Difference between an NP and PA

[ChrisNP87]

1,400 hours of mandatory training at the advanced level, as well as a broad base of knowledge versus just one area.

I'm sorry, not to be rude, but what is your title?

I'm currently enrolled in an Family Nurse Practitioner Program (a broad base of knowledge required ranging from neonates/pediatrics to OB/GYN to Adult/Geriatrics) that requires at least 700+ clinical hours and approximately 600 didactic hours. I also have over 5 years of acute/critical care nursing experience ranging from ICU/CCU, ED, and Cardiac/Stroke units and just over 2.5 years of inpatient Hospice experience. I am board certified by the ANCC in Medical and Surgical Nursing as well as going for my CCRN board certification this August. I've worked with patients across the life span ranging from neonates to geriatrics. I don't know about you but my pervious experience working as an RN is more than enough experience to launch me into my APRN role. There are many peer reviewed articles and journals discussing the differences between NP and PA. One major difference is: "Unlike physician assistants, nurse practitioners are able to operate independently in some states. However, most still work within larger healthcare settings or as part of a healthcare team."

Some physicians are against NP/PA roles and will make false opinionated statements like, "Mid level practitioners give sub par care" but they never seem to have any evidence to back up their empty words. I'd love to see you post some great peer reviewed journals, articles, and/or studies done that show mid level practitioners provide sub par care. I was looking up NP malpractice rates and they are pretty low compared to other practitioners, the AANP states "Malpractice rates remain low; only 1.9% have been named as primary defendant in a malpractice case". That's why our malpractice insurance is only $1600/year. Don't you think it would be higher if we gave sub par care or injured and killed patients? Let's not forget that it was a PHYSICIAN that helped create the NP role due to the shortages in 1965. "According to Ford, society's demand for primary care services and nursing's potential to meet the need were the reasons for the development of nurse practitioners; the physician shortage merely provided the opportunity. Others describe the physician shortage as the rationale for the expansion of nurse practitioner programs nationwide."

So don't try and defame my profession, especially when you have no sited sources to back up your egregious remarks. If I'm not mistaken this thread is specifically under the Clinician discussions for a reason, so if you don't have anything nice to say then please keep your derogatory comments to yourself. Thanks!

https://www.aanp.org/all-about-nps/np-fact-sheet
http://www.medscape.com/viewarticle/464663_2
http://nursejournal.org/nurse-practitioner/np-vs-physician-assistants/

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[ChrisNP87]

I have covered many, many times, and you know this, that NP's should not be allowed independent practice with their current education.

Your belief that PA's can be critical of NP's but not vice versa is not valid. If it was the case that NP education is inadequate why do meta-analysis show comparable outcomes between the professions. It's either insane luck from hundreds of studies p values being skewed or the foundation of your argument is invalid.

PA's are not in a position to evaluate DNP education because "they aren't living and experiencing that education or jumping through those hoops" either.

My DNP program is 8 semester, almost 4 semesters of which are identical to the PhD nursing program. I have 1500 clinical hours mandatory as part of my education.

I will continue to show the same amount of respect that I am shown, which is to say, very, very little.

This person is clearly an ignorant troll. Please continue to respectfully refute his claims as I will do the same. We are highly esteemed healthcare professionals and we mustn't entertain this puerile senselessness.

 

[Mad Jack]

I'm sorry, not to be rude, but what is your title?

I'm currently enrolled in an Family Nurse Practitioner Program (a broad base of knowledge required ranging from neonates/pediatrics to OB/GYN to Adult/Geriatrics) that requires at least 700+ clinical hours and approximately 600 didactic hours. I also have over 5 years of acute/critical care nursing experience ranging from ICU/CCU, ED, and Cardiac/Stroke units and just over 2.5 years of inpatient Hospice experience. I am board certified by the ANCC in Medical and Surgical Nursing as well as going for my CCRN board certification this August. I've worked with patients across the life span ranging from neonates to geriatrics. I don't know about you but my pervious experience working as an RN is more than enough experience to launch me into my APRN role. There are many peer reviewed articles and journals discussing the differences between NP and PA. One major difference is: "Unlike physician assistants, nurse practitioners are able to operate independently in some states. However, most still work within larger healthcare settings or as part of a healthcare team."

Some physicians are against NP/PA roles and will make false opinionated statements like, "Mid level practitioners give sub par care" but they never seem to have any evidence to back up their empty words. I'd love to see you post some great peer reviewed journals, articles, and/or studies done that show mid level practitioners provide sub par care. I was looking up NP malpractice rates and they are pretty low compared to other practitioners, the AANP states "Malpractice rates remain low; only 1.9% have been named as primary defendant in a malpractice case". That's why our malpractice insurance is only $1600/year. Don't you think it would be higher if we gave sub par care or injured and killed patients? Let's not forget that it was a PHYSICIAN that helped create the NP role due to the shortages in 1965. "According to Ford, society's demand for primary care services and nursing's potential to meet the need were the reasons for the development of nurse practitioners; the physician shortage merely provided the opportunity. Others describe the physician shortage as the rationale for the expansion of nurse practitioner programs nationwide."

So don't try and defame my profession, especially when you have no sited sources to back up your egregious remarks. If I'm not mistaken this thread is specifically under the Clinician discussions for a reason, so if you don't have anything nice to say then please keep your derogatory comments to yourself. Thanks!

https://www.aanp.org/all-about-nps/np-fact-sheet
http://www.medscape.com/viewarticle/464663_2
http://nursejournal.org/nurse-practitioner/np-vs-physician-assistants/

I think you're confusing my distaste for nurse independent practice with a distaste for nurse practitioners. NPs are great at what their role was designed for, but I believe they provide subpar independent care to board certified physicians. A good part of the reason their liability is still so low is precisely because they have supervising physicians or employers that set their protocols in over 98% of cases- lawyers go after the big fish, physicians and employers, rather than the little fish like nurses, because we're where the money is at. With more independent NPs, I predict an increase in NP malpractice and premiums.

As to quality, I'm hoping to conduct a study myself in a few years- 50 NPs with equally large patient panels to their FM counterparts and no oversight versus 50 freshly residency FM trained graduates. I think the results will speak for themselves. All current studies to date have focused on limited, singular outcome measures (such as HbA1c levels) but ignored confounding factors (in the glycemic control study, NPs were specifically provided with training in diabetes management, they had more time to counsel patients, and there was no controlling for patient complexity- and yet, with all those advantages, NPs merely had equal outcomes to their physician counterparts, hardly a victory). I'm going to create the most unbiased study possible- equal time per patient, equal acuity of patients, equal productivity expectations- and if the outcome is equal, I will then consider you adequate independent practitioners. It will be a groundbreaking study, one way or another.

Now, you have a lot of experience prior to NP school, but often today I find myself faced with direct entry NP nursing program graduates that don't know their ass from their elbow. The disparity in quality between a PA school graduate and these graduates is massive- in the ED, we'd throw fresh PAs out there, and we never lost a single one. Our organization (a major L1 trauma center), on the other hand, stopped hiring NP graduates without at least 5 years of prior acute care or ED experience, because anyone with less than that ended up either being too slow and inefficient or outright dangerous. The same ended up occurring in our medical intensive care units- fresh PAs were fine, but 3 years of ICU experience at a university medical center was expected for NPs. And this was at a place that was almost desperately short of staff- we'd run into so many bad NPs that went to subpar direct entry programs that clung to the minimum standards and couldn't function properly in an acute care environment and ended up being fired that we had to start being picky despite our need. Our good NPs were great, and could keep the ICU running smoothly while rounds had moved elsewhere, and knew when they were in over their head to grab the resident or attending. The bad ones, well- they were dangerously bad, to the point the RNs were having to go over their heads to contact attending directly and sidestep their incompetence. And that, right there, is my problem with independent nurse practice- quality control. The disparity in clinician quality between experienced NPs that came out of great programs and direct entry NPs or RNs that went straight from a BSN to a MSN NP program that barely clung to the minimum training requirements is astounding. Hell, go to allnurses and you can find your fellow nurses complaining about the same thing in some old threads. NP school was designed for experienced registered nurses to obtain an expanded scope of care in a specific field, with some degree of oversight or collaboration with a physician, after additional training within that area. It wasn't designed for some schmuck with a BA in art history to go straight through in 3 years and come out an independent provider capable of competently setting and treating a full spectrum of disease independently.

