NP vs PA vs CNS

allnurses Guide · May 23, 2014

Not true. There are plenty of MSN programs that will take people directly out of nursing school, with no experience, and there are plenty of "direct-entry" MSN programs that will take people like your friend, with a BA/BS in another discipline and no nursing education or experience whatsoever. These programs have been around for decades now; I continue to be amazed at how many people are unaware of that fact and someone, in these "NP vs. PA" discussions, always mentions that all NP students have years of nursing experience. That simply isn't true.

True. Though I don't know any direct entry NP schools that don't require at least a bare minimum of prerequisite courses for those with unrelated bachelors degrees (two semesters of A&P, microbiology, basic chemistry, growth and development), just like every PA program I know of.

elkpark · May 23, 2014

True. Though I don't know any direct entry NP schools that don't require at least a bare minimum of prerequisite courses for those with unrelated bachelors degrees (two semesters of A&P, microbiology, basic chemistry, growth and development), just like every PA program I know of.

The direct-entry program at the school I attended (as a traditional MSN student) has no requirements for prerequisites, although there is a statement about how some applicants might be "encouraged" to take some A&P or other life science courses prior to acceptance/admission.

dhart17 · May 23, 2014

Almost every single direct entry NP program requires the prerequisite courses. I only know of one, that being Yale, that does not. And undergrad students just fill their elective classes with the prerequisite classes if their degree is in a different field. That's what I did. A&P, Microbiology, Stats, developmental psychology, chemistry, nutrition and so on depending slightly on the school. I've also seen many masters level PA schools that have those same prerequisites along with organic chemistry and such and both require or expect some level of experience.

MurseJJ · May 23, 2014

You have no clue what it takes to get into PA school. Ignorance really is bliss. I have an honors degree in Microbiology from the University of Washington, 5 years experience as a CNA in acute care, long-term care, hospice/palliative care, I am ACLS certified, and have over 2,000 volunteer medical hours. I am currently in the PA program at the University of Washington and it is one of the hardest programs to get into. They require a minimum of 4,000 clinical hours, several hours of shadowing, 3 letters of recommendation, over 60 science credits, and an 8 hour long interview, YES 8 hours!

Yeah, Washington's PA program really is outstanding. If I applied to PA school, I would love to go there.

Just for clarity's sake, while not all PA schools have the same rigiorous requirements as Washington/MEDEX, it also isn't the case that they just take someone with a bachelor's degree like the other poster said. A friend of mine got into PA school with a BS in Biology, and years of experience as an EMT-B and ER PCA/tech. That school also required healthcare experience. Meanwhile, one of the PA schools in my area doesn't require any healthcare work/volunteering/shadowing (though I'm sure it's helpful). Another Ivy League program (Weill Cornell) didn't require a minimum number of hours of experience until the upcoming cycle, where 200 hours will be required. Science requirements also vary, from the likes of Washington, to only needing two semesters of biology, two semesters of chemistry, and microbiology, such as at Weill Cornell.

My point is just that, for both NP and PA programs, admissions requirements can vary, and PA schools definitely don't just take people that have a bachelor's degree as the other poster claimed, but also that the requirements for healthcare experience can vary, just like there are direct entry NP programs that may not require RN experience prior to beginning the NP portion of the program (though this is typically for the FNP track. I've seen generally that those going into the Acute Care NP program must leave after RN licensure for at least a year of RN experience, then can return for the MSN portion. Not sure if this is universal, but I've seen this many times).

Dranger · Jun 4, 2014

True. Though I don't know any direct entry NP schools that don't require at least a bare minimum of prerequisite courses for those with unrelated bachelors degrees (two semesters of A&P, microbiology, basic chemistry, growth and development), just like every PA program I know of.

