NP Changes that need to happen...

WRNCEN · Oct 17, 2012

It's not the coursework being online that bothers me, it's programs literally not caring who trains their students. Seriously, how can that possibly be acceptable? When it comes to level of clinical experience, I think that's a serious gray area (research doesn't support that RN experience contributes to NP practice, oddly enough). There are some NPs with minimal RN experience who are fabulous, and those with decades of experience who struggle.

Agree, not caring who trains the students is not acceptable, my program has strict guidelines for who and where we complete clinicals. Sadly research may not support RN experience as a new NP; granted it's a whole new scope of practice with no experience as a practitioner, but the experience gained as an RN aides in critical thinking skills, adequate decision making, real world clinical application, and use of evidence based practice.

Just a thought

nursetim, NP · Oct 18, 2012

I agree with a paid residency. We also need to ditch a few doctorates. A national license that is accepted everywhere, just pay a prescriptive fee and your are good to go. Being able to pick your clinical exposure. As in Derm, Ortho, gastro, internal med, hospitalist, primary care, ent, emergency med, you get the idea. 3000-4000 hrs clinical. Without, but I've got a family. So, maybe this isn't for you. Good luck seeing any of the changes. Oh yeah, how about " medical provider" as a general term?

Sabotai · Oct 18, 2012

Also I do think PA's are just that physicians assistans. NP's are designed to be providers, stand alone providers, that bridge the gap that is missing in primary care. I don't understand why a PA that has 2000 clinical hours in school, compares to my 9000+ working for only 4 years and my 1200 in just my masters. . That is 10,200(That number doesn't include my hours when getting my BSN) of patient interaction, learning what is done to take care of them, listening to medications being given, administering meds, and helping them do EVERYTHING they need to do. I have no problem with PA's, but to me those two roles are in no way interchangeable.

treejay · Oct 18, 2012

Also I do think PA's are just that physicians assistans. NP's are designed to be providers, stand alone providers, that bridge the gap that is missing in primary care. I don't understand why a PA that has 2000 clinical hours in school, compares to my 9000+ working for only 4 years and my 1200 in just my masters. . That is 10,200(That number doesn't include my hours when getting my BSN) of patient interaction, learning what is done to take care of them, listening to medications being given, administering meds, and helping them do EVERYTHING they need to do. I have no problem with PA's, but to me those two roles are in no way interchangeable.

I'm sorry friend but you appear to be quite misinformed. A bit surprising too considering you have the healthcare experience you speak of.

1) Very important to compare apples to apples, not apples to oranges. One can get a PA or NP degree with 0 hours of health care experience prior to entering school. Traditionally, in both professions, that is not the case. However, both professions have changed. Traditionally, for NP, one worked as a nurse for some time, then went on to get their NP to practice. Traditionally, for the PA, one worked in fields such as nursing, paradmedic, EMT, respiratory therapist, etc, then went on to get the PA to practice. It originally evolved out of returnings medics in the military with a high skill set but no way to enter the workforce as a civilian utilizing those skills. Of course this is still true for both professions, but less so, and becoming even more and more less so. Take my primary care provider for example, a PA-C. He was a respiratory therapist for 15-20 years, then went back to become a provider. Traditionally, PA schools required a certain number of healthcare experience (HCE) to be considered for admission. Most PA schools still do, although the amount seems to have decreased. UW for example requires 4000 (their average student has 8500ish). The same is true for NP schools. You can now apply to a "direct entry NP program" with no experience as a nurse or in healthcare. Here is a list of some of these schools:

http://www.aacn.nche.edu/research-data/GENMAS.pdf

So in comparing apples to apples, you would have to compare your 9000+ hours of HCE to a student who has chosen the PA profession with equal to what you have. There are tons of PA students with tons of experience. Additionally, if you are looking at a PA student with no HCE, you would have to look at the same type of NP student, whom are accepted in programs like in the list I posted above. I was one of those students. I has probably about 1500 hours of HCE. I got accepted to both quality PA schools and direct entry NP schools. Both would have taken me about 2.5 years to complete. After very tough deliberation, I chose the PA path because it was best for me.

2) Indeed, the "physician assistant" title that our profession has is misleading, no doubt. Reality is, the majority of PAs don't assist physicians at all. They practice medicine, autonomously, but are affiliated with a physician "supervisor". One notable exception might be in surgery, where a PA much more resembles an assistant in the OR itself. I, and many others, believe in a profession name change to "physician associate". It much more accurately reflects what we actually do, and hopefully eliminate confusion from folks like yourself.

3) Finally, and where you were way off the mark, was to say that the "two roles are in no way interchangeable." On the contrary, MANY if not most job listings are looking for a "PA or an NP". How could this be if the roles aren't interchangeable? It can't.