 

[Mad Jack]

The consensus is that 700 hours clinical and 600 hours didactic is insufficient to warrant the independent practice of medicine in a safe and effective manner.

Unfortunately this is not accurate. While your RN experience is valuable and important it does not give you "credit" or advanced standing. Only prescriber-level training can do that and RNs are not at that level.

The most amusing part is that must NPs have no idea just how inadequate 600 hours of didactics and 700 hours of clinical training is compared to the bare minimum to be BC/BE in FM, where you're looking at 15,000+ clinical hours and 4,000 didactic hours, give or take, sans CMEs. But yeah, all that experience is overkill compared to programs that give you a number of clinical hours that is equivalent to about four months of full-time work (at 40 hours per week). A resident gets 700 clinical hours in 9 weeks of inpatient.

 

[d2305]

The clinical hours for NP students may be supervised by another NP with no physician involvement. I know this as I have seen NP students rotate where I work. PA students and medical students are supervised by physicians.

 

[Mad Jack]

The clinical hours for NP students may be supervised by another NP with no physician involvement. I know this as I have seen NP students rotate where I work. PA students and medical students are supervised by physicians.

The PA students we had were effectively treated the same as medical students but had better hours (60ish a week on medicine and surgery and more weekends off).

 

[762513]

I think you're confusing my distaste for nurse independent practice with a distaste for nurse practitioners. NPs are great at what their role was designed for, but I believe they provide subpar independent care to board certified physicians. A good part of the reason their liability is still so low is precisely because they have supervising physicians or employers that set their protocols in over 98% of cases- lawyers go after the big fish, physicians and employers, rather than the little fish like nurses, because we're where the money is at. With more independent NPs, I predict an increase in NP malpractice and premiums.

As to quality, I'm hoping to conduct a study myself in a few years- 50 NPs with equally large patient panels to their FM counterparts and no oversight versus 50 freshly residency FM trained graduates. I think the results will speak for themselves. All current studies to date have focused on limited, singular outcome measures (such as HbA1c levels) but ignored confounding factors (in the glycemic control study, NPs were specifically provided with training in diabetes management, they had more time to counsel patients, and there was no controlling for patient complexity- and yet, with all those advantages, NPs merely had equal outcomes to their physician counterparts, hardly a victory). I'm going to create the most unbiased study possible- equal time per patient, equal acuity of patients, equal productivity expectations- and if the outcome is equal, I will then consider you adequate independent practitioners. It will be a groundbreaking study, one way or another.

Now, you have a lot of experience prior to NP school, but often today I find myself faced with direct entry NP nursing program graduates that don't know their ass from their elbow. The disparity in quality between a PA school graduate and these graduates is massive- in the ED, we'd throw fresh PAs out there, and we never lost a single one. Our organization (a major L1 trauma center), on the other hand, stopped hiring NP graduates without at least 5 years of prior acute care or ED experience, because anyone with less than that ended up either being too slow and inefficient or outright dangerous. The same ended up occurring in our medical intensive care units- fresh PAs were fine, but 3 years of ICU experience at a university medical center was expected for NPs. And this was at a place that was almost desperately short of staff- we'd run into so many bad NPs that went to subpar direct entry programs that clung to the minimum standards and couldn't function properly in an acute care environment and ended up being fired that we had to start being picky despite our need. Our good NPs were great, and could keep the ICU running smoothly while rounds had moved elsewhere, and knew when they were in over their head to grab the resident or attending. The bad ones, well- they were dangerously bad, to the point the RNs were having to go over their heads to contact attending directly and sidestep their incompetence. And that, right there, is my problem with independent nurse practice- quality control. The disparity in clinician quality between experienced NPs that came out of great programs and direct entry NPs or RNs that went straight from a BSN to a MSN NP program that barely clung to the minimum training requirements is astounding. Hell, go to allnurses and you can find your fellow nurses complaining about the same thing in some old threads. NP school was designed for experienced registered nurses to obtain an expanded scope of care in a specific field, with some degree of oversight or collaboration with a physician, after additional training within that area. It wasn't designed for some schmuck with a BA in art history to go straight through in 3 years and come out an independent provider capable of competently setting and treating a full spectrum of disease independently.

Still waiting for you to refute all 39 studies in the meta-analysis. I love your Texas marksman style of debate; when you are proven off target you simply move the target.

I would not read any study on NPs with you as a researcher. Your obvious bias suggests you should not put yourself in that position. This is not trolling, it's simply an observation that based on your behavior in these forums you may be incapable of objectivity in this matter.

I agree with you NPs should not be allowed independent practice right out of school; that, however, is not what we are discussing. I'll just sit here quietly while you refute the entire meta-analysis as you said you planned to do.

 

[Mad Jack]

Still waiting for you to refute all 39 studies in the meta-analysis. I love your Texas marksman style of debate; when you are proven off target you simply move the target.

I would not read any study on NPs with you as a researcher. Your obvious bias suggests you should not put yourself in that position. This is not trolling, it's simply an observation that based on your behavior in these forums you may be incapable of objectivity in this manner.

I agree with you NPs should not be allowed independent practice right out of school; that, however, is not what we are discussing. I'll just sit here quietly while you refute the entire meta-analysis as you said you planned to do.

I've never moved the target, I've said that no studies accurately compared NPs against physicians, and thus are flawed. I want a study that is a direct comparison, with equal standards, that shows equal outcomes, before I'll buy any of this "NPs are equal" nonsense. And I already told you, I'm not going to go through and refute all 39 studies, because we've done it before on this site numerous times in numerous threads and it takes more time than I've got with only 3 days of summer remaining. I'd rather be playing Fallout than arguing what should be obvious to someone as supposedly educated as yourself.

 

[762513]

I've never moved the target, I've said that no studies accurately compared NPs against physicians, and thus are flawed. I want a study that is a direct comparison, with equal standards, that shows equal outcomes, before I'll buy any of this "NPs are equal" nonsense. And I already told you, I'm not going to go through and refute all 39 studies, because we've done it before on this site numerous times in numerous threads and it takes more time than I've got with only 3 days of summer remaining. I'd rather be playing Fallout than arguing what should be obvious to someone as supposedly educated as yourself.

Fallout is always a better idea than online arguing. I heard the new Doom is very cool too.

The entire meta analysis has not been disproven on this forum. The last comment was by sb247 a few months ago who just notes that unsupervised NP care has not been adequately measuresd, but NPs with oversight are safe alternatives to physicians.

I'm simply waiting for you to do what you said you would do. If you can't, then get off the "all NP studies are flawed" wagon. Should be easy for someone as supposedly educated as you.

 

[ChrisNP87]

The consensus is that 700 hours clinical and 600 hours didactic is insufficient to warrant the independent practice of medicine in a safe and effective manner.

Unfortunately this is not accurate. While your RN experience is valuable and important it does not give you "credit" or advanced standing. Only prescriber-level training can do that and RNs are not at that level.

