Don't Hate Me, All....

[TakeBack]

I have been following your discussions here on the recent media coverage of the primary gap, and NPs place in it. I posted this on another forum that I moderate, and felt it was only fair to give you all a chance to chime in. I hope it doesn't come across as an attack, but rather a clinician of a different stripe with some real questions about how we market ourselves. The text below is addressed to PAs, so read in that context:

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I have been reading the coverage of the recent articles from CNN and Time that we discuss here, in particular the responses on allnurses.

Of course I have to provide my PA disclaimer.....I work with NPs.....about a dozen of them at my institution. I have never had a negative experience with any of them, and have no need to write a "hit piece". We confer, they give medical feedback, I give surgical, etc....collegial and pleasant.

That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc.....

I really don't see this as NP bashing, but I see these comments as somewhat elitist....or at least "leading the argument". The NPs I work with practice the same medicine (!) as the rest of us, PAs, MDs, etc. Their preop cardiac workups look just like any other. And they're good. A clinic NP treating OM...are they really offering that much of an edge over a non-NP due to their nursing background? What does the nursing backgroud teach about listening, empathy, and thinking about interdependent body systems that our medical model education does not?

This all seems like a phoney selling point that is SO subjective that there is no way to argue it, putting NPs in a position which is easy to defend and impossible to refute.

Thoughts?

Do you feel like you treat your patients any less holistically b/c you were trained in the medical model?

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Thanks for your feedback here.......

[ANPFNPGNP]

Compare the PA and NP curricula yourself. PAs don't have a bunch of nurse activism, nursing theory, multiple statistics courses, etc. to take. The PA curricula provides better basic science training and more clinical hours. I said the PA program is modeled after the medical program and provides better medical training than the NP curricula does and if you assess the differences in training, it seems like a true statement to make. I probably shouldn't have used the word "any" though since I can't say I've looked at every single NP curricula (although I've looked at quite a few); I do apologize for that slip up.

Once again, your experience doesn't really matter since it's anecdotal. What you've experienced is different from what I've experienced but who's right, you or me? We can't base decisions on anecdotal experience. As I've asked repeatedly, design and conduct a proper study to show that your education is good enough to practice independently.

Show me a study that PROVES that PA patient outcomes are SUPERIOR to NP's! Show me a study that PROVES that PA education is SUPERIOR to NP's! PROVE IT!

[dgenthusiast]

What??? Why don't you go to "Pub-Med" and pull up all the studies that have appeared in JAMA that compare NP/physician patient outcomes. Are you saying that not ONE study out of all those studies are valid?

Sounds to me like someone wishes they had chosen the NP route!

No sir, not me! :) I prefer to get the highest level of education I can before being let loose on patients, ie. medical training.

If you look back a page or two, you'll see me discredit one of those JAMA articles. It was the perfect example of a poorly designed study.

I haven't come across any studies without significant flaws or poor design/heavy bias yet.

[dgenthusiast]

Show me a study that PROVES that PA patient outcomes are SUPERIOR to NP's! Show me a study that PROVES that PA education is SUPERIOR to NP's! PROVE IT!

I never said PA outcomes are better than NP outcomes. I have said that PA training is significantly closer to medical training than NP training is and that because of that similarity, PAs receive better medical training. Seriously, just compare the curricula of PA programs and NP programs. A significant portion of the NP/DNP program revolves around fluff courses such as nursing theory, nurse activism, "DNP Capstone" (huh?!), effective leadership, etc. None of these courses really have any value in a clinical setting. NP/DNP training also has a minimal amount of basic sciences and clinical hours; 3-6 credits of pathophys isn't really enough to gain a solid foundation and 600-1000 clinical hours is not adequate training for independent practice. PAs, on the other hand, have a much stronger basic science foundation (they take a lot of the same basic science courses as medical students) and they have more clinical training. Logically, it makes sense that the medical training PAs receive is better than what NPs/DNPs receive. Did that prove it enough?