At the end of the day, PAs and NP fill a very similar role in healthcare, with significantly different paths to getting there. NPs, to my envy, have a vastly stronger advocacy and lobby, getting more recognition and legislation in your favour. But I don't believe this comes whatsoever from a better ability or skill set. It believe it has predominately to do with political factors, and also how the profession was set up. Anyone else care to chime in ?

Sabotai · Oct 18, 2012

The limitation to the NP profession being based in the hands on care of nursing, not being a phlebotomist, pt aide, ma, etc... These are things that I find give you pretty much no experience in patient care. If you do go into a PA program that doesn't require experience then you could literally have 0 patient interaction. If you are an RN becoming an NP you will have 600-1000 clinical hours from your BSN alone. I honestly feel like there should be work related requirements before NP school, but this whole thread was intended to look at the necessary regulatory changes needed for NPs. I do assume there are PA's out there that have a GREAT deal of experience, but from its inception PA's are to work under the supervision of an MD or DO. At this point in time, unless their title is changed and the role is revised that is what they are. NP's need to continue to work to establish their full autonomy in all states, which we have in many already, and do our best to establish the NP as the primary care provider in healthcare. The points I made in my earlier posts all lead to that goal with the added residency model instead of preceptors and the regulation of the curriculum.

WRNCEN · Oct 18, 2012

I'm sorry friend but you appear to be quite misinformed. A bit surprising too considering you have the healthcare experience you speak of.
1) Very important to compare apples to apples, not apples to oranges. One can get a PA or NP degree with 0 hours of health care experience prior to entering school. Traditionally, in both professions, that is not the case. However, both professions have changed. Traditionally, for NP, one worked as a nurse for some time, then went on to get their NP to practice. Traditionally, for the PA, one worked in fields such as nursing, paradmedic, EMT, respiratory therapist, etc, then went on to get the PA to practice. It originally evolved out of returnings medics in the military with a high skill set but no way to enter the workforce as a civilian utilizing those skills. Of course this is still true for both professions, but less so, and becoming even more and more less so. Take my primary care provider for example, a PA-C. He was a respiratory therapist for 15-20 years, then went back to become a provider. Traditionally, PA schools required a certain number of healthcare experience (HCE) to be considered for admission. Most PA schools still do, although the amount seems to have decreased. UW for example requires 4000 (their average student has 8500ish). The same is true for NP schools. You can now apply to a "direct entry NP program" with no experience as a nurse or in healthcare. Here is a list of some of these schools:
http://www.aacn.nche.edu/research-data/GENMAS.pdf
So in comparing apples to apples, you would have to compare your 9000+ hours of HCE to a student who has chosen the PA profession with equal to what you have. There are tons of PA students with tons of experience. Additionally, if you are looking at a PA student with no HCE, you would have to look at the same type of NP student, whom are accepted in programs like in the list I posted above. I was one of those students. I has probably about 1500 hours of HCE. I got accepted to both quality PA schools and direct entry NP schools. Both would have taken me about 2.5 years to complete. After very tough deliberation, I chose the PA path because it was best for me.
2) Indeed, the "physician assistant" title that our profession has is misleading, no doubt. Reality is, the majority of PAs don't assist physicians at all. They practice medicine, autonomously, but are affiliated with a physician "supervisor". One notable exception might be in surgery, where a PA much more resembles an assistant in the OR itself. I, and many others, believe in a profession name change to "physician associate". It much more accurately reflects what we actually do, and hopefully eliminate confusion from folks like yourself.
3) Finally, and where you were way off the mark, was to say that the "two roles are in no way interchangeable." On the contrary, MANY if not most job listings are looking for a "PA or an NP". How could this be if the roles aren't interchangeable? It can't.
At the end of the day, PAs and NP fill a very similar role in healthcare, with significantly different paths to getting there. NPs, to my envy, have a vastly stronger advocacy and lobby, getting more recognition and legislation in your favour. But I don't believe this comes whatsoever from a better ability or skill set. It believe it has predominately to do with political factors, and also how the profession was set up. Anyone else care to chime in ?

Well said. I think that NP has more advocacy due to the vast numbers of support. There are a multitude of organizations supporting the practice and advancement. Not only is there support from the NP community" but possibly the nursing profession as a whole, which I assume is much larger than PA, just a thought. No matter what between the two roles we are a healthcare providers seeking to improve health and disparities among the population.

