians interested.

The whole DNP-as-PCP movement is using the PCP shortage as a catalyst for NP autonomy. The DNP movement will go where the money is, and that, as of right now, is primary care. They are legislating their way to equal power and equal pay in primary care, so that's where they will end up.


pa's already own th midlevel specialty job market. np's are working themselves into a corner where they only do primary care and only in np run groups.
if it comes down to docs and pa's vs np's who do you think will win?


And once primary care is significantly influenced by DNPs, who do you think they will refer to? Specialists who fight them, or specialists who don't?

The whole DNP-as-PCP movement is using the PCP shortage as a catalyst for NP autonomy. The DNP movement will go where the money is, and that, as of right now, is primary care. They are legislating their way to equal power and equal pay in primary care, so that's where they will end up.


You miss the point. While the DNP advocates may claim that DNPs will go into primary care the evidence suggests they won't. If a physician can't make money in primary care, why will a DNP be able to? They can make more money doing specialty care with a physician than they can with their own primary care practice. The numbers bear this out. By best estimate less than 40% of NPs will be in primary care.

And once primary care is significantly influenced by DNPs, who do you think they will refer to? Specialists who fight them, or specialists who don't?

folks generally don't have a lot of choice which er they go to in an emergency or which specialist is on call once they get to the er. physician run groups won't hire dnp's and who would go to a dnp ent, cardiology, or derm clinic for the same price as a physician/pa specialty practice? the niche for dnp's is solo primary care or minute clinics and that's about it. dnp's have no place in surgical, hospital based or specialty practices unless they join physician run groups.

You miss the point. While the DNP advocates may claim that DNPs will go into primary care the evidence suggests they won't. If a physician can't make money in primary care, why will a DNP be able to? They can make more money doing specialty care with a physician than they can with their own primary care practice. The numbers bear this out. By best estimate less than 40% of NPs will be in primary care.

Part of PP-CACA is federal funding for nurse-run clinics. The nurses will go where the money is and where the autonomy is. As of right now, that's primary care.

folks generally don't have a lot of choice which er they go to in an emergency or which specialist is on call once they get to the er. physician run groups won't hire dnp's and who would go to a dnp ent, cardiology, or derm clinic for the same price as a physician/pa specialty practice? the niche for dnp's is solo primary care or minute clinics and that's about it. dnp's have no place in surgical, hospital based or specialty practices unless they join physician run groups.

There's much more to health care than the ER... and every health care proposal for the last 20 years has emphasized that we need to get away from sending patients to the ER for primary care needs. DNP's in primary care will refer to either DNP-friendly specialty groups or to DNP-run specialty clinics.

I can easily see ENT DNP's setting up practices where they pretend they can treat nonsurgical issues... chronic ears, vertigo, sinusitis, etc... and then just refer to real doctors when they need surgery. And I'm also not convinced that the move towards RNFA's isn't going to backfire.... sooner or later, they'll decide they can do T&A's, BMT's, maybe even the simple sinus case or two.

After all, they're better than MD's because they have nursing AND "medical" training, right?

(And yes, I realize I may be sounding paranoid.... but the nursing lobby has proven itself to be an effective manipulator of legislators and the public. I will not make the mistake of underestimating them...)

You miss the point. While the DNP advocates may claim that DNPs will go into primary care the evidence suggests they won't. If a physician can't make money in primary care, why will a DNP be able to? They can make more money doing specialty care with a physician than they can with their own primary care practice. The numbers bear this out. By best estimate less than 40% of NPs will be in primary care.

CoreO, well said, as usual a breath of common sense in the midst of paranoid providers. I am guessing closer to 35% of NPs will be in primary care and that MDs will stay right where they are or even lower.

The title says it all. I was told today by a new grad ICU nurse that her preceptor (a graduating nurse practitioner) claims that the move to the DNP was in an effort to phase out PAs. Of course that's ridiculous and I stated as much but it's also infuriating and insulting to hear (especially since the other nurses there share the same view). I told her that PA education comes from a medical and not nursing background and is usually considered more rigorous than NP education. On the national average PAs make more (due to specialties) and are governed by a different board than nurses.

The new grad replied that NPs have more education due to obtaining a doctoral degree and are more widely used so it makes sense that they would be replacing PAs altogether. My main question is: how do you all (mainly asking PAs here) handle these sorts of rumors and accusations? I know I shouldn't be bothered by petty misconceptions but how can I not be annoyed at the very least when someone spews stuff like this and then defends it?

/rant over

That's hilarious. I'm a nurse and I can tell you if I had been there when she said that to you, I would have laughed in her face.

Yeah, I agree that is just bizarre. I don't get too riled up about other people's misconceptions.

I am a newly minted FNP striving to finish a DNP, and I plan to work in primary care. I just got my first job offer, 93K a year for Mon-Thurs 8:30a to 5p, no call. What's not to love about that? I may not take it, b/c I didn't feel like the practice manager and I really clicked, and I wouldn't get to work with the physician directly very much, which I feel as a new grad I really need. I never thought I'd make that much money, MSN or DNP. I am pretty pleased with my prospects butI have no plans to take over the world or primary care.

We don't see a lot of PAs in my part of the country, but I've never heard a colleague say anything negative about PAs. I've never heard a doc say anything bad about NPs either. They all seem appreciative of NPs and PAs around here and value the team approach. I'm pretty excited about being part of the team!

And, none of the NP's on this site have heard of any nurses at any level talk about demanding equal privilege and pay to physicians. And yet, we know it's happening.

DNP's won't be hired by physicians. They'll be hired by nurse-run (or non-physician run, at any rate) clinics. I think, ultimately, DNP's will push PA's out because their stated goal is to take over primary care. Once physicians are out of primary care, who is going to supervise/sponsor PA's? The DNP's? :laugh:

There's so much paranoia on this board.

My NP class did have that very discussion. The general conclusion we had was that there are many things for which NP, PA and MD care are indistinguishable. For those things, it makes little sense for the MD to bill more. For the things that NP and PAs cannot do, it does make sense that physician expertise should be rewarded. Unfortunately my class can't re-write the entire medical billing system so we decided the current system where we just make about half as much (if that) as physicians do is a fair approximation.

Nor is the DNP some sort of evil plot, and no one wants to take over anything. NPs are just people who enjoyed nursing and want to do more. We aren't the borg.

Heck, one of my preceptors right now is a PA and PAs regularly lecture and teach procedures in my program. I'll check with my program director but I don't think we're on a holy mission to destroy them.

PAs should be safe for years to come. They have solid training (no degree creep), there are no shortcuts to training (online), and they aren't trying to bite the hand that feeds.

My NP class did have that very discussion. The general conclusion we had was that there are many things for which NP, PA and MD care are indistinguishable. For those things, it makes little sense for the MD to bill more. For the things that NP and PAs cannot do, it does make sense that physician expertise should be rewarded.

It makes complete sense for the MD to bill more. Just like in every other profession in the world, the individual with more experience/skill gets paid more for their time. If you need to see a lawyer for a basic issue, the one from the top firm will charge more for their time than the lesser known lawyer even though they will likely both do the job in a similar manner.

It's basically opportunity cost.

PAs should be safe for years to come. They have solid training (no degree creep), there are no shortcuts to training (online), and they aren't trying to bite the hand that feeds.

PA's have doctorate programs cropping up already. I believe the military initiated this and it is slowly creeping into civilian universities.

PA's have doctorate programs cropping up already. I believe the military initiated this and it is slowly creeping into civilian universities.
There is ONE doctorate residency program(not entry level) for pa's in the military(done with baylor) and it requires you be on active duty. this is more about the ability to get promoted than anything else. they are competing for promotions slots with other health care providers with a doctorate so needed to level the playing field.
there is 1 civilian pa/phd program at wake forest. this is a research track degree. you must apply and be accepted to both the pa program AND a basic sciences phd program at the university then meet all the requirements for each. it is not a short cut to a doctorate, it is like an md, phd in that it is designed for folks who want to be "medical scientists".
there are a few pa/pharmd dual programs out there(like 5 or 6). also not for slackers and not a short cut in any way.

You miss the point. While the DNP advocates may claim that DNPs will go into primary care the evidence suggests they won't. If a physician can't make money in primary care, why will a DNP be able to? They can make more money doing specialty care with a physician than they can with their own primary care practice. The numbers bear this out. By best estimate less than 40% of NPs will be in primary care.

You know a heck of a lot more about this than I do, but it seems to me percentage of PA's and NP's in primary care are dropping because there are more NP's/PA's than ever and they are increasingly being used in other areas (e.g. as hospitalists), diluting the percentage of those in primary care. I would guess (and it's just a guess) that the real number of those in primary care has increased while the percentage has decreased.

I can easily see ENT DNP's setting up practices where they pretend they can treat nonsurgical issues... chronic ears, vertigo, sinusitis, etc... and then just refer to real doctors when they need surgery. And I'm also not convinced that the move towards RNFA's isn't going to backfire.... sooner or later, they'll decide they can do T&A's, BMT's, maybe even the simple sinus case or two.

Trust me I worry about this too. I am an Audiologist by training, but the pay sucks, the respect is not there, and I have more training on the ear than most people and even with data to prove it, I cannot diagnose an ear infection. Yet a CNP can diagnose it, and prescribe medication to treat it? In my personal opinion from what I've seen the majority of CNP's, DNP's, and even MD's and DO's cannot properly diagnose or treat the majority of hearing and balance issues. Many like to think they can, which is probably why I see at least 10 patients a week with BPPV who have never been sent for a balance evaluation and have been put on Antivert for years at a time! Or why I see kiddos with a documented history of 10-12 cases of otitis media a year yet they've never been referred for an otolaryngology consult or even had a basic hearing evaluation performed.

I am jumping ship from Audiology. I've already decided that, I'm just looking at my options on whether I wish to go the PA or NP route. I have more than enough pre-med requirements with a degree in Psychology and a degree in Bio Pre-med and I've worked in the biotechnology industry before heading back to grad school for Audiology. I can go either route.

What it's coming down to for me, is who is going to back me the best in terms of respect of my profession and my salary. It's been my experience that the nursing board doesn't take crap and will defend it's turf with teeth. As for doctors controlling my fate of my profession? Sorry I don't trust the MD's or DO's at all. They've already proven to my profession time and time again that MD = God and anything less knows nothing and has nothing to offer. Because of this type of attitude I'll probably end up going the NP route and it will be cheaper in education costs and there will be more jobs. The PA is not common in my rural area.

Don't get me wrong either I respect both PA's and NP's a lot. I think mid level med is the future of health care unfortunately because of social medicine being rammed down our throats. Just in my personal opinion and experience, if someone is going to get the shaft it won't be the doctors, it will be the PA's. The nursing board will fight tooth and nail to keep it's members protected.

As for the whole DNP fiasco. The nursing community should take a look at the DPT and AuD issues both physical therapy and audiology are having from going from a masters to a doctorate level degree. The pay has not changed and will not change because the reimbursement has not changed (well it has, just not for the better, it's actually decreasing!). Eventually people will stop pursuing these careers because why should you sit for 8 years to obtain a doctoral degree that pays the same as a mid level RN salary? If I had it to do all over again my Au.D. would not be hanging on my wall. My PA or CNP degree would be hanging on the wall and I'd be much happier with my pay, my treatment from other medical professionals, and my loans.

You know a heck of a lot more about this than I do, but it seems to me percentage of PA's and NP's in primary care are dropping because there are more NP's/PA's than ever and they are increasingly being used in other areas (e.g. as hospitalists), diluting the percentage of those in primary care. I would guess (and it's just a guess) that the real number of those in primary care has increased while the percentage has decreased.

Thats true. The absolute number of PAs in primary care is rising very slowly. The number of PAs in specialty medicine especially and surgery is going up very quickly. So the percentages are changing. Whats happening with NPs is much harder to figure out since there is no good data, but is seems to be doing the same thing. The number of FNPs that work in non primary care jobs is probably more than 50% (of those that work as NPs).

The point is that if people are expecting PAs and NPs to be part of the "primary care shortage" solution, they are mistaken unless the pay changes.

Trust me I worry about this too. I am an Audiologist by training, but the pay sucks, the respect is not there, and I have more training on the ear than most people and even with data to prove it, I cannot diagnose an ear infection. Yet a CNP can diagnose it, and prescribe medication to treat it? In my personal opinion from what I've seen the majority of CNP's, DNP's, and even MD's and DO's cannot properly diagnose or treat the majority of hearing and balance issues. Many like to think they can, which is probably why I see at least 10 patients a week with BPPV who have never been sent for a balance evaluation and have been put on Antivert for years at a time! Or why I see kiddos with a documented history of 10-12 cases of otitis media a year yet they've never been referred for an otolaryngology consult or even had a basic hearing evaluation performed.



