Difference between NP & PA....

[jwk]

WRONG...
I'm From Chicago...
Illinois, like many/most states depend upon the national certification test to license NPs...
As such... you have to have a Masters to sit for the exam... Not to take a NP course. But if you took a NP course of study before 1/1/00 and passed... even without a masters... you can be licensed in Illinois!

ALL NPs that took the test before 1/1/00 were/are "grand-fathered" in!!!

DocNusum, FNP, PA-C

If memory serves me correctly, the non-master's CRNA's were grandfathered as well. Funny how the NP/CRNA/ARNP crowd conveniently forgets that many of their minions do NOT have a master's degree, at the same time that they're crowing about their own and how "all of us" have a master's.

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[KarineRN]

Wow, I don't really know what to say about the opinions in this thread.

I am currently an ER RN, have been for 2 years, and have applied to a variety of master's programs for my CRNA. I had no idea there was this type of opinion out there regarding nurses vs. medicine. Where I work, I work mainly with docs, not too many PAs or NPs, and that attitude generally isn't expressed. I haven't really talked to any docs or NPs regarding the attitudes towards both types of mid-level practitioners. Is this really how it is? Is there that strong of an opinion out there in general between PAs and NPs? It seems like, after reading this, that there is quite the strong sentiment...

 

[oldManDO2009]

OMG views from the real world...most of this is a ridiculous diatribe. I think it is great your are getting your CRNA

 

[hospPA]

Is there that strong of an opinion out there in general between PAs and NPs? It seems like, after reading this, that there is quite the strong sentiment...

There is a lot of strife in the PA vs. NP internet world. In the real world, it does not really matter. We do the same jobs in most cases. My emplyer hires both.

The difference in education seems to be where most of the turmoil comes from. There is quite a difference in the hours that PA's and NP's put in during their educational training. Check out Duke's website as an example to what I am talking about. Compare their PA and NP programs curriculum.

Oh yeah, that wanting to be independent thing stands the hair up on a lot of medical people's necks.

Pat, RN, PA-C, MPAS

 

[Mike MacKinnon]

hosppa

Well said. I think that much of the BS you see on this web site actually dosent exist in practice (from my experience). CRNA's seem very removed from all of the politics since its so specialized. When you read some stuff on here you would think CRNA and MDA are at each others throats and this simply isnt often the case at all. You cant work that close with ppl and not develop close relationships.

As for the hours of difference, well i think you have to consider the initial training as well. You can enter the majority of PA programs with a bachelors in bowling and volunteer work as a candy striper as long as you have the pre reqs. This means PA's need to start for the very beggining when it comes to medicine (even if they have a solid background like EMT-P or RN). So the program includes many clinical hours in order to essentially "get them up to speed" with the hospital and health care in general. You could enter PA school and have never touched a patient or seen a sick person. Conversly, all NP schools do require that these individuals are RN's and it seems the lowest minimum ive seen is 1 year critical care experience. This often translates into 3 years as many cannot get into critical care their 1st year. So i think that the "time" difference is irrelevant since much of the things PA's will spend time learning RN's would already be versed in.

At the end of the day i think you end up with good midlevels in either case (for the most part).

 

[hospPA]

hosppa
As for the hours of difference, well i think you have to consider the initial training as well. You can enter the majority of PA programs with a bachelors in bowling and volunteer work as a candy striper as long as you have the pre reqs. This means PA's need to start for the very beggining when it comes to medicine (even if they have a solid background like EMT-P or RN). So the program includes many clinical hours in order to essentially "get them up to speed" with the hospital and health care in general. You could enter PA school and have never touched a patient or seen a sick person. Conversly, all NP schools do require that these individuals are RN's and it seems the lowest minimum ive seen is 1 year critical care experience. This often translates into 3 years as many cannot get into critical care their 1st year. So i think that the "time" difference is irrelevant since much of the things PA's will spend time learning RN's would already be versed in.

At the end of the day i think you end up with good midlevels in either case (for the most part).

Mike,
I have heard your arguement before, and disagree with it again. I feel qualified to make judgment because I did get a BSN and was an RN prior to PA school (and still am). The nursing education and experience did most certainly help me in things like being comfortable touching a patient and knowing some of the medications.

It most certainly did not prepare me to an extent that the 2500 hours of clinical rotations were not necessary. I cannot imagine being anywhere near comfortable practicing with 1/4 to 1/5 that amount of clinical rotations I did. That is about the amount many NP programs offer. It's just not enough, unless you were practicing as a nurse above your licensure (like some "nurse clinician's" ie: some RN's I know who work for cardiologists writing "telephone" orders all day independently without actually using a telephone
Obviously that is outside their scope of practice but cheaper than hiring a properly trained PA or NP) gaining significant medical decision making experience that way.

Staff nurses, in general, do not make life and death decisions like NP's and PA's do everyday. They need to be trained to do that. The only way is through rigorous clinical rotations.

In summary, RN training and experience is helpful as a preparation for PA or NP school, but is not a substitute for thorough training.

Pat

 

[Mike MacKinnon]

Pat

Come now. Rarely if ever,do midlevels make life or death decisions. I make more in a week on the helicopter than you do in a year. There are expections but these are certainly NOT the typical jobs NP's and PA's are in. If your going to make claims like that show me the evidence.

I absolutely disagree with you in regards to how much a critical care RN brings to a PA or NP program. I would be willing to agree that an RN who became a PA would probably be better prepared but I would not at all accept that any other person than an RN entering PA school is near as prepared as the typical NP (assuming the general standard of years of critical care exp.)

I did an exhaustive search on midlevels and outcomes on MDconsult and pubmed and found that there is no evidence for what your saying at all. Clearly, you advocate the path you chose but you are not at all speaking from experience since you have not attended an NP program and therefore have no idea how well prepared you might be or if that extra clinical time mattered at all. Look around at your classmates in PA school. These people were learing what an IV was and how to spell levophed. There is a chasm the size of the grand canyon related to knowledge base difference between the increasingly typical PA program applicant and the RN to PA/NP applicant.

In fact you should read this research project done by a PA which dosent agree with your view.

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijapa/vol4n1/mhe.xml

This next web site does some education comparison. So you know, the average program length of PA programs in the US AND NP programs is 26 months. There goes your assumption that all PA programs have much more clinical time. Also it discussed that though there are more NP's nationally, the incidence of malpractice is less with NP's than PA's which also contradicts your claims. Since, if the PA was so much better prepared one would expect the opposite.

http://amwac.health.nsw.gov.au/amwac/amwac/pdf/US_nonphysician_clinicians_Rod_Hooker.pdf

Mike,
I have heard your arguement before, and disagree with it again. I feel qualified to make judgment because I did get a BSN and was an RN prior to PA school (and still am). The nursing education and experience did most certainly help me in things like being comfortable touching a patient and knowing some of the medications.

It most certainly did not prepare me to an extent that the 2500 hours of clinical rotations were not necessary. I cannot imagine being anywhere near comfortable practicing with 1/4 to 1/5 that amount of clinical rotations I did. That is about the amount many NP programs offer. It's just not enough, unless you were practicing as a nurse above your licensure (like some "nurse clinician's" ie: some RN's I know who work for cardiologists writing "telephone" orders all day independently without actually using a telephone
Obviously that is outside their scope of practice but cheaper than hiring a properly trained PA or NP) gaining significant medical decision making experience that way.

Staff nurses, in general, do not make life and death decisions like NP's and PA's do everyday. They need to be trained to do that. The only way is through rigorous clinical rotations.

In summary, RN training and experience is helpful as a preparation for PA or NP school, but is not a substitute for thorough training.

Pat

 

[hospPA]

Pat

Come now. Rarely if ever,do midlevels make life or death decisions. I make more in a week on the helicopter than you do in a year. There are expections but these are certainly NOT the typical jobs NP's and PA's are in. If your going to make claims like that show me the evidence.

Yes they do. I am unaware of where one would get evidence such as this except for personal experience. That's where mine is from.

Your comment is pretty insulting, considering you have no idea what I do. So, just you and the pilot on the helicopter?
I guess I just need to consider the source. Someone with a gazillion letters, but really only a BSN after his name.

I would be willing to agree that an RN who became a PA would probably be better prepared but I would not at all accept that any other person than an RN entering PA school is near as prepared as the typical NP (assuming the general standard of years of critical care exp.) .

I would argue paramedics fall into this area of being well prepared, better than say a scrub nurse for instance. Yes, the same nurse graduating from PA school would be better prepared than said nurse graduated from NP school. This is my opinion, I have no way to prove that.

