Nursing Model vs Medical Model (again!)

[jjjoy]

I went back to read previous posts on this topic but I think there's always more to say.

One thought goes that the medical model is about diagnosing disease processes/injuries and to treat that disease/injury whereas the nursing model is about helping a patient deal both physically and emotionally with the illness process. Since both medicine and nursing currently take part in preventative health care, perhaps we should develop a whole other discipline for that, and, in fact, that may happen eventually....

Anyway, the NP role, by those definitions, IS medical in most cases. They may be more aware of the nursing needs of the patient (assistance with ADLs, preventing skin breakdown, psychosocial support, etc), but their main practice would be medical (diagnosing and prescribing treatment).

Just tossing thoughts around...

[jjjoy, LPN]

Its all about wanting it. The students you will be competing for the slots really want it.

My point was just that for most RN-BSNs, they will need more than just 2-3 courses to be eligible for most PA programs.

I'm curious if you think that the science requirements for PA programs are NECESSARY, if they mostly function as WEEDER courses, or whatever other opinion you might have.

Since medical programs have tended to have these pre-reqs and nursing programs generally haven't had as high level chem/math/etc requirements, I wonder at how or if that reflects in NP vs PA practice in similar roles.

[caldje]

for the poster that asked about students required to find their own rotation sites.. this has been addressed in the new arc-pa standards. The programs are now required to PROVIDE the sites. Following are the ARC-PA standards.

B7 Supervised Clinical Practice

B7.01 The program must provide medical and surgical clinical practice experiences that enable

students to meet program expectations and acquire the competencies needed for clinical

PA practice.

B7.02 The program must assure that all sites used for students during supervised clinical

practice meet the program's prescribed expectations for student learning and

performance evaluation measures, regardless of location.

B7.03 Supervised clinical practice experience should be provided in the following settings:

a) outpatient.

b) emergency.

c) inpatient.

d) long-term care.

B7.04 The program must document that every student has supervised clinical practice

experiences in:

a) emergency medicine.

b) family medicine.

c) general internal medicine.

d) general surgical care, including operative experiences.

e) geriatrics.

f) pediatrics.

g) prenatal care and women’s health.

h) psychiatry and/or behavioral medicine.

[core0]

for the poster that asked about students required to find their own rotation sites.. this has been addressed in the new arc-pa standards. The programs are now required to PROVIDE the sites. Following are the ARC-PA standards.

snip

Unfortunately that is not completely true. This is from the administrative section:

A3.06 The program should not require that students supply their own clinical sites or preceptors for program-required clinical rotations.

There is a difference between must not and should not. My understanding is that this was put into place to give warning to schools that require students to find preceptors and that in the next 2-3 years it will be changed to must not. On the other hand if the student does not have a preceptor the school must find one. So if you show up at UND with a preceptor and they back out the school is obligated to find you one or they will be out of compliance with ARC-PA standards. So the school can make the students find preceptors but the onus is on the program to make sure these site are appropriate and provide the learning experience. Also the school is on the hook to provide the site if it doesn't work out.

David Carpenter, PA-C

[beckinben, CNM]

My point was just that for most RN-BSNs, they will need more than just 2-3 courses to be eligible for most PA programs.

I'm curious if you think that the science requirements for PA programs are NECESSARY, if they mostly function as WEEDER courses, or whatever other opinion you might have.

Since medical programs have tended to have these pre-reqs and nursing programs generally haven't had as high level chem/math/etc requirements, I wonder at how or if that reflects in NP vs PA practice in similar roles.

In terms of do you need the science prereqs for PA school, I can tell you my experience. I have 3 degrees, two summa cum laude. I'm usually considered a smart person. The basic science class - biochem/physiology - in my PA program KICKED MY BUTT. Hardest class I have ever taken. I passed, but I have never worked so hard in my life. The graduate curriculum for my MSN was a breeze in comparison.