If a kid has more then 3 ear infections in a year, they should go to an ENT (and all of the ones I've worked with employ audiologists).

Then again, you might be more rural than I am.

http://i73.photobucket.com/albums/i218/honeyrenea1/Gifs/tumblr_lc94a8aTee1qcxeggo1_500.gif

If a kid has more then 3 ear infections in a year, they should go to an ENT (and all of the ones I've worked with employ audiologists).

Then again, you might be more rural than I am.


I love you and I mean that in the straightest way possible

:laugh:

I am in a rural area, but even doing clinical rotations in urban areas I saw the same issues. I always love it when I meet someone who just gets it. Thank you!

I love you and I mean that in the straightest way possible

:laugh:

I am in a rural area, but even doing clinical rotations in urban areas I saw the same issues. I always love it when I meet someone who just gets it. Thank you!

I thought the 3 infections in a year (school year usually, not calendar) was pediatric standard of care... I mean, I'm not nor have I ever been at a really academic place and this is what everyone did.

As for the whole DNP fiasco. The nursing community should take a look at the DPT and AuD issues both physical therapy and audiology are having from going from a masters to a doctorate level degree. The pay has not changed and will not change because the reimbursement has not changed (well it has, just not for the better, it's actually decreasing!). Eventually people will stop pursuing these careers because why should you sit for 8 years to obtain a doctoral degree that pays the same as a mid level RN salary? If I had it to do all over again my Au.D. would not be hanging on my wall. My PA or CNP degree would be hanging on the wall and I'd be much happier with my pay, my treatment from other medical professionals, and my loans.

Let's not forget how the pharms too. That field is going down the toilet too.

When it comes down to it, it's all about economics. If the PA's are smart, they will keep it as a two year degree. I predict that as people start to realize that they don't earn any more money with a DNP over a NP or PA then PA schools will become more and more competitive. Physicians and hospitals have no interest in paying a premium for a DNP over a PA since they are seen at best equivalent. No matter what Mundinger says, DNP's are not equivalent in knowledge or clinical skills as physicians. So why spend 4 years getting a degree when you could do it in two years? It saves you a lot in years and tuition money.

The DNP is going down the same path as the pharmD, DPT, DOT (occupational therapy "doctorate"), and AuD. But don't worry, I'm not shedding a single tear for DNP's.

Just the facts as I see them when researching each profession.
Comparison PA vs. DNP vs. MD

The "doctor" of nursing practice
Total average 80 credits (unstandardized education accredited by one of two different nursing bodies)
Part time education (while a nurse works full time).
Average less than 800 hours of didactic education
Average program has 700 clinical training hours. Students set up their own clinicals (typically).
Total actual nursing credits for RN in a BSN or ASN degree is 38 credits (average) with a total of 400 hrs clinical training. In my opinion, this time does not count towards the education of a practitioner. It's very different training than that of medicine and most of it is more technical or vocational based rather than academic. NP's must pick a specific track such as pediatrics, adult healthcare, family practice, midwifery, or psych. NP's are regulated by the nursing boards in each state. Medical residencies don't exist for nursing - there is one in psych, overseen by nursing staff. My understanding is that there are a handful of nursing based residencies (1 year) Students generally sit for one of two different certification exams.
NP's want independent practice without oversight by physicians. Vs.

PA school (degree awarded is not emphasized rather competency based education is and a Masters is now required for all programs)
Accredited by ARC-PA, a subgroup of sorts of the American medical association. Average program is 140 credits in length crammed into an average 27 months.
All programs are full-time (employment is forbidden) Your time is theirs 24 hours a day.
All programs structured after medical school education
Minimum didactic hours >2000.
Minimum clinical training hours >2000 with specific objectives required in each rotation. All rotations are set up by faculty in established academic hospitals and clinical sites.
Must train in all systems of the body both didactically and clinically (Nursing picks one track and studies only the systems associated with that track from a nursing approach).
Regulated in each state by the medical boards.
Medical residency training optional (usually 1 year programs). Students must pass the PANCE overseen by the American medical association before practice.
Continuing education required (100 hours every two years).
Recertification required every 6 years in general pediatric and internal medicine.
PA's always team with physicians to provide care and share similar responsibilities.

Vs.

Medical School
All programs are standardized - not degree based, however all award a clinical doctorate degree.
Average program is 155 credits in length
Minimum didactic hours is 2300 hours
Minimum clinical training during medical school is 2500 hours (includes three elective rotations). All rotations are set up by faculty with specific objectives required for each rotation.
Must train in all systems of the body both didactically and clinically
In last year of medical school, student must match for a residency in a field they would like to work
Residency is required (minimum of 3 years for some primary care fields and as much as 7 years in some surgical specialties) Additional fellowship or research training is optional.

The point: PA's have superior training to function as a practitioner to that of a DNP.
A "doctorate" degree in nursing is not a higher degree than a PA. The content of the education is what matters, not what you call it. It's as though it's the degree that garners respect rather than the profession and education. PA's have it right!

Are we still being fooled.....as though "doctorate" (degree creep) means your more educated. It's purely political malingering.

Word from a Vanderbilt NP student today we are precepting for the next 2 months (Cardiology); supposedly in 2015 the 2 year NP program will be dropped for a 4 year "DNP" program. There will be no Masters 2 year program after 2015, only a 4 year "Doctorate" program. All current NP's will be grandfathered in. Hence, the giant influx of students within the last 2 years.

People will be deterred from the 4 year program. Period. Without increase in pay, the formula is destined to fail. And given the current decline in reimbursements....its a laughing matter.

DNP phasing out the PA. I really hope its the other way around.

DNP phasing out the PA. I really hope its the other way around.

It will never get that far. Physicians won't let it happen. We all know that PA's come out of school much better prepared to handle what the world has to offer (in regard to illness/injury).

Just the facts as I see them when researching each profession.
Comparison PA vs. DNP vs. MD

The "doctor" of nursing practice
Total average 80 credits (unstandardized education accredited by one of two different nursing bodies)
Part time education (while a nurse works full time).
Average less than 800 hours of didactic education
Average program has 700 clinical training hours. Students set up their own clinicals (typically).
Total actual nursing credits for RN in a BSN or ASN degree is 38 credits (average) with a total of 400 hrs clinical training. In my opinion, this time does not count towards the education of a practitioner. It's very different training than that of medicine and most of it is more technical or vocational based rather than academic. NP's must pick a specific track such as pediatrics, adult healthcare, family practice, midwifery, or psych. NP's are regulated by the nursing boards in each state. Medical residencies don't exist for nursing - there is one in psych, overseen by nursing staff. My understanding is that there are a handful of nursing based residencies (1 year) Students generally sit for one of two different certification exams.
NP's want independent practice without oversight by physicians. Vs.

PA school (degree awarded is not emphasized rather competency based education is and a Masters is now required for all programs)
Accredited by ARC-PA, a subgroup of sorts of the American medical association. Average program is 140 credits in length crammed into an average 27 months.
All programs are full-time (employment is forbidden) Your time is theirs 24 hours a day.
All programs structured after medical school education
Minimum didactic hours >2000.
Minimum clinical training hours >2000 with specific objectives required in each rotation. All rotations are set up by faculty in established academic hospitals and clinical sites.
Must train in all systems of the body both didactically and clinically (Nursing picks one track and studies only the systems associated with that track from a nursing approach).
Regulated in each state by the medical boards.
Medical residency training optional (usually 1 year programs). Students must pass the PANCE overseen by the American medical association before practice.
Continuing education required (100 hours every two years).
Recertification required every 6 years in general pediatric and internal medicine.
PA's always team with physicians to provide care and share similar responsibilities.

Vs.

Medical School
All programs are standardized - not degree based, however all award a clinical doctorate degree.
Average program is 155 credits in length
Minimum didactic hours is 2300 hours
Minimum clinical training during medical school is 2500 hours (includes three elective rotations). All rotations are set up by faculty with specific objectives required for each rotation.
Must train in all systems of the body both didactically and clinically
In last year of medical school, student must match for a residency in a field they would like to work
Residency is required (minimum of 3 years for some primary care fields and as much as 7 years in some surgical specialties) Additional fellowship or research training is optional.

The point: PA's have superior training to function as a practitioner to that of a DNP.
A "doctorate" degree in nursing is not a higher degree than a PA. The content of the education is what matters, not what you call it. It's as though it's the degree that garners respect rather than the profession and education. PA's have it right!

Are we still being fooled.....as though "doctorate" (degree creep) means your more educated. It's purely political malingering.

I would like to see your reference about the total average clinical time of an RN programme being 400 hours? My programme was around 900 or so and many of the programmes in my area shoot for around 700 or more. This is roughly consistent with the respiratory therapy programme clinical hours of around 700-900 and paramedic clinical hours of around 600. Again, this is in my area of the country.

With that said, I do not think clinical hours as a nurse, paramedic or otherwise counts toward anything other than said profession. Certainly, it does not count toward the ability for a mid-level provider to diagnose and manage problems IMHO, so I agree that it really does not count toward this whole nurses gone wild DNP mess. However, I am still curious to see where you obtained your statistics.

[COLOR=black][FONT=Arial]Just the facts as I see them when researching each profession.
Comparison PA vs. DNP vs. MD

The "doctor" of nursing practice
Total average 80 credits (unstandardized education accredited by one of two different nursing bodies)

Then that pretty much makes them standardized doesn't it? They teach to meet standards of one of two accreditation bodies.

Part time education (while a nurse works full time).

You're talking like this is a bad thing?


Average less than 800 hours of didactic education
Average program has 700 clinical training hours. Students set up their own clinicals (typically).

I set up my own quality clinicals, one at a Navy hospital overseas, even though my school had a list of preceptors.


Total actual nursing credits for RN in a BSN or ASN degree is 38 credits (average) with a total of 400 hrs clinical training.

I would include the total hours, 72 for the ASN and 124 for the BSN (where I taught). Otherwise you're leaving out important courses like biology, sociology, psychology which are part of nursing education.



In my opinion, this time does not count towards the education of a practitioner. My nursing school and years of experience proved valuable in my NP program. You're learning the healthcare system, dealing with patients, families, doctors, etc. I learned a lot about meds and disease processes and what many different physicians did them. My physical assessment skills improved...on and on and on....



It's very different training than that of medicine and most of it is more technical or vocational based rather than academic.

Technical or vocational...that's a trade school. You're really lacking in education, me thinks!


NP's must pick a specific track such as pediatrics, adult healthcare, family practice, midwifery, or psych.

Thank God for that. As a Psych NP I'd have loved to deal with pediatrics or birthing babies. I also wasted too much time dealing with damn pelvic exams!

Average program is 140 credits in length crammed into an average 27 months.
All programs are full-time (employment is forbidden) Your time is theirs 24 hours a day.


Do you know how much is retained in a stressful learning environment? My teacher wife says when you get a lot of information you need time to process it so it becomes part of your long-term memory. I certainly wouldn't be bragging on the "rigors" of medical education...which I understand is being look at in order to bring it up to more modern educational theories.

All programs structured after medical school education
Minimum didactic hours >2000.
Minimum clinical training hours >2000 with specific objectives required in each rotation. All rotations are set up by faculty in established academic hospitals and clinical sites.

And I've had physicians tell me they were not allowed to do much on some rotations due to malignant personalities of their residents/attendings.

Must train in all systems of the body both didactically and clinically (Nursing picks one track and studies only the systems associated with that track from a nursing approach).

You're under the impression we skipped learning about, for example, neuro?
But true that I didn't do a neuro rotation.

PA's always team with physicians to provide care and share similar responsibilities.

While it's true some of my work involves the same as a psychiatrist, I also have that nursing prospective, which in many cases results in patients asking to switch over to me. That does set up a tricky situation!



Minimum clinical training during medical school is 2500 hours (includes three elective rotations). All rotations are set up by faculty with specific objectives required for each rotation.

Np school also has specific objectives for clinical.

Just wanted to throw out a few things to think about. And I don't care to discuss it as I'm on vacation. :D

I would like to see your reference about the total average clinical time of an RN programme being 400 hours? My programme was around 900 or so and many of the programmes in my area shoot for around 700 or more. This is roughly consistent with the respiratory therapy programme clinical hours of around 700-900 and paramedic clinical hours of around 600. Again, this is in my area of the country.



True, you have to be careful here. I had a 2 hr course which required 14 actual hours of clinical per week.

Then that pretty much makes them standardized doesn't it? They teach to meet standards of one of two accreditation bodies.



