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Just a quick thought in the PA vs NP

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MexicanDr

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This is not necessarily another PA vs NP war zone, but simply something I wanted to bring up from observation on different comments from different members here.

In many threads is said: If you want to do outpatient/primary care go NP, if you want to do EM/Acute Care/Hospitalist go PA.

What is your thought on institutions such as UCSF, UCLA, John Hopkins, Duke, Emory, UC Irvine, UPenn (Just to mention a few) utilizing NPs in their acute care setting such as ICUs, ERs and other non-outpatient settings?
 

AnnoyedByFreud

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While it is more common for PAs to work in acute settings and for NPs to work in outpatient settings, these rules aren't set in stone. In some areas it is extremely common for NPs to work in EDs, ICUs, etc.
 
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deleted6669

there are probably as many PAs doing neonatology, psych, women's health, etc (traditional NP strongholds) as there are NPs doing traditionally PA jobs.
Places with strong nursing depts (ucsf, etc) and no PA programs are likely to try to fill their depts with their own NP grads.
 

AnnoyedByFreud

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Agreed. Basically all the universities that OP mentioned have very strong nursing schools.
 

NYCGuy86

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Yes, places like UCSF, Penn, Columbia, Duke, Hopkins, etc (linking just to the adult versions) have specific Acute Care NP programs which train NPs for inpatient/specialty/critical care practice. From what I hear (haven't done my own research on the matter), the ACNP is newer NP as compared to the FNP. Perhaps as such programs proliferate, you will see even more NPs in inpatient/specialty settings. So, I'd say that if you like nursing and want to do inpatient, you should do an ACNP program, not an FNP/ANP/PNP (though yes, there are examples of graduates of those NP programs functioning in inpatient/specialty settings, such as an RN I used to work with that did ANP, did a few rotations in cardiology and the cath lab in addition to the primary care rotations, and now is an interventional cardiology NP). I've worked with a number of RNs that did ACNP and now work or have worked as NPs in surgical critical care, neurocritical care, trauma critical care, cardiothoracic surgery, and ED. Also, in the hospitals I've worked in, I've seen both NPs and PAs, sometimes working in the same areas, other times separately. It really can vary depending on geographic location and specific hospital in question.

So for me, I don't buy the "If you want to do outpatient/primary care go NP, if you want to do EM/Acute Care/Hospitalist go PA." argument, especially if you realize that there are ACNP programs out there. The only two exceptions I personally would make are for surgery, specifically including an intra-operative/first assist role (go PA) and psych (go PMHNP).

My 2 cents.
 
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deleted6669

So for me, I don't buy the "If you want to do outpatient/primary care go NP, if you want to do EM/Acute Care/Hospitalist go PA." argument, especially if you realize that there are ACNP programs out there.
you realize EVERY PA has around 3x the clinical hours of the typical ACNP program (600-800 hrs total), right? I had more hours just in trauma surgery than most ACNPs get in their whole program. Then I had 22 weeks of em, including 5 in peds em AND all the other core rotations in psych, fp, ob, im, etc for around 3000 hrs in 54 weeks.
 

NYCGuy86

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you realize EVERY PA has around 3x the clinical hours of the typical ACNP program (600-800 hrs total), right? I had more hours just in trauma surgery than most ACNPs get in their whole program. Then I had 22 weeks of em, including 5 in peds em AND all the other core rotations in psych, fp, ob, im, etc for around 3000 hrs in 54 weeks.

What is your point? My point is that the "outpatient=NP, inpatient=PA" argument is simplistic, and that inpatient/specialty practice certainly is possible as an NP, and the ACNP is specifically designed for that (and that we'll possibly see further expansion in that area as ACNP programs grow, being a newer NP role in comparison to FNP). I said nothing about who has more hours in what or what you personally did as a PA student. If someone likes nursing and wants to do inpatient/specialty/critical care advanced practice, they can look at ACNP. I made no comment about PA training (besides alluding to the obvious advantage PA has in first assist surgical roles), so I'm not sure why you went off about the above.
 