Well if I am “inaccurate” then why do you not provide any evidence based studies, peer reviewed journals, or any study, for that matter, to prove your nonsensical opinions. If NPs don't provide safe evidence based care then they wouldn't be allowed to practice medicine period, but that's not the case is it now?

I think you somehow misunderstood what I said... I don't recall ever mentioning that my RN experience gives me "credit" or an "advanced standing" in regards to prescribing or practicing medicine. However, I did say My VAST amounts of experience in acute/critical care (in addition to assisting in numerous codes/RRTs) has more than prepared me for the increase in my knowledge base and the necessary experience I need to launch my journey into the advanced practice role. Nonetheless, I do think my acute/critical care bedside nursing experience will not only help mold me into a better NP but it has taught me invaluable skills that will forever be essential in type of care I provide to my patients in the advanced practice setting.

I'm really trying to understand how you say my RN experience is “valuable" and "important" but it basically doesn't count for anything… Let’s not forget I'm the healthcare professional that double checks physician/NP/PA medication orders and calculations prior to administering them to my patients, especially those medications that are weight based. RNs are required to know more than just basic knowledge of pharmacology, as I’m sure you already know.

One of the many skills I've obtained over the years is the ability to treat and care for the patient as a whole, not to solely focus on the physical aspect, like the diagnosis, but the ability to incorporate the emotional, psychological, and spiritual components which are just as equally important as prescribing medication(s). Other important skills that I believe will enhance my APRN degree, on account of my bedside nursing experience, include having mastered my assessment, critical thinking, leadership , and therapeutic communication skills.

Whereas PAs aren't required to obtain a clinical degree, professional license, or pass a state board certification prior to enrolling into the program. They have little to NO knowledge in obtaining an H & P, generating a differential diagnosis, diagnostic tests required to r/o differential diagnosis, a final diagnosis, treatment plans, most medical procedures, or pharmacological interventions. Nurses are the eyes and ears of the practitioners and we’re highly trained to accurately relay assessment findings and recommend possible diagnosis and treatment options (which are well within our scope of practice).

I read this little article written from the view point of a physician, Shirie Leng, that I thought was well executed. She goes on to say: "Surely knowledge, skill, and ability separate nurses from doctors? Of course not. Your experienced floor nurse knows way more about medicine than your average intern. Physician assistants can sew up wounds and assist in surgery. A person who becomes a nurse is just as smart as a person who becomes a doctor, which has always been true, but not always acknowledged. An MD is just a piece of paper that gives a person permission to start learning how to be an actual doctor. An RN is much the same. Clinical experience and training are the only things that matter materially to patients. Some argue that training level is also part of the definitional differences between doctors and nurses. Doctor’s clinical training in a formal educational system is usually longer. So you could equivocally say that a doctor has longer training." http://www.kevinmd.com/blog/2013/04/separates-doctors-nurses.html

So tell me again how this experience doesn't help nurses in advancing to the APRN role? Actually, there's no need, the evidence speaks for itself.

Chris L.

 

[ChrisNP87]

The clinical hours for NP students may be supervised by another NP with no physician involvement. I know this as I have seen NP students rotate where I work. PA students and medical students are supervised by physicians.

Why must an NP have student rotations with an MD/DO? We are not in school to become physicians, we are in school to become NPs... So are you basically trying to say that NPs aren't good enough to teach student NPs on properly providing evidence based diagnosis and treatment plans? If you could please provide your evidence I'd greatly appreciate it. Oh, and the reason PA students must shadow PAs and Physicians is because they have the word "Physician" and "Assistant" in their title. A physician is required to oversee and supervise ALL PAs (I think a max of 4 at one time), whereas it's not required for the same with NPs in many states.

http://www.pac.ca.gov/supervising_physicians/faqs.shtml
https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-map/

 

[Mad Jack]

Fallout is always a better idea than online arguing. I heard the new Doom is very cool too.

The entire meta analysis has not been disproven on this forum. The last comment was by sb247 a few months ago who just notes that unsupervised NP care has not been adequately measuresd, but NPs with oversight are safe alternatives to physicians.

I'm simply waiting for you to do what you said you would do. If you can't, then get off the "all NP studies are flawed" wagon. Should be easy for someone as supposedly educated as you.

Point out a study, then describe why it isn't flawed and is perfect. Do that 39 times and we're good.

Really though, I don't have time. I'm going to be baking all day tomorrow and at a festival of sorts the next day, then it's on to third year.

Well if I am “inaccurate” then why do you not provide any evidence based studies, peer reviewed journals, or any study, for that matter, to prove your nonsensical opinions. If NPs don't provide safe evidence based care then they wouldn't be allowed to practice medicine period, but that's not the case is it now?

I think you somehow misunderstood what I said... I don't recall ever mentioning that my RN experience gives me "credit" or an "advanced standing" in regards to prescribing or practicing medicine. However, I did say My VAST amounts of experience in acute/critical care (in addition to assisting in numerous codes/RRTs) has more than prepared me for the increase in my knowledge base and the necessary experience I need to launch my journey into the advanced practice role. Nonetheless, I do think my acute/critical care bedside nursing experience will not only help mold me into a better NP but it has taught me invaluable skills that will forever be essential in type of care I provide to my patients in the advanced practice setting.

I'm really trying to understand how you say my RN experience is “valuable" and "important" but it basically doesn't count for anything… Let’s not forget I'm the healthcare professional that double checks physician/NP/PA medication orders and calculations prior to administering them to my patients, especially those medications that are weight based. RNs are required to know more than just basic knowledge of pharmacology, as I’m sure you already know.

One of the many skills I've obtained over the years is the ability to treat and care for the patient as a whole, not to solely focus on the physical aspect, like the diagnosis, but the ability to incorporate the emotional, psychological, and spiritual components which are just as equally important as prescribing medication(s). Other important skills that I believe will enhance my APRN degree, on account of my bedside nursing experience, include having mastered my assessment, critical thinking, leadership , and therapeutic communication skills.

Whereas PAs aren't required to obtain a clinical degree, professional license, or pass a state board certification prior to enrolling into the program. They have little to NO knowledge in obtaining an H & P, generating a differential diagnosis, diagnostic tests required to r/o differential diagnosis, a final diagnosis, treatment plans, most medical procedures, or pharmacological interventions. Nurses are the eyes and ears of the practitioners and we’re highly trained to accurately relay assessment findings and recommend possible diagnosis and treatment options (which are well within our scope of practice).

I read this little article written from the view point of a physician, Shirie Leng, that I thought was well executed. She goes on to say: "Surely knowledge, skill, and ability separate nurses from doctors? Of course not. Your experienced floor nurse knows way more about medicine than your average intern. Physician assistants can sew up wounds and assist in surgery. A person who becomes a nurse is just as smart as a person who becomes a doctor, which has always been true, but not always acknowledged. An MD is just a piece of paper that gives a person permission to start learning how to be an actual doctor. An RN is much the same. Clinical experience and training are the only things that matter materially to patients. Some argue that training level is also part of the definitional differences between doctors and nurses. Doctor’s clinical training in a formal educational system is usually longer. So you could equivocally say that a doctor has longer training." http://www.kevinmd.com/blog/2013/04/separates-doctors-nurses.html

So tell me again how this experience doesn't help nurses in advancing to the APRN role? Actually, there's no need, the evidence speaks for itself.

Chris L.

While clinical experience isn't a set requirement, call up any PA program and ask what their average hours of clinical experience are- they're generally well into the thousands of hours. Most of the PAs I worked with were former paramedics, nurses, RTs, and PTs.