Clearly, you advocate the path you chose but you are not at all speaking from experience since you have not attended an NP program and therefore have no idea how well prepared you might be or if that extra clinical time mattered at all. Look around at your classmates in PA school. These people were learing what an IV was and how to spell levophed. There is a chasm the size of the grand canyon related to knowledge base difference between the increasingly typical PA program applicant and the RN to PA/NP applicant. .

I have not attended NP school. I can only base my opinion on the RN's who work full time while doing it. This is very rough to do while in PA school. There are not enough hours in the day. I agree, entering PA school as an RN is the ideal preparation. I am against the ill prepared PA applicants of today. One needs experience for either profession. I am also against straight through NP programs that are also becoming the trend. I certainly see pleanty of 22 year old NP students in our hospital.

In fact you should read this research project done by a PA which dosent agree with your view.

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijapa/vol4n1/mhe.xml.

I took a look and will have to take it as written. I seem to think this study demonstrated less malpractice for all midlevels than docs.

This next web site does some education comparison. So you know, the average program length of PA programs in the US AND NP programs is 26 months. There goes your assumption that all PA programs have much more clinical time. Also it discussed that though there are more NP's nationally, the incidence of malpractice is less with NP's than PA's which also contradicts your claims. Since, if the PA was so much better prepared one would expect the opposite.

http://amwac.health.nsw.gov.au/amwac/amwac/pdf/US_nonphysician_clinicians_Rod_Hooker.pdf

Of course the LENGTH is the same. Look at the cirriculum. That is where the discrepancy is. The clinicals involve part-time, 3 day a week type rotations. PA clinical rotations are almost always 40+ hours a week for a year straight through. Of course I have not looked at every course catalog, only about ten. It was this way in all ten. Hardly scientific, but it gives one a good idea.

What I mean is that given the same applicant (experienced), a PA education is a much better preparation.

For the record, I work with many NP's and after awhile on the job, they most certainly get up to speed. We end up on the same level doing the same job.

Pat

 

[deleted6669]

a couple points:
1.you need critical care experience to be a crna, not an np. most( ?all) np programs will take folks with 1 yr of floor rn experience. in many places this equals glorified cna. many floor nurses do not do procedures but mostly do bedside care like feeding and giving po meds.
there are also direct entry np programs that require only a bs in anything.
2.many pa's and np's for that matter who work in the er make"life or death decisions" daily. mild ones like "should I do a cardiac workup or blow this off since it is probably nothing" to running codes while working as a solo provider.
3. I agree that there are folks entering pa school at this point with just a bs degree and I think this is a major problem with our educational process at this point. that wasn't the case in the past when all pa's were former medics, nurses, or r.t.'s.
4. while nursing is a valuable background for a midlevel it is a different kind of education. yes, you learn about pt care and interacting with people but it is not the same clinical background that you get when you are trained as a clinician( md/do/pa/np). in my mind an rn, an emt-p, and an r.t. are all equivalent backgrounds for becoming a midlevel provider.
5. in clinical practice where pa's and np's work together they do the same things and after a while practice the same way as the docs they work with.

 

[Mike MacKinnon]

EMDPA

As usual we agree

You also have to admitt though that in general, midlevels dont work unsupervised in the ER or make the typical "life or death" decisions

 

[deleted6669]

EMDPA

As usual we agree

You also have to admitt though that in general, midlevels dont work unsupervised in the ER or make the typical "life or death" decisions

don't know what the % is for np's but of pa's working in em probably 10% work solo or essentially unsupervised aside from chart review at the end of the day. so yes, for most midlevels in most settings they are seeing more benign pt presentations.

 

[fab4fan]

most( ?all) np programs will take folks with 1 yr of floor rn experience. in many places this equals glorified cna. many floor nurses do not do procedures but mostly do bedside care like feeding and giving po meds.

That has to be the most uninformed/ignorant statement I have read in a while. You clearly have no clue how acutely ill medical-surgical pts. are these days, and the kind of care they require.

Please, give the same respect to others as you would wish to receive. Maybe you should take a stroll outside the ED and check out what's going on on the M/S floors; you learly need some remedial ed. in that area.

I'm surprised you even said this. You're usually somewhat respectful toward nurses.

 

[Mike MacKinnon]

HospPA

Yes they do. I am unaware of where one would get evidence such as this except for personal experience. That's where mine is from.

I know you seem to feel that way but the cross-section of midlevels in practice suggests you are wrong. Personal experience is certainly not emperical and hold no weight in argument. As well, the fact is that midlevels were never created to replace physicians. The sickest patients will always be seen and evaluated by physicians (at the very least close supervision of)

Your comment is pretty insulting, considering you have no idea what I do. So, just you and the pilot on the helicopter?

Actually, yes it is me and a medic. We dont want to compare management of acute life threatening decision making OR intervention, you HAVE to know as a flight RN i have much more autonomy to manage acute patients (both medical and trauma) than you do as a midlevel within a facility. I could give you examples if your not farmiliar with what flight nursing entails. I practice without a physican present (avaliable by patch if needed) and do NOT have protocols to follow. We work off clinical decision making and expected level of knowledge to be in the position. I deal with Trauma Adult/Peds Medical and High risk OB run balloon pump, ecmo and Lvads and i manage them all independantly. Not only is this covered legally, but also by the board of nursing as an advanced practice role.

I dont have to ask what you do as I know what PA's do both within and outside of the hospital based on the physician assistant website. With the rare exception of rural areas, PA's do not manage and take care of acute patients without direct MD/DO supervision.

I guess I just need to consider the source. Someone with a gazillion letters, but really only a BSN after his name.

Sure you should. Those "gazillion" letters are certification exams which I have passed that test clinical knowledge, decision making and level of competance. Do you say the same thing to boarded EM physicians? Dont assume that because someone is not a physician that their knowledge is limited to floor nursing, you would be dead wrong. Why dont you ask the physicians who work ER and ICU?

I would argue paramedics fall into this area of being well prepared, better than say a scrub nurse for instance. Yes, the same nurse graduating from PA school would be better prepared than said nurse graduated from NP school. This is my opinion, I have no way to prove that.

I agree with you here. I would also say that the med surg rn is also not as prepared.

I certainly see pleanty of 22 year old NP students in our hospital.

Now i will say i havent seen this where i am in AZ. However, i have heard there are programs which do this? In anycase, that seems near impossible since you cant enter BSN until after highschool which is at the earliest 18 years old. 4 years of BSN = 22. One year (minimum critical care) = 23 assuming they went right to the NP track which i dont think is typical judging by the average age of NP's nationally which is 40 something.

I took a look and will have to take it as written. I seem to think this study demonstrated less malpractice for all midlevels than docs.

This is true in general, but if you read that part of the document it says this:

Based on the annual report by the National Practitioner Data Bank, a federal agency which tracks the “misadventures” of health professionals, the annual rate of settled claims by PAs is one-tenth the rate of doctors, depending on the classification of the case (Exhibit 9).

The payment ratio for an incident is one-third of that of physicians. The incidence of malpractice is less for NPs.

Of course the LENGTH is the same. Look at the cirriculum. That is where the discrepancy is. The clinicals involve part-time, 3 day a week type rotations. PA clinical rotations are almost always 40+ hours a week for a year straight through. Of course I have not looked at every course catalog, only about ten. It was this way in all ten.

I cant say ive looked at them all either The averages in that report are total time in training. It cant be called 26 months if it is 12 months in a 26 month period (part time).

What I mean is that given the same applicant (experienced), a PA education is a much better preparation.

I actually think we agree :L) When i have audited the majority of mid level programs before i decided to goto med school, i believe there is a better

For the record, I work with many NP's and after awhile on the job, they most certainly get up to speed. We end up on the same level doing the same job.

Pat, I have no doubt your a good PA. I also have no doubt you work well with others based on how you present yourself here on SDN. I just think your as good as you are because you were an RN b4

Good luck! Hopefully once im through med school ill be working with people like you and emdpa.

 

[hospPA]

HospPA

Yes they do. I am unaware of where one would get evidence such as this except for personal experience. That's where mine is from.

I know you seem to feel that way but the cross-section of midlevels in practice suggests you are wrong. Personal experience is certainly not emperical and hold no weight in argument. As well, the fact is that midlevels were never created to replace physicians. The sickest patients will always be seen and evaluated by physicians (at the very least close supervision of)

Your comment is pretty insulting, considering you have no idea what I do. So, just you and the pilot on the helicopter?