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deleted6669

What is your point? My point is that the "outpatient=NP, inpatient=PA" argument is simplistic, and that inpatient/specialty practice certainly is possible as an NP, and the ACNP is specifically designed for that (and that we'll possibly see further expansion in that area as ACNP programs grow, being a newer NP role in comparison to FNP). I said nothing about who has more hours in what or what you personally did as a PA student. If someone likes nursing and wants to do inpatient/specialty/critical care advanced practice, they can look at ACNP. I made no comment about PA training (besides alluding to the obvious advantage PA has in first assist surgical roles), so I'm not sure why you went off about the above.
my point( and I didn't mean to come off as hostile) was that if you want to do a 2 yr program(pa or np) you will be better prepared for inpt roles as a pa than as an np due to the significantly better training in those settings. sure , an NP can work in these roles and a pa can do psych/neonatology/women's health, etc but it is just easier to do some jobs from one background than the other.
Peace-e
 

NYCGuy86

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my point( and I didn't mean to come off as hostile) was that if you want to do a 2 yr program(pa or np) you will be better prepared for inpt roles as a pa than as an np due to the significantly better training in those settings. sure , an NP can work in these roles and a pa can do psych/neonatology/women's health, etc but it is just easier to do some jobs from one background than the other.
Peace-e

No problem. It's just that I have no interest in participating in yet another PA vs NP war zone, as the OP termed it. I do agree that it is easier to do some jobs from one background than the other. Having an intraoperative role in surgery is vastly easier for PAs since they have didactic and clinical education in that area. Psych/neonatology/women's health is easier for NPs because there are specific NP programs with didactic and clinical education for those areas (PMHNP, NNP, WHNP). I think it's important to point out those specific NP types because some may not realize that it isn't any "NP" that practices in so-called traditional NP areas, but specific NPs educated and certified in those areas (or at least that's what the powers that be are going for these days). And if one would like to be in the nursing profession as an inpatient/specialty NP, they can look to ACNP.
 

NYCGuy86

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NYCGuy86

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There are also a few ENP programs out there, which are hybrid FNP programs. here are 2:
http://www.nursing.vanderbilt.edu/msn/enp.html
http://www.nursing.emory.edu/admission/programs/msn/emergency.html
they do look better than the typical fnp curriculum for those who want to do np and focus on more acute care.

Yeah. Vanderbilt is interesting. In addition to the ENP, they also have hospitalist and intensivist tracks for their ACNP, in addition to the standard ACNP program. They also have a 2 year critical care DNP fellowship for ACNPs. If only more post-masters DNP programs were like that...

http://www.nursing.vanderbilt.edu/dnp/acnp_fellowship.html
 
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deleted6669

That fellowship/DNP hybrid program looks cool. There are a number of postgrad programs for PAs in Trauma/critical care as well, which can be found on this site:
www.appap.org
A friend of mine runs the one at St. Luke's in Pennsylvannia which accepts both PAs and NPs.
 
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MexicanDr

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you realize EVERY PA has around 3x the clinical hours of the typical ACNP program (600-800 hrs total), right? I had more hours just in trauma surgery than most ACNPs get in their whole program. Then I had 22 weeks of em, including 5 in peds em AND all the other core rotations in psych, fp, ob, im, etc for around 3000 hrs in 54 weeks.

This is an interesting comment I have seen plenty of times as well. I do agree that PA programs have more hours than NP programs, but in general NP program students have way more hours than PA programs. Look at current PA programs, most them not only require 1000 or 500 hours (Those at the Master's level) compared to the minimal that require 3000 or more.

So yes, PA programs do have more hours compares to NP programs, but what about the experience many of these RNs learned through the years? It simply you like you have mentioned, as an experienced PA you have gained extreme amounts of knowledge because of your years of experience, similar to those RNs that gained knowledge through the years of experience before deciding to go into an NP program. Both PA and NP programs have their outlier pros and cons.

As mentioned, I simply wanted to get a more introspective view on this matter since nowadays we are seeing both PAs and NPs doing a lot of roles, especially in areas where physicians dont want to move.
 