You're talking like this is a bad thing?



I set up my own quality clinical, one at a Navy hospital overseas, even though my school had a list of preceptors.




I would include the total hours, 72 for the ASN and 124 for the BSN (where I taught). Otherwise you're leaving out important courses like biology, sociology, psychology which are part of nursing education.


My nursing school and years of experience proved valuable in my NP program. You're learning the healthcare system, dealing with patients, families, doctors, etc. I learned a lot about meds and disease processes and what many different physicians did them. My physical assessment skills improved...on and on and on....




Technical or vocational...that's a trade school. You're really lacking in education, me thinks!



Thank God for that. As a Psych NP I'd have loved to deal with pediatrics or birthing babies. I also wasted too much time dealing with damn pelvic exams!



Do you know how much is retained in a stressful learning environment? My teacher wife says when you get a lot of information you need time to process it so it becomes part of your long-term memory. I certainly wouldn't be bragging on the "rigors" of medical education...which I understand is being look at in order to bring it up to more modern educational theories.



And I've had physicians tell me they were not allowed to do much on some rotations due to malignant personalities of their residents/attendings.



You're under the impression we skipped learning about, for example, neuro?
But true that I didn't do a neuro rotation.


While it's true some of my work involves the same as a psychiatrist, I also have that nursing prospective, which in many cases results in patients asking to switch over to me. That does set up a tricky situation!



Np school also has specific objectives for clinical.

Just wanted to throw out a few things to think about. And I don't care to discuss it as I'm on vacation.

I would have to disagree with your teacher wife, especially a comment with regards to "modern educational theories" of which there are NONE.
My doctorate (for what that is worth) is in andragogy. (I teach PT/ATC students)

There are many things wrong with her reasoning based on my education.
And many flaws in nurse practitioner education.
As well as many other clinical programs.

A broad education is important. Clinical and didactic training in all systems of the body is very important for any practice. A 6 week rotation in surgery, peds, geriatrics, emergency medicine, ect is invaluable to the future of a family practitioner. PA school has 9 required clinical rotations (including psych). It's true for any specialty you end up in.
Training in only family practice with a small sampling in other areas of medicine......the logic from here is obvious.

I would also add that neuro in and of itself in PA school is close to 100 hours of lecture not including the neuro anatomy you get in cadaver lab. That would be 1/7th the total education of an NP. The fact is you can't get a good education in less than 700 hours of didactic education.

Perhaps you set up your own clinical and perhaps you did a good job. This does nothing to standardize the education for the masses of NP's who are practicing.

I agree that RN education is a great background before becoming a midlevel provider, but an RN who goes to PA school will be better prepared, IMO.

Lastly, if you are a purest, you would likely agree that fields such as nursing, PA, NP is vocational (or the friendlier word is professional). As an example, many RN programs exist at trade schools. They are not arts degrees, they are in fact vocational!


"I would include the total hours, 72 for the ASN and 124 for the BSN (where I taught). Otherwise you're leaving out important courses like biology, sociology, psychology which are part of nursing education-Zenman"

The core education of an RN is approx 40 credits. Clearly, earning a BS degree includes other elective and general education courses. Not all RN programs have pre-requisite courses.

The facts

DNP (including the RN) education averages <2400 hours of medical education.

PA education averages > 4000 hours (not including pre-requisite coursework

MD education is a minimum of >15000 hours for family medicine and as much as 45,000 for specialty practice.

The great facade of "doctorate" nursing degrees

Much more to say on this issue - just no time

I would have to disagree with your teacher wife, especially a comment with regards to "modern educational theories" of which there are NONE.
My doctorate (for what that is worth) is in andragogy. (I teach PT/ATC students)

There are many things wrong with her reasoning based on my education.
And many flaws in nurse practitioner education.
As well as many other clinical programs.

A broad education is important. Clinical and didactic training in all systems of the body is very important for any practice. A 6 week rotation in surgery, peds, geriatrics, emergency medicine, ect is invaluable to the future of a family practitioner. PA school has 9 required clinical rotations (including psych). It's true for any specialty you end up in.
Training in only family practice with a small sampling in other areas of medicine......the logic from here is obvious.

I would also add that neuro in and of itself in PA school is close to 100 hours of lecture not including the neuro anatomy you get in cadaver lab. That would be 1/7th the total education of an NP. The fact is you can't get a good education in less than 700 hours of didactic education.

Perhaps you set up your own clinical and perhaps you did a good job. This does nothing to standardize the education for the masses of NP's who are practicing.

I agree that RN education is a great background before becoming a midlevel provider, but an RN who goes to PA school will be better prepared, IMO.

Lastly, if you are a purest, you would likely agree that fields such as nursing, PA, NP is vocational (or the friendlier word is professional). As an example, many RN programs exist at trade schools. They are not arts degrees, they are in fact vocational!


"I would include the total hours, 72 for the ASN and 124 for the BSN (where I taught). Otherwise you're leaving out important courses like biology, sociology, psychology which are part of nursing education-Zenman"

The core education of an RN is approx 40 credits. Clearly, earning a BS degree includes other elective and general education courses. Not all RN programs have pre-requisite courses.

The facts

DNP (including the RN) education averages <2400 hours of medical education.

PA education averages > 4000 hours (not including pre-requisite coursework

MD education is a minimum of >15000 hours for family medicine and as much as 45,000 for specialty practice.

The great facade of "doctorate" nursing degrees

Much more to say on this issue - just no time

Just one of many examples:

RN curriculum (the core RN curriculum is 37 credits in length)

Nursing
GENERAL EDUCATION REQUIREMENTS
ENGL 100 English Composition 3
ENGL 115 Introduction to Literature 3
PSYC 100 Introduction to Psychology 3
PSYC 220 Developmental Psychology 3
BIOL 130 Anatomy & Physiology I 3
BIOL 131 Anatomy & Physiology I Lab 1
BIOL 135 Anatomy & Physiology II 3
BIOL 136 Anatomy and Physiology II Lab 1
BIOL 250 Microbiology with Lab 5
Fine Arts or Humanities Elective 3
Social Science Elective 3

ACADEMIC MAJOR REQUIREMENTS
NURS 100 Dosage Calculations 1
NURS 125 Nursing I 9
NURS 175 Nursing II 9
NURS 225 Nursing III 9
NURS 275 Nursing IV 9

in defense of np's( and I know I don't say that much) the dual fnp/acnp( "emergency np") curriculum at vandy looks pretty strong in terms of clinical hrs(granted it is 2 full np programs compressed together) . 1400 hrs of clinicals, which I think makes it the longest np program in the country. definitely a step in the right direction. and it's still taught at the ms level. even better. and requires a min of 2 yrs as an er nurse to enter.
http://www.nursing.vanderbilt.edu/msn/enp.html
grads of this program are also eligible to apply directly to crna school. that would be a powerful combo: crna/acnp/fnp in 4 years!

I would have to disagree with your teacher wife, especially a comment with regards to "modern educational theories" of which there are NONE.

I tend to listen to my wife, not only because she wears the panties in the family but because she has 40 yrs in special education, in both the USA and international and has worked with 50 different cultures. I can't ask her at the moment as she is asleep. (I'm awake because I'm in Thailand and my internal clock is off.

I would disagree that there is nothing new in education. As long as there is new knowledge about the brain I suspect the educational folks are all over it. I recently picked up a neuroscience book my wife was reading so I know she tries to keep up. I just did a google search and I see the term "modern educational theories" all over the place. I see there are also lot's of educational journals and I'll bet they are not putting out the same info year after year.

I was an assistant professor teaching both in ADN and BSN programs. (I've also taught Zen Shiatsu and Hapkido, both very hands-on arts) Every RN program I know of is college or university based, except for the few remaining hospital-based diploma programs...if there is still one around. You must be thinking about the licensed practical/vocational nursing programs which are "vocational" programs.

I do agree there are problems with our educational system from elementary on up. I think there needs to be another flexnor report on medical education however, I bet it will lag behind everyone else before any changes are made. I would like to see changes in NP education but I would hate for it to be a copycat of medical and PA education. Something has to make it stand apart.





Perhaps you set up your own clinical and perhaps you did a good job. This does nothing to standardize the education for the masses of NP's who are practicing.

You must be under the impression NP schools can just go off in any direction they want. I'd start one myself if that were true.

I agree that RN education is a great background before becoming a midlevel provider, but an RN who goes to PA school will be better prepared, IMO.

Better prepared to be a clone?

I have no problem with the DNP program. I guess some people do as they think the DNP's are trying to be equal to physicians. I've taken a financial DNP course as an elective and it was as challenging as one in my MBA program. I recently looked at some capstone projects of DNP students and I think your worries might be displaced. Some of these guys are in the business of running healthcare, from small innovative clinics to major institutions. IMHO, physicians, who mostly lack any business sense, are going to be blind-sided once again.

I tend to listen to my wife, not only because she wears the panties in the family but because she has 40 yrs in special education, in both the USA and international and has worked with 50 different cultures. I can't ask her at the moment as she is asleep. (I'm awake because I'm in Thailand and my internal clock is off.

I would disagree that there is nothing new in education. As long as there is new knowledge about the brain I suspect the educational folks are all over it. I recently picked up a neuroscience book my wife was reading so I know she tries to keep up. I just did a google search and I see the term "modern educational theories" all over the place. I see there are also lot's of educational journals and I'll bet they are not putting out the same info year after year.

I was an assistant professor teaching both in ADN and BSN programs. (I've also taught Zen Shiatsu and Hapkido, both very hands-on arts) Every RN program I know of is college or university based, except for the few remaining hospital-based diploma programs...if there is still one around. You must be thinking about the licensed practical/vocational nursing programs which are "vocational" programs.

I do agree there are problems with our educational system from elementary on up. I think there needs to be another flexnor report on medical education however, I bet it will lag behind everyone else before any changes are made. I would like to see changes in NP education but I would hate for it to be a copycat of medical and PA education. Something has to make it stand apart.







You must be under the impression NP schools can just go off in any direction they want. I'd start one myself if that were true.



Better prepared to be a clone?

I have no problem with the DNP program. I guess some people do as they think the DNP's are trying to be equal to physicians. I've taken a financial DNP course as an elective and it was as challenging as one in my MBA program. I recently looked at some capstone projects of DNP students and I think your worries might be displaced. Some of these guys are in the business of running healthcare, from small innovative clinics to major institutions. IMHO, physicians, who mostly lack any business sense, are going to be blind-sided once again.

Interesting

Would love to hear all about these "modern theories". What are we talking about now.....you trying to link formitive assessment in elem. edu with medical education.

Come on, Zenman

The business of nursing....great. Comparing it to MBA programs is nothing to brag about.

I don't think we can have an intellegent discussion.

My best

Just one of many examples:

RN curriculum (the core RN curriculum is 37 credits in length)

Nursing
GENERAL EDUCATION REQUIREMENTS
ENGL 100 English Composition 3
ENGL 115 Introduction to Literature 3
PSYC 100 Introduction to Psychology 3
PSYC 220 Developmental Psychology 3
BIOL 130 Anatomy & Physiology I 3
BIOL 131 Anatomy & Physiology I Lab 1
BIOL 135 Anatomy & Physiology II 3
BIOL 136 Anatomy and Physiology II Lab 1
BIOL 250 Microbiology with Lab 5
Fine Arts or Humanities Elective 3
Social Science Elective 3

ACADEMIC MAJOR REQUIREMENTS
NURS 100 Dosage Calculations 1
NURS 125 Nursing I 9
NURS 175 Nursing II 9
NURS 225 Nursing III 9
NURS 275 Nursing IV 9


I'm not a nursing student but have thought about becoming an NP before so I do have some information. A BSN degree at my school (ETSU) has 75 credit hours of actual nursing classes and takes 5 semesters. This isn't counting any pre-reqs or elective courses. The DNP program requires at least a year of experience as a BSN RN. The FNP DNP program has 83 credit hours and over a 1000 practical hours. But to be comparing the PA or DNP requirements to an MD is stupid anyways. Most MDs are specialists and shouldn't be compared to PAs or NPs who in most cases practice under an MD/DO. I see an NP myself and she is wonderful. I do believe the major problem with DNPs is that some schools are allowed to have online programs. I don't think any health care program should be allowed to be completed online. (I also think the ASN should be phased out considering most programs don't even have half the hours as a BSN, but that's for a different thread.)

Interesting

Would love to hear all about these "modern theories". What are we talking about now.....you trying to link formitive assessment in elem. edu with medical education.

Are you really trying to say that, with our increased knowledge of how the brain works, that the folks who research education and teach are just ignoring that new info? I think not. Like I said, google might be your friend.


