Quote from Justine_
Are you going to tell me that your wife knew as much about the neonatal field than did a NNP from the get-go? I said it was a handi-cap; not something that couldn't be overcome. At my hospital, we have PAs as well and they do an excellent job, but they didn't walk out of PA school like that. It's more rare to have a PA rather than an NNP simply because it's such a specialized field. <snip> It's a well-known fact that it's required to have at least two years of NICU experience, most of them require level 3 experience.
As I said, some of your statements have merit; I disagree with your terminology and conclusions, though. A Neonatal Nurse Practitioner has a background in the field, which is obviously an advantage, the primary of which is the familiarity with terminology and basic concepts. The knowledge of "neonatal nursing care" is good, but by no means essential, as advanced practice is more akin to medicine then nursing, if you will forgive the generalities. While an NNP may start out with an advantage because of their familiarity, within six months a PA and NNP are virtually indistinguishable, and later in their career as advanced concepts and understanding at deeper levels of pathophysiology become more understandable and important, the Physician Assistant (which usually has a stronger science background) may actually be at an advantage (as was admitted by a colleague of my wife's.) That is not to say the NNP is "handicapped" by the lower science requirements of their program, just that they may not have that advantage.
I do understand that all NNP programs require experience prior to admission. This is relevant to me for a different reason then you, but I will address your reasoning first. At two years, a NICU nurse is still relatively new to the field, particularly if not working at a major referral center. Two years at a level IIIa program, or even a smaller IIIb program, is a good familiarity, but depending on your facility, average daily census, and the acuity of your patients (some IIIbs are still sending away their most acute patients, even in the absence of a need for ECMO or other advanced procedures) it still may not be enough to give you much more then a passing familiarity with the terminology, and disabuse you of the "fear" of working with neonates (particularly the extremely small/extremely young.) If you were to work two years at UCLA, CHOP, Yale, Mayo, Texas Children's, I definitely agree you have an advantage. If your experience is not one of those facilities (or that "tier,") how much did those two years -really- help you? Yes, it helps. Even working a IIIa for two years is better then nothing, but within six months if you took the name badges off, would you notice a difference? Do you know of any orientation for new neonatal nurse practitioner that is less then six months?
Probably if she didn't have family or financial considerations. In the field of neonatal medicine, I'd recommend NNP over PA, however, because I would probably be scared ******** walking out of school knowing only this much about neonates versus a NNP. The learning curve is already steep; why make it worse for yourself?
Now to get to my point on the "two year experience" point you raised ... if you don't want to be a nurse, why drag it out? I would think, since you already should be getting your BSN (hence need at least four years of school) that it would be smarter to do a five-year PA program, graduate -once- and go on to advanced practice. Rather then four years of school, two years of nursing while you begin prerequisites for your nurse practitioner program, begin your NNP program, spend two years part time while working as a nurse, then .. what, eight years later you can -begin- your orientation period to become a midlevel in the NICU? You argue it's financially a better position, probably because you're able to work for four years of that process ... but a PA would have worked for three years of that, and at a much better pay rate then a new grad RN. Loans at the end would largely even out (both PA and NP programs are expensive) so from a family and financial perspective, as a PA you are making better money at an earlier age, can spend more time with your family because you're not at work all day and school all night ..
Oh, and the Physician Assistant that became a midlevel three years before you has already had -three years- of advanced practice before you even began your orientation. So how much does your advantage of nursing previously help in comparison? I'm not trying to be adversarial, because I feel that becoming an NNP is a smart move for some people--people who are interested in being nurses and later interested in doing something more. If you are a junior in high school and you're telling the world you want to be a midlevel, the -smart- move is to become a PA and go directly to your goal.
For a general PA, yeah I'd probably go with a PA rather a NP, but it does limit you in some ways. For example, you cannot work with Medicins Sans Frontieres (Doctors without Borders) if you are a PA.
I blame the French. Actually, I've spent a fair amount of time in various places of the world doing that type of medicine. I've worked with/around (though not for) MSF. They don't use PAs because they don't have PAs in France. They do have Nurses. They treat everyone who isn't a Physician like crap. I would never recommend working with them, unless you're French, smoke, and a doctor. Everyone else should look at medical support missions that appreciate them for what they bring to the table, because there are a lot of medical missions (most supported by a church) that are doing the same or better work with less snobbery. That is simply my opinion, based on my personal experience, on MSF.
RE: working as an NNP offers more opportunities. I think that is largely a false argument. The factionalization of the Nurse Practitioner world has actually -hurt opportunities- for NPs in the future. I know a girl who had to bust her ass for two years because even though she had worked in the NICU for years as midlevel, she was then told that "oh, I'm sorry, you're a PEDIATRIC nurse practitioner, you can't work here any longer until you get your NNP." I also know a few guys that were FNPs working in ERs that were forced out of their positions because they were FAMILY NPs rather then ACUTE CARE NPs (they actually retired after 20 years in the ER rather then undergo a transition course because it was so insulting.) Opportunities for an NNP exist ... well, solely in the NICU. Not so for a PA. So you are hurting yourself if you're not sure you want to work nights/weekends/on call for the rest of your life on the unit.
That's a larger conversation then I want to get into (the PA v. NP argument) and I don't think either is better then the other in practice. I believe that they are better for some people, but not in any sweeping statements. I do appreciate the conversation, and welcome it's continuation, even though I feel as if we've slightly threadjacked, the OP still may be interested and learn something. Take care.