Why must an NP have student rotations with an MD/DO? We are not in school to become physicians, we are in school to become NPs... So are you basically trying to say that NPs aren't good enough to teach student NPs on properly providing evidence based diagnosis and treatment plans? If you could please provide your evidence I'd greatly appreciate it. Oh, and the reason PA students must shadow PAs and Physicians is because they have the word "Physician" and "Assistant" in their title. A physician is required to oversee and supervise ALL PAs (I think a max of 4 at one time), whereas it's not required for the same with NPs in many states.

http://www.pac.ca.gov/supervising_physicians/faqs.shtml
https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-map/

Let's see... If one expects to be taught something and achieve a level of competence, it helps if they are being taught by someone that is an expert in it. Now, nurses have a more limited preclinical education, as well as a more limited clinical education, so barring a lot of mentoring from an expert in differential diagnosis, how the he'll are you supposed to end up with nurses that can teach and ecaluate the abilities of other nurses to do something they are not an expert at? Where did the original experts come from, and how is it they impart clinic perfection in a mere 700 hours of training in advanced diagnostics and such? And what of all the direct entry NPs these days? I wouldn't trust a new nurse to work the floor unsupervised, and yet your boards are letting them run straight through with 4 months worth of full time hours and declaring them safe for public utilization. It would be hilarious if it weren't so dangerous.

 

[762513]

[citation needed]

Show me a study, and I'll show you where it falls short.

Here's what you said. I showed you 39 studies from a literature review of 27,000. I'll just wait quietly until you do what you said you were going to do.

 

[Mad Jack]

Here's what you said. I showed you 39 studies from a literature review of 27,000. I'll just wait quietly until you do what you said you were going to do.

A study. Not 39 of them.

 

[762513]

A study. Not 39 of them.

A meta-analysis is the highest form of evidence available. Pick any study from there you would like. Please find the flaws and then explain why your opinion is superior to the independent panel of MD's that verified the findings and the PhD's involved in the original research. I'm gonna get some pop corn while I wait.

 

[ChrisNP87]

I think you're confusing my distaste for nurse independent practice with a distaste for nurse practitioners. NPs are great at what their role was designed for, but I believe they provide subpar independent care to board certified physicians. A good part of the reason their liability is still so low is precisely because they have supervising physicians or employers that set their protocols in over 98% of cases- lawyers go after the big fish, physicians and employers, rather than the little fish like nurses, because we're where the money is at. With more independent NPs, I predict an increase in NP malpractice and premiums.

As to quality, I'm hoping to conduct a study myself in a few years- 50 NPs with equally large patient panels to their FM counterparts and no oversight versus 50 freshly residency FM trained graduates. I think the results will speak for themselves. All current studies to date have focused on limited, singular outcome measures (such as HbA1c levels) but ignored confounding factors (in the glycemic control study, NPs were specifically provided with training in diabetes management, they had more time to counsel patients, and there was no controlling for patient complexity- and yet, with all those advantages, NPs merely had equal outcomes to their physician counterparts, hardly a victory). I'm going to create the most unbiased study possible- equal time per patient, equal acuity of patients, equal productivity expectations- and if the outcome is equal, I will then consider you adequate independent practitioners. It will be a groundbreaking study, one way or another.

Now, you have a lot of experience prior to NP school, but often today I find myself faced with direct entry NP nursing program graduates that don't know their ass from their elbow. The disparity in quality between a PA school graduate and these graduates is massive- in the ED, we'd throw fresh PAs out there, and we never lost a single one. Our organization (a major L1 trauma center), on the other hand, stopped hiring NP graduates without at least 5 years of prior acute care or ED experience, because anyone with less than that ended up either being too slow and inefficient or outright dangerous. The same ended up occurring in our medical intensive care units- fresh PAs were fine, but 3 years of ICU experience at a university medical center was expected for NPs. And this was at a place that was almost desperately short of staff- we'd run into so many bad NPs that went to subpar direct entry programs that clung to the minimum standards and couldn't function properly in an acute care environment and ended up being fired that we had to start being picky despite our need. Our good NPs were great, and could keep the ICU running smoothly while rounds had moved elsewhere, and knew when they were in over their head to grab the resident or attending. The bad ones, well- they were dangerously bad, to the point the RNs were having to go over their heads to contact attending directly and sidestep their incompetence. And that, right there, is my problem with independent nurse practice- quality control. The disparity in clinician quality between experienced NPs that came out of great programs and direct entry NPs or RNs that went straight from a BSN to a MSN NP program that barely clung to the minimum training requirements is astounding. Hell, go to allnurses and you can find your fellow nurses complaining about the same thing in some old threads. NP school was designed for experienced registered nurses to obtain an expanded scope of care in a specific field, with some degree of oversight or collaboration with a physician, after additional training within that area. It wasn't designed for some schmuck with a BA in art history to go straight through in 3 years and come out an independent provider capable of competently setting and treating a full spectrum of disease independently.

Okay, I now understand your point of view. I am very interested in knowing more about this small-scale study you plan on conducting. It would be wonderful to see your research study provide the unbiased quantitative data necessary to effectively measure the quality outcomes and relay factual scientific evidence that will prove if board certified FM physicians provide better, equal, or subpar levels of care than primary care family nurse practitioners. I think it's absolutely imperative to conduct these types of research studies, to not only show which healthcare profession provides better care, but to explore reasons as to why such a disparity exists. I hope your study serves as the catalyst that incites further research studies to be done on a larger scale. If NPs are found to provide subpar independent care then I would hope our governing agencies implement changes like requiring more didactic and clinical rotation, or even better, require a residency program for new NP graduates; I know I would love that!

Only licensed RNs can apply to an NP program, unlike the PA program, where you can have pretty much any undergrad degree but take the required courses needed to apply to the program...

However, I 100% agree with your argument above. New nurses SHOULD NEVER be allowed to attend an APRN program without previous relevant clinical experience. I find it an absolute disgrace that universities would even consider accepting nurses into an NP program without at least 2-3 years of relevant acute/critical care experience... It's not only a disgrace to our profession but a huge disservice to our patient's! I couldn't imagine going right into an NP program immediately after I graduated nursing school, I'm nervous as it is now, even with my current nursing experience. Thankfully I'm the type of person who would ask a fellow physician/NP/PA for help rather than put my patient's life in jeopardy. That behavior is unacceptable and should never be tolerated, as I'm sure you agree.

Oh by the way, I found this journal quite interesting, it's in regards to the quality and effectiveness of care provided by NPs. http://www.medscape.com/viewarticle/810692

I'm glad you explained yourself and I have to agree with the critical points you so thoroughly bring up. I look forward to hearing more about your study! Keep me posted.

Best,

Chris L.

 

[ChrisNP87]

I've already done it in other threads. You are aware we get a thorough education in biostatistics and study design in medical school, right?

Just an FYI; we do get a graduate level Biostatistics course in NP school.

 

[ChrisNP87]

Which perpetuates and compounds the problem, leading to an entire new generation of NPs who don't know what they don't know.

Not knowing what you don't know is a disastrous outcome no matter the healthcare profession. I, for one, plan on doing at least half of my clinical rotations with physicians rather than all NPs. I even asked my advisors if I could do more clinical hours than the required 700; still waiting to hear back from them. Everything I learn and/or don't learn will ultimately affect the quality of care I give to my patient's. I would never want to be of a disservice to my patient's in any way. I'm in agreement with requiring more didactic and clinical rotation hours. I'd even like to see an NP residency program come to fruition!

 

[ChrisNP87]

While clinical experience isn't a set requirement, call up any PA program and ask what their average hours of clinical experience are- they're generally well into the thousands of hours. Most of the PAs I worked with were former paramedics, nurses, RTs, and PTs.