So if you are thinking about PA school, take as much science as you can before. You'll need it. I don't regret for a moment going through a PA program, even though I ended up doing a CNM program and now practice only as a CNM. I have a much firmer grasp on the whys of what we do because of the basic science I got in the PA program than I would have doing just a MSN. (Except maybe for CRNA - that's a pretty intense curriculum too).

[PMFB-RN, RN]

You are going to need a bachelors to get into UND.

*** Ya, I know. It says so right on their web site. The same is true for CRNA school (which I am also considering), but not true for NP. I could go from ADN RN to MSN NP in 5 semesters, no BSN needed or received in several programs.

The issue will be timing. Most programs close their application process in September to November. Some will allow you to complete pre-reqs after but some won't. No matter what you are probably looking at a 2009 start date.

*** I am planning on starting in early summer 2008. If I were to go to another PA school I would have to wait until 2010.

If you did your pre-reqs then finished your BSN after you turned in your app you should be able to finish it.

*** I am well into my BSN and should graduate in December 2007. Doing pre reqs would add another 2 years of part time study. I can afford to study full time for two years, not a year of full time pre-reqs and then 2 years of PA school. If that's the case I will just put all my effort into CRNA school. No further pre-reqs required.

Also look outside the midwest for programs. Approximately 1/3 of the PA programs are in PA and NY. It is sometimes easier to get in there than some of the midwest programs.

*** I either have to go locally or do on-line. UND is the only program I found with significant portions online.

Marquet and UW LaCrosse can be incredibly competitive at times. You can use the CASPA system to apply:https://portal.caspaonline.org/

Although I don't see Marquet.

*** I know, in addition to being very competitive UW LaCrosse requires 26 units of pre-reqs I don't and won't have from my nursing program that would not be required for CRNA school or NP school.

http://www.uwlax.edu/pastudies/admissions/prerequisites.htm

Not saying that UND is necessarily bad,

*** But you did say that UND didn't have a good reputation. I didn't get that impression from any of the UND PAs I work with.

but you have to keep your eyes open. I will also say that given the volume of material that you get in PA school it would take a special student to do the didactic portion online.

*** I am a special student :)

It would also depend on whether you want to do specialty care. You will not have as much opportunity as in other programs. One of the PAs that posts on Physicianassistantforum.com had decided that he wanted to go into EM. He did almost 5 months of his 12 months of rotations in EM or related sites. This is the variability that you will have with a more traditional program that you will not have with UND (or Stanford).

*** I understand what you are saying. I also have to consider that I know several UND grads (that's how I first learned of the UND program) working in CV and neuro surgery as well as the critical care PA on my unit is a UND grad. I did my RN program at a tiny community college and we did all our clinicals at 25 bed rural community access hospitals that didn't even have ICUs and I had no problem going directly to work in a large hospital ICU. True I did pick a hospital with a good ICU training program.

I hate to see PA or any education further restricted. I wonder why they are choosing to further restrict PA school to people who would otherwise be able to go?

[PMFB-RN, RN]

My understanding is that this was put into place to give warning to schools that require students to find preceptors and that in the next 2-3 years it will be changed to must not.

*** Why? WHy do they want to reduce the number of opportunities available? Is the idea to restrict the number of grad to increase pay for existing PAs?

[jjjoy, LPN]

It's not to reduce to opportunities as I understand it. It's to keep students who for whatever reason haven't been able to come up with their own site from being stuck without any options. Presumably, students could still arrange their own sites as long as the sites met whatever requirements the school sets.

[core0]

It's not to reduce to opportunities as I understand it. It's to keep students who for whatever reason haven't been able to come up with their own site from being stuck without any options. Presumably, students could still arrange their own sites as long as the sites met whatever requirements the school sets.

Exactly. I believe there is a thread on this. Part of the educational mission is to provide sufficient resources to complete the educational process. You are still allowed to make your own arrangements but ARC-PA is making it very clear that you are not allowed to lower your standards to do this. This is really for the protection of the student. You have to complete all the appropriate rotations to graduate and get certified.