The business of nursing....great. Comparing it to MBA programs is nothing to brag about. Interesting. I was saying that the DNP course I took was as rigorous as the one I took in business school and not a "fluff" course. I wasn't implying that it was as tough as biochem, for Christ's sake. And I think most of us know that physics majors think med school is a cakewalk, so don't get too high horse here. I'm saying you better not get blind-sided by DNP's who are running businesses and hiring you. Go talk to your hospital CEO and tell him his MBA was nothing if you think you're in charge!

I'm also glad I made it through High School before education went too far down the drain. Guess you came years after!:D


I don't think we can have an intelligent discussion. Not till you get rid of that Walkman and catch up, lol!

Thanks for the fun!

But to be comparing the PA or DNP requirements to an MD is stupid anyways. Most MDs are specialists and shouldn't be compared to PAs or NPs who in most cases practice under an MD/DO. I see an NP myself and she is wonderful. I do believe the major problem with DNPs is that some schools are allowed to have online programs. I don't think any health care program should be allowed to be completed online. (I also think the ASN should be phased out considering most programs don't even have half the hours as a BSN, but that's for a different thread.)

True, which is why I like to have fun with those who just don't get it. I do disagree with you though about distance education. Lot's of good research about it if you want to check it out. I've done both and prefer the distance, although we did meet up for physical exams and psych interviewing class.

I think the initial statement about an ARNP stating the move to doctorate degrees in order to phase out PAs is just the misrepresented view of few individuals. I can tell you most ARNPs do not feel we need to phase out PAs. I do disagree that PAs have more education because if you look at the majority of PA programs there are a variety of paths to become a PA such as associates, bachelors and masters. There is only one way to be able to sit for a national ARNP certification board and apply for a license and that is through a master's program and in 2015 a doctorate or PhD.

Again, the statement that ARNPs want to phase out PAs is the ignorant statement of a select few!

It will never get that far. Physicians won't let it happen. We all know that PA's come out of school much better prepared to handle what the world has to offer (in regard to illness/injury).

Who knows that PA's come out of school better prepared???

It's not about who comes out better prepared. I can tell you that ARNPs at least have several years of nursing already under their belt by the time they graduate from an ARNP program. PAs do not have that when they graduate. PA school is the first time they have touched or even talked to patients as opposed to the majority of ARNPs who have already had years of practicing as an RN. I know of practicing PAs who are great.

I think we need to stop wagging this war of PAs vs ARNPs and who is better. What happened to collaborative practice????

If anything, the DNP's will increase the interest in PA's.

Why?

Because DNP's have to spend more time and more tuition money to get their degrees, they obviously want more salary for their efforts. However, in the eyes of physicians, DNP's have no more clinical training than NP's and in most cases have even less clinical training than PA's. So why would a physician hire a DNP who costs more money but can't function any more than a PA/NP? It doesn't make sense logically or economically. It's simply cheaper and easier to hire PA/NP's than DNP's.

The conclusion you can draw from this is that the DNP's will price themselves out of the market unless they accept the same salary as PA's. If DNP's ask for more salary, interest in hriring PA's will soar.
.
You failed to mention that 1,000-2,000 hours that DNPs already have completed at the master's level. No one has said that DNPs have more clinical training than NPs. DNP programs are not about getting more clinical training. The Doctor of Nursing Practice (DNP) represents an important advancement in the evolution of the nursing profession. In October 2004, member institutions of the American Association of Colleges of Nursing (AACN) endorsed the Position Statement on the Practice Doctorate in Nursing, calling for moving the current level of preparation for advanced specialty nursing practice from the master’s degree level to the doctoral level by the year 2015.

The goals of the program are to prepare nursing leaders able to:

Integrate knowledge, theories, and concepts from the biophysical, psychosocial, analytical, and organization sciences to develop ethical health care systems and new frontiers for nursing practice that addresses health care disparities.
Evaluate research methods and findings to create an evidence base for nursing practice and health care delivery systems that reflect best practices and alleviate health care disparities.
Synthesize knowledge gained from traditional and innovative learning methods to lead quality, cost-effective health care collaborations addressing health care disparities.
Demonstrate expert clinical judgment and knowledge of health care systems to design, deliver and evaluate evidence-based care interventions to reduce health care disparities.
Model expert nursing practice and serve as mentors to nursing colleagues in their efforts to improve nursing practice and health care systems.
Employ knowledge of health care policy and economics to develop and evaluate programs to address health care disparities.
I think you need to look at the curriculum of DNP programs.

Who knows that PA's come out of school better prepared???

It's not about who comes out better prepared. I can tell you that ARNPs at least have several years of nursing already under their belt by the time they graduate from an ARNP program. PAs do not have that when they graduate. PA school is the first time they have touched or even talked to patients as opposed to the majority of ARNPs who have already had years of practicing as an RN. I know of practicing PAs who are great.

I think we need to stop wagging this war of PAs vs ARNPs and who is better. What happened to collaborative practice????

Physicians and Pas know we are better prepared due to being trained in the medical model unlike NPs. The war wages due to you being ignorant to my profession and making baseless comments(the first time touching patient one for example) also I would prefer a new PA-C instead of a direct entry np anyday of the week! When i graduate from med school i will only hire 1 np(that is an old schoool nurse that i know personally) and any other ones that want to work at my facility will have to find another person. Why do you think the Nps were not allowed to take part in the d.o. bridge-) variable training and cirriculums that are not as streamlined as the PA route.

Physicians and Pas know we are better prepared due to being trained in the medical model unlike NPs. The war wages due to you being ignorant to my profession and making baseless comments(the first time touching patient one for example) also I would prefer a new PA-C instead of a direct entry np anyday of the week! When i graduate from med school i will only hire 1 np(that is an old schoool nurse that i know personally) and any other ones that want to work at my facility will have to find another person. Why do you think the Nps were not allowed to take part in the d.o. bridge-) variable training and cirriculums that are not as streamlined as the PA route.

No NP wants to take part in a DO bridge. There is nothing wrong with being trained in a nursing model. Being educated under a medical model does not make the program superior. Case in point, are they any states where PAs can practice independently without physician supervision as opposed to several states that have already opted out where advance practice nurses do not need a supervising physician.

We know that there are many program entries into nursing such as associates and bachelors-no one is denying that but there are moves to make entry level nursing at only the bachelors level. However, there is only one way to become an NP and that is at the master's level and by 2015 it will be through DNP or PhD. I haven't heard of any programs for PAs at the doctorate level-case in point if you want to go that route then it's an MD or DO. NPs don't want to be doctors, junior doctors or physician extenders. NPs have their own identity through the nursing model and I am not saying PAs or NPs-one is better then the other because honestly like you I am not well versed in knowing what type of program the other profession has gone through so I try not to make judgements.

Let's just call it what it is-it's a money issue. MDs don't have a problem with PAs because they will always have to practice under a physician and their license, so there is no threat to monetary income for physicians. This is a fact that several states have already opted out of physician supervision and ARNPs and CRNAs do not need a supervising physician so it's extremely threatening to others in these states. Don't get me wrong ARNPs know when to refer and to collaborate with physicians on patient care. But when there is money involved, there is always going to be power struggles.

No NP wants to take part in a DO bridge. There is nothing wrong with being trained in a nursing model. Being educated under a medical model does not make the program superior. Case in point, are they any states where PAs can practice independently without physician supervision as opposed to several states that have already opted out where advance practice nurses do not need a supervising physician.

We know that there are many program entries into nursing such as associates and bachelors-no one is denying that but there are moves to make entry level nursing at only the bachelor’s level. However, there is only one way to become an NP and that is at the master's level and by 2015 it will be through DNP or PhD. I haven't heard of any programs for PAs at the doctorate level-case in point if you want to go that route then it's an MD or DO. NPs don't want to be doctors, junior doctors or physician extenders. NPs have their own identity through the nursing model and I am not saying PAs or NPs-one is better than the other because honestly like you I am not well versed in knowing what type of program the other profession has gone through so I try not to make judgments.

Let's just call it what it is-it's a money issue. MDs don't have a problem with PAs because they will always have to practice under a physician and their license, so there is no threat to monetary income for physicians. This is a fact that several states have already opted out of physician supervision and ARNPs and CRNAs do not need a supervising physician so it's extremely threatening to others in these states. Don't get me wrong ARNPs know when to refer and to collaborate with physicians on patient care. But when there is money involved, there is always going to be power struggles.

I'm not sure you understand education

Degree awarded does not correlate with level of education especially comparing NP and PA. The degrees awarded by nursing are a facade.
PA associates and bachelors programs must meet the same minimum standards. It's not less education (emphasis added)

Further, NP's have achieved independent practice in some states because they have lobbied for it. PA's have never once lobbied for independent practice. They seem to understand that anything less than physician education should not practice independently. PA's are devoted to patient care, not autonomy. PA's recognize their limits. Please note that NP's have the least amount of education of any provider....PERIOD!

Please note that PA programs typically require previous healthcare experience as does NP. Many RN's go to PA school.. Further, practice and training as an RN shouldn't exclude you from learning patho of disease, pharm, physiology, microbiology, A&P, ect for every SYSTEM of the body. Also note that there are many direct entry nursing programs that require no experience as there are PA programs.

Further, it is true that a nurse must complete a FA certification if they wish to 1st assist in the OR and be reimbursed. Further, you can't compare the level of autonomy of a surgical PA to that of any other surgical 1st assist. PA's may perform a significant portion of the surgery, ect... PA's also do pre-op/post op care of the patient, follow patient in clinic, ect. This is something that sets PA apart from other providers. There are NP's with FA certifications that may function at a similar level. It's also important to note that PA's have a much easier time with hospital privilege’s than NP's due to their extensive training.. Again, hospital privileges are based on the content of your education, not the degree awarded (which in the case of nursing, they inflate the degrees they award purely for political malingering).

.
You failed to mention that 1,000-2,000 hours that DNPs already have completed at the master's level. No one has said that DNPs have more clinical training than NPs. DNP programs are not about getting more clinical training. The Doctor of Nursing Practice (DNP) represents an important advancement in the evolution of the nursing profession..


WRONG - BLATENTLY WRONG

THE AVERAGE NP PROGRAM HAS ROUGHLY 700 hours of clinical training TOTAL!

DNP's HAVE THE LEAST AMOUNT OF TRAINING OF ANY HEALTHCARE PROFESSIONAL.

RN and NP training combined = total of 2200-2400 hours (AVERAGE)

just a couple comments on the doctorate issue for pa's.
pa's can continue in their education and get health related doctorates other than md/do.
there are 2 DHSC programs for pa's(nova southeastern and ATSU).
there is also a pa/phd program at wake forest.
there are 5-6 pa/pharmd joint programs.
there is a DHSC pa em residency through the army and baylor.

Word from a Vanderbilt NP student today we are precepting for the next 2 months (Cardiology); supposedly in 2015 the 2 year NP program will be dropped for a 4 year "DNP" program. There will be no Masters 2 year program after 2015, only a 4 year "Doctorate" program. All current NP's will be grandfathered in. Hence, the giant influx of students within the last 2 years.

People will be deterred from the 4 year program. Period. Without increase in pay, the formula is destined to fail. And given the current decline in reimbursements....its a laughing matter.

I have to agree with you. The only reason I have looked at a DNP program is because I teach nursing and if I want tenure I need a doctoral degree. However as a practicing FNP (I work part time in a physician owned urgent care/Family Practice clinic that employs 1 fulltime FNP and another part time PA, its really a great environment), getting a DNP will not change what I do in primary care. Here in New Mexico, NP's have independent practice, the DNP will not change anything as far as actual clinical practice.
So why should I spend $10,000 (that's the cheapest DNP I found) and 2-4 years with some questionable courses? "Those pushing the DNP keep trying to tell me it will "improve my practice and make me more independent". Try telling them good clinician know their limits and when to consult the doc or refer to the specialist. Really, during the winter I see 3-4 patients an hour with a variety or illnesses. Most of those pushing the DNP (Academia) do not understand what clinics like the one I work in focus on and the types of patients we see. Working with this particular doctor, I know my NP education is nowhere at the level of a physician, that's with 34 years nursing experience including ER as an RN. Every day I work I learn something new, especially reviewing labs.
The university I teach at is starting a DNP program. It requires fulltime enrollment (12 credits at grad level) plus "residency hours". It's going to be tough to work even 20 hours per week and do this program that takes 4 semesters to complete. They were hoping to get 12 students for the first cohort but did not. It doesn't make sense. They are also starting a BSN to DNP that is 3 years full time (12 credits) plus the "residency hours."Also, they did not get the 10-12 students they were hoping for. Oh yeah, when I asked what the residency hours would entail, the students go spend time at a clinic with a practicing MD/DO or NP like me!!! Ironic??