Let's see... If one expects to be taught something and achieve a level of competence, it helps if they are being taught by someone that is an expert in it. Now, nurses have a more limited preclinical education, as well as a more limited clinical education, so barring a lot of mentoring from an expert in differential diagnosis, how the he'll are you supposed to end up with nurses that can teach and ecaluate the abilities of other nurses to do something they are not an expert at? Where did the original experts come from, and how is it they impart clinic perfection in a mere 700 hours of training in advanced diagnostics and such? And what of all the direct entry NPs these days? I wouldn't trust a new nurse to work the floor unsupervised, and yet your boards are letting them run straight through with 4 months worth of full time hours and declaring them safe for public utilization. It would be hilarious if it weren't so dangerous.

I know what it takes to become a PA, I was referring to those who were not yet in the program. Those that you mentioned are exactly the types of people who should be applying to PA programs!

I personally plan on doing at least half of my clinical rotations, if not more, with physicians. But isn't an NP with 10-30 yrs experience technically considered an expert in the care they provide? I also agree that new NP should be required to have some sort of residency or fellowship programs. I don't see how an NP can come out of school prepared to practice medicine autonomously with only 700 hours of clinical and 600 hours didactic... that's just ABSURD! Physicians are the experts in care and I would never argue that, but NPs become experts eventually. I think they should be allowed to practice autonomously after a certain amount of hours being supervised by physicians. I believe NY State allows NPs to practice autonomously after 5000 physician supervised clinical hours, which is fair in all honesty. Do you agree then?

 

[Jules A]

The consensus is that 700 hours clinical and 600 hours didactic is insufficient to warrant the independent practice of medicine in a safe and effective manner.

Unfortunately this is not accurate. While your RN experience is valuable and important it does not give you "credit" or advanced standing. Only prescriber-level training can do that and RNs are not at that level.

So the RN experience would be invaluable if it was still required. Worth considering is the current trend of NP schools, including the well respected brick and mortar, to maintain a hold on their undergraduate students and push them through graduate school without any requirement that they ever practiced as a RN. Apparently if they let them go out and practice some won't return to school and others might take their tuition funds to another school. This negates the original intent of accepting the brief NP program curriculum in consideration of years of nursing experience to augment the lack of formal education. I'm surprised the AMA hasn't latched on this like a dog on a bone.

Something that I also didn't see mentioned is that DNP programs count their "nursing research capstone project" as clinical hours which they absolutely are not. These programs have no more actual clinical hours than the Masters NP programs which average around 750. In fact the last underwhelming "capstone project" I saw was on hand washing, sweet!

 

[762513]

So the RN experience would be invaluable if it was still required. Worth considering is the current trend of NP schools, including the well respected brick and mortar, to maintain a hold on their undergraduate students and push them through graduate school without any requirement that they ever practiced as a RN. Apparently if they let them go out and practice some won't return to school and others might take their tuition funds to another school. This negates the original intent of accepting the brief NP program curriculum in consideration of years of nursing experience to augment the lack of formal education. I'm surprised the AMA hasn't latched on this like a dog on a bone.

Something that I also didn't see mentioned is that DNP programs count their "nursing research capstone project" as clinical hours which they absolutely are not. These programs have no more actual clinical hours than the Masters NP programs which average around 750. In fact the last underwhelming "capstone project" I saw was on hand washing, sweet!

Citation needed. My program most certainly does not.

CL87 I think there should be a two step NP exam, one for supervised and one for independent practice.

Someday the government may fund NP residencies the way they fund MD residencies today.

 

[Jules A]

Citation needed. My program most certainly does not.

.

Citation needed for what?

 

[762513]

Citation needed for what?

That DNP programs include their thesis study time as clinical hours. Not true at my school. Clinical hours is at the bedside wearing a white coat.

 

[Jules A]

That DNP programs include their thesis study time as clinical hours. Not true at my school. Clinical hours is at the bedside wearing a white coat.

[QUOTE="IknowImnotadoctor, post:My FNP program has more than 1500 hours of clinical training time and is in the top 10% of graduate schools in the country. [/QUOTE]

Thanks for the clarification. While I could only wish that all 1,500 of your clinical hours were required to be done providing care at the bedside, wearing whatever garb customary for the particular setting, I'm doubtful that is the case and suspect its more like the typical Masters 500-750 hours in practicum with that capstone project accounting for the rest of the "clinical hours". The DNP historically is not known as a clinical Doctorate. If your school is different and is offering a clinical doctorate perhaps you would consider posting the name or a link because I know more than a few RNs and NPs who would be much appreciative and consider enrolling it if it is actually more than extra nursing fluff courses and that underwhelming capstone thing that differentiates the masters from the doctorate.

 

[762513]

[QUOTE="IknowImnotadoctor, post:My FNP program has more than 1500 hours of clinical training time and is in the top 10% of graduate schools in the country.

Thanks for the clarification. While I could only wish that all 1,500 of your clinical hours were required to be done providing care at the bedside, wearing whatever garb customary for the particular setting, I'm doubtful that is the case and suspect its more like the typical Masters 500-750 hours in practicum with that capstone project accounting for the rest of the "clinical hours". The DNP historically is not known as a clinical Doctorate. If your school is different and is offering a clinical doctorate perhaps you would consider posting the name or a link because I know more than a few RNs and NPs who would be much appreciative and consider enrolling it if it is actually more than extra nursing fluff courses and that underwhelming capstone thing that differentiates the masters from the doctorate.[/QUOTE]

I fail to see any rational reason for your opinion. I have three practicum semesters in clinic in which my first 1000 hours is divided into. Then I have a residency semester in which I am responsible to accue 500 hours at the bedside. The DNP project is not included in any bedside hours. The DNP is a clinical doctorate today, what it has been historically is not a useful comparison as it is a relatively new degree and title. I don't understand where you are coming from at all.

Here is a link to the recent white page updates to the DNP program from the AACN. After reading the document let me know if I can clarify anything for you futher.

http://www.aacn.nche.edu/news/articles/2015/dnp-white-paper

 

[Jules A]

[QUOTE="IknowImnotadoctor, post:My FNP program has more than 1500 hours of clinical training time and is in the top 10% of graduate schools in the country.
I fail to see any rational reason for your opinion. I have three practicum semesters in clinic in which my first 1000 hours is divided into. Then I have a residency semester in which I am responsible to accue 500 hours at the bedside. The DNP project is not included in any bedside hours. The DNP is a clinical doctorate today, what it has been historically is not a useful comparison as it is a relatively new degree and title. I don't understand where you are coming from at all.

Here is a link to the recent white page updates to the DNP program from the AACN. After reading the document let me know if I can clarify anything for you futher.

http://www.aacn.nche.edu/news/articles/2015/dnp-white-paper[/QUOTE]

While again I'd love to think you actually have 1,500 true clinical hours of diagnostic and prescribing experience in a clinical setting what sticks out is that you separate it into 1,000 and "500 hours at the bedside" which makes me wonder exactly what the other 1,000 hours are? I you are not physically at a facility with your preceptor caring for patients I don't consider them clinical hours. In any event here is a citation for you indicating the clinical hours needed to get a DNP from one of the Big Boys, not a flimsy for profit online school.

Program consists of 82 credits and 784 clinical hours that may be completed in as few as four semesters.
http://nursing.jhu.edu/academics/programs/doctoral/msn-dnp/dnp-family/index.html

I won't be responding further so you can take what I offered and consider it or not. Have a good rest of the weekend.

 

[762513]

[QUOTE="IknowImnotadoctor, post:My FNP program has more than 1500 hours of clinical training time and is in the top 10% of graduate schools in the country.
I fail to see any rational reason for your opinion. I have three practicum semesters in clinic in which my first 1000 hours is divided into. Then I have a residency semester in which I am responsible to accue 500 hours at the bedside. The DNP project is not included in any bedside hours. The DNP is a clinical doctorate today, what it has been historically is not a useful comparison as it is a relatively new degree and title. I don't understand where you are coming from at all.

