DNP Phasing Out PAs?

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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

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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.
 
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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.
 
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...
 
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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
 
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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
 
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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.
 
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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.
 
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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.
 
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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:
 
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:
 
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?
 
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.
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)

ATCPT, if we are being honest regarding clinical hours training and paid (under active state license) here is a more realistic picture.

RN-1000 (clinical training)
RN-2000(PRE-REQ for entry into any NP program, post grad, paid)
NP- 500(clinical training)
DNP-200(clinical training)

**these are sequential, the RN must complete the 3000 before NP program, and NP must complete the 500 before the DNP program...

PA-2000(clinical training)

I pretty sure this adds up to... 3700 clinical hours at DNP level, 3500 clinical hours at NP level. I am not even going to add in the hours that can be accomplished while in school, since the learning can be reinforced if the licensed RN is still working in say... an ER, like myself. Going out on a limb here... so really an NP receives twice the clinical hours than the PA does at the time of graduation. OMG... argument debunked!

I have had more MDs tell me they would rather hire an NP (because I was determining whether to go PA or NP) because the NP has experience, ALL NPs HAVE EXPERIENCE day one after graduation. MDs have said the first year with PAs is usually a lot of babysitting until they feel confident enough to become a functional part of the team. I have seen this personally as well. Honestly... the only place you encounter these stupid arguments are on pre-academic and academic forums like this one, where most of the contributors who are instigating the issue are clueless. You don't see this in practice, because there is no time for this kind of BS.

Oh, and just if you were interested here is an 18 year study of patient outcomes comparing NP and... (not PA) MD care http://www.medscape.com/viewarticle/751807_4
I'll give you a highlight, the data overwhelmingly states that "When comparing NP and MD care, there is a high level of evidence to support equivalent levels of patient outcomes." Sounds as if the air is starting to seep from that massively inflated head of yours.

What is so interesting about these posts, that are everywhere, is that the real discussion isn't even about NPs vs PAs. Considering that 19 states now allow for COMPLETELY independent practice for NPs, and next year there will be 4-5 more added as the trends suggest. The old world way the healthcare industry has been locked down by maintaining demand via limited MD access is coming to an end.

Call me NURSE, call me DOCTER, call me A$$H0$@, doesn't really change what/how I practice or that my patients have good outcomes. Refocus your energy on something that matters vs how vulnerable you think your job is.
 
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several issues:
1. consider the direct entry np- bs in anything + 3 yrs = DNP. year 1 they become an rn, year 2-3 for the np. total clinical hrs around 1000-1500.
2. also consider someone who is a bsn with 3 yrs of experience. they could become an np or become a pa. which route will result in more total clinical hrs of experience upon completion?
3. remember that the avg hce of accepted applicants to PA school is around 4000-6000 hrs. these folks were paramedics, resp therapists, and yes, some were RNs too. PAs do stuff before school too.
http://www.aapa.org/twocolumnmain.aspx?id=288
 
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I needed a good laugh, thanks for that. Lol

Cannot imagine why the turf battle continues... When you scoff at outcome based data. Have some courage and research perspective from something other than the SDN site.
 
several issues:
1. consider the direct entry np- bs in anything + 3 yrs = DNP. year 1 they become an rn, year 2-3 for the np. total clinical hrs around 1000-1500.
2. also consider someone who is a bsn with 3 yrs of experience. they could become an np or become a pa. which route will result in more total clinical hrs of experience upon completion?
3. remember that the avg hce of accepted applicants to PA school is around 4000-6000 hrs. these folks were paramedics, resp therapists, and yes, some were RNs too. PAs do stuff before school too.
http://www.aapa.org/twocolumnmain.aspx?id=288