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deleted6669

not trying to start a np vs pa war here, but realize the #s listed for PA programs are minimums. most programs have accepted averages significantly higher than their listed minimums. In 2013, for example the avg pa student admitted to a program had 6000 hours of experience. at my local program this # was 8000 hrs.
yes that is an avg so some had 1000 and some had 30,000, but look at the stats of accepted folks, not mimimums.
one additional point: training/experience at the provider level (PA/NP/MD/DO) is very different than training at other levels such as rn or paramedic. you can't count pre-training as equivalent to provider training. certainly hce is great(and those who know me here and elsewhere know I am a huge advocate for good hce) . but it is not the same as time spent learning to be a provider.
looked at another way- consider this: 2 RNs both with 5 years experience go back to school. 1 becomes an FNP and gets 500 hrs of training. One becomes a PA and gets 2500 hours of training. who is better prepared the first week after graduation to practice medicine considering they were identical candidates the day they started school?
sorry- one more point: direct entry np programs allow folks with zero nursing experience to do a 3 yr post bs program to become an np. there are direct entery pa programs too. I don't like those either.
 

pamac

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The thing is that your local PA program is one of the premier programs in the field... And one that might have the highest requirement for previous health care experience of any PA program, along with specifically designated careers that that HCE must consist of. Let's look at the Pacific Northwest.... University of Washington and university of Utah are quickly becoming the exception. Idaho State and OHSU are the trend, where HCE means nothing. Pacific is a mixed bag. When I interviewed with UW, I had the bare minimum hce at something like 3100 hours, and was a lab scientist (one of about 6 interviewing). Lots of paramedics with many years hce, lots of RTs, lots of ER techs (paramedics . One RN. RNs don't flock to PA. They work while they go to NP school and get tuition reimbursement from where they work and make connections for work when they become NPs. PA school is a no brainer for a paramedic/firefighter/ER tech/RT because that's their ticket. Problem is that more and more programs are giving that ticket to CNAs, scribes, hospital volunteers, or mission trip pre meds. And although direct entry NP programs are out there, they are nowhere near the numbers you see for PA programs that aren't the UWs, U of U's, and your own alma mater which I can't remember.

That said, I used to work with an acute care NP who was a nurse for over a decade (mostly in management and supervision) who frankly sucks. Watching this person was painful. They thought they knew not only their own job, but also the nurse's. This is problematic because when you pop your head in a room for two minutes, you really can't get a grasp of how the RN nursing cares are flowing like the person who's been providing them for the previous 5 hours, but by gosh if this person didn't think they had all the answers for that. Then to see the attending physician hospitalist basically have to go over and gently correct that NPs entire take on that patient's plan of care from a medical standpoint on almost every point of action was concerning to say the least. What I got out of that, apart from the fact that overconfident people need to check themselves, is that nursing knowledge can't make up for 1) lack of background in the biological sciences, and 2) lack of insight into a completely new role. It's similar to the CNAs who think they could do RN work because they see what we do and could imagine themselves being able to easily handle that. What they don't see is my thought process, my background knowledge, and the fact that I'm keeping tabs on not only what my CNAs are doing for my patients, but what all my patients are doing. So I'm not one who assumes that nursing roles directly correlate to provider roles because the thought process is different. If there is one thing I consistently see in NPs with significant RN experience that I don't like, it is how that colors their view of their abilities. They get overconfident too quick, and they are quick to tell the RNs how to do that job better. I never have a PA telling me some stupid observation that often is wrong (like "oh, she looks pregnant, let's run ANOTHER preg test.... What's that? She's on meds that are know to make people gain weight quickly? Well, I'm not familiar with those meds, so I'll just order another test"..... Or "oh, we might want to throw a stethescope on that guy and listen to his lungs because he sounds really coarse when I walked by him.... Oh he had a cold when he came in for his other thing, and you already documented lung sounds? Ok... I'd still give it a listen!"... Yeah, NP... He's got a treatment plan for his primary diagnosis, as well as his multiple comorbidities. I documented all that crap two hours ago after I did more than walk by and overhear him breathing loudly after he exerted himself. I listened to all 5 lobes of the lungs in back and the upper lobes in front, checked his O2, read the notes and compared all this to the RT assessment, but I'm sure with your highly tuned ears walking by and the patient not even being yours, you picked up on it.....