Actually, yes it is me and a medic. We dont want to compare management of acute life threatening decision making OR intervention, you HAVE to know as a flight RN i have much more autonomy to manage acute patients (both medical and trauma) than you do as a midlevel within a facility. I could give you examples if your not farmiliar with what flight nursing entails. I practice without a physican present (avaliable by patch if needed) and do NOT have protocols to follow. We work off clinical decision making and expected level of knowledge to be in the position. I deal with Trauma Adult/Peds Medical and High risk OB run balloon pump, ecmo and Lvads and i manage them all independantly. Not only is this covered legally, but also by the board of nursing as an advanced practice role.

I dont have to ask what you do as I know what PA's do both within and outside of the hospital based on the physician assistant website. With the rare exception of rural areas, PA's do not manage and take care of acute patients without direct MD/DO supervision.

I guess I just need to consider the source. Someone with a gazillion letters, but really only a BSN after his name.

Sure you should. Those "gazillion" letters are certification exams which I have passed that test clinical knowledge, decision making and level of competance. Do you say the same thing to boarded EM physicians? Dont assume that because someone is not a physician that their knowledge is limited to floor nursing, you would be dead wrong. Why dont you ask the physicians who work ER and ICU?

I would argue paramedics fall into this area of being well prepared, better than say a scrub nurse for instance. Yes, the same nurse graduating from PA school would be better prepared than said nurse graduated from NP school. This is my opinion, I have no way to prove that.

I agree with you here. I would also say that the med surg rn is also not as prepared.

I certainly see pleanty of 22 year old NP students in our hospital.

Now i will say i havent seen this where i am in AZ. However, i have heard there are programs which do this? In anycase, that seems near impossible since you cant enter BSN until after highschool which is at the earliest 18 years old. 4 years of BSN = 22. One year (minimum critical care) = 23 assuming they went right to the NP track which i dont think is typical judging by the average age of NP's nationally which is 40 something.

I took a look and will have to take it as written. I seem to think this study demonstrated less malpractice for all midlevels than docs.

This is true in general, but if you read that part of the document it says this:

Based on the annual report by the National Practitioner Data Bank, a federal agency which tracks the “misadventures” of health professionals, the annual rate of settled claims by PAs is one-tenth the rate of doctors, depending on the classification of the case (Exhibit 9).

The payment ratio for an incident is one-third of that of physicians. The incidence of malpractice is less for NPs.

Of course the LENGTH is the same. Look at the cirriculum. That is where the discrepancy is. The clinicals involve part-time, 3 day a week type rotations. PA clinical rotations are almost always 40+ hours a week for a year straight through. Of course I have not looked at every course catalog, only about ten. It was this way in all ten.

I cant say ive looked at them all either The averages in that report are total time in training. It cant be called 26 months if it is 12 months in a 26 month period (part time).

What I mean is that given the same applicant (experienced), a PA education is a much better preparation.

I actually think we agree :L) When i have audited the majority of mid level programs before i decided to goto med school, i believe there is a better

For the record, I work with many NP's and after awhile on the job, they most certainly get up to speed. We end up on the same level doing the same job.

Pat, I have no doubt your a good PA. I also have no doubt you work well with others based on how you present yourself here on SDN. I just think your as good as you are because you were an RN b4

Good luck! Hopefully once im through med school ill be working with people like you and emdpa.

Mike,
Flight nurses are the most autonomous RN there is, I cannot believe that this is not a midlevel role, to tell you the truth. I have a good friend I worked fire service with who is a flight nurse. He is excellent as I am sure you are. I have only respect for what you all do. I actually have a friend who was a flight PA, which sounds pretty cool.

I get a little heated in this type of discussion and do not mean to be so nasty at times. I value all members of the healthcare team but have pretty strong opinions on education, founded or not. For the record, I am not an NP because I had VERY poor role models in my BSN program. Old "Betty's" who hadn't touched a patient in years. We were trained for academia, not patient care. They train NP's over there the same way. Sadly, the school is highly recognized in the nursing research circles. Handwashing research is so cutting edge That is sad.

I think we agree on more than we disagree. For the record, I manage patients on my own and choose what to talk to the docs about. I actually sleep better at night with the availability of higher lever coverage to run my plans by once in awhile

The nurses and I are "tight". I think it's because I have been where they are.

Thanks for the comments,

Pat

 

[Quicksilver]

oh look it's a certificate np program! wow nondegree granting so all you need is an rn certificate, not even an adn to get in/out. I understand there are still 4-5 others around like this just in california alone! so time to cut out the "all np's have masters degree bs"

Los Angeles BioMedical Research Institute

at Harbor-UCLA Medical Center
Women's Health Care
Nurse Practitioner Program

The Women's Health Care Nurse Practitioner Program

is a certificate (non-degree granting) program

that educates Registered Nurses in an expanded role

to provide primary health care to women throughout the life cycle.

The program is directed by the Department of Obstetrics and Gynecology, David Geffen School of Medicine,

and is offered through Los Angeles BioMedical Research Institute

at Harbor-UCLA Medical Center in Torrance, California.

The WHCNPP is nationally accredited

by the National Association of Nurse Practitioners in Women’s Health,

and is approved by the California Board of Registered Nursing

as a provider of advanced practice nursing education.

California Certificate Level Nurse Practitioner Program Meets Rural Needs

Those who know about the Women's Health Care Nurse Practitioner Program at Harbor-UCLA Research and Education Institute in Torrance, California often say it is one of California's best kept secrets. Martha Baird, CNM, NP, MSN, director of education for the program would like to change that perception. She and the program staff are committed to increasing the awareness of the program through outreach efforts, particularly to registered nurses practicing in rural areas.

"This certificate level program is a perfect fit for rural Registered Nurses (RNs) because two-thirds of the clinical experience is done at home in the community where he or she is already practicing," says Baird. "Students only have to be on-site at the Harbor-UCLA campus for 16 weeks." The certificate program educates RNs in an expanded role to provide primary health care to women throughout the life cycle.

Under the direction of the Department of Gynecology, UCLA School of Medicine, but not housed at the university, the program offers an alternative to a master's level nurse practitioner degree. A nurse practitioner can be a critical addition to a rural staff. Once a student is a graduate and licensed, he or she does not need a physician on site in order to practice, according to Baird. "You don't need to be an MD to provide contraception or to do a pap smear," says Baird. "This allows the physician to be better utilized in his or her area of expertise." The role of a rural NP can also be very broad. The practitioner may also set the stage for a teenager's continued use of health services, provide ambulatory care to a pregnant woman both during the prenatal and postpartum periods and create an environment in which a woman is able to share, and receive help for, difficult areas in her life such as substance abuse, domestic violence, or eating disorders.

The Harbor-UCLA nurse practitioner program is one of the few certificate programs left in the country; California is one of the few remaining states that licenses NPs with this type of education. With the women's health certification program, students study in Torrance, California for 16 weeks. Following those 16 weeks is a five month clinical preceptorship under a physician, nurse midwife or nurse practitioner. It is possible to engage in the preceptorship program while maintaining another part time job. If students want to continue on with the program to obtain a certificate as an adult or family nurse practitioner, there is an additional two to three semesters of training, each of which begins with a 2-3 week intensive didactic course at Harbor-UCLA, followed by 16 weeks of precepted clinical experience in the student's home community. The adult course requires two semesters of training, each of the family course adds a third semester of pediatric focus.

Tuition for the Women's Health Care Nurse Practitioner Program is $10,000, with an additional $6,000 for the optional adult program, and another $2000 for the pediatric semester to complete the Family Nurse Practitioner program. Tuition support from the California Family Health Council Inc. (CFHC) offers a partial tuition waiver for RNs who are already employed by a CFHC-funded agency. For students willing to practice in an Health Professions Shortage Area or Medically Underserved Area after graduation, a grant from the Maternal-Child Health Branch of California DHS provides 50% tuition waiver. This is especially helpful for students who are already working in rural, underserved communities.

Currently, the majority of program participants are from urban areas and Baird says they are interested in recruiting more rural nurses to participate. "This is a very attractive program for nurses in rural areas. They have to be RNs but they can have any type of RN preparation. Many nurses in rural areas have associate's degrees and they are still able to participate in the program," explains Baird. In 2002 only 50 percent of participants had a bachelor's degree. The program has linkages with four universities, California State Long Beach, Azusa Pacific, University of Phoenix and Western University of Health Sciences, so participants can earn academic credentials along with a certificate.

Baird said that many of the program's students are older learners, with half being over the age of 34. Often they have been practicing for quite some time, but for some nursing is a second career. Baird says, "It's very scary for them because they aren't sure they can still learn. We work very closely with our students to make sure they are successful."

