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DNP Phasing Out PAs?

Discussion in 'Clinicians [ RN / NP / PA ]' started by Vulgatus, Mar 23, 2011.

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  1. Vulgatus

    Vulgatus

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    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
  2. emedpa

    emedpa GlobalDoc2B2015

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    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.
    freemontie likes this.
  3. zenman

    zenman Senior Member

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    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.
  4. Taurus

    Taurus Paul Revere of Medicine

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    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.
  5. Maybeknot

    Maybeknot Member

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    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:
  6. emedpa

    emedpa GlobalDoc2B2015

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    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?
  7. core0

    core0 Which way is the windmill

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    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.
  8. Maybeknot

    Maybeknot Member

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    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.

    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?
  9. core0

    core0 Which way is the windmill

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    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.
  10. emedpa

    emedpa GlobalDoc2B2015

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    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.
  11. Maybeknot

    Maybeknot Member

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    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.

    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...)
    Last edited: Mar 24, 2011
  12. prairiedog

    prairiedog Junior Member

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    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.
  13. fab4fan

    fab4fan TiredRetiredRN Gold Donor

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    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.
  14. ChillyRN

    ChillyRN DNP, FNP-BC

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    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!
  15. Themanatee

    Themanatee

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    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.
    Last edited: Mar 26, 2011
  16. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    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.
  17. The Coon

    The Coon

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    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.
  18. HooahDOc

    HooahDOc

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

    emedpa GlobalDoc2B2015

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    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.
  20. sarjasy

    sarjasy I have action potential

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    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.
  21. TheEarDoc

    TheEarDoc Au.D., CCC-A, F-AAA

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    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.
  22. core0

    core0 Which way is the windmill

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    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.
  23. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    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.
  24. Simann

    Simann Beats and Rhythm

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  25. TheEarDoc

    TheEarDoc Au.D., CCC-A, F-AAA

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    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!
  26. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    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.
  27. Taurus

    Taurus Paul Revere of Medicine

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    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.
  28. atcpt1

    atcpt1

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    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.
  29. Simann

    Simann Beats and Rhythm

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    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.
  30. cbrons

    cbrons love machine

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

    Simann Beats and Rhythm

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    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).
  32. Paseo Del Norte

    Paseo Del Norte

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    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.
  33. zenman

    zenman Senior Member

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    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 clinicals, 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. :D
  34. zenman

    zenman Senior Member

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    True, you have to be careful here. I had a 2 hr course which required 14 actual hours of clinical per week.
  35. atcpt1

    atcpt1

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    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
  36. atcpt1

    atcpt1

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    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
  37. emedpa

    emedpa GlobalDoc2B2015

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    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!
    Last edited: Apr 6, 2011
  38. zenman

    zenman Senior Member

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    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.
  39. atcpt1

    atcpt1

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    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
  40. ETSUUndergrad

    ETSUUndergrad

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    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.)
  41. zenman

    zenman Senior Member

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    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.


    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

    Not till you get rid of that Walkman and catch up, lol!

    Thanks for the fun!
  42. zenman

    zenman Senior Member

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    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.
  43. taraflorida

    taraflorida

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    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!
  44. taraflorida

    taraflorida

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    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????
  45. taraflorida

    taraflorida

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    .
    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.
  46. Makati2008

    Makati2008 Moderator

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    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.
  47. taraflorida

    taraflorida

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    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.
  48. atcpt1

    atcpt1

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    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).
    Last edited: Apr 10, 2011
  49. atcpt1

    atcpt1

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    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)
    Last edited: Apr 10, 2011
  50. emedpa

    emedpa GlobalDoc2B2015

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    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.

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