Yeah, so unfortunately those two NPs are the ones around me that I'm most familiar with. The PAs jump in, see the patient, write their notes and hit the trail. We have no PAs around in hospitalist roles, nor in the ED, where you will find NPs. The hospitalist NPs are acute care specialty, and not FNPs. The other day an acute care NP student said that the FNP folks generally now do rotations through the clinics, and to get into hospitalist rotations you need to be acute care track. The lack of PAs around the facility part from the ones belonging to the physicians is mostly due to hospital policy from above. The admin wants fully independent providers so the buck stops with that provider. As much as they want good outcomes (which I'm certain an experienced PA could easily provide), they still don't want open ended liability and decision making. Apparently, the doctors felt it meant more to them to not have any elements of a supervisory requirement tying them to a decision, and that fueled the NP preference. That's the ED groups and the hospitalists who prefer NPs. The independent physicians and surgeons are the ones who have all the PAs, and apparently they find that arrangement to be preferable to having NPs, since each patient is generally a patient of the entire clinic. And that's with my state being rather PA friendly.
 
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deleted6669

OHSU, pacific and medex all require at least 2000 hrs MINIMUM HCE...
I agree with most of your other points. Not a fan of lowering entry level hce requirements for any health care provider field. I think allowing CNAs, scribes, etc sets a bad precedent for the pa profession. I am almost done with my doctorate and will probably teach a bit for medex when done. They still respect a solid HCE background.
 
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NYCGuy86

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In my area, it seems as if the experience requirement for PA programs is much lower (Weill Cornell=no minimum, starting next cycle it will be at least 200+ hours, Stony Brook=1000, Touro=200, Pace=200, Mercy=500, CUNY=no requirement, NYIT=100, SUNY Downstate=225). Either way, PA clinical rotations obviously more than make up for that.

It is also often the case that in direct entry NP programs, depending on the program, the student will be required to take a leave of absence after passing the undergraduate RN education (some confer a BSN degree, others don't) and licensure to work for at least a year as an RN before returning to start the MSN. You see this with the ACNP and NNP specialties. Some also work as RNs part time during the MSN (as pamac mention, that tuition reimbursement must be enticing). On the other hand, FNP direct entry programs seem to allow students to go straight through. I had a friend that started FNP immediately after graduating BSN school (traditional), this was at Georgetown though, which has a great nursing school. I also remember an ADN student at the nursing school of a hospital I used to work at that came to my unit, and she told me that she had absolutely no interest in working as an RN, and her goal was to graduate, do RN-BSN then her MSN, or one of those RN-MSN programs, all without RN practice experience.

Can't remember who, but I think a poster here is in a direct entry program, or did one, so perhaps if they see this they can comment on their experiences and perspective on the necessity of RN experience to practice. Over on allnurses, you see varied views on the matter.
 

NYCGuy86

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NYCGUY- are you planning on rn to np/dnp?

I'm currently a second degree BSN student. In the future I'm thinking NP (I have no plans to immediately go to NP school following my BSN, as I do want to be a bedside [critical care] nurse, even after years as an ER tech/PCT and seeing some of what RNs go through, I like the role that nurses have, despite originally thinking it was just being a mindless "follow orders" role like some think it is).

I periodically consider PA since I find the curriculum attractive (which is why I try to take a balanced view of the whole PA vs NP ordeal, despite the condescension I've heard some RN/NP student coworkers express about PAs). I think I'll stick with nursing, but you never know. I appreciate the work PAFT is doing and hope that PAs can have the same legislative wins that NPs are having.
 