I'm sorry... Are you a DNP? Nurse? BSN are TWO years to complete (following 2 years of prereqs and entry exams), there is your first 1000 clinical hours. Followed by, AND this is a requirement to apply to most all MSNP programs, two years as a clinical nurse (I'll make it easy 36x52x2=3744hours). Then the actual MSNP program being about 500hrs. That's over 5000 REQUIRED clinical hours before practicing as a masters prepared NP. You quote the avg hce of those accepted into PA programs is 4-6k hours hce. The difference is the NP has required scope prerequisites, and as you already know the PA hce is a hodgepodge of experience and shadowing. Also do not make the mistake of thinking NPs don't learn the medical model... That's just stupidity. Next time you're cruzing through the ER take a quick look around to who is running the show... It's not the MD or the PAs... It's the nurses and you know it. Next time you're on a code... Look to your left and to your right and who's there... Yep the nurses kicking ass as usual. There is a powerful liberal movement fueling this change. The historically oppressive hierarchy of medicine is changing as women slowly gain more and more control and influence politically. Evaluate the full landscape of the issue and you will come to realize the outcome is inevitable. I actually looked into becoming a PA, had 7 interviews and 6 offers, but ultimately decided to go NP. The patient outcomes between physician care and NP care in primary settings are comparable, and the data supports it. Really, what is there to discuss after that?
I guess the need for the argument is one to safeguard the ego. If you just keep saying "I'm smarter", "I'm better" it must be true.
 
As a 4 year Critical care RN and someone who attended NP school for 3 semesters and about to complete PA school, I can say with great authority that your whole message is bunk.

NP and PAs both provide high quality of care, should work together as equals. But the notion that NPs receive training better than a PA is flat wrong.

Nursing school you act as little more than a tech. Real learning happens on the job. Every RN will tell you just about everything they learned about REALLY nursing, they learned on the job.

Next, nursing experience itself is variable. Most nurses, particularly floor nurses, flounder in codes. I see it time and time again now, and as a ICU nurse responding to codes.

Lastly, what matters most is a experience as a provider, which clinical rotations in PA school provide more of and more consistently than NP school as they only require minimum 500 (average though is 750) and the lack of educational standardization that NP themselves admit they lack.

Again I repeat, this is not a dig on NPs. I see many wonderful NPs running ICUs and many terrible PAs, and MDs for that matter, and vice versa. NPs and PAs should be working together to help establish benefits for both parties, see each other as equals, judge providers as individuals by practice and not by initials after their name.
 
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I'm sorry... Are you a DNP? Nurse? BSN are TWO years to complete (following 2 years of prereqs and entry exams), there is your first 1000 clinical hours. Followed by, AND this is a requirement to apply to most all MSNP programs, two years as a clinical nurse (I'll make it easy 36x52x2=3744hours). Then the actual MSNP program being about 500hrs. That's over 5000 REQUIRED clinical hours before practicing as a masters prepared NP. You quote the avg hce of those accepted into PA programs is 4-6k hours hce. The difference is the NP has required scope prerequisites, and as you already know the PA hce is a hodgepodge of experience and shadowing. Also do not make the mistake of thinking NPs don't learn the medical model... That's just stupidity. Next time you're cruzing through the ER take a quick look around to who is running the show... It's not the MD or the PAs... It's the nurses and you know it. Next time you're on a code... Look to your left and to your right and who's there... Yep the nurses kicking ass as usual. There is a powerful liberal movement fueling this change. The historically oppressive hierarchy of medicine is changing as women slowly gain more and more control and influence politically. Evaluate the full landscape of the issue and you will come to realize the outcome is inevitable. I actually looked into becoming a PA, had 7 interviews and 6 offers, but ultimately decided to go NP. The patient outcomes between physician care and NP care in primary settings are comparable, and the data supports it. Really, what is there to discuss after that?
I guess the need for the argument is one to safeguard the ego. If you just keep saying "I'm smarter", "I'm better" it must be true.


Keep it civil. Further warnings will lead to infarctions.
 