Here is a link to the recent white page updates to the DNP program from the AACN. After reading the document let me know if I can clarify anything for you futher.

http://www.aacn.nche.edu/news/articles/2015/dnp-white-paper

While again I'd love to think you actually have 1,500 true clinical hours of diagnostic and prescribing experience in a clinical setting what sticks out is that you separate it into 1,000 and "500 hours at the bedside" which makes me wonder exactly what the other 1,000 hours are? I you are not physically at a facility with your preceptor caring for patients I don't consider them clinical hours. In any event here is a citation for you indicating the clinical hours needed to get a DNP from one of the Big Boys, not a flimsy for profit online school.

Program consists of 82 credits and 784 clinical hours that may be completed in as few as four semesters.
http://nursing.jhu.edu/academics/programs/doctoral/msn-dnp/dnp-family/index.html

I won't be responding further so you can take what I offered and consider it or not. Have a good rest of the weekend.[/QUOTE]

My 3 semesters of practicum is 2-3 8 hour shifts in a clinic per week. Once those hours are done you can start your residency which must be 500 hours but can now be inpatient instead of outpatient.

The argument of "I just don't believe you" is a pretty poor argument.

 

[762513]

My 3 semesters of practicum is 2-3 8 hour shifts in a clinic per week. Once those hours are done you can start your residency which must be 500 hours but can now be inpatient instead of outpatient.

The argument of "I just don't believe you" is a pretty poor argument.

PA clinicals consist of five weeks per rotation, 8am-5pm, five days a week, for an entire year. Some require more.


Sent from my iPad using Tapatalk[/QUOTE]

How does that have anything to do with the previous poster disputing how many hours my program requires?

 

[deleted782953]

Students of both don't generally want to go into primary care to fill the needs where they are most if they get a chance to work in a specialty/subspecialty instead. PA students require prerequisite 1000-4000 hours of clinical training to apply to PA school. NP's want to be doctors with independent practice rights with further online degrees leading to a DNP. PAs have more background medical knowledge rather than nursing knowledge.

 

[pamac]

A lot of this has to do with the intimate relationship between PA and MD/DO education. In my PA program we take classes with the medical students and have the same professors, tho we take not as many classes as the medical students. PAs have no wish to severe or end the physician-lead team and have every interest in increasing our medical knowledge lead by our collaborating physicians. NP, on the other hand, don't know what they don't know.

Oh please... the condescension there is intense. Physician folk use the "don't know what they don't know" statement against PA's all the time. I most recently read it in print in a publication last year in an article that had no mention of NP's.

How many stand alone PA schools are out there where no med students are around to take classes with. Should we count them? Maybe lets not use that as a foundation for your argument. Just like not every NP program is a fully online operation, not every PA program is attached to a medical school. Of the PA programs nearest to me, none of them has a medical school attached.

Go to the PA forums and do a quick cursory search to see how many of your fellow PA's (or who will be your fellows once you graduate) would like to re-evaluate the physician/physician assistant professional relationship before you speak as if PA's and MD's have a unified, monolithic approach. Also, don't be so hasty to assume you and the MD's are on the same page running a united front against NP's. PA's for the most part are lumped in with NPs and get to sit at the kids table in the eyes of most physicians. It wasn't until recently that PA's were even allowed into the physicians lounge at my facility, and when they did, it was because NP's made it happen. Non physician providers still get the side eye from a few of the surgeons when they take a trip in there.

There is merit to the arguments made regarding certain aspects of PA's coming out of school very well trained in comparison to many NP's, but the BS is getting a little thick when the PA student is telling ICU nurses that are NP students that they don't know much. Most of us aren't direct entry NP students, we've seen quite a bit, and can manage stressful situations. For quite some time now, the line of attack on NPs involves casting a broad net and insisting that most NP programs consist of the direct entry of fully online version.

I took a tour of a PA program in the past where (by the professors own estimation that he volunteered without me even asking) 5/6 of the class had zero health care experience, and the ones that did were essentially mediocre. It used to be that health care experience was heavy in the PA realm. That's changed quite a bit too.

 

[pamac]

Neither are physicians. This is the reason why PAs and physicians go to school for 3 and 4 years, respectively. Are you suggesting that physicians are unprepared for medical school because they do not have a clinical degree, professional license, or pass a state board certification prior to enrolling into the program?

Where are you getting the 3 years of school for PA's from? PA school is for the most part about 2 years... One year didactic, one year clinical.

 

[pamac]

PA clinicals consist of five weeks per rotation, 8am-5pm, five days a week, for an entire year. Some require more.


Sent from my iPad using Tapatalk

How does that have anything to do with the previous poster disputing how many hours my program requires?[/QUOTE]

I've seen PA students twiddling their thumbs in clinical settings and dinking around, so not everyone's clinical experience is something straight out of the TV show ER.

I just think its funny that all NP programs are online with new grads and low expectations, with low clinical hours to boot, but every PA programs is attached to a medical school, and the applicants have thousands of hours of experience as RTs, Paramedics, and RN's who want more of a challenge. That's all I hear when people want to put down NP's.

 

[pamac]

Most of the PAs I worked with were former paramedics, nurses, RTs, and PTs.

I can't remember the last time I met a PA that was a former nurse, RT, physical therapist (for real?), or even a paramedic (not even an emt basic). I couldn't even say that most of them even spent any considerable amount of time doing any kind of licensed patient care whatsoever, even at entry level. I just met one that was a tech at a specialty facility prior to PA school, and I was impressed at that because its been so long that I've met a PA that didn't have the typical profile of young female in early 20's with a big heart, great grades, and was in her first real job of her life. I've personally listened to a PA program director brag to me that "studies have shown that health care experience is disconnected to the success of PA students... we can take any good student and turn them into a PA." This was a person with significant health care experience who was saying that.

I like PA's, and respect the achievement, so when this topic comes up every week, it seems like needless polarization to me. I switched focus from PA to NP precisely because I wanted more daylight between my job, and the reliance upon establishing a business relationship directly with a physician in order to perform my duties. To some degree, even in the best states for NP's, there is still some kind of relationship that needs to be in place, but its less than what would have been required of me if I would have become a PA. But I really like the PAs I work with, and experience no friction with them like I have with NP's, and I think a lot of that has to do with them not carrying over baggage from a nursing career. I'm not interested in being an independent operator either. But for me as a nurse, I like how my profession is my own, just like an RT or any other profession out there. I'm not interested in being a PA squire to the MD/DO knight, and I think it would be a good thing for PA's to have some distance from physicians as well. I think it will happen as more physicians become employees. In fact, they may even demand it as their work will be less wedded to them being business owners. If I were a physician, I wouldn't be eager to sign on as an employee only to be told that I'm on the hook for up to 4 PA's to supervise. Something will change for PA's, but a lot of that will be because the establishment is seeing NP's make inroads without the sky falling. The alphas among the PA's are also pushing for the right things, but of course are getting rebuffed from a lot of different sides (sometimes even from NP's).

 

[Apollyon]

I wish all (or most) of you dopes could just quote properly.

MD/EMT-P snob, ABEM certified

 

[762513]

Just demonstrating the contrast in PA vs NP clinical education.

Students of both don't generally want to go into primary care to fill the needs where they are most if they get a chance to work in a specialty/subspecialty instead. PA students require prerequisite 1000-4000 hours of clinical training to apply to PA school. NP's want to be doctors with independent practice rights with further online degrees leading to a DNP. PAs have more background medical knowledge rather than nursing knowledge.