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deleted6669

Thanks- PAFT pushed through some big stuff with AAPA last year. We were a significant reason the aapa went to the new policy of PA over "assistant" and collaboration over supervision. More to come.
If you think you might ever want to become a physician remember there is a bridge PA to doc at this point that requires no mcat and no similar program for NP.
Good luck where ever your training takes you.
 

pamac

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OHSU requires 2000 hours hce, but lists scribe, phleb, and CNA as acceptable. Pacific only requires 1000 hours (6 months basically) and it doesn't specify it be worthwhile hce. That doesn't put them very high in the hce requirement category. Medex has a 3000 hour threshold, not 2000, and has very high standards (I forgot to mention all the former military medics at the interview as well... many of them combat vets). U of U might require 4000 if I recall... All high quality.
 

pamac

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The biggest reason I decided to go the nursing route was the impotence I saw at the aapa about even basic things like exploring name change and seeking parity with NP advancements. I'm not militant about NPs supplanting physicians, but when you look at a career path, it makes sense to pick the strong horse (and I'm talking in terms in terms of organization, not rigor of training), vs the weaker one. I was on the PA forums egging people on to push for better leverage for a while and it didn't seem to go anywhere (a couple of aapa former leaders really set the time for impotence). By the time the conversation really took off, I was off to the nursing world. I didn't think I could be proud of being part of that profession if it didn't take a role hat made for more separation as a profession. This isn't to knock physicians at all either, I just think that a little daylight between being supervised and being in a collaborative relationship is healthier from the standpoint of having some leverage in employment. Basically I didn't like the idea of tying my ability to work with linking myself directly to a physician who would set the tone for every aspect of the professional environment. Most of the NPs I know function the same as PAs, but I get the feeling that as an NP, my destiny is more in my own hands. I'm in a good state for NPs to practice, and it seems like every year that number grows by at least 2. I saw nothing on the PA side that was even similar. With insurance companies and facilities requiring close collaboration, the legal independence may only be a mirage, but psychologically it is important to me. Calling the profession PA is a good thing, but so is getting independent practice rights. A med school bridge for PAs that shaves off a year is nice, but NYU does the same thing for PAs, NPs, and the general public with no HCE with their 3 year track. Primadonna even says that med school is a bigger beast to tackle than PA, along with the significant depth. More bridge programs probably aren't in the cards once schools realize we need all hands on deck, and that it's less important to train medical prescribers (PAs) into medical prescribers (DOs). That's cool that they have a program that bridges, but every bridge seat they allow means one less provider than there could be because no increase in provider number takes place, it's just transferred. We'll see that project wrap up at some point, sooner rather than later.
 
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BreathDeep

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Since it is borderline related to this thread, I will add that just through my own experience the ICU ACNP's here at UCSF are indeed pretty good. I was never a fan of NP's before working here, but working with them side by side has definitely changed my opinion somewhat. At least, those that train here at UCSF that is (and for the most part, the majority of our ACNP's have gone through our program).

They have a nicely defined role here. At night they indeed will "solo" cover the MICU on nights when there is no resident. Also in our Neuro and Cardiothoracic ICU's they will manage the patient from the Critical Care standpoint while the Neurosurgeon or CT-Surg physician/NP handles their stuff. But at the same time there is always someone for them to call when **** hits the fan. There's an endless supply of Cardiac/CT/Neuro/Pulm/Anesthesia residents for all of your "my patient is actively dying right this second!" needs.

They all pretty much understand that their job isn't to captain the ship through troubled waters, but just to keep it upright and on course through a typical night, putting out little fires here and there as they pop-up before they become full fledged infernos. They're good at starting or adjusting a patient's pressors, intubating the slowly decompensating patient, tweaking the ECMO circuit, starting the septic admit on fluids and broad spectrum abx, and so on. They know their role and they're always in the unit, and it honestly just makes the night much more smooth overall.

Though they still don't understand ventilators too well, but nobodies perfect I guess.
 
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Neoq

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I'm currently a second degree BSN student. In the future I'm thinking NP (I have no plans to immediately go to NP school following my BSN, as I do want to be a bedside [critical care] nurse, even after years as an ER tech/PCT and seeing some of what RNs go through, I like the role that nurses have, despite originally thinking it was just being a mindless "follow orders" role like some think it is).