The program boasts over 1500 graduates around the world and hopes recruit more rural applicants for the next term beginning in May (other sessions begin in September and January of each year). Applications are still being accepted.

"It's a life changing experience for our students. Transformative. They come in expecting to get more clinical skills and knowledge but beyond that they learn more about the lives of the women. They come to appreciate the circumstances of women's lives and how that affects them," says Baird.

For more information on this certification program go to www.womenshealthnp.org or contact Martha J. Baird, CNM, NP, MSN, director of education at 310.222.3713 or [email protected]. All application materials are available to be downloaded from the Web site. For application materials, deadlines, and requirements of tuition waiver programs, please contact Lynette Short at 310-222-3729.



Article Posted 4/7/03

emedpa

It used to be one could get their NP in a certificate program. However, from now on everyone desiring to be an NP must have the Master's degree to sit for the NP exam. I know, because I am an RN with 15 years experience, a BSN and I'm still having to go back to school FULL TIME for at least another 2 years . I am in classes with a guy who has been a practicing NP for about 12 years and he is having to go back to school. No it's not just a certificate program anymore Plus I work FULL TIME an support a family while going to school. Please tell me how easy I have it......

 

[zenman]

That has to be the most uninformed/ignorant statement I have read in a while. You clearly have no clue how acutely ill medical-surgical pts. are these days, and the kind of care they require.

I worked on an acute med/surg unit prior to moving to my present location. Holy crap, it was the hardest work I've done (including helicopter flight nurse ) Every patient I took care of were the ones that I used to take care of in ICU. Vents, chest tubes, lines everywere, etc.. and scattered all up and down a long hallway. Codes almost everynight. I made life and death decisions all the time. That was the turning point in my decision to go to NP school as I would never go back to that hell. I've seen ICU nurses come unglued in that setting when they have more than 2 patients as sick as these were. Glad I'm out of there!

 

[Mike MacKinnon]

hey Pat

Well we are both RN's so we have had lots to get defensive about before we got where we are today I agree, its easy for me to jump on the defensive but i do realise that easily 90% of nurses are not prepared enough to make much of an impact in NP school, making them less prepared than PA's.

Yes we are on the same page for sure!

 

[hospPA]

emedpa

It used to be one could get their NP in a certificate program. However, from now on everyone desiring to be an NP must have the Master's degree to sit for the NP exam. I know, because I am an RN with 15 years experience, a BSN and I'm still having to go back to school FULL TIME for at least another 2 years . I am in classes with a guy who has been a practicing NP for about 12 years and he is having to go back to school. No it's not just a certificate program anymore Plus I work FULL TIME an support a family while going to school. Please tell me how easy I have it......

Just to be fair, this program offers a masters in 46 weeks, less than a year.

Women's Health Nurse Practitioner Program — Starting July 17, 2006

* for experienced RNs with BSN degrees to become women's health nurse practitioners

* for certificate-prepared women's health nurse practitioners with BSN degrees to obtain a master's degree in nursing

* for master's prepared nurses to obtain postgraduate certificates as women's health nurse practitioners

* for masters-prepared FNPs, ANPs and CNMs to obtain postgraduate certificates as women's health nurse practitioners

The Planned Parenthood Federation of America Women's Health Nurse Practitioner (PPFA-WHNP) Distance Learning Program is a 46-week, distance learning, continuing education program with options for obtaining a Master of Science in Nursing (MSN). The program can be taken as a postgraduate course, resulting in a certificate of course completion, or as the Women's Health specialty component, leading to the MSN degree. The following academic institutions have articulation agreements available through this PPFA-WHNP program:

* Master of Science in Nursing Completion Program: Drexel University College of Nursing and Health Professions, Philadelphia, PA

* Master of Science in Nursing: Wilmington College, Newark, DE

* Master of Science in Nursing: University of Medicine and Dentistry of New Jersey, Newark, NJ

The PPFA- WHNP Program is nationally accredited by the Council on Accreditation of the National Association of Nurse Practitioners in Women's Health. Graduates are eligible to take the National Certification Corporation (NCC) certifying exam for women's health NPs following satisfactory course completion.

A full-time course of study that is two semesters in length, the PPFA-WHNP Program is designed for highly motivated, self-directed individuals who are computer literate. Students spend the first two weeks of the program in Philadelphia, focusing on hands-on advanced practice skills, introduction to didactic course content, and orientation to the multimedia educational modalities. On returning home, students begin Clinical I, a three-day—per-week Women's Health clinical experience while also taking four didactic courses, OB I, GYN I, Pharmacology I, and Primary Care of Women I, delivered via the specialized Lotus Notes software. At week 23, students return to Philadelphia for a week of lectures and skills workshops and first-semester final examinations. Throughout the second semester, weeks 24-45 are spent back at the student's home site taking Clinical 2, the continued three-day-per-week clinical experience, and five didactic courses, OB II, GYN II, Pharmacology II, Primary Care of Women II, and Professional Issues. The last week of the program, week 46, takes place in Philadelphia for final examinations and graduation. Students are eligible to take the NCC exam following successful course completion. The PPFA-WHNP Program offers one Women's Health NP course of study each year in July.

The next class starts July 17, 2006. The application deadline is May 1, 2006. You can download our application from this site.

Tuition: $14,000.00 to be paid in full by the first day of class
$11,000 for employees of Planned Parenthood affiliates


For further information, contact:
Barbara Siebert, MSN, CRNP, APRN-BC Associate Director
Planned Parenthood Federation of America, Inc.
Medical Continuing Education Department

Women's Health Nurse Practitioner Program
260 South Broad Street, Suite 1000
Philadelphia, PA 19102
Phone: 215-985-2612
Fax: 215-546-3989
Email: [email protected]

Download brochure and application (PDF) for Women's Health Nurse Practitioner Program.

 

[deleted6669]

That has to be the most uninformed/ignorant statement I have read in a while. You clearly have no clue how acutely ill medical-surgical pts. are these days, and the kind of care they require.

Please, give the same respect to others as you would wish to receive. Maybe you should take a stroll outside the ED and check out what's going on on the M/S floors; you learly need some remedial ed. in that area.

I'm surprised you even said this. You're usually somewhat respectful toward nurses.

fab- no offense to the hardworking nurses of the icu, ccu, sicu,tele, etc who take care of really sick folks. at my facility we have general medical beds that are filled mostly with folks with mild chf, pneumonia, dvt's, cellulitis, etc
the nurses on these floors call iv therapy every time a pt needs an iv.
I have to work 3-5 times a month with inpts and although I am very impressed with the nurses in specialty areas I have minimal confidence in the folks who work only the general medical floors at my facility. their entire job consists of the following:
take an inpt nursing hx on pt arrival.
check vitals q 4 hrs(this means hook up the dynamap, some of them are shaky on manual presssures when requested.)
give po and iv meds through iv established elsewhere by someone else.
call r.t. for any resp probs
give prn orders per the chart
feed pts.
coordinate pts getting to and from ct, mri, nuclear medicine, etc
discharge pts per established criteria.
really, that is the entire job. an lpn or medical asst could do it if the nursing lobby wasn't so strong.

 

[fab4fan]

I don't know what part of the country you practice in, but around here (PA, as in the state) a lot of med-surg pts. are people who not so long ago would have been ICU/stepdown pts. It is rare that someone is only on po's, and I don't know any licensed nurses in my area who are occupied primarily with feeding pts. Good grief, pts. with chest tubes are on the regular med-surg. floors, pts. who need multiple central line infusions/pts. with epidural infusions, sometimes chemo/multiple transfusions...hardly minimal care.

I get very upset for M/S nurses because they get little respect. M/S is like a dumping ground, and a lot of times the pt. load is dangerous. There is no way I could handle 8 or more acutely ill patients who needed complex care. On top of that, many of them are elderly, medically fragile, and more than a few are demented. Just trying to keep them from climbing out of bed and falling is challenging enough. (God forbid you should try to restrain the "climbers" in any way, or face the wrath of JCAHO.)

Maybe the nurses call for IV starts because they simply do not have the time to get bogged down sticking pts. who have crappy veins; it's hard enough getting meds out on time, let alone try to get a line on someone when you have call bells lighting up the hallways like it's the 4th of July, stupid family members who think your sole purpose is to fetch them coffee, admits from the ED, post-ops coming back, etc. Unless you have actually worked in that area, you can't fully understand how bad it is. I used to go start lines on M/S when I was an ED nurse, and it didn't bother me at all. I felt sorry for those nurses most of the time. They were stretched to the max. Taking the time to start a line could mean not getting other pts. their meds on time...is that appropriate?

