[Sflowerssweeney]

In Maryland you have to have a Bachelors Degree and then you can apply to a PA school. It is a 2 year program and is not done in conjunction with your previous Bachelors degree, it is a separate program.

[PACPhD]

I work in a level 1 trauma center. I primarily work in ambulatory but also do some shifts in critical care, ob/gyn, medical, etc pods. I am not required to run anything by my SP. I tend to get some really sick people in ambulatory (bad triage system) and do my own central lines, LP, arthrocentesis, etc. I don't have to talk to the physician for anything if I chose not to. Even on the critical side, there are no requirements to run anything by my SP or any of the docs. But I do when I have a complicated case. And the reason? Look at a medical lawsuit against a midlevel and one of the biggest thing they will hang you with is "so let me understand this, you are not a doctor, you had this patient presenting with (fill in the blank) and the patient ended up going home and dying the following week and you didn't feel the need to run the case by someone with more medical knowledge and experience!" Yes, I know all of the arguments of how there are lots of bad doctors out there but the bottom line is we (PA/NP) are not doctors, and the public's perception of this is just that. They don't care that for 10 years you have done well in your practice.

[Cyndee, MSN, NP]

Originally Posted by imisscoco

I am graduating from an adult NP program in June. There is not anyone in my progam who has not been practicing less than 3 years and most have been practicing 10 years or more. Everyone has a BSN as a requirement for admission. This is a traditional graduate program, not the GEP (graduate entry pathway) which does not require you to be an RN prior to entering the program. That is an entirely different program. We, in the traditional master's program have 540 hrs of clinical in adult primary care and for a subspecialty, such as geri, 180 hrs additional, for a total of 720 hrs. which is 24 hrs of clinical for 36 weeks. Why anyone would make a generalization that NP programs do not have stringest admission requirements as well as a hefty clinical component is beyond me.

Congratulations on your graduation. I went to a program similar to yours, I'm certified in both Adult and Geriatric health. I had worked as a BSN for 10 years before applying to graduate school. I was shocked to find that the majority of students in my program had never even worked as a nurse. They had bachelor's degrees in something else, then were rushed through a 1 year RN program and then went directly into the NP program. I'm strongly opposed to these programs. I noticed that the ANCC is now requiring neonatal NP's to have a minimum of 2 years experience as a neonatal nurse before even applying to a NNP program. The majority of NNP's at my school had never even worked as a nurse! I have a strong feeling that these "direct entry" programs are going to cease to exist.

Listen to this one...one of the instructors at our school, who had gone through the direct entry program and never worked as a nurse, was talking about giving an IM injection with an 18 gauge needle! Unbelievably STUPID! Also, the direct entry students were met with a lot of disrespect by RNs/LVNs when they started their clinical rotations.

[ML_FNP]

Depending upon which state you work- PA's practice under the physician's license & NP's practice under their own license. PAs may have either an Associate's or Masters in PA studies and may have an educational background preferably in health sciences, etc. NPs have a background in nursing. NPs (esp. Adult NPs who specialize in particular areas) do perform procedures (e.g. d/c'ing CT, suturing, casting, etc...)Most NPs primarily work in primary care. But I do know that PAs can work as a 1st or 2nd assist in surgery...if that interests you. NPs will not normally do that. If you have a background as an ED tech, it may just be a faster route to go through a PA program. But here is of course my biased opinion, if you want to be a primary care provider who integrates holistic approaches, cost effective treatments, and attains more autonomy-->go for the NP degree! Plus, the settings in which you can work (e.g. internal med, family practice, community health, visiting nurse services, hospice, LTC, hospitals) is much more broad. But then again if you are in a rural area, there are perks to working as a PA. I hope this helps. Good luck!

[FNP/DNP]

Originally Posted by PACPhD

I work in a level 1 trauma center. I primarily work in ambulatory but also do some shifts in critical care, ob/gyn, medical, etc pods. I am not required to run anything by my SP. I tend to get some really sick people in ambulatory (bad triage system) and do my own central lines, LP, arthrocentesis, etc. I don't have to talk to the physician for anything if I chose not to. Even on the critical side, there are no requirements to run anything by my SP or any of the docs. But I do when I have a complicated case. And the reason? Look at a medical lawsuit against a midlevel and one of the biggest thing they will hang you with is "so let me understand this, you are not a doctor, you had this patient presenting with (fill in the blank) and the patient ended up going home and dying the following week and you didn't feel the need to run the case by someone with more medical knowledge and experience!" Yes, I know all of the arguments of how there are lots of bad doctors out there but the bottom line is we (PA/NP) are not doctors, and the public's perception of this is just that. They don't care that for 10 years you have done well in your practice.