I periodically consider PA since I find the curriculum attractive (which is why I try to take a balanced view of the whole PA vs NP ordeal, despite the condescension I've heard some RN/NP student coworkers express about PAs). I think I'll stick with nursing, but you never know. I appreciate the work PAFT is doing and hope that PAs can have the same legislative wins that NPs are having.

I think there are few significant differences between NP vs PA in terms of career after clinical work. This is because BSN RNs and even practicing NPs are pursuing DNPs in much greater numbers now. This route is significantly more flexible than typical MSN NP, even if it is debatable whether it pays significantly more.

This is because a DNP has a quite a few more administrative roles that can be filled versus an MSN NP or PA. Just in case you decide that you don't want to stay clinical your entire life, DNPs can pretty easily pursue numerous administration, leadership, research and education roles. Examples that are fairly common are head nurses and nurse executives, patient administration, patient safety, informatics, ethics, JC (formerly JACAHO) committees, hospital protocol groups, bed coordinator, teaching, research committees, etc. It's true that many of these roles are currently filled with BSN or MSN RNs with experience combined with some certs. (Usually the leadership nursing roles are filled by BSNs with an MBA or MHA, or an MSN with an administration focus), however, I'm seeing more and more of these roles being filled by DNPs, either with an administration focus, or DNPs that practiced clinically for a while and then stepped into the role later. More and more, DNPs are being preferred as clinical instructors at graduate universities since it's deemed that DNP students should be taught by doctorate level nurses rather than master level nurses. In fact, there is a trend now of giving DNP nurses tenure for positions that traditionally only PhD nurses would hold. Also, switching from clinical to an administration, education, research or leadership role can be easily done by a DNP since many DNPs have multiple focuses that can be changed after graduation by taking the additional graduate classes in the other focus at a later date, saving a lot of time over getting an MBA/MHA or entire other degree.

Anyways, just thought that I'd have to put this out because I didn't see much discussion on futures of PA vs NP that pointed out that nursing has a much greater administration role to it than PA, especially after doing years in clinical environments. Oh, and I almost forgot, nurses sometimes pursue PhDs as well, and since a nursing PhD is essentially an individually tailored degree, you can specialize in just about anything. I have looked into pursuing a PhD in nursing and wanted to do research on the biochemical and neurological structure differences among various personality disorders. Obviously this takes a fairly comprehensive background in both neuropsychology, neurobiology, medicine, and psychology and the proposed curriculum tas set up for me through University of Maryland, Baltimore, was heavy in basic sciences and courses from various departments other than nursing. I think about 2/3rds of the proposed curriculum came from the departments of neuropsychology and biology and 1/3rd from nursing.

Some advantages of the PA route: Deeper understanding of pathophysiology, minor surgery, radiology, and more overall clinical hours, especially in surgery, ER, and physician specialty areas. Also, a PA can switch their specialty just by switching their physician. That's huge!

NPs have to specialize at graduate level in a certain milieus (Psych, family practice, acute care, administration, women's health, and public health are the most prevalent and standardized in nursing at this point). Also, focus and general philosophy is a little different. Nurses emphasize the importance of the patient experience, including the communication with patients, how to get patients to be more active in their own care, the experience the patient receives as a whole from their environment, and trying to affect and understand what patients do in their lives outside of the hospital/clinic (like importance of making things more convenient, enjoyable, understandable or motivating to increase adherence, etc.), whereas the medical approach emphasizes that patients need help from medical professionals to alleviate or eliminate a specific disease process. The medical approach emphasizes the role of the medical provider as more of an authoritative role in the patient's life, seen as a consultant whose job it is to tell the patient what to do or to do a specific procedure that will eliminate the disease or symptoms of the disease. This role is better for acute processes or clearly defined disease processes where the role is intermittent and temporary.

I personally believe that both approaches have their merit and glad that there exist both professions to provide a different emphasis and approach to healthcare and in the end, that just gives consumers more choices.
 