I'm sorry... Are you a DNP? Nurse? BSN are TWO years to complete (following 2 years of prereqs and entry exams), there is your first 1000 clinical hours. Followed by, AND this is a requirement to apply to most all MSNP programs, two years as a clinical nurse (I'll make it easy 36x52x2=3744hours). Then the actual MSNP program being about 500hrs. That's over 5000 REQUIRED clinical hours before practicing as a masters prepared NP. You quote the avg hce of those accepted into PA programs is 4-6k hours hce. The difference is the NP has required scope prerequisites, and as you already know the PA hce is a hodgepodge of experience and shadowing. Also do not make the mistake of thinking NPs don't learn the medical model... That's just stupidity. Next time you're cruzing through the ER take a quick look around to who is running the show... It's not the MD or the PAs... It's the nurses and you know it. Next time you're on a code... Look to your left and to your right and who's there... Yep the nurses kicking ass as usual. There is a powerful liberal movement fueling this change. The historically oppressive hierarchy of medicine is changing as women slowly gain more and more control and influence politically. Evaluate the full landscape of the issue and you will come to realize the outcome is inevitable. I actually looked into becoming a PA, had 7 interviews and 6 offers, but ultimately decided to go NP. The patient outcomes between physician care and NP care in primary settings are comparable, and the data supports it. Really, what is there to discuss after that?
I guess the need for the argument is one to safeguard the ego. If you just keep saying "I'm smarter", "I'm better" it must be true.
The enormous number of nurses with your attitude really make me want to get a law degree when I get bored of clinical practice. NP malpractice is an untapped market, and you could win almost every case by simply pointing out the shortfalls of NP training in regard to the case as compared to a physician.
 
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Lol. Infractions.

Sorry. Just had this in my head when I read your post....

Makati
telepathy.jpg


Noncompliant posters
asthma-s14-man-coughing.jpg
 
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I'm sorry... Are you a DNP? Nurse? BSN are TWO years to complete (following 2 years of prereqs and entry exams), there is your first 1000 clinical hours. Followed by, AND this is a requirement to apply to most all MSNP programs, two years as a clinical nurse (I'll make it easy 36x52x2=3744hours). Then the actual MSNP program being about 500hrs. That's over 5000 REQUIRED clinical hours before practicing as a masters prepared NP. You quote the avg hce of those accepted into PA programs is 4-6k hours hce. The difference is the NP has required scope prerequisites, and as you already know the PA hce is a hodgepodge of experience and shadowing. Also do not make the mistake of thinking NPs don't learn the medical model... That's just stupidity. Next time you're cruzing through the ER take a quick look around to who is running the show... It's not the MD or the PAs... It's the nurses and you know it. Next time you're on a code... Look to your left and to your right and who's there... Yep the nurses kicking ass as usual. There is a powerful liberal movement fueling this change. The historically oppressive hierarchy of medicine is changing as women slowly gain more and more control and influence politically. Evaluate the full landscape of the issue and you will come to realize the outcome is inevitable. I actually looked into becoming a PA, had 7 interviews and 6 offers, but ultimately decided to go NP. The patient outcomes between physician care and NP care in primary settings are comparable, and the data supports it. Really, what is there to discuss after that?
I guess the need for the argument is one to safeguard the ego. If you just keep saying "I'm smarter", "I'm better" it must be true.
Do an internet search for both "2nd degree bsn" and "direct entry FNP" then get back to us.
 
I know this thread has been inactive for a couple of years, but I was wondering if anyone's views have changed since then.

I'm an AG-ACNP student. I had to do over 1,000 hours to get my BSN. I have had 600 for my MSN. I need 480 more for my DNP. However, my program required FIVE years of full time acute care experience to even apply (I have 7+), but that is a minimum of over 11,400 clinical hours.

In my area, NPs and PAs have essentially the same function in a hospital setting. Roughly, they are both utilized in the way a resident might be. We work together, not in competing roles. And it is very nice.

Since this post was started, there have been a large number of studies comparing and contrasting ICUs and offices run by NPs vs those run by MDs/PAs. They basically all found that NPs work as well or better than MDs/PAs in terms of morbidity, patient outcome, chronic illnesses, readmission rates, and length of stays. And the patients prefer the NP more, claiming they connect better, followup better, and are better listeners. Additionally, the nurses prefer NP led teams over MD led teams. These studies have led many major hospitals to hire more NPs. An example that comes to mind is Vanderbilt, which both conducted some of the studies I am referring to and are hiring NPs by the droves.

I am not trying to make a case for NPs over MDs or PAs. I'm just wondering if anyone involved in this thread has changed or begun to change their belittling views of NPs since their original post.
 
I know this thread has been inactive for a couple of years, but I was wondering if anyone's views have changed since then.

