[core0]

Originally Posted by Hopefull2009

That is what I have been sitting here wondering while reading this thread...I had remembered reading somewhere about the difference in the scope of practice, but couldn't remember exactly where, but had never actually seen it in use, so I wasn't sure if that was the case or not.

The NP scope of practice varies tremendously by state. In Texas the BON (at least in their publication) enforces the scope fairly stringently. In Georgia on the other hand the state BON does not. In Colorado, FNPs could work in the hospital, but new grad FNPs were having a hard time getting credentialled. The original NP designation was based on an age range. Similarly of the next four NP designations, three (ANP, NNP and GNP) were also based on age. The FNP was meant to compliment the family practice physician (as far as I can tell). However, many found themselves working in inpatient and specialty settings. Now with increasing number of ACNPs there is competition over these positions and a fair amount of conflict.

David Carpenter, PA-C

[elkpark]

Originally Posted by Hopefull2009

I have to agree with Salesman 217 on this one.

I know that PA schools vs a Masters or Doctorate NP programs are set up differently, however, having had both treat me in a hospital/office on numerous occasions, I have yet to figure out what they do that is different.

Both walk in, both listen to the problem both write prescription, both work under the supervision of a physician. Both are billed under a physician....and they sure don't charge less than a physician.

Sounds pretty much the same to me.

I was not attempting to make any comment on similarities or differences between NPs and PAs -- I was questioning the other poster's sweeping statements about individuals' motivations for choosing one occupation or the other, as well as the assumption that PAs are males and NPs are females ...

[forrester]

Originally Posted by elkpark

Do you have any documentation or evidence to support your assertions, or is this just your own, personal theory? Have you actually read anything about the historical development of the NP and PA roles? On what do you base these sweeping generalizations?

Actually, I think the PA was a response to the more independent looking NP.
The NP's started in the late 1960's, beginning with the pediatric nurse practitioners in Colorado (I think). The PA's started during the 1970's, and the driving need was to do something for all the Medics and Corpsmen coming back from Nam.
The AMA saw the PA role as the intermediate role, but one they could directly control.
They were uncertain then how to deal with the more independent minded NP, and continue to this day to oppose legislation in virtually every state possible (in other words those states who choose NOT to listen to evidence and reason) to liberate the NP.

They don't mind taking the kickback though.

Maybe if we could convince the AMA that by providing MORE primary practice providers, we can entrain more people into the healthcare system, avoid the train wrecks, and refer more people to specialists for detailed care.
Every wins...especially the patients.

Maybe if we worked together, we could begin to address their major issues, malpractice rates and stupid lawsuits.

Wow, what a novel thought, work together...

[core0]

Originally Posted by forrester

Actually, I think the PA was a response to the more independent looking NP.
The NP's started in the late 1960's, beginning with the pediatric nurse practitioners in Colorado (I think). The PA's started during the 1970's, and the driving need was to do something for all the Medics and Corpsmen coming back from Nam.
The AMA saw the PA role as the intermediate role, but one they could directly control.
They were uncertain then how to deal with the more independent minded NP, and continue to this day to oppose legislation in virtually every state possible (in other words those states who choose NOT to listen to evidence and reason) to liberate the NP.

snip

Actually that would be incorrect. The PNP program at CU and the Duke PA program started in the same year. They both graduated their first students in 1967. Dr. Stead credited Dr. Silver with a prominent role in the establishment of the PA profession by showing that PNPs could be utilized in public practice where Dr. Stead had failed attempting the same type of program in the 1950's.

As far as the AMA, there was little AMA input until 1969 when they published "Guidelines for the development of new health occupations". They officially recognized PAs in 1970. You can find the timeline here:
http://www.pahx.org/period02.html

If you read the original paper by Silver and Ford its clear that the original purpose of the PNP program was to provide a collaborative environment for the NP to work in similar to the CHA/PA program later developed by Dr. Silver.

David Carpenter, PA-C

[forrester]

Originally Posted by core0

Actually that would be incorrect. The PNP program at CU and the Duke PA program started in the same year. They both graduated their first students in 1967. Dr. Stead credited Dr. Silver with a prominent role in the establishment of the PA profession by showing that PNPs could be utilized in public practice where Dr. Stead had failed attempting the same type of program in the 1950's.

As far as the AMA, there was little AMA input until 1969 when they published "Guidelines for the development of new health occupations". They officially recognized PAs in 1970. You can find the timeline here:
http://www.pahx.org/period02.html

If you read the original paper by Silver and Ford its clear that the original purpose of the PNP program was to provide a collaborative environment for the NP to work in similar to the CHA/PA program later developed by Dr. Silver.