[ANPFNPGNP]

I never said PA outcomes are better than NP outcomes. I have said that PA training is significantly closer to medical training than NP training is and that because of that similarity, PAs receive better medical training. Seriously, just compare the curricula of PA programs and NP programs. A significant portion of the NP/DNP program revolves around fluff courses such as nursing theory, nurse activism, "DNP Capstone" (huh?!), effective leadership, etc. None of these courses really have any value in a clinical setting. NP/DNP training also has a minimal amount of basic sciences and clinical hours; 3-6 credits of pathophys isn't really enough to gain a solid foundation and 600-1000 clinical hours is not adequate training for independent practice. PAs, on the other hand, have a much stronger basic science foundation (they take a lot of the same basic science courses as medical students) and they have more clinical training. Logically, it makes sense that the medical training PAs receive is better than what NPs/DNPs receive. Did that prove it enough?

NO, that did NOT prove anything! I want to see STUDIES!

[Dr. Tammy, FNP/GNP-C]

PAs will not be using the title "Doctor" in the clinical setting.

Really? Is that your final word?

[Dr. Tammy, FNP/GNP-C]

Look at previous posts of mine where I provided a detailed comparison of a BSN to DNP program with an MD program.

Great comparison as both are in two different disciplines and professions. Gee, you must be a research scientist too. Have you tried comparing florists to day care workers, too?

The DNP curricula is somewhat of a joke. It's not only me who thinks that but there have been many who've raised that concern, even on these forums

As a Duke DNP student, I wish this were true. I'd sure have a lot more time for family. Perhaps you and those who feel this way can get a Masters Degree in nursing, obtain grades consistent with getting into a cohort within a top DNP program in a top university in the US, and then give us all a first-hand description of how much of a joke it is.

[dgenthusiast]

Great comparison as both are in two different disciplines and professions. Gee, you must be a research scientist too. Have you tried comparing florists to day care workers, too?

As a Duke DNP student, I wish this were true. I'd sure have a lot more time for family. Perhaps you and those who feel this way can get a Masters Degree in nursing, obtain grades consistent with getting into a cohort within a top DNP program in a top university in the US, and then give us all a first-hand description of how much of a joke it is.

Hah, that's funny! First the NPs state that they do the same jobs as physicians and that their training is equivalent. Then, you go on to say that they're distinct professions and disciplines? Sounds pretty contradictory to say.

And what I have said about DNP curricula is true; it is somewhat of a joke. What's the point of having so many fluff courses that have not much value in a clinical setting? Do you really need to take 4-5 statistics courses? Why do you have so many research courses when the DNP is a clinical degree? Do you not think that a clinical degree should focus on clinical training rather than research methods? How does having half the curriculum be about nursing theory, nursing activism, "DNP Capstone," effective leadership, etc. have a valid place in a clinical degree? Why is there such a minimal amount of science courses? Why is there a minimal amount of clinical training? Does taking around 80 credits (to go from BSN to DNP) with approximately half devoted to completely non-clinical things constitute a doctoral degree?

[Dr. Tammy, FNP/GNP-C]

And what I have said about DNP curricula is true; it is somewhat of a joke.

So is it a joke, or somewhat of a joke? I suppose you really don't have any first hand experience with which to base your opinion. That's OK, though, as all are welcome at allnurses.com.

[Dr. Tammy, FNP/GNP-C]

I never said PA outcomes are better than NP outcomes. I have said that PA training is significantly closer to medical training than NP training is and that because of that similarity, PAs receive better medical training.

Perhaps you are having difficulty appreciating the fundamental differences between PA and NP training. PA's are trained as dependant medical practitioners who must, and can only practice, under the medical model-using physician. Whereas NP's practice independently (independent of the need for physician collaboration) in many states, PA's may not function independently in any state.