I'm an AG-ACNP student. I had to do over 1,000 hours to get my BSN. I have had 600 for my MSN. I need 480 more for my DNP. However, my program required FIVE years of full time acute care experience to even apply (I have 7+), but that is a minimum of over 11,400 clinical hours.

In my area, NPs and PAs have essentially the same function in a hospital setting. Roughly, they are both utilized in the way a resident might be. We work together, not in competing roles. And it is very nice.

Since this post was started, there have been a large number of studies comparing and contrasting ICUs and offices run by NPs vs those run by MDs/PAs. They basically all found that NPs work as well or better than MDs/PAs in terms of morbidity, patient outcome, chronic illnesses, readmission rates, and length of stays. And the patients prefer the NP more, claiming they connect better, followup better, and are better listeners. Additionally, the nurses prefer NP led teams over MD led teams. These studies have led many major hospitals to hire more NPs. An example that comes to mind is Vanderbilt, which both conducted some of the studies I am referring to and are hiring NPs by the droves.

I am not trying to make a case for NPs over MDs or PAs. I'm just wondering if anyone involved in this thread has changed or begun to change their belittling views of NPs since their original post.
:rolleyes:
 
I think a lot of the belitting of NP's comes from the fact that many started as RN's and well let's just say RN's often times seem to think they know it all and the doctors are idiots.

I think the newer NP's are a little better about this and a lot of the newer RN's are better about this.

PA vs NP? Two different mindsets for patients and two very different programs of study.

I compared both long and hard before I ever stepped into nursing. I also spent several hours of my program getting my RN with every class having about 5-10 minutes of doctor bashing. I didn't have a medical degree, but I was sitting in this class with a clinical doctorate and just wanted to slam my head off the desk because half of the people in the class talking smack knew hardly anything about medicine. The idea of half of the stuff I covered in pre-med (genetics, general microbiology, virology, etc.) were all stuff they did not understand.

I think nurses unfortunately have a lot of the blame for why the NP's are belittled.

I've seen and worked with both NP's and PA's. I like both. Both serve well as mid-level practitioners. Neither are a physician nor ever will be no matter how many degrees or letters they add after their names.

"Additionally, the nurses prefer NP led teams over MD led teams"
- Probably more to do with the us vs. them mentality than anything else. Just like I'm sure PA's preferred the MD led teams over the NP led teams.
 
I've been a bit puzzled over the studies showing patients connect better with NPs than physicians. As a nurse, I've noticed that physicians are often the final word with patients, and a lot of times that means they are communicating things that patients might not want to hear. They tend not to over promise, and are fairly concise.... Which has a lot to do with them having a good view of the big picture. I think that comes across to patients as the doctors talking at them vs with them, but I don't know if I'd want it any other way. When patients are talking to NPs, and even PAs, there really is this sense that if an issue gets too deep, there is a fallback. I've seen a lot of interactions between patients and various providers, and I've noticed that pattern. For some folks it's just more comfortable to pray to Mary than take their case to God directly, and that can make NPs and PAs, even nurses seem more approachable. However, when I'm running into issues with patients, it's a relief to have a physician step in and say "look... All the info is in front of us, and my expertise tells us we need to take this approach", and they are simply the last word. From there, difficult patients usually get onboard vs all the hell they give everyone "down the line" from the doctor. Sometimes that makes the doc the hard a-- to patients, and everyone who told them "I'm going to do everything I can for you, let me go ask the doctor what he wants" into the reasonable people. Then you even have nurses that make the doctor the bad guy so they can cope with the 12 hours they have to deal directly with the patient. My approach is to form a united front with the providers. I've noticed it doesn't score me many points either as far as popularity, but I think it's best for the patients. Obviously, I'm an advocate for my patients if there were to be an issue, but most of the problems I deal with are in the realm of stupid things that patients want accommodated that really can't be. My patients hear a lot of me saying "well, Dr. X knows about that issue, and has decided to go this way, and I agree with her on that regard and here's why." And even in that situation, I end up looking like the hero because I'm the one with the opportunity to explain it 3 different ways to them, or I know how to say things best because I've been their best friend for 8 hours already. Sometimes doctors just can't win.
 
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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.

Yeah I'm pretty sure your basic combat medic does a lot of the same things critical care nurses and ED physicians do and many of them only have an AIT program of 3 months if they are National Guard and 9 months if they are full time active duty.
 