1000-4000 of clinical "training" as a prerequisite to PA school. Are you talking about the volunteers who answers the phones and get water for patients twice a week?

As a ICU RN my prerequisite time was spent doing CPR, titrating pressors, running CRRT, paralyzing and sedating, running complex hypothermia order sets, and catching the codes before they even happen. (And btw, I continue working as a ICU RN 25 hours a week every weekend while I apply some of what I am learning in NP school directly at the bedside, outside of my NP clinical time)

Please describe what most PA students "1000-4000 hours of clinical training" refers to. It IS getting deep in here.

 

[Boatswain2PA]

I'm currently enrolled in an Family Nurse Practitioner Program (a broad base of knowledge required ranging from neonates/pediatrics to OB/GYN to Adult/Geriatrics) that requires at least 700+ clinical hours and approximately 600 didactic hours. ....


...One major difference is: "Unlike physician assistants, nurse practitioners are able to operate independently in some states. However, most still work within larger healthcare settings or as part of a healthcare team."

700+ clinical hours! BWAAAAAHAHAHAAA!!!! A PA student generally gets two FP rotations, averaging 5 weeks, that's at least 800 (and more likely 1000-1200 hours) of FP...PLUS they have required rotations in EM, Womens health, psych, inpatient care, and pediatrics!

Regarding independent practice - kinesiologists can practice independently in most states. So can naturopathic docs, along with shamans and other quacks. Independent practice does not equal quality practice.

A meta-analysis is the highest form of evidence available. Pick any study from there you would like. Please find the flaws and then explain why your opinion is superior to the independent panel of MD's that verified the findings and the PhD's involved in the original research. I'm gonna get some pop corn while I wait.

Wrong. Meta-Analysis is often a terrible form of evidence. The highest form of evidence available is RCT double blinded study. You should have learned that in your "graduate level biostatistics class"...unless it was taught by someone who wasn't a biostatistician.

Program consists of 82 credits and 784 clinical hours that may be completed in as few as four semesters.

784 clinical hours in as few as four semesters! I think I had 784 clinical hours in my 6 week general surgery rotation!! (ok, slight exaggeration)

PA clinicals consist of five weeks per rotation, 8am-5pm, five days a week, for an entire year. Some require more.

8am-5pm? Try again! 32 hour shifts on trauma rotation (24 hours trauma followed by 8 hour ICU) every other day. 5 days a week? I only had 2 rotation where I consistently had weekends off. This intense schedule is common in PA programs.

1000-4000 of clinical "training" as a prerequisite to PA school. Are you talking about the volunteers who answers the phones and get water for patients twice a week?

As a ICU RN my prerequisite time was spent doing CPR, titrating pressors, running CRRT, paralyzing and sedating, running complex hypothermia order sets, and catching the codes before they even happen. (And btw, I continue working as a ICU RN 25 hours a week every weekend while I apply some of what I am learning in NP school directly at the bedside, outside of my NP clinical time)

Please describe what most PA students "1000-4000 hours of clinical training" refers to. It IS getting deep in here.

While too many PA schools are getting away from accepting the old school experienced FMF corpsmen, paramedic, RT, or RN, the same problem exists in the NP/DNP world which is rapidly accepting more and more "direct entry" programs.

However, at least PA programs give adequate didactic and clinical training to turn a brilliant but inexperienced young person into a SUPERVISED provider.

NP programs have a fraction of the didactic and clinical training, but yet they are turning out UNSUPERVISED providers.

 

[762513]

700+ clinical hours! BWAAAAAHAHAHAAA!!!! A PA student generally gets two FP rotations, averaging 5 weeks, that's at least 800 (and more likely 1000-1200 hours) of FP...PLUS they have required rotations in EM, Womens health, psych, inpatient care, and pediatrics!

Regarding independent practice - kinesiologists can practice independently in most states. So can naturopathic docs, along with shamans and other quacks. Independent practice does not equal quality practice.



Wrong. Meta-Analysis is often a terrible form of evidence. The highest form of evidence available is RCT double blinded study. You should have learned that in your "graduate level biostatistics class"...unless it was taught by someone who wasn't a biostatistician.



784 clinical hours in as few as four semesters! I think I had 784 clinical hours in my 6 week general surgery rotation!! (ok, slight exaggeration)



8am-5pm? Try again! 32 hour shifts on trauma rotation (24 hours trauma followed by 8 hour ICU) every other day. 5 days a week? I only had 2 rotation where I consistently had weekends off. This intense schedule is common in PA programs.



While too many PA schools are getting away from accepting the old school experienced FMF corpsmen, paramedic, RT, or RN, the same problem exists in the NP/DNP world which is rapidly accepting more and more "direct entry" programs.

However, at least PA programs give adequate didactic and clinical training to turn a brilliant but inexperienced young person into a SUPERVISED provider.

NP programs have a fraction of the didactic and clinical training, but yet they are turning out UNSUPERVISED providers.

Woah, where to start:

1: I didn't say 784 hours. I was quoting someone else. Find the primary source.

2: A meta-analysis is not the best form of evidence? You seriously need more education if that is actually what you think. (My Biostats course was taught by a Harvard trained PhD in statistics, my epidemiology class by a PhD epidemiologist. You simply couldn't be more wrong than you are: Referencehttps://hsl.lib.umn.edu/biomed/help/levels-evidence-and-grades-recommendations) It's honestly hard to believe anything you say now, I'm shocked that someone who at least says they are a practicing PA could be that uneducated.

 

[deleted782953]

Case in point: derm NP programs. Really? And where's the shortage in healthcare? Primary care. My point: Do NP/PAs exist to supplement and work alongside physicians or are they just another way to reach the "lucrative" fields? NP/PAs talk about being a positive force in reaching the shortage of physicians in the US...then almost all the PAs and NPs I've ever met are not working in primary care and the NP/PA students who are looking for first jobs are looking for "fun, interesting" jobs, aka not primary care. So again, what is their role?

 

[762513]

Case in point: derm NP programs. Really? And where's the shortage in healthcare? Primary care. My point: Do NP/PAs exist to supplement and work alongside physicians or are they just another way to reach the "lucrative" fields? NP/PAs talk about being a positive force in reaching the shortage of physicians in the US...then almost all the PAs and NPs I've ever met are not working in primary care and the NP/PA students who are looking for first jobs are looking for "fun, interesting" jobs, aka not primary care. So again, what is their role?

A derm NP program doesn't exist.

 

[deleted782953]

A derm NP program doesn't exist.

http://www.lahey.org/Departments_an...e_Practitioner_Fellowship_in_Dermatology.aspx

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_residency.html

 

[762513]

http://www.lahey.org/Departments_an...e_Practitioner_Fellowship_in_Dermatology.aspx

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_residency.html

That's a fellowship. That's not an NP degree. There is no such thing as a NP derm program. That "derm NP" will have not have a differen license or credential.

 

[Boatswain2PA]

Woah, where to start:

1: I didn't say 784 hours. I was quoting someone else. Find the primary source.

2: A meta-analysis is not the best form of evidence? You seriously need more education if that is actually what you think. (My Biostats course was taught by a Harvard trained PhD in statistics, my epidemiology class by a PhD epidemiologist. You simply couldn't be more wrong than you are: Referencehttps://hsl.lib.umn.edu/biomed/help/levels-evidence-and-grades-recommendations) It's honestly hard to believe anything you say now, I'm shocked that someone who at least says they are a practicing PA could be that uneducated.

You are going to be "shocked" a lot when you get out into the real world.

A meta-analysis of a bunch of retrospective observational studies is poor evidence.

The prospective, double blinded, randomized control trial is the gold standard for research. Sorry your nursing education didn't fill you in on that.