Like I said, it may be different in your part of the country, but in my area, M/S is far from a cakewalk, and there is no way on God's green earth it could be staffed only with LPNs and CNAs.

The nursing lobby has nothing to do with it; there are aspects of care that are just out of the LPN's scope of practice. Are you aware that there are differences in the licensure between an LPN and an RN?

I doubt your intended to be insulting, but your additional comments proved further that you really don't know what M/S is like in many hospitals.

 

[deleted6669]

I don't know what part of the country you practice in, but around here (PA, as in the state) a lot of med-surg pts. are people who not so long ago would have been ICU/stepdown pts. It is rare that someone is only on po's, and I don't know any licensed nurses in my area who are occupied primarily with feeding pts. Good grief, pts. with chest tubes are on the regular med-surg. floors, pts. who need multiple central line infusions/pts. with epidural infusions, sometimes chemo/multiple transfusions...hardly minimal care.

I get very upset for M/S nurses because they get little respect. M/S is like a dumping ground, and a lot of times the pt. load is dangerous. There is no way I could handle 8 or more acutely ill patients who needed complex care. On top of that, many of them are elderly, medically fragile, and more than a few are demented. Just trying to keep them from climbing out of bed and falling is challenging enough. (God forbid you should try to restrain the "climbers" in any way, or face the wrath of JCAHO.)

Maybe the nurses call for IV starts because they simply do not have the time to get bogged down sticking pts. who have crappy veins; it's hard enough getting meds out on time, let alone try to get a line on someone when you have call bells lighting up the hallways like it's the 4th of July, stupid family members who think your sole purpose is to fetch them coffee, admits from the ED, post-ops coming back, etc. Unless you have actually worked in that area, you can't fully understand how bad it is. I used to go start lines on M/S when I was an ED nurse, and it didn't bother me at all. I felt sorry for those nurses most of the time. They were stretched to the max. Taking the time to start a line could mean not getting other pts. their meds on time...is that appropriate?

Like I said, it may be different in your part of the country, but in my area, M/S is far from a cakewalk, and there is no way on God's green earth it could be staffed only with LPNs and CNAs.

The nursing lobby has nothing to do with it; there are aspects of care that are just out of the LPN's scope of practice. Are you aware that there are differences in the licensure between an LPN and an RN?

I doubt your intended to be insulting, but your additional comments proved further that you really don't know what M/S is like in many hospitals.

I know the difference between an lpn and an rn.
the pts you describe would all be on specialty units in my facility.
m/s pts here can't have vasopressors, ntg, heparin, needs for tele, psych issues, chest tubes, nebs more often than q 4, 1:1 care requirements or any special needs. they are stable medical pts who need admission for things like iv abx, hydration, social admits(grandma with a fx hip, no other hx, clear mental status and waiting for short term snf bed.)
the m/s nurses here only take care of 4 pts at a time. more pts than that? sorry, this floor is closed. I have all the respect in the world for nurses. it is an important job and the hospital would close without them. I just don't feel like floor nursing (as I have described it) is a great background for a midlevel provider. I know medical assistants working outside the hospital who have a broader scope of practice than some of our floor nurses.

 

[fab4fan]

M/S pts. in my area encompass everything you listed with the exception of pressors. Not even heparin infusions? No resp. tx. more than q 4h? No medical detox pts.? A nurse to pt. ratio of 4:1? Is this in CA?

In that case, I can see why you think M/S nurses have it realtively easy. The fact is though, LPNs cannot be charge in most hospitals. Maybe in a very rural area, but no way in most hospitals. IIRC, this is also a JCAHO issue (Not that I am in any way a fan of JCAHO...I think it's a scam.)

Social admits rarely happen here. The pts. you described would be the extreme exception. I work in a relatively small hospital (approx. 140 beds) in a Day Surgery dept. Heck, our pt. acuity is higher that what your M/S staff deal with! Go to Philly (not far from me) and the M/S pts. would be even sicker.

Sorry if I sounded argumentative; frankly, I am gabberflasted that your M/S pts. are so uncomplicated. In that case, you are right, that sort of environment would not be as helpful in terms of clinical experience toward becoming a midlevel.

 

[oldManDO2009]

The difference you fail to mention between an RN and an LPN is very important. An LPN is not trained to assess a patient to the degree an RN is trained to in respects to skill level. It is true an LPN can feed, patients, give medications, and even be IV certified to give IV medication. But, the LPN does not have the skill level or educational background to manage or understand the basis for more complex presentations.

The RN takes vastly more pathophysiology and can trouble shoot difficult cases. For example the RN would have a better understanding of respiratory physiology then an LPN and this “position” is bases on the educational difference in curriculum. This is an awfully similar argument made for other professions but it holds true – an LPN’s job is mostly task oriented.

Now, before everyone flames me for being insensitive to all those hard working LPN’s I am just contrasting educational differences and how they apply to patient management. In every field there are those individuals that exemplify the profession and then there are slackers – this argument does not represent either.

This disclaimer was offered in an attempt to avoid a long drawn out debate about how LPNS are (pick one – better than, the same as, or equal to) RN’s


seven down and one more to go and hell week is over!!!

 

[fab4fan]

(Hands oldManDO a flame-******ant suit, just in case.)

 

[KarineRN]

Ack!! Look what I've started!!

As an LPN, I worked on a med/oncology floor. I put my time in, and would I do it again? Nope. Not because I hated it but because it was TOUGH. Perhaps it was just the hospital I'm at (a 150 bed facility) and because we are the ONLY HOSPITAL in town and didn't have a bigger, more technologically up to speed hospital around...but the pts on my floor had heparin, cardiac meds, sometimes insulin/glucose drips...all sorts of things that needed close monitoring running at various times, not to mention chemo and blood transfusions regularly(the two things that I was not allowed to touch in my scope of practice). I guess we just had 'sicker' patients there because the ICU capacity was so small and pts typically weren't kept if they were somewhat stable. If their VS were stable, they were A&O, and their labs looked good, they were sent down after some ICU monitoring. That didn't mean they were weaned off their heparin drips, though. Sure, I passed alot of meds and I did alot of nursing procedures as an LPN, but I also had to make judgement calls spur of the moment as I had pts stroking out, throwing PEs, pleural effusions up the ying yang causing all sorts of respiratory distress, MIs, TIAs (if you ask me, mainly because the ICU wouldn't keep them long enough, because typically pts who had these sorts of problem were new ICU admits and then back they went)...you name it, I saw it and I had to figure out what to do without taking the time to step out of the pt room and go chase down the RN. Perhaps because I was in a BSN program at the time and was learning all of the advanced critical thinking skills that separates an LPN from an RN it wasn't too bad, and most of the RNs just let me be and checked my interventions later.

But thank doG now for emergency medicine, because M/S nursing can be tough. But I guess I have only worked M/S in one hospital so I have nothing to compare to

 

[corpsmanUP]

My heavens! This thread is one of many reasons I decided to become a doctor. PA's always argue with NP's and RN's about education, who's better...etc..etc...etc......

Being autonomous on a helicopter does not make one a midlevel provider. The scope of practice on the helicopter is nothing more than cookbook, protocol driven medicine. Its why they let interns in EM ride the bird...because even an intern can learn protocols.

To say that 2 programs of study are similar simply based on length is hilarious. EM residency training is 3 years minimum, but do you think 3 years in elementary school is the same simply because they are both 36 months? Its funny how some of you can be all into researching your answers on pubmed but then you come up with an answer like...."well there both 26 months".....

 

[Mike MacKinnon]

Wow, you are obviously clueless.

Since i feel i need to defend myself I will.

The 7 medical directors we have would beg to differ with you since they teach us how to operate independantly and practice under their directon. They stress (and i agree) that we should never be following protocols we should be knowing the whys and therefore critically thinking, and we do. You are ignorant and making statements about something you clearly know nothing about.

What are my protocols? I dont have ANY. We practice based upon clincial knowledge and make clinical decisions on a regular basis without the guidence of a physician. There are no boxes to follow. I carry around 40 drugs which i give at my own disgression. You are making generalizations without ANY proof whatsoever.

Here are some of the other things we do as flight RN's.

- Chest tubes
- Central Lines
- Pericardiocentisis
- cric
- needle oxygenation
- IABP's
- VAD's
- Manage complicated ICU patients over long flights
- Manage acute MI's
- Manage Codes

Here are some of the things ive picked up (correctly diagnosed) and managed in the last month FROM the field and not a hospital (no physicians)

- Thyroid Storm
- Brugada Syndrome
- Massive MI's
- PE
- Massive TBI with cushings reflex
- Multi-system trauma
- pedatric resp arrest due to DKA
- Adult DKA
- Hyperkalemia
- TCA OD
- Organophosphate poisioning

Most midlevels rarely, if ever, manage these types of patients independantly.