WRNCEN · Oct 18, 2012

The limitation to the NP profession being based in the hands on care of nursing, not being a phlebotomist, pt aide, ma, etc... These are things that I find give you pretty much no experience in patient care. If you do go into a PA program that doesn't require experience then you could literally have 0 patient interaction. If you are an RN becoming an NP you will have 600-1000 clinical hours from your BSN alone. I honestly feel like there should be work related requirements before NP school, but this whole thread was intended to look at the necessary regulatory changes needed for NPs. I do assume there are PA's out there that have a GREAT deal of experience, but from its inception PA's are to work under the supervision of an MD or DO. At this point in time, unless their title is changed and the role is revised that is what they are. NP's need to continue to work to establish their full autonomy in all states, which we have in many already, and do our best to establish the NP as the primary care provider in healthcare. The points I made in my earlier posts all lead to that goal with the added residency model instead of preceptors and the regulation of the curriculum.

Quite honestly, to the roles of nursing assistant, RT, and a phlebotomist not being a pt care experience, you are very mistaken. My greatest understanding of lab diagnostics with disease process came from being a plebe, basics for physical care and hemodynamic values being a CNA, I am not an RT or have I ever, but they are my lifeline for anything airway. Anyone completing these roles can utilize this experience as a building block for advanced practice.

morganvibes · Nov 22, 2012

I agree that NPs need a residency Program. Why do we have to hear all these horror stories of first NP jobs over and over, it is ridiculous and unprofessional and sadly the norm.There is usually no actual training for jobs, even when they say so in an ad. The training in my experience has been on the computer or for 3 days following someone before you are on your own. i feel that it is truly a disservice to patients, and soon will be the blind leading the blind. I can fly by the seat of my pants but wouldnt it be better to learn from someone's experience instead? I have been out of school for 3 years and so disappointed that I havent been able to find a position with a mentor type provider. Actually I had one for 6 months with a great Doc that was wonderful but unfortunately it was a contract job.It would be so nice to at least have the opportunity to apply for a residency in Family practice or Derm or Gastro, womens health, or whatever you wanted, so you could get real "On the job" training, there is really no substitute for it. I found a few but then they had a requirement that you had to be less than 1 year out of NP school, yikes.Also yes, all the levels of nursing makes it hard and Ive been amazed at how ignorant people are about NPs.I had a medical assistant the other day tell me that I should keep going and become a PA. Huh? Funny world.

Heart2015FNP · Nov 22, 2012

With the merging of AANP and ACNP, I look forward to the changes of how the unified organization will continue to regulate the NP profession. Obviously, NP's don't get the respect they deserves because of the loop holes created, in regards to education and experience.

IcySageNurse · Nov 30, 2012

I'm interested in psych, and for that I think the psych np programs are definitely the best answer - psychiatrists are overstrained IMO for their role in most cases, while counselors/MSWs are great but can't diagnose or prescribe...so psych NPs are perfect for mental healthcare, combining medicine and counseling..For anything else, I would do MD or PA. The nurse practitioner model is total crap. There are NO standards, no required courses, no residency, etc. it's terrifying that there are people who, with no nursing experience, go to a two year program with a pathetic 600 hours of patient care, and can now prescribe and treat patients. The main changes we need are: 1. National standards on length and required courses for NP programs (I think 2.5-3 years or so). 2. Standardized exams throughout the program that students must pass to continue (similar to MD usmle). 3. 1 year residency programs that are done as part of the degree. We can't have separate residency programs because the government pays for MD residency and hospitals couldn't afford it, it would have to be a full time year that the college pays the student a small stipend for completing. 4. Make the DNP more practice classes, not research based.

SycamoreGuy · Dec 1, 2012

"We can't have separate residency programs because the government pays for MD residency and hospitals couldn't afford it"

I'm not sure I follow you here. NPs and PAs are pretty much treated like 3rd yr residents anyway, why would it hurt the hospital to pay and train a NP at $40,000 vs hiring an NP without a residency and paying them $60,000 to $80,000 straight out of school?

Tinabeanrn · Dec 1, 2012

Here's my two cents. I think the more training the merrier. You really cant get enough education :). A residency would be cool. I started my first job in September working with 5 docs and they kept referring to me as a Resident, lol. I sure feel like one in some respects. I think if we had residencies on top of our regular training that our title should change (to be be called a physician or anything but to something else). I love being a nurse, dont get me wrong. But patients dont understand and are confused when you say your a Nurse Practitoner. All they heard was the word "nurse". Some immediately want to know where the doctor is. And when you try to explain what a NP is to some of these patients they have no clue. And they always revert back to calling you their doctor anyway, even after you keep telling them you are an NP. I dont want to mislead someone and make them feel I am something that I am not. They even understand the term PA. But to them a Nurse is the medical assistant that brought them in the room. Not the person that is treating them. Its a catch twenty two...