Neoq

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I think there are few significant differences between NP vs PA in terms of career after clinical work. This is because BSN RNs and even practicing NPs are pursuing DNPs in much greater numbers now. This route is significantly more flexible than typical MSN NP, even if it is debatable whether it pays significantly more.

This is because a DNP has a quite a few more administrative roles that can be filled versus an MSN NP or PA. Just in case you decide that you don't want to stay clinical your entire life, DNPs can pretty easily pursue numerous administration, leadership, research and education roles. Examples that are fairly common are head nurses and nurse executives, patient administration, patient safety, informatics, ethics, JC (formerly JACAHO) committees, hospital protocol groups, bed coordinator, teaching, research committees, etc. It's true that many of these roles are currently filled with BSN or MSN RNs with experience combined with some certs. (Usually the leadership nursing roles are filled by BSNs with an MBA or MHA, or an MSN with an administration focus), however, I'm seeing more and more of these roles being filled by DNPs, either with an administration focus, or DNPs that practiced clinically for a while and then stepped into the role later. More and more, DNPs are being preferred as clinical instructors at graduate universities since it's deemed that DNP students should be taught by doctorate level nurses rather than master level nurses. In fact, there is a trend now of giving DNP nurses tenure for positions that traditionally only PhD nurses would hold. Also, switching from clinical to an administration, education, research or leadership role can be easily done by a DNP since many DNPs have multiple focuses that can be changed after graduation by taking the additional graduate classes in the other focus at a later date, saving a lot of time over getting an MBA/MHA or entire other degree.

Anyways, just thought that I'd have to put this out because I didn't see much discussion on futures of PA vs NP that pointed out that nursing has a much greater administration role to it than PA, especially after doing years in clinical environments. Oh, and I almost forgot, nurses sometimes pursue PhDs as well, and since a nursing PhD is essentially an individually tailored degree, you can specialize in just about anything. I have looked into pursuing a PhD in nursing and wanted to do research on the biochemical and neurological structure differences among various personality disorders. Obviously this takes a fairly comprehensive background in both neuropsychology, neurobiology, medicine, and psychology and the proposed curriculum tas set up for me through University of Maryland, Baltimore, was heavy in basic sciences and courses from various departments other than nursing. I think about 2/3rds of the proposed curriculum came from the departments of neuropsychology and biology and 1/3rd from nursing.

Some advantages of the PA route: Deeper understanding of pathophysiology, minor surgery, radiology, and more overall clinical hours, especially in surgery, ER, and physician specialty areas. Also, a PA can switch their specialty just by switching their physician. That's huge!

NPs have to specialize at graduate level in a certain milieus (Psych, family practice, acute care, administration, women's health, and public health are the most prevalent and standardized in nursing at this point). Also, focus and general philosophy is a little different. Nurses emphasize the importance of the patient experience, including the communication with patients, how to get patients to be more active in their own care, the experience the patient receives as a whole from their environment, and trying to affect and understand what patients do in their lives outside of the hospital/clinic (like importance of making things more convenient, enjoyable, understandable or motivating to increase adherence, etc.), whereas the medical approach emphasizes that patients need help from medical professionals to alleviate or eliminate a specific disease process. The medical approach emphasizes the role of the medical provider as more of an authoritative role in the patient's life, seen as a consultant whose job it is to tell the patient what to do or to do a specific procedure that will eliminate the disease or symptoms of the disease. This role is better for acute processes or clearly defined disease processes where the role is intermittent and temporary.

I personally believe that both approaches have their merit and glad that there exist both professions to provide a different emphasis and approach to healthcare and in the end, that just gives consumers more choices.

Just to add a few more differences between NP vs PA career/route:

PA advantages: You won't spend anytime wiping butts, washes, sheets, etc. Usually as an NP, even though there exist a few routes to go from RN to NP without being a nurse in between (but those are the exception, not the rule), as a nurse, you have to put in the "grunt" time and do all manner of menial and intimate things with your patients, usually for years. You'll also find out all manner of their personal lives and day to day activities of your patients. This may or may not be a plus to you as a background in becoming a provider.