Oh yeah, when I asked what the residency hours would entail, the students go spend time at a clinic with a practicing MD/DO or NP like me!!! Ironic??

The entire DNP idea is ironic. Even though the ACCN has called for the DNP to be the entry-to-practice degree for advanced practice nursing by 2015, there is no legal requirement of any type for this to happen as far states' requirements for nursing practice are concerned.

Many schools have transitioned to the DNP only degree, others will offer both MSN and DNP degrees, and others will not offer a DNP, choosing to remain MSN-based. Therefore, there will ultimately be a two-tiered process for becoming a NP in the future - just like with RN's (ASN or BSN).

For a practicing NP like SailorNurse, what is the reason to seriously consider a DNP? To do what? Teach? Be tenured in a college of nursing? OK, perhaps. But for clinical practice? The DNP is entirely unnecessary.

For a practicing NP like SailorNurse, what is the reason to seriously consider a DNP? To do what? Teach? Be tenured in a college of nursing? OK, perhaps. But for clinical practice? The DNP is entirely unnecessary.

There are Nursing Ph.Ds for that. Of course, these probably require more rigorous classes and research, so I can see why people don't want to go that route. :rolleyes:

There are Nursing Ph.Ds for that. Of course, these probably require more rigorous classes and research, so I can see why people don't want to go that route. :rolleyes:

I should have been more specific. Of course there are nursing PhD's - they've been around forever. And the goal of obtaining a PhD in nursing has typically been the same as for any other PhD, to do research in your area of interest.

For nursing schools offering a DNP, the clinical faculty that have generally consisted of MSN-level instructors are now being required to have a DNP or PhD in order to remain on faculty. The DNP takes less time to obtain than a PhD, so most current MSN instructors will go for the DNP if they want to continue teaching.

My point is that the entire process of having to get a DNP is superfluous, contextually speaking. If your institution now requires this and you want to keep your job, then you could argue from a practical standpoint, it might make sense. But academic nursing pays so poorly anyway, who would want to do it?

My point is that the entire process of having to get a DNP is superfluous, contextually speaking. If your institution now requires this and you want to keep your job, then you could argue from a practical standpoint, it might make sense. But academic nursing pays so poorly anyway, who would want to do it?

I think the Ph.D. would offer more opportunities outside of teaching in a nursing program. I'd have a hard time taking courses that were superfluous, though maybe others wouldn't care as much.

...But academic nursing pays so poorly anyway, who would want to do it?

I would, and do...Summers off with my kiddos, home for dinner, and no toxic hospital drama...

After 20 years at the bedside, I am done...Teaching is the way for me!

I got married and had kids later in my career/life, so it's a no brainer...I missed too much of the important stuff when my kids were toddlers, so now, (they are 9 and 12) I am always around, and have the same schedule they do (plus Fridays off!!)

And I am no more hungry now -making half of what I was before...And my bank account balance is the same-We spend (and live) smarter, and I have all the toys I need, from the previous nursing salary (Then - I was making low six figures as a mid-level house manager, shift work, three 12s, plus meetings/committees)

Now I work eight months a year, four days a week...

Doing that math was the easiest decision for me and my family (and my well-being...waaaay too much drama in the hospital, from patients at al)

There are Nursing Ph.Ds for that. Of course, these probably require more rigorous classes and research, so I can see why people don't want to go that route. :rolleyes:

Get a PhD nurse into a private conversation about the DNP concept, and you'll hear all this and more.

...unless it is a school administrator (dean, program coordinator, etc) then there is a more enthusiastic response, directly related to the $$$ that a DNP program can bring in to a nursing program.

It's the MSN-prepared NPs who are going to be getting the shaft on this one, and relatively few have been sympathetic to my warnings. Maybe (probably) not by 2015, but it's coming.

RDIv,

What will happen to MSN prepared NPs? They have a degree from an accredited institution stating that they are NPs. Are hospitals going to suddenly do without MSN NPs?

RDIv,

What will happen to MSN prepared NPs? They have a degree from an accredited institution stating that they are NPs. Are hospitals going to suddenly do without MSN NPs?
they will be grandfathered just like the np's who still practice with a bs after the "standard" went to an ms. they may have billing issues with medicare, etc but will still have state licenses.
do a google search for " bs nurse practitioner" and you will get multiple hits for practicing np's who do not have an ms.

they will be grandfathered just like the np's who still practice with a bs after the "standard" went to an ms. they may have billing issues with medicare, etc but will still have state licenses.
do a google search for " bs nurse practitioner" and you will get multiple hits for practicing np's who do not have an ms.

I ask because of a situation that I heard a while back. There is a BSN RN working in a local elementary school that will have to leave because the position now requires a masters and they are not being grandfathered.

I ask because of a situation that I heard a while back. There is a BSN RN working in a local elementary school that will have to leave because the position now requires a masters and they are not being grandfathered.

This is an employer-based decision and has nothing to do with the law or being 'grandfathered.' Grandfathering refers to a legal occurrence whereby once there is a change in state law, those practicing under prior regulations are excused from the new requirements and can still continue to practice under the new state law.

Grandfathering only occurs once a state has amended it's practice act; unless this happens, there is nothing to grandfather because nothing has changed from a legal standpoint. So, even if every nursing school in a state has gone to the DNP and no longer offers the MSN, if the state hasn't changed its practice act, then absolutely nothing is different. If a state should change its practice act to require the DNP, then the MSN NPs will be grandfathered in and can continue to practice.

For the DNP to be a universal requirement, this process will have to happen in each of the 50 states. I' m not holding my breath.

I ask because of a situation that I heard a while back. There is a BSN RN working in a local elementary school that will have to leave because the position now requires a masters and they are not being grandfathered.

that's an individual facility, not a state reqirement.

For the DNP to be a universal requirement, this process will have to happen in each of the 50 states. I' m not holding my breath.

All that needs to happen, in a state with a requirement for certification for an NP to practice, is for the certification provider to change to only offering the certification to DNPs.

I don't claim to have any inside information, I'm just offering up the possibility. But I do know that the DNPs are hot for certification requirements at the state level. My understanding is that all but a few states have passed this requirement. I'll be interested to see what the certification bodies will be doing over the next few years.

All that needs to happen, in a state with a requirement for certification for an NP to practice, is for the certification provider to change to only offering the certification to DNPs.

I don't claim to have any inside information, I'm just offering up the possibility. But I do know that the DNPs are hot for certification requirements at the state level. My understanding is that all but a few states have passed this requirement. I'll be interested to see what the certification bodies will be doing over the next few years.

This is correct - to an extent. There are multiple accrediting bodies for NPs, not just one. Accrediting bodies generate a substantial amount of their revenue through the board certification process. They have no intrinsically vested interest to change to support only the DNP as the minimal educational standard.

The title says it all. I was told today by a new grad ICU nurse that her preceptor (a graduating nurse practitioner) claims that the move to the DNP was in an effort to phase out PAs. Of course that's ridiculous and I stated as much but it's also infuriating and insulting to hear (especially since the other nurses there share the same view). I told her that PA education comes from a medical and not nursing background and is usually considered more rigorous than NP education. On the national average PAs make more (due to specialties) and are governed by a different board than nurses.

The new grad replied that NPs have more education due to obtaining a doctoral degree and are more widely used so it makes sense that they would be replacing PAs altogether. My main question is: how do you all (mainly asking PAs here) handle these sorts of rumors and accusations? I know I shouldn't be bothered by petty misconceptions but how can I not be annoyed at the very least when someone spews stuff like this and then defends it?

/rant over

In her dreams. I have not seen this in clinical practice at all. PA's are more flexible and trained in various specialties, while NP's may have a wealth of experience to contribute. In my hospital we use both NP's and PA's, but there are far more PA's here than NP's despite a local NP program with a lot of nurses enrolled and a strong nursing union. They are all excellent and the nurses and doctors really enjoy working with them. Each facility or MD who is looking for a midlevel provider will make the choice on who to hire, most likely based on how comfortable they feel with that individual and how they perform. It is not going to happen that when DNP's start turning out that PA schools are going to close or something. That will never happen, and it shouldn't.

I've seen the training of both, more so with PA's, and have worked with both, too.

I intend to open my own practice.

Should I feel the need to hire a midlevel in the future it will only be a PA due to their superior training.

I believe the move to a DNP will only hurt their field.

PAs should be safe for years to come. They have solid training (no degree creep), there are no shortcuts to training (online), and they aren't trying to bite the hand that feeds.

no doubt...we do not, and can not, exist without physicians. i'm confident in my abilities, but i know my place and limitations.

Ya, you all seem like *******s to me. Not once, did any of you mention patient care. It is sad that today, health care to you, has become a challenge in the clear division among who took the most clinical hours and “since they are in doctorate school, they just want to prove more”. It’s ****ing pathetic. Instead of spending your free time researching clinical hours spent by the DNP and PA, hey why not research how Haiti still has over half a million people living in tents? How can you help the pandemic of cholera in Haiti? No your right, I’ll sit here and look up reasons why a higher education is better. I respect anyone that wants to further their education and skills. Shouldn't you? In reality, you all suck and everyone knows that success through interdisciplinary teams, requires the upmost respect and equality for EVERYONE you work with, thus providing the highest patient outcome. So shut the **** up and remember why you became a doctor,NP, DNP, PA, RN, ****ing intern, or nurses aid. My leadership skills are speaking to my spirit, saying you all may lack focus and especially desire? Oh and I hope I see none of you on my floor.

Ya, you all seem like *******s to me. Not once, did any of you mention patient care. It is sad that today, health care to you, has become a challenge in the clear division among who took the most clinical hours and “since they are in doctorate school, they just want to prove more”. It’s ****ing pathetic. Instead of spending your free time researching clinical hours spent by the DNP and PA, hey why not research how Haiti still has over half a million people living in tents? How can you help the pandemic of cholera in Haiti? No your right, I’ll sit here and look up reasons why a higher education is better. I respect anyone that wants to further their education and skills. Shouldn't you? In reality, you all suck and everyone knows that success through interdisciplinary teams, requires the upmost respect and equality for EVERYONE you work with, thus providing the highest patient outcome. So shut the **** up and remember why you became a doctor,NP, DNP, PA, RN, ****ing intern, or nurses aid. My leadership skills are speaking to my spirit, saying you all may lack focus and especially desire? Oh and I hope I see none of you on my floor.

Ya, you all seem like *******s to me. Not once, did any of you mention patient care. It is sad that today, health care to you, has become a challenge in the clear division among who took the most clinical hours and “since they are in doctorate school, they just want to prove more”. It’s ****ing pathetic. Instead of spending your free time researching clinical hours spent by the DNP and PA, hey why not research how Haiti still has over half a million people living in tents? How can you help the pandemic of cholera in Haiti? No your right, I’ll sit here and look up reasons why a higher education is better. I respect anyone that wants to further their education and skills. Shouldn't you? In reality, you all suck and everyone knows that success through interdisciplinary teams, requires the upmost respect and equality for EVERYONE you work with, thus providing the highest patient outcome. So shut the **** up and remember why you became a doctor,NP, DNP, PA, RN, ****ing intern, or nurses aid. My leadership skills are speaking to my spirit, saying you all may lack focus and especially desire? Oh and I hope I see none of you on my floor.

Equality is the main reason why some are against the DNP programs as the "doctorate" label looks to be used loosely by the nursing programs. The fact of the matter is that the entire doctorate program didactics pales in comparison to a masters (PA) program in a medical school. For the type of duties the NP provides, the DNP fullfills no more of that same job description as a NP. So it at its very core is clearly a "nametag" debate.

The problem i personally see is that the quality of research and field study of students coming out of NP programs versus students out of PA programs is drastically different, yet for some reason NP are given more autonomy/ privledge than a PA. The title the DNP comes out of school with is just not correct. I would rather see it kept at NP P.h.D frankly. Its misleading to patients. It forms a false sense of trust. When people come to my clinic, they want to see the Doctor, not the NP. Its a trust thing.....