I could go on. I manage these without protocols and without a physician. I make decisions that are based in education, research and clinical competance. Dont insult me "resident" (if you are one), your cocky attitude will not get you anywhere in medicine.

Let see, what else do I do. Im a researcher and have been published in peer reviewed journals, i teach every class that exists to both physicians and RN/EMT-P. Simply put, this isnt my first rodeo just a different set of clowns.

Its funny how some of you can be all into researching your answers on pubmed but then you come up with an answer like...."well there both 26 months"

I especially liked this one. My answer IS from research comparing overall averages of the two midlevel track programs including clinical time and didatic time. Your post is simply the opinion of the uneducated in the issue. Some PA programs are better than others and some NP programs are better. The argument, however was in relation to time spent in clinicals and didatic.

My heavens! This thread is one of many reasons I decided to become a doctor. PA's always argue with NP's and RN's about education, who's better...etc..etc...etc......

Being autonomous on a helicopter does not make one a midlevel provider. The scope of practice on the helicopter is nothing more than cookbook, protocol driven medicine. Its why they let interns in EM ride the bird...because even an intern can learn protocols.

To say that 2 programs of study are similar simply based on length is hilarious. EM residency training is 3 years minimum, but do you think 3 years in elementary school is the same simply because they are both 36 months? Its funny how some of you can be all into researching your answers on pubmed but then you come up with an answer like...."well there both 26 months".....

 

[jwk]

Wow, you are obviously clueless.

Since i feel i need to defend myself I will.

The 7 medical directors we have would beg to differ with you since they teach us how to operate independantly and practice under their directon. They stress (and i agree) that we should never be following protocols we should be knowing the whys and therefore critically thinking, and we do. You are ignorant and making statements about something you clearly know nothing about.

What are my protocols? I dont have ANY. We practice based upon clincial knowledge and make clinical decisions on a regular basis without the guidence of a physician. There are no boxes to follow. I carry around 40 drugs which i give at my own disgression. You are making generalizations without ANY proof whatsoever.

Here are some of the other things we do as flight RN's.

- Chest tubes
- Central Lines
- Pericardiocentisis
- cric
- needle oxygenation
- IABP's
- VAD's
- Manage complicated ICU patients over long flights
- Manage acute MI's
- Manage Codes

Here are some of the things ive picked up (correctly diagnosed) and managed in the last month FROM the field and not a hospital (no physicians)

- Thyroid Storm
- Brugada Syndrome
- Massive MI's
- PE
- Massive TBI with cushings reflex
- Multi-system trauma
- pedatric resp arrest due to DKA
- Adult DKA
- Hyperkalemia
- TCA OD
- Organophosphate poisioning

Most midlevels rarely, if ever, manage these types of patients independantly.

I could go on. I manage these without protocols and without a physician. I make decisions that are based in education, research and clinical competance. Dont insult me "resident" (if you are one), your cocky attitude will not get you anywhere in medicine.

Let see, what else do I do. Im a researcher and have been published in peer reviewed journals, i teach every class that exists to both physicians and RN/EMT-P. Simply put, this isnt my first rodeo just a different set of clowns.

Its funny how some of you can be all into researching your answers on pubmed but then you come up with an answer like...."well there both 26 months"

I especially liked this one. My answer IS from research comparing overall averages of the two midlevel track programs including clinical time and didatic time. Your post is simply the opinion of the uneducated in the issue. Some PA programs are better than others and some NP programs are better. The argument, however was in relation to time spent in clinicals and didatic.

I'm just curious - officially, you are licensed as an RN only. (correct me if I'm wrong) How does all of this fall within an RN's legal scope of practice? MD's can't give a blanket order to do whatever the hell you think is appropriate. How would you be covered from a medico-legal standpoint if something went wrong? You're claiming you operate totally outside medical control, but are you really?

 

[DocNusum]

- Chest tubes
- Central Lines
- Pericardiocentisis
- cric
- needle oxygenation

Dude... all these things were skills taught to and performed by 17 and 18 year old Army, Navy and Airforce medics... who after their service obligation... get out and can only get jobs as CNAs!!!!

- IABP's
- VAD's

If you are not ordering and inserting... then staring at the screen looking for the diachrotic notch is no big deal... or unique "high speed" skill!

- Manage complicated ICU patients over long flights
- Manage acute MI's
- Manage Codes

ALL "mid-levels" are trained to do this (MI's and Codes)...Most have had to for the same time period you have on the helicopter! EMT-Is/Ps also do this on the ground!

I'm just curious - officially, you are licensed as an RN only. (correct me if I'm wrong) How does all of this fall within an RN's legal scope of practice? MD's can't give a blanket order to do whatever the hell you think is appropriate. How would you be covered from a medico-legal standpoint if something went wrong? You're claiming you operate totally outside medical control, but are you really?

If so... You are "practicing medicine without a license"... which is Illegal and sanctionable in most states...

Also...

Most midlevels rarely, if ever, manage these types of patients independantly.
I could go on. I manage these without protocols and without a physician. I make decisions that are based in education, research and clinical competance.

Most midlevels manage these illnesses... you are NOT managing... you provide emergency interventions from point a to point b... during the flight...!!!

Dude... I'm sure you are a most excellent Flight Nurse... but please be honest about your scope of practice as compared to officially designated Mid-levels. My buddy that lives one block over was a Flight Nurse in AZ prior to moving here after PA school... I just showed him and the NPs your posts (we work UC together)... his response... We ALL have a tendency toward "PUFFERY"...

Good Luck... and do well in Med school...

DocNusum, FNP, PA-C

 

[Mike MacKinnon]

Hey there

A valid question (same one i asked when i started the job). Essentially, we are covered by the physicians. RN's can be delegated any of these skills and clinical decision making ability as long as there is sufficient testing and training. This is covered as an Advanced RN practice role legally.

At the end of the day, we are practicing under the physicians and they make sure we are good enough to do the job.

I'm just curious - officially, you are licensed as an RN only.


(correct me if I'm wrong) How does all of this fall within an RN's legal scope of practice? MD's can't give a blanket order to do whatever the hell you think is appropriate. How would you be covered from a medico-legal standpoint if something went wrong? You're claiming you operate totally outside medical control, but are you really?

 

[Mike MacKinnon]

Hey there

We typically agree. Ill answer your questions individually.

Dude... all these things were skills taught to and performed by 17 and 18 year old Army, Navy and Airforce medics... who after their service obligation... get out and can only get jobs as CNAs!!!!


The military is not a good example. Medics also work int he Navy aboard ship as family physicians to some degree. The same standards of care and education do not apply as they do in the real world.


If you are not ordering and inserting... then staring at the screen looking for the diachrotic notch is no big deal... or unique "high speed" skill!

Seems to me you have never seen exactly how sick a patient on a VAD or IABP is. That would be expected as midlevels do not manage these patients. In anycase, a 6 dripper on an IABP with a L main occl. They do not get transported out when they are doing well, my friend. You would be lost with 6 drips that needed to be constantly titrated correctly against each other in order to maintain perfusion. Moreover, troubleshooting IABP's and VADS are an absolute clinical competancy. This is when the level of knowledge and skill makes the difference between a dead patient and a living one.


ALL "mid-levels" are trained to do this (MI's and Codes)...Most have had to for the same time period you have on the helicopter! EMT-Is/Ps also do this on the ground!

Im sure they are trained to do it, however, the majority of mid levels will never manage these patients. That is a fact directly from your association webpage based on where the majority of mid levels are employed. I do it daily. Paramedics manage these in a protocol driven fashion without options for management. I have a far expanded drug bag including thrombolytics, beta blockers, IV nitro etc etc. This is where the advanced management comes in. We also read and interpret 12 leads in order to have faster time to cath.



If so... You are "practicing medicine without a license"... which is Illegal and sanctionable in most states...

Not at all. Everything we do is covered under the advanced RN practice act (same as NP's) and our medical physicians.


Most midlevels manage these illnesses... you are NOT managing... you provide emergency interventions from point a to point b... during the flight...!!!

Uh Huh. Why dont you be honest about what most mid levels do? They work in urgent cares giving out levequin for pneumonia or suturing lacs. Either that or doing H&P's in offices. The medical students call that "the scut work".