Active and reserve Army medics have the same initial training (BCT+ AIT). After that, it's a (potentially) different can of worms.

I get your point, though. :)
 
Active and reserve Army medics have the same initial training (BCT+ AIT). After that, it's a (potentially) different can of worms.

I get your point, though. :)

Reserves and active duty do yes, but often times you'll find if someone goes National Guard and does 68W they will throw them in a shorter AIT especially if it's a person switching MOS.

I remember in nursing school we had a former 68W. I think he could have taught the instructors a few things. They did not like him. Not because he was arrogant or anything, just they felt he couldn't be retrained to think like a nurse rather than a combat medic. They had the same problems with a couple EMT's in our class.
 
The DNP's are backing themselves into a corner. They have created their own online doctorate programs. There are literally DNP programs that are only 9 credits of coursework. This is absolutely laughable. Currently every physician I am speaking with is saying they are not going to hire NP's because PA's are much better trained. As for the independent thing--that is a joke. EVERY state specifically requires that any NP at any level who wishes to prescribe medicine or perform any procedures MUST have a written signed agreement with a physician. Go read the nursing acts--the NP's are only independent for practicing "nursing." The NP"s have completely overblown their so-called independence. In reality their relationship with physicians is not different that the PA-physician relationship. What is more--look at the data. A PA with a Master's degree has more didactic hours of training AND more clinical rotation hours of training than most NP's with a doctorate. What is more the NP training is all online and their clinical rotations are very poorly managed and structured. There is a reason why PA school cannot be done online; the training is too intense and in-depth. I anything happens, the PA profession is going to benefit tremendously from the DNP move.
 
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The DNP's are backing themselves into a corner. They have created their own online doctorate programs. There are literally DNP programs that are only 9 credits of coursework.
This is absolutely laughable.

While I agree that the DNP, in most cases, is laughable at this point, I've never seen a 9 credit DNP. Can you please link to the site of one of these programs?
Currently every physician I am speaking with is saying they are not going to hire NP's because PA's are much better trained.

I'm sure there are many physicians that prefer PAs due to their training (especially since they are trained in the same, medical, model). However, there are also many physicians that prefer NPs, due to the belief that they have less supervisory requirements, and therefore are less of a liability to them than PAs (which of course depends on the state).

As for the independent thing--that is a joke. EVERY state specifically requires that any NP at any level who wishes to prescribe medicine or perform any procedures MUST have a written signed agreement with a physician. Go read the nursing acts--the NP's are only independent for practicing "nursing." The NP"s have completely overblown their so-called independence. In reality their relationship with physicians is not different that the PA-physician relationship.

As I mentioned in the other thread, this is simply incorrect. There are, I believe, 20 states with actual "independent" practice (or what the AANP terms "full practice authority"), which means that in these states, the state practice laws allow NPs to evaluate patients, diagnose, order and interpret tests, initiate and manage treatments, and prescribe medication, independent of a physician, all under the authority of the state board of nursing. There is absolutely no requirement in these states for a written signed agreement with a physician to prescribe medication or perform any procedure. If that is actually the case in those "independent" states, please provide evidence for that.

In other states, there are varying degrees of physician collaboration or supervision required to carry out at least one function of NP practice (whether it's prescribing or diagnosing). These requirements can be the same as that for PAs in the same state, less restrictive, or more restrictive.

What is more--look at the data. A PA with a Master's degree has more didactic hours of training AND more clinical rotation hours of training than most NP's with a doctorate. What is more the NP training is all online and their clinical rotations are very poorly managed and structured. There is a reason why PA school cannot be done online; the training is too intense and in-depth. I anything happens, the PA profession is going to benefit tremendously from the DNP move.

I do agree that PA education is more rigorous in terms of didactic hours and clinical hours. Not all NP training is online. There are plenty of "brick and mortar" schools available around the country for those that don't want to do an online program. And even with online programs, there are many, at reputable institutions, that offer well managed and structured programs, including their clinical rotations. Unfortunately, there are also many that don't.

Interestingly, it seems that Yale will be starting the nation's first online PA program. We'll see what happens after that.
 
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