Ya, you all seem like *******s to me. Not once, did any of you mention patient care. It is sad that today, health care to you, has become a challenge in the clear division among who took the most clinical hours and “since they are in doctorate school, they just want to prove more”. It’s ****ing pathetic. Instead of spending your free time researching clinical hours spent by the DNP and PA, hey why not research how Haiti still has over half a million people living in tents? How can you help the pandemic of cholera in Haiti? No your right, I’ll sit here and look up reasons why a higher education is better. I respect anyone that wants to further their education and skills. Shouldn't you? In reality, you all suck and everyone knows that success through interdisciplinary teams, requires the upmost respect and equality for EVERYONE you work with, thus providing the highest patient outcome. So shut the **** up and remember why you became a doctor,NP, DNP, PA, RN, ****ing intern, or nurses aid. My leadership skills are speaking to my spirit, saying you all may lack focus and especially desire? Oh and I hope I see none of you on my floor.

Utmost, for future reference. Please have your leadership skills convey that to your spirit.

hey why not research how Haiti still has over half a million people living in tents? How can you help the pandemic of cholera in Haiti?
don't know how much of your rant was directed at me but I have made 4 trips to Haiti since 2009 including the week after the earthquake and last june to staff a cholera treatment center. I am going back again this summer and am working on a doctorate in health science with a global health emphasis. I will be doing my field research in Haiti on the post earthquake recovery process.
How many times have you been to Haiti?

don't know how much of your rant was directed at me but I have made 4 trips to Haiti since 2009 including the week after the earthquake and last june to staff a cholera treatment center. I am going back again this summer and am working on a doctorate in health science with a global health emphasis. I will be doing my field research in Haiti on the post earthquake recovery process.
How many times have you been to Haiti?

The mods need to do what they do best and ban summer good sir.

Utmost, for future reference. Please have your leadership skills convey that to your spirit.
:laugh:

I guess I just got caught up on the low hanging fruit.

Ya, you all seem like *******s to me. Not once, did any of you mention patient care.

Advocating for higher standards is about patient care. It is about ensuring that patients receive high-quality care.

It’s ****ing pathetic. Instead of spending your free time researching clinical hours spent by the DNP and PA, hey why not research how Haiti still has over half a million people living in tents? How can you help the pandemic of cholera in Haiti?

You are assuming that people don't...help? Really? Or that people don't give some of their time for free? I am sure everyone here has examples...I have been a disaster response volunteer for countless hurricanes, house fires, etc. Also...why does it have to be international? Are people right here in the USA not worthy enough for help?

No your right, I’ll sit here and look up reasons why a higher education is better. I respect anyone that wants to further their education and skills. Shouldn't you?

You're.....

I think most people here support a person's desire to further their education, but the DNP is CLEARLY politically motivated and NOT about enhancing patient care. If people just cared about gaining advanced skills....why not just take CMEs? Why is there a need to award a degree? If you are SERIOUS about gaining advanced skills....do a fellowship. If you want to do research...get an MS or Ph.D. from an established program. If you want to work in the administration....get an MPH or MPA.

In reality, you all suck and everyone knows that success through interdisciplinary teams, requires the upmost respect and equality for EVERYONE you work with....

...and there it is, the real crux of the issue. You want everyone to be treated with respect? So do I! You want equality for everyone? Yet another "you do XYZ, we do XYZ! You do ABC, we do ABC! You are called doctor, we should be called doctor!" If you put in the same amount of time as other real doctorates, maybe you will be treated equally.

I constantly attend CME talks, seminars, take classes, conduct research studies, work on teams to track patient outcomes, and a host of other things that are included in the typical DNP program...where is my DNP-like degree?

My last post in this thread was 11 months ago. I didn't take that job, btw. I got a better one which I love, love, LOVE. I still haven't ever heard anyone say a bad word about PAs or NPs or DNPs. Where do you all live that there is all this bad blood?

And I'm still pluggin away at the DNP. I'd really like to know where all these schools are where you can finish in 8 weeks or whatever the most hyperbolic current rumor is. My anticipated graduation date is December 2013, making it 9 semesters. In all fairness, I could have done it in 7, and that was the original matriculation plan, but I was invited to do a one yearfellowship* :ninja: in a specialty area, which slows me down a bit. I have no intention of practicing in this specialty area full time, but we see enough of it in primary care that I'd like to be better working with those patients, and I was flattered to have been invited, so what the heck. I'll sleep when I'm dead, right?

I still love my DNP program and have no regrets about pursuing it. I find the course work interesting, and the additional clinical experience is providing me a lot of opportunity I would not have had otherwise. I've been able to network with a lot of internal medicine and specialty physicians all over the city, which has been a great boon to my referrals. They know me now and know what my project is, so they are sending me every patient that they think might qualify, lol. I've been in practice less than 6 months and my panel is full. I've used the DNP clinical hours to get extra training in things that I only got to do a few times as a student: arthrocentesis, intra-articular injections and colposcopy so far, and am looking for additional learning opportunities. That is what it is all about, after all! I feel weak sometimes in working with patients taking a lot of anti-psychotics. I have a lot of guys just out of prison, and I can't get them into mental health in a timely manner. It seems like they are possibly a tad over medicated in prison, but I am so unsure about messing with that cocktail. Point being that some time with an expert in that realm is next up on my list. What say you Zenman? :help:

I guess those that are of the mind can snicker all you like. I'm gaining knowledge and insight and learning skills and enjoying the hell out of myself, so I get the last laugh. I'm heading out to observe Mohs surgeries all day tomorrow, though no, I won't be doing them in my little clinic. Hopefully I'll learn a little more about recognizing skin cancers and getting them treated by the REAL dermatologist sooner. That is the plan, nothing nefarious. It really is about me being a better provider and my patients having better outcomes.

*I know you guys freak out that they call it that, but I can't help what they call it and I can't go around making up new words for stuff. I guess I could rephrase and say I am doing one year of intensive study and clinical training in a specialty area.

My point is, I can say with assurance that I am not driving any PAs out of practice! I don't have any bones to pick with PAs, physicians or other NPs. I'm just over here in my corner of the world trying to learn as much as I can and do my best. I'll keep at it until I know everything there is to know about everything and am the smartest, most awesome DNP in the whole wide world. Or until I'm dead, or senile, whichever comes first.

Sounds like a good program chilly, best of luck.
I am currently pursuing an academic doctorate due to an interest in global health and disparities in health care delivery. I may do a clinical pa residency in the future. I have a tentative offer to join the faculty of a new pa em residency program. they would bring me on at a regular salary and I would do all the off service rotations then work full time with the em pa residents in the main er. seriously considering it.

I like it. I think it's been a good choice for me. I suspect, that as with most things, you get out what you put in. There will always be those who want to skate by and do the minimum, I can't help that. I've always agreed the bar ought to be set a bit higher to account for the underachievers, lol.

My point stands however, that DNPs and those of striving to become DNPs aren't trying to push anyone else out. The whole unfortunate thread began due to the ignorant comments of one person, who isn't even an NP, much less a DNP.

I like it. I think it's been a good choice for me. I suspect, that as with most things, you get out what you put in. There will always be those who want to skate by and do the minimum, I can't help that. I've always agreed the bar ought to be set a bit higher to account for the underachievers, lol.

My point stands however, that DNPs and those of striving to become DNPs aren't trying to push anyone else out. The whole unfortunate thread began due to the ignorant comments of one person, who isn't even an NP, much less a DNP.

wondering why you think making intelligent statements without being nasty to others would actually be tolerated within the context of this thread?

*I know you guys freak out that they call it that, but I can't help what they call it and I can't go around making up new words for stuff. I guess I could rephrase and say I am doing one year of intensive study and clinical training in a specialty area.

....like a Ph.D. (Doctorate of Philosophy, a broad spectrum liberal arts doctorate).

My point is, I can say with assurance that I am not driving any PAs out of practice! I don't have any bones to pick with PAs, physicians or other NPs. I'm just over here in my corner of the world trying to learn as much as I can and do my best. I'll keep at it until I know everything there is to know about everything and am the smartest, most awesome DNP in the whole wide world. Or until I'm dead, or senile, whichever comes first.

:thumbup:

I like it. I think it's been a good choice for me. I suspect, that as with most things, you get out what you put in. There will always be those who want to skate by and do the minimum, I can't help that. I've always agreed the bar ought to be set a bit higher to account for the underachievers, lol.

My point stands however, that DNPs and those of striving to become DNPs aren't trying to push anyone else out. The whole unfortunate thread began due to the ignorant comments of one person, who isn't even an NP, much less a DNP.

I sometimes have to check myself, and make sure I emphasize that my opposition is purely towards the DNP as entry-to-practice for NPs. I have no desire to denigrate the degree or those who pursue it. Good on you for enjoying your program and getting value out of it.

I have no problem with the DNP as a non-PhD doctoral option for nurses. But I plan on vigorously opposing the DNP-as-entry-to-practice, focusing on my State level but nationally as needed.

There's a school around here that has ABSN, ELMSN, and DNP programs and are considering combining their programs to offer what is the equivalent of an Accelerated ELMSN / DNP (18 months) for those with a masters in other professions (they're flooded with demand from other professions - law, engineering, business).

It follows the same model as the ABSN 12 month program for those with a previous non-healthcare degree, but is 6 months longer.

The concern seems to be that many candidates will continue choosing the ABSN 12m program because it costs less and is shorter with the same / similar compensation potential.

That would be pretty cool if it came to pass. I'd certainly go for it - 18 months and collect all the alphabet soup :D

I feel weak sometimes in working with patients taking a lot of anti-psychotics. I have a lot of guys just out of prison, and I can't get them into mental health in a timely manner. It seems like they are possibly a tad over medicated in prison, but I am so unsure about messing with that cocktail. Point being that some time with an expert in that realm is next up on my list. What say you Zenman? :help:



Sometimes they are over medicated in the guise of "population control." Sometimes that's good; sometimes not. Prison today is becoming the new mental health clinics and in some places prisoners get better mental health care than the outside poor population.

I'd get Stahl's Illustrated Antipsychotics: Treating Psychosis, Mania, and Depression as well as Psychiatry Essentials for Primary Care. Take them off as much meds as possible. Most probably need the older cheaper stuff which is probably what they were getting in prison.

Sometimes they are over medicated in the guise of "population control." Sometimes that's good; sometimes not. Prison today is becoming the new mental health clinics and in some places prisoners get better mental health care than the outside poor population.

I'd get Stahl's Illustrated Antipsychotics: Treating Psychosis, Mania, and Depression as well as Psychiatry Essentials for Primary Care. Take them off as much meds as possible. Most probably need the older cheaper stuff which is probably what they were getting in prison.

Yes, I think population control sums it up. I saw a guy a few weeks ago who seemed as gentle as a ***** cat. He was in his late 50s and had been locked up since 20. He had dismembered quite a few people back in the day. He said the voices still talked to him, but they weren't telling him to hurt anyone anymore, they just tell him he is "stupid and ugly." He broke my heart, but I don't want to see him off his meds. He could be quite dangerous I guess. The state gave him 30 days in a halfway house but he's on the street now. He gets his meds for free from the coalition for the homeless. He said they make him sleep all the time, which was fine when he was in prison, but he has no where to lay down now and he just wanders around the city in a daze.
Please, tell me what on earth a primary care FNP -less than a year out of school- is supposed to do for this guy?
What I did do for him was spend two hours on the phone calling every psych NP in town literally begging until I found one that would see him, and then he no showed. It was probably too many bus transfers, etc. :( I may never see him again, but there will be others.
I'll get the reference book, thanks.

Yes, I think population control sums it up. I saw a guy a few weeks ago who seemed as gentle as a ***** cat. He was in his late 50s and had been locked up since 20. He had dismembered quite a few people back in the day. He said the voices still talked to him, but they weren't telling him to hurt anyone anymore, they just tell him he is "stupid and ugly." He broke my heart, but I don't want to see him off his meds. He could be quite dangerous I guess. The state gave him 30 days in a halfway house but he's on the street now. He gets his meds for free from the coalition for the homeless. He said they make him sleep all the time, which was fine when he was in prison, but he has no where to lay down now and he just wanders around the city in a daze.
Please, tell me what on earth a primary care FNP -less than a year out of school- is supposed to do for this guy?
What I did do for him was spend two hours on the phone calling every psych NP in town literally begging until I found one that would see him, and then he no showed. It was probably too many bus transfers, etc. :( I may never see him again, but there will be others.
I'll get the reference book, thanks.

Not to sound like a jerk but this is a perfect case where expert consultation(your supervising Physicians) should have been handed care. No questions asked. Too many medical pitfalls I could see coming form this guy.....and if th docs refused to at least help you with this problem then no comment.....

I do agree he needed an expert, which is why I went to great lengths to get him seen by one.
I don't have supervising physicians.

I do agree he needed an expert, which is why I went to great lengths to get him seen by one.
I don't have supervising physicians.