Secondly, managing involves initial care as well as care over a period of time adjusting for change in patients condition. I sometimes have these patients for 2 hours and that is definitly managing though only for a short term acute period. If your point was the case then EM physicians do not manage patients, they simply get them from the ER door to the floor or home again and we both know this isnt the case.


Dude... I'm sure you are a most excellent Flight Nurse... but please be honest about your scope of practice as compared to officially designated Mid-levels.

Well i agree. I never said i was a mid level. Another person said we should be considered so, not me. Of course my scope is not the same as an NP or PA, never said it was. If fact i would say there is nothing i do that is out of mid level scope at all and there is much management a mid level does that i wouldnt have a clue about. However, i have no doubt that i manage & Treat sicker patients in the acute phase more often than the average midlevel. This is directly evidenced by where the majority of mid levels are employeed and that is exactly why i chose to goto med school and not NP/PA school.

My buddy that lives one block over was a Flight Nurse in AZ prior to moving here after PA school... I just showed him and the NPs your posts (we work UC together)... his response... We ALL have a tendency toward "PUFFERY"...

Well he is entitled to his opinion. I know what i do, he dosent. In anycase, as usual i enjoy talking with you as your a good debator!

Have a good one DN im excited for med school but terrified at the same time. So much I know nothing at all about, heh, way out of my comfort zone!

 

[DocNusum]

However, i have no doubt that i manage & Treat sicker patients in the acute phase more often than the average midlevel.

No doubt here...
But then so do most EMT-Bs/Is/Ps... and ER Techs... and CENs... etc.

That would be expected as midlevels do not manage these patients

Go shadow a Few CVT Mid-levels (there are atleast 16 in AZ).

The PA candidate would preferably have 2 years cardiac surgery experience.
Responsibilities will include management of the cardiac surgery patient population throughout the continuum. This includes preoperative assessment, intraoperative endoscopic saphenous vein harvesting, first assisting and postoperative management. Management includes both ICU and telemetry. The candidate should be proficient in all clinical procedures pertinent to the cardiac surgery patient, such as central line placement, arterial line placement, swan ganz placement, chest tube placement and removal, thorocentesis, IABP removal and femoral line placement.

PHYSICIAN ASSISTANT (P.A.) / CARDIOTHORACIC SURGERY
DEPARTMENT OF SURGERY DELINEATION OF PRIVILEGES
GENERAL SUMMARY
The P.A. in Cardiovascular Surgery assists the supervising surgeon in the management of patients, and performs diagnostic and therapeutic procedures under the supervision of the surgeon. The P.A. works closely and assists the surgeon in providing quality, efficient and continuous and cost-effective care during the patient's hospitalization.

PRINCIPLE DUTIES AND RESPONSIBILITIES
• Preoperative Care
• Perform and record history and physical examinations.
a. Write appropriate admission orders (including nursing care, medication orders, laboratory and radiological examinations, and obtain consultations approved by the surgeon).
b. Review pertinent abnormal findings in the patient's history, physical examination, radiological and laboratory data with the surgeon, and obtain appropriate consultation, additional laboratory or radiological studies as needed, and initiate appropriate medical intervention.
c. Record in progress notes pertinent findings from history, physical examination, laboratory studies, and radiological examination.
d. Evaluate unstable patients and initiate emergency management (of conditions such as unstable angina, evolving myocardial infarction, arrhythmia, cardiac arrest, hypothermia, hypertensive crisis, hemorrhage, chest trauma, etc.).
e. Conf irin operating room schedule, adding urgent or emergency cases as needed.
f. Patient education as needed.
• Intraoperative Care
a. First and second assist the surgeon in the operating room.
b. Saphenous vein harvest.
c. Place indwelling catheters, such as Foley, intravenous, and arterial catheters.
d. Assist in preparation of patient for procedure.
e. Closure of chest as delegated by the attending surgeon.
f. Monitoring and transport of patient to ICU.

Postoperative Care
a. Write appropriate postoperative orders including general and specific nursing care, respiratory therapy and ventilator settings, medications, including inotropes, parenteral vasodilators and controlled substances for analgesia and sedation, laboratory and radiological studies.
b. Attend the patient in the early postoperative period reviewing laboratory and radiologic data and making appropriate interventions.
c. Initiate treatment of postoperative complications such as hemorrhage, hypovolemia, hypotension, hypertension, arrhythmia, cardiac arrest, seizures, stroke, pneumothorax, hemothorax, cardiogenic shock, renal failure, etc.
d. Advise the attending surgeon of unexpected events, providing an accurate synopsis of events related to a major change in the patients condition and describing corrective measures already taken.
e. Daily assessment of patients postoperative course, write note of patients progress in chart as it pertains to the supervising physician- and implement indicated therapy as determined by the supervising physician.
f. Complete discharge summaries.

The P.A. assistant shall have the knowledge and competency to perform the following functions, and may perform them with appropriate supervision:
a. Insert and remove intravenous lines
b. Insert and remove Foley catheters
c. Pass and remove nasogastric tubes
d. Placement and removal of chest tubes
e. Remove monitoring lines
f. Irrigate chest tubes and Foley catheters
g. Apply dressings and bandages
h. Control external hemorrhage
i. Cardiopulmonary resuscitation
j. Carry out aseptic and isolation techniques
k. Venipuncture
l. Draw arterial blood gases
m. Place indwelling arterial lines by percutaneous or cutdown technique
n. Evaluate CXR for catheter placement, and make appropriate changes
o. Assist in placement of IABP catheter, and adjust LKBP for timing
p. Remove IABP catheters
q. Perform thoracentesis
r. Drain, debride and culture wounds
s. Placement of central lines
t. Perform pleurocentesis

Seems to me you have never seen exactly how sick a patient on a VAD or IABP is. That would be expected as midlevels do not manage these patients. In anycase, a 6 dripper on an IABP with a L main occl. They do not get transported out when they are doing well, my friend. You would be lost with 6 drips that needed to be constantly titrated correctly against each other in order to maintain perfusion.

I generally agree with your premise... but these ASSUMPTIONS need to be worked on!
(as I am a former Medic, CCRN, and FNP/PA-C who has worked closely with intinsivists, and in cardiology with cardiac surgeons... for a while... a small part of my job entailed IABP "management")

DocNusum

Btw... The Icu experience is only required for CRNA... not for many if any other MSN/APN school/program...

 

[Mike MacKinnon]

hey DN

right now 80% of all NP programs are masters prepared (per assoc. website).

I understand what your saying about the CV assist PA but this is not the majority of PA's but a small subset.

I think we actually agree overall!

 

[deleted6669]

hey DN

right now 80% of all NP programs are masters prepared (per assoc. website).

I understand what your saying about the CV assist PA but this is not the majority of PA's but a small subset.

I think we actually agree overall!

throw in em pa's there as well and you have me in agreement too.
MOST ( 80% ?) midlevels do primary care.
some don't.
I work up mi's every day including inpt nonsurgical management.
I take care of all presenting trauma at a small facility as the solo provider.
I run codes solo at this facility as well.
I place chest tubes, do lp's, etc as well.
I'm certainly not the only pa doing this.

 

[Mike MacKinnon]

Oh i agree as well.

Sorry for leaving you out

 

[corpsmanUP]

Hey Mike, how tough was it diagnosing that multi-system trauma? Did you use your "disgression" to treat the patient, or the physician's discretion?

You are in for a rude awakening when you put on that short white coat. Something tells me you are going to lose your marbles the first time a tech in the ED tries to ask you to do something you think you are above doing.

No matter what you think you may doing on the bird, you are merely operating under someone else. And don't think it won't come back to bite you in the butt when you do some cowboy stunt that places your physician on the hot seat. I have no doubt that you are good at what you do, but your attitude needs a minor adjustment. Thats nothing that 4 years in a short white skirt won't fix!

You don't want to hear this, but your education up to this point does not give you the necessary knowledge to think all that critically outside the box. You know enough pathophysiology today to put on a 3 x 5' notecard and still have room to tell your life story.

Lets see what you think a few years down the line and my guess is you will be a bit more humble and a bit less arrogant. I recall having a similar conversation about 5 years ago with Freeedom and you know what...he was right.

Good luck to you, sincerely.

 

[Mike MacKinnon]

CorpsmanUP

You dont know me buddy, nor do you have any idea at what point my critical thinking is or my level of knowledge. I am not a physician but the knowledge you get in medical school is not at all secret or hidden. It is freely avaliable in journals (many of which i subscribe to) as well as books and individuals.

I freely admitt there is much i do not know simply because it isnt what I do. Things like endo. and the like which I have no experience with. However, that does not at all imply i am not a critical thinker or dont know much pathophysiology.