You won't be a nurse, so the stereotype of nurses just being female or gay guys won't be a danger for you on the dating scene. (That's mainly for those young males out there who are single and concerned about the perception by young (and admittedly shallow, but probably pretty) girls out there. However, being thought of as not being good enough or ambitious enough to go through medical school WILL be a concern.

NP (DNP NP route most likely today) advantages: NP schools are geared towards working nurses, many of whom are women who have children, and maybe even single mothers, so that means most graduate nursing schools are WAY more convenient to attend than the typical PA school structure. PA schools are meant to be taken where your only focus is the PA school and you have no other life. Again, PAs follow the medical model. It is intense and all encompassing for pretty much the entire period of time so it's hard to, if not impossible, to work at the same time and makes some income or pursue any other activities that may be significant (like child rearing). In addition, even if you could work, most PA students don't have as high paying of an hourly paying, part-time, float type job that experienced RNs would have access to, so even if PA school is the shorter route, it might be harder, or even impossible to complete, versus pursuing the DNP if you are already an experienced nurse. (Not to mention that many hospitals will pay for most, if not all, of the costs to go to nursing graduate school if you are a good nurse and promise to come back and work for the same hospital after graduating).
 

pamac

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I agree with what you said about extra clinical opportunities. That's really what the DNP seems to be about, at least from my perspective. Nursing wants to have and hold sway over the direction of healthcare, so they came up with that to be ready for the corporatization of healthcare that we are seeing right now. It's a smart move. I have no interest in pursuing a DNP in the slightest, but people who complain about it not having much of a clinical impact have been missing the whole point all along.

As for perceptions of male nurses among females and others, most of the women In the world are simply starting to appreciate a male with a good job. Most of the male nurses I know seem to be either married to or date gorgeous women. Folks have caught on that nursing has a lot to offer males. I'm around home to help out all the time. I have a very flexible schedule, and most nurses work when they want. Switching shifts isn't usually a difficult thing to do if you help out your peers when they need it. And the pay can be impressive, considering you can become a nurse in a year if you find an accelerated program. I know husband and wife nurse couples that definately make bank and have plenty of time off. But, like you said, there's the issue of the unpleasantness that exists when dealing with the bad parts of the job.
 
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In my area, it seems as if the experience requirement for PA programs is much lower (Weill Cornell=no minimum, starting next cycle it will be at least 200+ hours, Stony Brook=1000, Touro=200, Pace=200, Mercy=500, CUNY=no requirement, NYIT=100, SUNY Downstate=225). Either way, PA clinical rotations obviously more than make up for that.

It is also often the case that in direct entry NP programs, depending on the program, the student will be required to take a leave of absence after passing the undergraduate RN education (some confer a BSN degree, others don't) and licensure to work for at least a year as an RN before returning to start the MSN. You see this with the ACNP and NNP specialties. Some also work as RNs part time during the MSN (as pamac mention, that tuition reimbursement must be enticing). On the other hand, FNP direct entry programs seem to allow students to go straight through. I had a friend that started FNP immediately after graduating BSN school (traditional), this was at Georgetown though, which has a great nursing school. I also remember an ADN student at the nursing school of a hospital I used to work at that came to my unit, and she told me that she had absolutely no interest in working as an RN, and her goal was to graduate, do RN-BSN then her MSN, or one of those RN-MSN programs, all without RN practice experience.

Can't remember who, but I think a poster here is in a direct entry program, or did one, so perhaps if they see this they can comment on their experiences and perspective on the necessity of RN experience to practice. Over on allnurses, you see varied views on the matter.

I'm in a FNP DNP program as well. I did a hefty presentation on ARDS risk factors, diagnostic criteria, and the AECC vs Berlin diagnostic defintions as well as a detailed case study. This weekend I have a critical ARDS patient on paralytics I was able to APPLY everything I had learned to take care of. Being able to reinforce what you learn at school on the job while it's fresh in your mind is an overlooked aspect of the NP education process.
 
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