Smh. Further proving my point on why ALL MLP's need one(I am a PA fyi). Did you at least ask the help of the Physicians you work with or for?
PS-Pysch NPs are not expert consultation in my opinion it should be Physician first then NP/PA in this case but oh well.

Smh. Further proving my point on why ALL MLP's need one(I am a PA fyi). Did you at least ask the help of the Physicians you work with or for?
PS-Pysch NPs are not expert consultation in my opinion it should be Physician first then NP/PA in this case but oh well.

What point are you proving? I think she did what was appropriate since she is primary care and she linked him up with psych. If he's been in prison he's likely to have better physical and mental healthcare than many in the community so should just need tweaking. He probably doesn't have the means to afford any meds but the older ones that are typically used in prison...and are mostly as effective as new expensive ones. In my role as Psych NP it's me first, then any consultation if I feel I need it. My med director expects me to know what I'm doing and not to wear her out "bothering" her. Just saying. In my new job I have run into 2 PAs; one who said she didn't know what to do for a psych patient admitted for medical problems and another one who wrote orders to transfer a depressed patient (with medical problems) to the psych unit. I helped both and explained why every depressed patient doesn't need to go to a psych unit. Cancelled that order btw.

What point are you proving? I think she did what was appropriate since she is primary care and she linked him up with psych. If he's been in prison he's likely to have better physical and mental healthcare than many in the community so should just need tweaking. He probably doesn't have the means to afford any meds but the older ones that are typically used in prison...and are mostly as effective as new expensive ones. In my role as Psych NP it's me first, then any consultation if I feel I need it. My med director expects me to know what I'm doing and not to wear her out "bothering" her. Just saying. In my new job I have run into 2 PAs; one who said she didn't know what to do for a psych patient admitted for medical problems and another one who wrote orders to transfer a depressed patient (with medical problems) to the psych unit. I helped both and explained why every depressed patient doesn't need to go to a psych unit. Cancelled that order btw.

1.)Just stating we as MLPs need supervision(and for a story about something a NP did to show you both professions has it weaklings-> A NP tried to give someone in my family Medrol Dose Pak for gastritis smh. Luckily that person was smart enough to throw away the rx and get treated for H. Pylori by a Physician lol. Or one I know that literally couldn't treat CHF or do admit orders and said NP's aren't trained enough for that)
2.)With his history(if she really meant he was so violent as she said) if I was a Physician that had any responsibility for her I would want to know about his care at least? What if for some unknown reason he decided to go off and have another violent episode right after leaving the clinic both her and the Doc take the hit on that one.

Again just trying to say that ALL nonphysician providers need some sort of oversight.

2.)With his history(if she really meant he was so violent as she said) if I was a Physician that had any responsibility for her I would want to know about his care at least? What if for some unknown reason he decided to go off and have another violent episode right after leaving the clinic both her and the Doc take the hit on that one.

Again just trying to say that ALL nonphysician providers need some sort of oversight.

Just want to clarify, that I didn't ever say any such thing. I said he had been violent in the distant past, and I implied concern that the potential may still exist.

And further, again, that no physician (or any other person) has any responsibility for me whatsoever. I understand clearly that you do not think that is the way it ought to be. However, it is the way it is.

To your question, did I approach my physician colleagues for advice about how to deal with this patient? The answer is no, I didn't have to. I know full well any one of them would have said "I'd refer him to psych." The referral was appropriate. It is just a pity that he did not keep his appointment.

did I approach my physician colleagues for advice about how to deal with this patient? The answer is no, I didn't have to. I know full well any one of them would have said "I'd refer him to psych." The referral was appropriate. It is just a pity that he did not keep his appointment.

Actually, you said you referred him to a psych NP, not a psychiatrist. You said that you called "every psych NP in town." You never mentioned trying to refer him to a psychiatrist (e.g, MD/DO).

Sounds like we have the makings of a double standard of care here. See an NP for one thing, see an NP for everything. Not exactly the ideal collaborative model.

Quote:
Originally Posted by ChillyRN http://dkmg2azsloi0e.cloudfront.net/images/buttons/viewpost.gif (http://forums.studentdoctor.net/showthread.php?p=12116955#post12116955)
did I approach my physician colleagues for advice about how to deal with this patient? The answer is no, I didn't have to. I know full well any one of them would have said "I'd refer him to psych." The referral was appropriate. It is just a pity that he did not keep his appointment.

Actually, you said you referred him to a psych NP, not a psychiatrist. You said that you called "every psych NP in town." You never mentioned trying to refer him to a psychiatrist (e.g, MD/DO).

Sounds like we have the makings of a double standard of care here. See an NP for one thing, see an NP for everything. Not exactly the ideal collaborative model.

No, no double standard. I refer to all kinds of providers. A psychiatrist wasn't an option for him due to the payment system and the providers accepting his (special state vouchers for mental health care-not traditional medicaid). Surely you cannot blame me or my profession for the fact that so few psychiatrists are opting to provide care to this under served population?

Quote:
Originally Posted by ChillyRN http://dkmg2azsloi0e.cloudfront.net/images/buttons/viewpost.gif (http://forums.studentdoctor.net/showthread.php?p=12116955#post12116955)
It is just a pity that he did not keep his appointment.

So...you're just letting it drop? "AMFYOYO?" Have you made any attempts to contact him? Have you tried to get him back into the office? Have either you or the psych NP tried to reschedule his appointment there? Have you tried to enlist the help of community resources (e.g, community mental health, social services,etc.)?

Your patients are still your patients even when they aren't in your office, and even when they aren't doing what they're supposed to do. Nearly all patients with chronic diseases require collaborative care for optimal outcomes. Primary care ain't a one man (or one woman) show. As his PCP, you're supposed to be the team leader. Or, somebody is...

He is homeless. As in, he lives on the street. He did say he sticks close to the University as the students are kinder to him than others. I guess I could just start cruising the streets looking for him. I am required to hand him a list and tell him "go to psych." What I did was to spend half the morning trying to find him a provider, made the appointment and mapped out the bus route and gave him bus fare (yes, out of my pocket).
When they emailed me about the no show, I left a message for him at the coalition for the homeless where he picks up his free meds. Unless you really think I ought to go physically searching for him in my free time, I'm not sure what more you would have me do.

I think you just want to pick a fight. I am confident I did everything I could for him that day. We even gave him lunch. If he doesn't come back, I am not sure what else I can do, but I am more than willing to hear your ideas!

Edited to say I don't know why the quote is so messed up, but this is in response to BlueDog, whom has since edited his original comments, which is perhaps why it won't quote properly. Sorry for the confusing format.

Blue Dog, I don't know what is going on with the board, seems as though there is a glitch. I see the comments I thought you had redacted have returned. Sorry for the confusion. Nope, they are gone again. Wow, there is a bug in the system today!

Just to clarify, my post above is totally devoid of snark. If anyone does know how to reach out to homeless patients and find them when it appears they are lost to care, I really would love some suggestions. I have two such patients (that I know of).

I think you just want to pick a fight.

No, I don't...which is why I edited my post (22 minutes before you posted your reply).

The followup issue is tangential to my main point that you should not be referring to midlevels. If something's over your head, you should be referring to physicians.

No, I don't...which is why I edited my post (22 minutes before you posted your reply).

The followup issue is tangential to my main point that you should not be referring to midlevels. If something's over your head, you should be referring to physicians.

??? My apologies if the timing of my reply is somehow irksome. Respectfully, I don't see how that the fact the you edited in the interim suggests anything about me just because I was responding to the original, especially when I did not know you edited until after I replied. I'm distracted by pretending to be a doctor here :p while playing SpongeBob Operation with my kids.

I disagree with the blanket statement that all referrals should go directly to physicians (as would they!). Just as often a NP or PA in the specialty area is the best first choice. They will turn the referral over to the specialist physician if they deem it necessary or prudent. When something is over my head, I aim to find someone more qualified than I. That is what I did in this instance. I don't approach situations with hard and fast ideas about whom the initial specialty referral should go to first, especially when I can almost always get them in with a PA or NP much faster and I suspect, get the crux of the issue addressed weeks or months sooner. In any event, I utilize the resources I have for each case, individually.

I am inferring (perhaps incorrectly, in which case please forgive the misunderstanding) that you think I have somehow failed this patient. I agreed from the outset that I am not the best choice of person to manage his psych meds (I can, and did, address his COPD and HTN). I did my very best to get him to someone better suited. I simply do not agree with anyone who would assert that I failed to meet my legal, ethical or moral responsibility to this patient.

This whole scenario really has nothing to do with the fact that I am a FNP, and everything to do with the fact that there are too few resources for people in his circumstance. Had he seen one of the MDs in my office he's have been handed the list and shooed out the door, without lunch or bus fare (that may have been used for cigarettes, ETOH or drugs for all I know-I'm Polyanna so I'm choosing to believe it was for supper). However, I concede that the outcome would have been the same, i.e. no psych follow up for the patient. The difference is, my physician colleagues would have not wasted hours trying to affect a different outcome. One of them told me to figure out whom can be helped and whom cannot and to appropriate my time accordingly. They didn't teach me how to discern that in NP school and my instinct for it is underdeveloped. I guess that does mark him as smarter, or at least more pragmatic, than I. ;)

I am not discouraged. I'll keep giving 110% to everyone. That is the beauty of being Pollyanna; too obtuse to know better.

If you have suggestions about how I might better serve this patient population given the constraints, I would be most grateful to have them. I shan't entertain more of what appears to be commentary aimed at launching criticism without making it constructive enough to be helpful for future such interactions

Regards.

No, I don't...which is why I edited my post (22 minutes before you posted your reply).

The followup issue is tangential to my main point that you should not be referring to midlevels. If something's over your head, you should be referring to physicians.

Agreed. That is also one of the problems I see with the DNP. I foresee NPs trying to use it as a way to gain more practice rights. Why not form a NP to MD/DO bridge if you guys want to truly be a "Doctor". Matter of time until we see more bad outcomes and more patient led suits to hopefully deter states where DNP/NP have gained full practice rights.

I disagree with the blanket statement that all referrals should go directly to physicians (as would they!)

I wouldn't necessarily assume that.

I believe it is unfortunate that the Nursing boards have sold themselves as a low cost alternative to physicians, and were able to politically aligned themselves with those that want to save money or make more money without considering the overall cost to the patient. The power trip that MOST NP's have, not all, I hope can come to an end soon before patients are truly harmed long term. I believe there is a place for all levels, but nurses should not be practicing medicine. If you want to do that o to Medical School. There are no short cuts to this, but there can be some very bad outcomes.

Please keep in mind that an NP is still a Nurse governed by the board of Nursing and regardless of what political tactics or alignments are used NP's are indeed practicing medicine without a license (I will continue to believe this until NP's are sanctioned under the medical boards and not nursing boards).

Attack away :D

1.)Just stating we as MLPs need supervision(and for a story about something a NP did to show you both professions has it weaklings-> A NP tried to give someone in my family Medrol Dose Pak for gastritis smh. Luckily that person was smart enough to throw away the rx and get treated for H. Pylori by a Physician lol. Or one I know that literally couldn't treat CHF or do admit orders and said NP's aren't trained enough for that)
2.)With his history(if she really meant he was so violent as she said) if I was a Physician that had any responsibility for her I would want to know about his care at least? What if for some unknown reason he decided to go off and have another violent episode right after leaving the clinic both her and the Doc take the hit on that one.

Again just trying to say that ALL nonphysician providers need some sort of oversight.

I think your anecdote is more or less an example of individual shortfalls rather than a shot at MLPs in general. Even as a lowly Pre-Med/BSN if someone asked my opinion on reoccurring peptic ulcers or gastritis I would suggest blood work, endoscope and a H. Pylori stool sample test early on as well as the subsequent triple threat therapy if it was indeed positive.I must agree though I believe even with independent/semi independent practice there should at least be a relatively close physician to collaborate with at all times. Really Medrol? Lol what?

Really Medrol? Lol what?

"Gastritis" ends in -itis, which means "inflammation," right? At least someone was paying attention in medical terminology class. ;)

"Gastritis" ends in -itis, which means "inflammation," right? At least someone was paying attention in medical terminology class. ;)

Haha sorry this O-chem review is hurting my brain, Yes and yes inflammation and all that good stuff but I thought anti-inflamm were usually pulled in the case of gastritis, or at least NSAIDS? Sorry off-topic...maybe the NP took it too literally :p

Haha sorry this O-chem review is hurting my brain, Yes and yes inflammation and all that good stuff but I thought anti-inflamm were usually pulled in the case of gastritis, or at least NSAIDS? Sorry off-topic...maybe the NP took it too literally :p

That's the point. NSAIDs (or steroids, in the case of Medrol) can most certainly aggravate gastritis, despite their "anti-itis" function. I was making a funny. :p

That's the point. NSAIDs (or steroids, in the case of Medrol) can most certainly aggravate gastritis, despite their "anti-itis" function. I was making a funny. :p


That's what I figured, sometimes sarcasm or humor can be hard to discern on a forum....haha back to my hexane rings...