I research around 150 of the PA programs and the vast majority require:

A/P 1 and 2

Gen Bio 1 and 2 (About 50-60% of programs)

Gen Chem 1 and 2 (not the kind I took for my BSN)

O chem 1 or 1 and 2

Biochem (A lot require this class which uses O chem 1 and 2 as pre reqs)

Physics (handful of programs)

Upper division Microbiology (non-nursing verision)

Psych with abnormal/developmental

Genetics (A surprising amount of schools require this)

Medical Terminology

Upper division biology courses (About 10-15 schools require this)

Just with my BSN pre req classes I qualified to apply to 2 or 3 schools at the most with the other couple hundred requiring anywhere from 2-7 more classes to qualify for admission. Many of these programs had more requirements than MEDICAL SCHOOl. Frankly I was shocked at the amount for pre classes needed so here I am back in college knocking them out....

futureeastcoastNP · Jun 4, 2014

PA school requires a lot more pre-reqs than NP school. Yes, someone can go with a history degree...but someone can also go to medical school with a history degree. It doesn't mean they didn't take the required science prereqs to get in, and in June case of PA school they are A LOT more rigorous than for NP school, usually requiring organic chemistry, biochemistry, etc.

Furthermore, the PA curriculum is a lot more standardized, and they have no online, for profit colleges with 99% acceptance rates. You know that your PA colleagues have worked very hard to be where they are and are likely intelligent....the same cannot be said of NPs since your colleague could have gone to a for profit with absolutely NO admissions standards.

Once in school, the PA curriculum is not only more standardized, but also more science heavy. There is a lot less fluff in PA school, and almost every program has gross anatomy, surgery, histology, pathology, etc. All classes that most NP programs skip so they can take bogus filler courses, such as nursing theory.

Finally, all PA programs have predetermined rotations led by faculty of the school in specific hospitals. The school is in ohm molten control of what the student learns during clinical and ensures they learn what they need. Contrast this to NP school - most programs don't even set up your clinicals! They let the student do it themselves and have no idea whether or not the student is learning.

Overall, due to the current rampant greed of both the nursing boards and some colleges, the NP profession has some major, major issues, that are amplifying each year as more and more students give up on trying to get into the real schools and sign up for a for profit online school. The PA curriculum is much more standardized, science heavy, and overall just a lot better than the NP curriculum right now.

MurseJJ · Jun 4, 2014

For me, because I am interested in/love nursing as a profession and body (yes, having worked as a PCA and ER tech for years, I am aware that nursing is not all roses and happiness, nor is any other profession for that matter), I decided not to choose the PA route (though I very strongly considered it for some time). I do find the PA curriculum very attractive, since I love science, and most, if not all PA programs have very little "fluff". I particularly like that PA programs generally have a gross anatomy course, since I'm wondering if undergraduate anatomy is enough (yes, I received As in both A&P I and II). Who knows, maybe after I'm done with the BSN (I start this Fall) I'll just do PA, though at this point, I'm just focused on nursing.

However, there is nothing stopping anyone from supplementing their BSN and/or NP curriculum with electives in the sciences. For me personally, I have already taken Bio I and II, A&P I and II, Gen Chem I and II, Organic I, Analytical Chem, Microbio, and Nutrition (As in all of them, fortunately). I'm planning on taking Immunology, Genetics, and maybe Virology as electives during the program. That of course is in addition to the pharmacology, pathophysiology, and health assessment courses taken in addition to the nursing courses. Yes, there are some "fluff" courses involved as well (I have to take a "transcultural nursing" course, though luckily my school has a section that is online, so I don't have to sit in class for two hours suffering).

As far as NP, what I've realized is that there are many quality NP programs, for all the talk about for profit schools and students having to find their one clinical rotations. If you don't want to do that, you don't have to (and hopefully more people not going to such schools would show that such things aren't acceptable). Online programs also aren't necessarily bad (and it always must be said that online NP programs require clinical rotations offline, since it seems as if those disparaging NP programs conveniently forget this detail). My nurse manager recently graduated from a reputable online NP program (completing rotations at a major urban medical center and affiliated clinics), and is now a NP in a pulmonary hypertension practice, with both inpatient and outpatient responsibilities, including in the cath lab with his collaborating physician. You can definitely attend an NP program that sets up clinical rotations; there are plenty out there. Further, these reputable programs always include advanced physiology, advanced pathophysiology, advanced physical assessment, clinically-focused didactic coursework (usually hidden with titles like "Family NP I" or "Acute Care NP IV". read the course descriptions), and other courses depending on the specialty (such as developmental and neonatal physiology). It also seems as if many NP programs are now including coursework in genetics and genomics. My point only is that you don't have to go to fluff-filled programs, or set up your own clinical rotations if you don't want to. I'm sure there are many that would want the option of setting up their own rotations, but you don't have to.