David Carpenter, PA-C

Thanks, guess I'll have to read more on the PA. What is correct to note that the returning medics and corpsmen made up a significant percentage of the original PA's?

[core0]

Originally Posted by forrester

Thanks, guess I'll have to read more on the PA. What is correct to note that the returning medics and corpsmen made up a significant percentage of the original PA's?

All four of the original PA students were Navy corpsman, however within 3 years there were another 4-5 PA type programs and a significant diversity developed. The number of corpsman in the Duke program was pretty significant in the first 10 or so years. Buddy Treadwell who is widely regarded as the first unofficial PA did not have a military background.
http://www.paeaonline.org/perspective/10072.pdf

Interestingly Dr. Stead along with nursing educator Thelma Ingles developed what was probably the first CNS program. However NLN refused to accredit the program and it was dropped.

David Carpenter, PA-C

[markdanurse]

Man do I feel compelled to respond. Did anyone read this article??? They are talking about Dr. Nurse's becoming PCP's. They are talking about having pt's address them as "Doctors". They are talking about preparing nurses on a doctoral level to give them equal knowledge of their PCP counterparts! They are even having the Board of Medical Examiners help create a certification exam for DNP's to show equal knowledge of a PCP. They want the DNP to be able to admit, discharge, and manage pt care in a hospital setting. Basically, we are trying to make NP's and MD's have parity by creating a bogus nursing doctoral degree. That's right, I feel the DNP degree is bogus compared to an MD/DO degree.

Why is nursing having the Board of Medical Examiners help create an examination for NP's? I thought supposedly advanced practice nursing and medicine were "different" from each other... you know, separate disciplines? Apparently not.

Why does the article show a DNP prepared NP doing everything a PCP does and yet in another breath state nursing is not trying to usurp the physician? I tell you what, if you have the DNP prepared RN do a 3 year family residency program after the DNP degree is granted and have them take the same certification exam as a family practice MD/DO, then I will say the NP is equal. Oh, and did I mention how many of these new DNP programs are online? How many MD/DO, DPT, PharmD, DPM, AudD, etc. programs do you see online? I wouldn't have a problem with it if the NP were still directly supervised by the MD/DO, but because the NP is independent, I have issues with an online program...

They say in the article that having these DNP prepared nurses will increase the amount of staff to train nurses. Really? Most universities have trouble recruiting doctorally prepared nursing faculty because they pay so low. Let me think... hmmm, $100K plus a year job v.s. $60,000 a year as a faculty university educator? Which one would I choose as a DNP educated nurse? Where is the empirical evidence that this will create more educators???

The MD/DO educational path is way more in depth and demanding than ANY DNP degree. Why does nursing feel that NP's need to be independent? What empirical evidence does the AACN have to show that a DNP is needed in order to become an effective NP, CNM, CRNA, CNS, etc? Aren't we all about evidence based practice? Where is all the evidence?

Think about this. This is about EGO. This is about more money for the universities. This is about nurses needing to feel equal with physicians. There is no evidence that this DNP degree is what the profession needs right now. We have the mentality of "Well, all the other healthcare professions are doing it, so why shouldn't we?"

Answer: Nursing should embrace its uniqueness, use scientific reasoning when making huge decisions, and stop trying to be something it's not... medicine. We train nurses, not physicians.

[Super Nurse JoshuA]

I agree with the previous poster is this will not help generate more educators, and it could also pull valuable nurse educators away from undergraduate programs where they are badly needed.
I also question the merits of the DNP. It is often brought to attention that other professions have strengthened their degree requirements. I had a physical therapist complain to me during nursing school about the raising standards, as he did not see the degree inflation as being beneficial to him. If any changes need to be made to nursing education it's time to clear up the ADN,BSN, Diploma mess. As I was being prepared for licensure at the AD.N level I believed BSN were not in anyway better than the AD.N. I am currently pursuing my RN-BSN degree, and I still believe that having a BSN does not make an individual a better nurse, there is currently room for all preparations. The DNP would probably be beneficial to some individuals, but at this time I believe is not doing anything to the benefit of the entire nursing profession. The NLN and ANA have been wanting to make the BSN the entrance requirement for nursing for sometime, should they have not worked towards that first? I believe sometimes nursing educators and nursing professional organizations have abandoned the bedside RN in favor of the APN/DNP roles.