I believe it is unfortunate that the Nursing boards have sold themselves as a low cost alternative to physicians, and were able to politically aligned themselves with those that want to save money or make more money without considering the overall cost to the patient. The power trip that MOST NP's have, not all, I hope can come to an end soon before patients are truly harmed long term. I believe there is a place for all levels, but nurses should not be practicing medicine. If you want to do that o to Medical School. There are no short cuts to this, but there can be some very bad outcomes.

Please keep in mind that an NP is still a Nurse governed by the board of Nursing and regardless of what political tactics or alignments are used NP's are indeed practicing medicine without a license (I will continue to believe this until NP's are sanctioned under the medical boards and not nursing boards).

Attack away :D

No attacks, but there will always be some blurring of roles, unless you want to sit down and clearly make a list of what nurses and physicians are allowed to do. But, I'll bet on that list there are some things I have done to save a patient's life and if there was a line drawn in the sand...well goodbye patient. Paramedics do some of the same things ED nurses and physicians do but I don't see anyone griping about them. They shouldn't have to go to medical school for practicing medicine, IMO.

I wouldn't necessarily assume that.

You are correct that I cannot assume that about your profession as a whole; I can only speak to the physicians with whom I work directly. They do not want to see these patients, they want them referred to the psych NPs in our network. That is exactly what they do with their psych patients requiring the kind of intervention I was looking to obtain for my patient. Give me enough credit for knowing the culture of my own workplace, won't you? :laugh:

Still hoping for constructive suggestions that might have improved the outcome of my scenario.
:whistle:

I believe it is unfortunate that the Nursing boards have sold themselves as a low cost alternative to physicians, and were able to politically aligned themselves with those that want to save money or make more money without considering the overall cost to the patient. The power trip that MOST NP's have, not all, I hope can come to an end soon before patients are truly harmed long term. I believe there is a place for all levels, but nurses should not be practicing medicine. If you want to do that o to Medical School. There are no short cuts to this, but there can be some very bad outcomes.

Please keep in mind that an NP is still a Nurse governed by the board of Nursing and regardless of what political tactics or alignments are used NP's are indeed practicing medicine without a license (I will continue to believe this until NP's are sanctioned under the medical boards and not nursing boards).

Attack away :D

No attack from me either, it's not my style. I don't think you are going to get the outcome you are hoping for though.

Personally, I don't know any NPs "on a power trip." I don't know any physicians or PAs "on a power trip" either. I just know a lot of people trying to serve patients to the best of their ability within the system as it is currently structured.

The only place I have ever seen all this gnashing of teeth is on SDN, lol. This was my whole intent in posting on this thread in the first place-to assure lurking students and wannabes that this tension does not permeate the real world. No one I know cares about these semantics. The situation is what it is, and it is less ideal on many counts than a lot of us would prefer. In the oft heard litany of complaints, all this NP/DNP/PA vs MD/DO stuff doesn't even come up. It is simply a non-issue IME. YMMV.

So to you hopeful NPs and PAs out there, don't be discouraged or deterred! :banana:

Regards.

No attacks, but there will always be some blurring of roles, unless you want to sit down and clearly make a list of what nurses and physicians are allowed to do. But, I'll bet on that list there are some things I have done to save a patient's life and if there was a line drawn in the sand...well goodbye patient. Paramedics do some of the same things ED nurses and physicians do but I don't see anyone griping about them. They shouldn't have to go to medical school for practicing medicine, IMO.

Using paramedics as an example is a bad one. We work under physician oversight with strict protocols, and constant QA/QI. Which is frankly how MLPs should function.

Using paramedics as an example is a bad one. We work under physician oversight with strict protocols, and constant QA/QI. Which is frankly how MLPs should function.

I knew it. I knew it. I went and erased my comment about protocols cause I knew someone would bring it up, lol!

I knew it. I knew it. I went and erased my comment about protocols cause I knew someone would bring it up, lol!

Fine, ignore the protocol issue. We still require the oversight and license of a physician medical director, and again the vast majority are subject to extensive QA/QI. Still a bad example for your purposes.

Still hoping for constructive suggestions that might have improved the outcome of my scenario.

Don't hold your breath. If I wanted to talk about that, I wouldn't have edited my original post.

The only place I have ever seen all this gnashing of teeth is on SDN, lol.

Try your local state legislature.

Those that believe they are capable of and should practicing medicine without medical training from an approved medical training site, medical school, is on a power trip. Why else would someone want to blatantly practice outside their scope of practice, nurses practice nursing not medicine.

I understand that there are going to be some lines blurred, but the problem is that the lines are not being blurred at this point.

If someone wants to pursue nursing or even become an NP that is fine with me, I think it just needs to made clear that those that do this are practicing medicine, not in the nursing scope of practice. This push for independence just makes things worse and I do not see the outcome being good.

Collaboration is needed and those that do not have the proper education need oversight/supervisors. If NP's want to be like physicians and practice medicine then go to medical school. If anything else NP schools need to vamp up their learning models to at least equal that of PA programs, and have mandatory physician supervision to practice.

Don't hold your breath. If I wanted to talk about that, I wouldn't have edited my original post. I understand perfectly.

Try your local state legislature.
Perhaps in your state, though not mine thank goodness. NPs have been independent here for years and enjoy collegial relationships with all of the team members. My point throughout the entire thread, however, has been that malevolence simply isn't part of the day to day aspects in most working environments, and the gentle reader should not be disquieted by the content of SDN. :beat:

And now I must invoke the threefold repetition rule, lol, for we are at an impasse.

Regards.

Those that believe they are capable of and should practicing medicine without medical training from an approved medical training site, medical school, is on a power trip. Why else would someone want to blatantly practice outside their scope of practice, nurses practice nursing not medicine.

I understand that there are going to be some lines blurred, but the problem is that the lines are not being blurred at this point.

If someone wants to pursue nursing or even become an NP that is fine with me, I think it just needs to made clear that those that do this are practicing medicine, not in the nursing scope of practice. This push for independence just makes things worse and I do not see the outcome being good.

Collaboration is needed and those that do not have the proper education need oversight/supervisors. If NP's want to be like physicians and practice medicine then go to medical school. If anything else NP schools need to vamp up their learning models to at least equal that of PA programs, and have mandatory physician supervision to practice.

Yes, yes, I understand your opinion on the subject. I am sure we all do. It simply isn't going to come to fruition in such a manner, no matter how much you wish it. I think one would do better to work within the system to improve upon it, rather than to go tilting at windmills, but your time is yours to spend how you please, lol.

What you could try to do is figure out a way to reverse the rotation of the earth, like Superman, and turn back time. Short of that, I don't think your present course is enough to stop the inexorable evolution of health care delivery.

Let's meet back here in 20 years and reassess.
Until then...

[QUOTE=ChillyRN;12120639]Yes, yes, I understand your opinion on the subject. I am sure we all do. It simply isn't going to come to fruition in such a manner, no matter how much you wish it. I think one would do better to work within the system to improve upon it, rather than to go tilting at windmills, but your time is yours to spend how you please, lol.

What you could try to do is figure out a way to reverse the rotation of the earth, like Superman, and turn back time. Short of that, I don't think your present course is enough to stop the inexorable evolution of health care delivery.


Let's meet back here in 20 years and reassess.
Until then...[/QUOTE

Yes, yes, I understand your opinion on the subject. I am sure we all do. It simply isn't going to come to fruition in such a manner, no matter how much you wish it. I think one would do better to work within the system to improve upon it, rather than to go tilting at windmills, but your time is yours to spend how you please, lol.

What you could try to do is figure out a way to reverse the rotation of the earth, like Superman, and turn back time. Short of that, I don't think your present course is enough to stop the inexorable evolution of health care delivery.

Let's meet back here in 20 years and reassess.
Until then...

Ah, but many are.... it's called advocating for QC/QA measures for Mid-Level's that are not optional.

I liked the childish bit about Superman towards me, made me laugh a little. I really did expect there to be a more substantive post from a professional adult. :thumbup:

(so much for the no attacks on your behalf)

Zenman, thank you for keeping your post professional, enjoy most of your posts.

Have a Good Day :D

Ah, but many are.... it's called advocating for QC/QA measures for Mid-Level's that are not optional.

I liked the childish bit about Superman towards me, made me laugh a little. I really did expect there to be a more substantive post from a professional adult. :thumbup:

(so much for the no attacks on your behalf)

Zenman, thank you for keeping your post professional, enjoy most of your posts.

Have a Good Day :D

Don't be shocked. Most NP's balk at this(why only take a national certification ONCE even my wife takes hers more than once and she is not a MLP or Physician). The one I had come to my class to help teach was how do I say....worthless. I didn't tell her I was a PA and I had her as she put it on the "hot seat" for her 2hour visit. One of my classmates decided to stop me from asking more questions because I was going for the finishing blows lol.

Also don't be shocked about the superman comment its one of those six kids that kept her from going to medical school smh lol

Perhaps in your state, though not mine thank goodness. NPs have been independent here for years and enjoy collegial relationships with all of the team members.

Things are very collegial in my state as well, despite the fact that NPs are not independent. That's not to say there haven't been scope issues.

As for that followup situation we were talking about yesterday, I initially overlooked the fact that the patient you were talking about was homeless, and edited the post once I realized it. I probably wouldn't have done anything different under those circumstances.

Don't be shocked. Most NP's balk at this(why only take a national certification ONCE even my wife takes hers more than once and she is not a MLP or Physician). The one I had come to my class to help teach was how do I say....worthless. I didn't tell her I was a PA and I had her as she put it on the "hot seat" for her 2hour visit. One of my classmates decided to stop me from asking more questions because I was going for the finishing blows lol.

Also don't be shocked about the superman comment its one of those six kids that kept her from going to medical school smh lol

No Worries.
No shock, just thought it was a little funny.

Don't be shocked. Most NP's balk at this(why only take a national certification ONCE even my wife takes hers more than once and she is not a MLP or Physician). The one I had come to my class to help teach was how do I say....worthless. I didn't tell her I was a PA and I had her as she put it on the "hot seat" for her 2hour visit. One of my classmates decided to stop me from asking more questions because I was going for the finishing blows lol.

Also don't be shocked about the superman comment its one of those six kids that kept her from going to medical school smh lol

One could question why take a certification exam more than once (except to make money for the exam people) when you have strict requirements in order to renew, such as CME, practice hours, research, publishing, etc, etc.

One could question why take a certification exam more than once (except to make money for the exam people) when you have strict requirements in order to renew, such as CME, practice hours, research, publishing, etc, etc.

Maybe because things change...? CME is largely based on the honor system. You can't bluff your way through an exam.

Maybe because things change...? CME is largely based on the honor system. You can't bluff your way through an exam.

That's what CME, practice hours, etc is for...because things change and you want to keep up with the latest. If you know how to take a multiple choice exam you can pass one in almost any subject.

If you know how to take a multiple choice exam you can pass one in almost any subject.

I assume by "you" you actually mean you, you super-genius, you. ;)

I assume by "you" you actually mean you, you super-genius, you. ;)

No, I mean anyone who knows how multiple tests are constructed can take one in almost any subject and pass it. This should be very clear.

No, I mean anyone who knows how multiple tests are constructed can take one in almost any subject and pass it. This should be very clear.

I don't think medicine is one of those. Either you know it or you don't. Why don't NP's just agree to be tested once every six years like PAs. Good quality assurance and you would gain some respect.

I don't think medicine is one of those. Either you know it or you don't. Why don't NP's just agree to be tested once every six years like PAs. Good quality assurance and you would gain some respect.

One should always question the status quo and ask why.:confused:

One should always question the status quo and ask why.:confused:

lol. You try to be sooo deep but your arguments are a tad superficial. How about the infamous- "For the safety of ALL our patients"

lol. You try to be sooo deep but your arguments are a tad superficial. How about the infamous- "For the safety of ALL our patients"

You think that's deep...:laugh:

You think that's deep...:laugh:

Not at all. Believe me. I just notice your tone on the board overall.

Not at all. Believe me. I just notice your tone on the board overall.

In your experience what tone would that be...and would I always use the same tone all the time and everywhere and with everyone? Or would I be serious with some people, playful with others, and downright slapping the crap out of idiots?

Would I act the same with all patients or...well you get it....don't ya?