As NP's we are nurses first and foremost. Unlike the PA, we do not borrow another disciplines model--we use nursing to guide, direct and inform care. We are not trained to use the medical model--that is to say we provide care in a holistic manner, using the nursing process. As a dependent medical provider, I can understand how you cannot appreciate the nursing process, but fortunately our patients do appreciate the difference, which is why many of our patients wait three weeks for an appointment with an NP whereas they can get a same day appointment with a medical or medical-dependent provider.

As far as our training, the level of education speaks for itself. As an example, do you know of any junior colleges where Nurse Practitioners are prepared? Do let me know if you need a list of community colleges where PA's are prepared in their dependent role.

Please don't misinterpret this as a slam on PA's. I feel there is a place for all qualified dependent technical providers of care such as EKG techs, Pharmacy Techs, EMT's and yes, even PA's, so long as they have the proper physician-based and state-mandated supervision.

[AbeFrohman, BSN, RN]

Perhaps you are having difficulty appreciating the fundamental differences between PA and NP training. PA's are trained as dependant medical practitioners who must, and can only practice, under the medical model-using physician As you well know, dependence can mean hours away. NC only requires a chart review every 6 months. Whereas NP's practice independently (independent of the need for physician collaboration) in many states It's been a couple of months since I looked, but "many" comes to no more than 14, PA's may not function independently in any state.

As NP's we are nurses first and foremost. Unlike the PA, we do not borrow another disciplines model What? They aren't borrowing anything. Do LPNs borrow nursing. This statement is asinine.--we use nursing to guide, direct and inform care. We are not trained to use the medical model--that is to say we provide care in a holistic manner, using the nursing process. As a dependent medical provider, I can understand how you cannot appreciate the nursing process, but fortunately our patients do appreciate the difference, which is why many of our patients wait three weeks for an appointment with an NP whereas they can get a same day appointment with a medical or medical-dependent provider.

As far as our training, the level of education speaks for itself.Can you be anymore self gratuitous. As an example, do you know of any junior colleges where Nurse Practitioners are prepared? Do let me know if you need a list of community colleges where PA's are prepared in their dependent role.

Please don't misinterpret this as a slam on PA's. HOW COULD I NOT?!?!? I feel there is a place for all qualified dependent technical providers of care such as EKG techs, Pharmacy Techs, EMT's and yes, even PA's Thank you for gracing that profession for us. Did you even notice that you lumped them with techs?, so long as they have the proper physician-based and state-mandated supervision. I could say the same for NPs

Seriously? Take some advice from this nurse. It's gonna hurt when you fall off the tall ivory tower passing judgment on the all the little peasants below.

And those PA "junior" colleges are for typically for people with a MINIMUM (typically much higher) of 4000 hours in healthcare such as EMT, RN, RT, and have no need for a silly graduate or doctorate degree to make themselves feel important. Plus, I can count the AS schools on one hand.

Also, just because NPs can practice independently, doesn't mean they should. I'm a nurse and I know better when you speak of things like holistic care, etc, etc. You have nothing but anecdotal evidence to support your claims that you "treat the whole person" anymore than an MD or a PA. What if a nurse becomes a PA or MD? Do they all of the sudden become ravenous creatures, seeking only to treat the diabetes this week, htn the next, and not worry about their ability to pay? I'll have you know that my father, an MD, runs a clinic where many of the patients trade their services (cleaning fish, skinning deer, working on his car) for meds. Do YOU offer such a thing? All of the sudden you aren't the Saint of Healthcare. See how easy anecdotal evidence is to use against your opponents?

I'm a nurse, half way to my NP degree, working with 5 NPs, and I can tell you that there is diddly spit difference between the practices of a NP, PA, or MD.

I'm not against NPs in any way (well, at least the non-direct entry ones), but your post was blatant PA demeaning and filled with ridiculous self gratifying claims.

[sirI, MSN, APRN, NP]

We will all have to agree to disagree.

This has gone on and on and everything printable and beneficial has been said.