 

[Mad Jack]

Woah, where to start:

1: I didn't say 784 hours. I was quoting someone else. Find the primary source.

2: A meta-analysis is not the best form of evidence? You seriously need more education if that is actually what you think. (My Biostats course was taught by a Harvard trained PhD in statistics, my epidemiology class by a PhD epidemiologist. You simply couldn't be more wrong than you are: Referencehttps://hsl.lib.umn.edu/biomed/help/levels-evidence-and-grades-recommendations) It's honestly hard to believe anything you say now, I'm shocked that someone who at least says they are a practicing PA could be that uneducated.

Actually, this paper explores what to trust in regard to trials: http://www.ncbi.nlm.nih.gov/pubmed/19027095

Often, a single, large RCT is preferred to a meta-analysis, hence why many CPGs are based on large, multi-center studies rather than meta analyses (ARDSNet, for instance, comes to mind, as do many other ED and ICU protocols). Meta-analyses have their limits, particularly when the writer has a confirmation bias or political agenda, or when the studies comprising a meta-analysis are poorly constructed (as is the case in the NP debate). That you simply throw out, "meta-analysis=best form of evidence" sells short that there is actually a great deal of debate over when to trust which form of study. Here's a debate on the issue that was held by the ASCO: http://www.ascopost.com/issues/june...als-vs-meta-analyses-which-is-the-better-bet/

RCTs are nice because they provide less room for fudging things to fit a narrative, and less ability to cherry-pick data when the study is large enough and well-constructed. Meta-analyses are more prone to cherry-picking, as they are only as strong as the writer constructs them to be, and depend entirely upon which data the author deems to be important versus not to share at all. So a well-constructed meta-analysis can be the gold standard for something, while a poorly constructed one can exploit the flaws of the studies that comprise it to craft a result that fits a narrative, something that is more difficult to do when you only have one set of data to draw from.

 

[Mad Jack]

How does that have anything to do with the previous poster disputing how many hours my program requires?

I've seen PA students twiddling their thumbs in clinical settings and dinking around, so not everyone's clinical experience is something straight out of the TV show ER.

I just think its funny that all NP programs are online with new grads and low expectations, with low clinical hours to boot, but every PA programs is attached to a medical school, and the applicants have thousands of hours of experience as RTs, Paramedics, and RN's who want more of a challenge. That's all I hear when people want to put down NP's.[/QUOTE]
NP students and PA students are both going to be ****ing around for some of their hours, but when you've got >2,000 to work with, you're going to be getting a lot more mid-level experience than when you've got ~700. And the 8-5 thing isn't really true- it depends on the service. PA residents in surgery at most places around here do 60-80 hours per week, same with IM and OB, often with call. Psych, peds, and FM are usually 8-5 M-F.

 

[pamac]

I went and asked a PA near me how many hours they spent in surgery on average during his rotation... they were lucky if they had a full 40 hours. This person went to school back east. But I'm a believer in the robustness of PA education.

So the thing is, you have a psyche rotation for PAs, and you have psyche NPs who have the focus on psyche. PA's have a rotation to OB, NPs have a whole NP track for that. We keep discussing how NP's don't do all these hours in certain specialties like surgery.... its because NP education is generally not as spread out as the generalist PA. Are very many new grads FNP's jumping into surgery and harshing your buzz? I'm not blind to the benefit that a surgical rotation can bring to overall insight for a midlevel provider, but NP's generally get put into more of a specialty focus.

 

[Boatswain2PA]

I went and asked a PA near me how many hours they spent in surgery on average during his rotation... they were lucky if they had a full 40 hours. This person went to school back east. But I'm a believer in the robustness of PA education.

So the thing is, you have a psyche rotation for PAs, and you have psyche NPs who have the focus on psyche. PA's have a rotation to OB, NPs have a whole NP track for that. We keep discussing how NP's don't do all these hours in certain specialties like surgery.... its because NP education is generally not as spread out as the generalist PA. Are very many new grads FNP's jumping into surgery and harshing your buzz? I'm not blind to the benefit that a surgical rotation can bring to overall insight for a midlevel provider, but NP's generally get put into more of a specialty focus.

Yes, but they are into more of a specialty focus TO THE DETRIMENT OF the other specialties.

PAs, however, often get the same amount of "specialty training" as the "specialized NPs", but also have significant exposure to the rest of medicine as well.

With the rapid growth of PA schools I'm sure there are some programs who are slacking. However the standard is still there...at least that PA got 40 hours a week of surgery. I doubt any NP programs give that much unless they specialize in surgery.

 

[pamac]

You are full of it, Boatswain. My program has 1000 hours of specialty training... so you got 1000 hours of training in my specialty? You don't, dude.

Most of your stats on PAs lean heavy to the benefit of your profession, and to the extreme detriment of NPs. 2 years of PA school is mentioned by you to be 2 to 3 years, every NP program has the lowballed clinical hours and is fully online with most of the applicants being direct entry. PA programs have 20-40 applicants per seat. There very well could be a program out there with 40 applicants per seat, and there definitely are 3 year PA programs (I was invited to interview at one). But you routinely mix in your highs and lows according to your biases and assert that its the rule. Everyone knows somebody that does that, and they get eyes rolling because they are seen as serial BS'ers. There is where you fit in.

 

[Boatswain2PA]

You are full of it, Boatswain. My program has 1000 hours of specialty training... so you got 1000 hours of training in my specialty? You don't, dude.

Most of your stats on PAs lean heavy to the benefit of your profession, and to the extreme detriment of NPs. 2 years of PA school is mentioned by you to be 2 to 3 years, every NP program has the lowballed clinical hours and is fully online with most of the applicants being direct entry. PA programs have 20-40 applicants per seat. There very well could be a program out there with 40 applicants per seat, and there definitely are 3 year PA programs (I was invited to interview at one). But you routinely mix in your highs and lows according to your biases and assert that its the rule. Everyone knows somebody that does that, and they get eyes rolling because they are seen as serial BS'ers. There is where you fit in.

What specialty are you in? I'm certainly not saying PAs get the same amount of hours in EVERY specialty, but my premise is accurate for many "specialized" NPs. A FNP is "specialized" in family because they do 1000 hours (just to make you happy Pamac I am not using the minimum 500 hours that many programs have). But virtually all PAs get as many family practice/Peds/Womens health hours as the FNP who is "specialized", PLUS they get the surgery, inpatient, EM and Psych.

An ACNP is "specialized" because they have 1000 hours in acute care, but many PAs have that between EM, surgery, and inpatient rotations. PLUS they get the FP, womens health, peds, and psych.

I'm sure that, out of allllll of the specializations that the NPs have, there are some specializations where they get a lot more clinical specialty hours than PA students. Perhaps Gerontology.

Yeah....eyes are rolling when I, and many others, show how ridiculous NP education is in comparison to PA education.

And your comment on other thread. I've always said MD/DO >>>> PA >>>>>NP education. I've also always advocated for PAs and NPs to maintain the status quo of working for physicians for this very reason.

 

[pamac]

I can see where you are coming from on the FNP, and it would be hard to assert the educational prowess between an FNP and a PA. I'm a believer in PA education. But coming down the pike, there are even nurse led initiative that will screw nurses over plenty, so sit back and wait for those to hit, and then you'll get some satisfaction if the powers that be pull them off. Maybe you would like the idea of NP's being pushed more towards a commitment to a specific track. I see it already happening to the PA world as well.

 

[pamac]

But really, if you are going to use the >>>>>>'s, you should see it the way physicians might see it. Under the best of circumstances for you guys, doctors look at it as MD/DO >>>>>>>>>>>PA>NP. But most of them see it as
MD>>>>>>>>>>>>>>>>>>>>>PA+NP.