In anycase, you dont know me or what my attitide is nor how i operate in the medical arena. Your making assumptions. I am good at my job and thats because i take the time to research, read and question on a regular basis. I dont have protocols and dont do "cowboy" things because I know the WHYS not just the whats.

Hey Mike, how tough was it diagnosing that multi-system trauma? Did you use your "disgression" to treat the patient, or the physician's discretion?

You are in for a rude awakening when you put on that short white coat. Something tells me you are going to lose your marbles the first time a tech in the ED tries to ask you to do something you think you are above doing.

No matter what you think you may doing on the bird, you are merely operating under someone else. And don't think it won't come back to bite you in the butt when you do some cowboy stunt that places your physician on the hot seat. I have no doubt that you are good at what you do, but your attitude needs a minor adjustment. Thats nothing that 4 years in a short white skirt won't fix!

You don't want to hear this, but your education up to this point does not give you the necessary knowledge to think all that critically outside the box. You know enough pathophysiology today to put on a 3 x 5' notecard and still have room to tell your life story.

Lets see what you think a few years down the line and my guess is you will be a bit more humble and a bit less arrogant. I recall having a similar conversation about 5 years ago with Freeedom and you know what...he was right.

Good luck to you, sincerely.

 

[corpsmanUP]

CorpsmanUP

You dont know me buddy, nor do you have any idea at what point my critical thinking is or my level of knowledge. I am not a physician but the knowledge you get in medical school is not at all secret or hidden. It is freely avaliable in journals (many of which i subscribe to) as well as books and individuals.

I freely admitt there is much i do not know simply because it isnt what I do. Things like endo. and the like which I have no experience with. However, that does not at all imply i am not a critical thinker or dont know much pathophysiology.

In anycase, you dont know me or what my attitide is nor how i operate in the medical arena. Your making assumptions. I am good at my job and thats because i take the time to research, read and question on a regular basis. I dont have protocols and dont do "cowboy" things because I know the WHYS not just the whats.

No, I do know your attitude. Its all over this forum. Once you've cried yourself to sleep at night because it takes you 10 minutes to read one single page out of Robbin's path, drop us all a reply so we can pump you up big guy!! You're going to need it. Don't forget you have boards at the end, and your helo physicians won't be able to help you with those.

 

[Mike MacKinnon]

heheh

Well i dont deny that is comming

Im sure youll see me frustrated and overwhelmed when that comes. I expect it. My knowledge of medicine in general is about 10% of whats in med school (i would guess). In anycase, i cant wait to cry myself to bed reading Robbins

No, I do know your attitude. Its all over this forum. Once you've cried yourself to sleep at night because it takes you 10 minutes to read one single page out of Robbin's path, drop us all a reply so we can pump you up big guy!! You're going to need it. Don't forget you have boards at the end, and your helo physicians won't be able to help you with those.

 

[lloydchristmas]

Would a moderator please help these poor faceless beings by closing this thread so they can leave their mom's basement and talk to some real people? For God's sake... I remember arguing like this over my hot wheels when I was 5, but not since then.

I wonder if it really is stimulating to light candles and rub baby oil all over yourself while listening to Enrique Eglesias sing "I can be your hero baby" and watching yourself dance in the mirror.

Get out!!! Go get some sunlight!!!

 

[corpsmanUP]

Would a moderator please help these poor faceless beings by closing this thread so they can leave their mom's basement and talk to some real people? For God's sake... I remember arguing like this over my hot wheels when I was 5, but not since then.

I wonder if it really is stimulating to light candles and rub baby oil all over yourself while listening to Enrique Eglesias sing "I can be your hero baby" and watching yourself dance in the mirror.

Get out!!! Go get some sunlight!!!

Well, since you are bringing it up, I specificallyt recall LloydXmas himself having a little 2 week mini-vacation (suspension) from SDN for a little "argument" last year about NP's and PA's. Merry Christmas Lloyd; I hope you'll still keep me on your holiday card list

 

[lloydchristmas]

Well, since you are bringing it up, I specificallyt recall LloydXmas himself having a little 2 week mini-vacation (suspension) from SDN for a little "argument" last year about NP's and PA's. Merry Christmas Lloyd; I hope you'll still keep me on your holiday card list

Really? I didn't notice, as I'm not on 23 hours a day like you. Take some Thorazine and shut the f*ck up. How's that for a new SDN vacation???

 

[lloydchristmas]

Really? I didn't notice, as I'm not on 23 hours a day like you. Take some Thorazine and shut the f*ck up. How's that for a new SDN vacation???

Lloyd Christmas out.

 

[oldManDO2009]

now that is frakin funny

 

[a_ditchdoc]

Mike,

I am sure you are a great flight nurse, but I hope you are not nearly as arrogant in person. If so, I can see where you might have some issues maintaining close friendships. I also happen to feel that four years of medical school will allow you to "get over yourself".

I was a street medic for over 12 years; I thought I was pretty damned good at it. I "diagnosed" bullet wounds, multi system trauma, stabbings, and did CPR once or twice. Sometimes I even put oxygen on people having heart attacks. That is, of course, after going over my protocols to make sure it was covered. Us medics ain't real big thinkers if you know what I mean...

Despite being a fairly humble and well educated guy, my transition to medical school was a little difficult. I have great tidbits of clinical knowledge but most of it I could not support with reasoning (although I thought I could). The truth is, I didn't even know what I didn't know. Path, Biochem...physiology....sheesh. I felt like they were trying to make me a scientist. Of course, it all comes together somewhat toward the end. Then I hit the clinical portion of medical school, where I am now. What kind of cool stuff and great decisions do I get to make now? Let me put it this way, CPR would be a highlight at this point. Let me give you a few tips before you get started, just to help the learning curve:

The nursing assistants will do more invasive and life altering procedures on a daily basis than you will. Get ready, for the sake of maintaining friendships in medical school, and to save yourself great frustration, to suck it up and swallow your ego and showboat attitude. Noone gives a damn how many times you have intubated, how you could manage 23 drips in rough weather while blinded by streaks of lightening, or how you happened to diagnose Brugada syndrome using a bag of IV fluids, a copper penny, 3 inches of wire, and a swiss army knife. You are a STUDENT, the bottom of the food chain. Your opinion, or presence, is of no importance. You will eventually show gratitude for being allowed to simply draw blood. If you go in with the attitude you show in this forum, you will not survive the journey.

I really do wish you the best of luck, but your posts reflect a high degree of self importance. If you do not work on modifying that now, you are in for a rough ride...

 

[oldManDO2009]

"my transition to medical school was a little difficult. I have great tidbits of clinical knowledge but most of it I could not support with reasoning (although I thought I could). The truth is, I didn't even know what I didn't know. Path, Biochem...physiology....sheesh"

a_ditchdoc, how true - I had the same issue. I am amazed at how much I did not know when I started and as I finish my first year how little I still know. The best part is that as I learn the details - all those neuro checks now make complete sense.

Medical school is a blast -I pretty much hate this year and look forward to next year with more pathophysiology and pharm. I do appreciate how much I need to know to get through next year though, so I slog on through immunology (which is actually really cool)

Mike is a good guy - this is just an on going debate that rarely ends well. I have thrown some punches myself

 

[a_ditchdoc]

Mike is a good guy - this is just an on going debate that rarely ends well. I have thrown some punches myself

I'm sure he is a good guy, and certainly well versed in critical care. I just wish he would be more humble. Perhaps I was just having a bad day...

No offense Mike...

 

[Mike MacKinnon]

Hey

Its OK man. After reading how i wrote some things i can see why you would think that. It wasent meant to come off that way but hell, what can yah do?

In reality i have no illusions that medical school will be easy for me, ill just have an edge most do not. Sadly, little of that will come into play until the clinical years.

In anycase, i cant wait to go!

 

[fab4fan]

No, I do know your attitude. Its all over this forum. Once you've cried yourself to sleep at night because it takes you 10 minutes to read one single page out of Robbin's path, drop us all a reply so we can pump you up big guy!! You're going to need it. Don't forget you have boards at the end, and your helo physicians won't be able to help you with those.

And we nurses know your attitude. Try making a point without being derogatory to nursing...or is that too much of a stretch for you?

 

[yalepa99]

this thread arguing and bitching about how PA's are better than NP's and how NP's are better than PA's is EXACTLY the reason I am getting out of the human medicine field. Its so petty. I am a Yale PA graduate as of 1999, and I'm so tired of this kind of thing. Ego's amoung midlevels is outrageous!