Anyway, just my opinion, but I think that you have the power to take your nursing education in the direction you want it to go. I don't want a school with a lot of fluff, so I won't go to one that has it. I don't want to have to look for my own rotations, so I won't go to a school where I have to do that. Yes, there seem to be issues in NP education, and hopefully those that see issues are/will be taking steps to correct those issues, at least in some small way (who knows, maybe when I'm actually in NP school I'll see things differently), instead of the constant moaning about nursing and NP education (and exaggerations about certain things like the amount of theory and most schools not knowing whether students are learning in clinical) that I see over and over.

My two cents.

elliebelle01 · Jul 12, 2014

I am 2/3 of the way through the FNP program at Grand Canyon University. It is a rigorous program and I feel that I will be well prepared to practice. GCU does assist or find clinical placements for students. I have chosen to find my own preceptors. Friends who have completed the program have assisted me in finding great placements. I have learned an incredible amount and look forward to every clinical day. I also know that most of my learning will come on the job, as it did with nursing. You just can't possibly see it all in clinicals, but I feel that I am getting a comprehensive, well-rounded experience.

There seems to be a feeling on these posts that NP programs take every applicant. I really don't know how true that is. But I do know that by the time a BSN prepared nurse applies for a NP program he or she has finished 2 years of pre-reqs, has a 4 year nursing degree, has passed state boards, and has valuable nursing experience. The RN who decides to go on for further training has already paid a lot of dues and knows what it takes to be successful. That is perhaps why the acceptance rate is higher than for PAs. The PA vs NP discussion seems to have evolved into a competition on this website. But as some have stated, the careers are quite similar. The deciding factor for me is that I eventually want to be in a NP-run clinic. I like knowing that I have the option of practicing with a group of NPs without physician oversight. My friend went the PA route because she doesn't want the ultimate responsibility. It's a matter of personality and preference.

nandosport · Jul 12, 2014

If your friend went to PA school because she doesn't want ultimate responsbility, she's in for an awakening. A PA I shadowed in neurology runs the clinic when his supervising physician decides to take a ~2 month vacation in the summertime with the family.

elliebelle01 · Jul 12, 2014

Wow. I didn't know that was allowed. I am in a family practice for clinicals. There are 3 docs, 1 NP, and 4 PAs. Last week all the docs were going to be on vacation the same week and there was one day when there would be no physician in the office. The docs had to reschedule so that someone would be in the office every day. The office manager told me that it would not affect the NP's schedule, but that the PAs were not allowed to practice without a physician present on the premises. I live in AZ. Perhaps it is different in other states?

core0 · Jul 13, 2014

Wow. I didn't know that was allowed. I am in a family practice for clinicals. There are 3 docs, 1 NP, and 4 PAs. Last week all the docs were going to be on vacation the same week and there was one day when there would be no physician in the office. The docs had to reschedule so that someone would be in the office every day. The office manager told me that it would not affect the NP's schedule, but that the PAs were not allowed to practice without a physician present on the premises. I live in AZ. Perhaps it is different in other states?

Really this would imply that you are wrong:

Supervision must be continuous but does not require the personal presence of the physician at the place where health care tasks are performed if the physician assistant is in contact with the supervising physician by telecommunication.

Technically the physician doesn't even have to be in the country (not a good idea though). A practice manager is probably not the best source of information. There are very few states that require personal presence of the physician.

elliebelle01 · Jul 13, 2014

I checked and you are correct. I asked with the office mgr (at this practice for 18 years) and she said that it is the preference of the physician that owns the practice to always have a doc on site.

Further research confirmed that NPs have autonomy that PAs do not. This is neither bad nor good, just something to take into consideration when deciding which route to pursue. Regarding supervision of PAs, the supervising physician will choose one or more of the following mechanisms to provide supervision:

The physician sees the patients the same day that they are treated by the PA.
The physician reviews, signs and dates the medical record of every patient treated by the physician assistant within thirty days of the treatment.
The physician adopts written protocols which specifically guide the actions of the PA. The physician must select, review, sign and date at least 5% of the medical records of patients treated by the physician assistant according to those protocols within 30 days.
Or, in special circumstances, the physician provides supervision through another mechanism approved in advance by the Board.