I agree. We don't have very specific guidelines in my ED on what we need to involve the docs in, but I always try to for the same reasons that you mentioned. We are not physicians and it would not look good in a lawsuit that we were taking care of critical patients without involving our MD's.

[wellnessNP]

A Nurse Practitioner can own clinics and can practice independently. Big deal that many states make you have a collaborating physician. SO we gotta have protocols. Doctors have protocols also. I work with many PAs and they do have the advantage of generalist where as a NP is declared a specialist in a particular field. The PA is trained more in medicine which means protocols. THEY will never practice independent. In fact the role is pushed to keep the NP role at bay. I just gave a seminar in which several physicians attended and I am treated as an equal amoung them. Maybe it is the self defeatest attitude and we are no better attitude that holds the NP to the ground. There is nothing wrong with being proud of being a NP.

[kurlos]

Correct you are! Don't ever say it...but go ahead and think it, because it is so obviously true. If someone comes to your private practice and you give them a MEDical diagnosis, prescribed MEDicine, and then MEDicare reimbursres you for that service, you, by definition are practicing medicine, regardless if you asked them about their spirituality.
By like she adviced, don't ever say the truth out loud.

[augigi]

How advanced can nursing be?

Wow. How very patronising.

[ACNPCOLO]

1. NP’s can have private independent practices in some state, please refer to the pearsons report which is pub. every year. It contains the entire practice requirement, etc for each and every state. Here in Colorado, I personally know of 4 private practice owned and operated by Np’s. In our state we are required to have a collaborative agreement (see CO scope of practice doc) not and supervisory agreement. Which is completely different! As a result of the collaborative agreement, the Np functions completely independent in all aspect unless a consult deemed necessary by the NP. Both PA and NP’s can only bill 80% of the MD fee in most cases. Further I would like to say that the above mentioned private practices are not planned parenthood, or a women’s clinic, 3 are Fp and 1 is county sponsored first emergent contact clinic (talk about independence).

• NP do not make “nursing diagnosis”, we have to function under the allopathic modal just as PA, MD and DO’s. we do incorporate the holistic view point.
• there are PA schools which are certificate not just BS, MS. Both professions have moved away from this programs because Medicare require ALL mid-level providers to have MS and National Certs. Further ALL accredited NP program REQUIRE BSN most have a min. of 2 years in “critical care areas” do the math, 3744 hours of previous exp. + 600- 1000hrs in NP rotation + 600-1000hrs in RN rotation = approx 5744 hours.
• I’m a ACNP (Acute care) if you did not know thus stating that we ACNP spent our time in just fp, peds, ob/woman health. Apparently your not getting the correct info. We focus on systems, thus we had to do clinical rot in cards, neuro, neph, GI, internal, etc. unlike PA’s – NP come in may different “colors” FNP, ACNP, ANP, ENP, Onco-NP, CRNA, Midwife, etc. These are specialties, and yes some of us are in peds and women’s health.
• AS for being on the medical boards, we are not licensed under the board of medicine, why would we be on there board?

There is not clinical difference in functionality of PA and NP other then above mentioned. To assume one is superior to the other is false. I would like to make a final statement as the MD preference. As mentioned above, NP have independent license, thus we can function without direct supervision (collaborator) in 21ish states. This means that unlike PA’s, the MD is not required to be on premises. This further limits liability of the MD because unless consulted he/she had no involvement in the pt. WE ARE INDEPENDENTLY LICENSED sole responsible in most cases.

[txspadequeen921]

On the same note Ill add here that the University of North Texas Health and Science Center in Ft Worth has a well respected PA program, However a student only needs 90 hours of course work for admission and most of those are the same as your nursing pre-classes. So no you do not need a bachelor degree (you may in some state) and you definitly do not have to have any prior certs or degrees. I am not a PA or NP but I have checked into this and know people that have done it...