I had this happen on my last rotation when the practice that I was going to do my rotation in disintegrated one month before I was going to start. I was able to find another rotation but my school made it clear that they had multiple rotations for me. My program had 3 full time clinical coordinators to find new sites and check on students during their rotations. They visited me twice on away sites and most of the nearby sites.

Consider in the ND program if the practice decides they can't take you after you start the program. Now you are able to do the didactic portion but not the clinical portion and will not be able to graduate. The ARC-PA rule are meant to protect the student and preserve the educational environment.

David Carpenter, PA-C

[core0]

Snip

*** I understand what you are saying. I also have to consider that I know several UND grads (that's how I first learned of the UND program) working in CV and neuro surgery as well as the critical care PA on my unit is a UND grad. I did my RN program at a tiny community college and we did all our clinicals at 25 bed rural community access hospitals that didn't even have ICUs and I had no problem going directly to work in a large hospital ICU. True I did pick a hospital with a good ICU training program.

I hate to see PA or any education further restricted. I wonder why they are choosing to further restrict PA school to people who would otherwise be able to go?

Only you can tell what is best for you. The UND program is accredited and that will be good for five years unless something changes dramatically. If they have a good reputation locally then that is what matters. I can only think of one PA locally that was a grad there. She is a great PA but didn't think much of the program (small N for any reference). She make most of her comparisons on the students she precepts from the local programs.

Ultimately you are evaluated on your clinical competence and realistically once you get past the first year or so in practice no one will care what school you graduated from or what degree you have. Any relationships that you have developed with local physicians will probably be more important than what school you went to.

Good luck

David Carpenter, PA-C

[PMFB-RN, RN]

Only you can tell what is best for you. The UND program is accredited and that will be good for five years unless something changes dramatically. If they have a good reputation locally then that is what matters. I can only think of one PA locally that was a grad there. She is a great PA but didn't think much of the program (small N for any reference). She make most of her comparisons on the students she precepts from the local programs.

Ultimately you are evaluated on your clinical competence and realistically once you get past the first year or so in practice no one will care what school you graduated from or what degree you have. Any relationships that you have developed with local physicians will probably be more important than what school you went to.

Good luck

David Carpenter, PA-C

*** Dave thanks for your input, wisdom and opinions. I will consider what you have told me. I was really interested in the UND program as it is basically my only option for PA and I am most interested in being a PA over an NP or CRNA. I simply don't have the time, money or desire to do the 26 credits of hard sciences required for the other PA programs in my state, don't really have the option to relocate for school, I have a young family and pretty much need to support system I have here if I am going to be unemployed for a couple years of school. There are 5 CRNA programs fairly close to me and I could do NP online.

I don't know about PAs but in nursing nobody gives a darn what nursing school you went to if you have a license and you know what you are supposed to know.

[caldje]

I don't know about PAs but in nursing nobody gives a darn what nursing school you went to if you have a license and you know what you are supposed to know.

nobody cares.. well, there are some people who paid way too much money to go to duke because they think it matters.. but in the end, most people dont even KNOW what schools have PA programs. You'll be fine. You should really apply to the UND program, from what i understand they really like having nurses in their program, you're probably a shoe in from reading your posts. Good luck whatever you decide and just read a lot on your own. No school will spoon feed you.

[shadowapollo]

Greetings to all!

I am new to posting but not new to this site and love the conversations and different opinions, I am a FNP and would rather be governed by the BON rather than the BOM. NP's can start an independent practice where PA's cannot ( unless the laws have changed) I like the fact that in order to become a NP you have to be a nurse first and many NP's have years of nursing experience before even attempting graduate school. I think this is an asset- I have worked with PA's who have had a degree in ( for instance) Biology, no previous healthcare experience and on to PA school though I realize also that each school has different requirements. I am not suggesting that is wrong just a fact. NP's do not have to have onsite MD visits and I think in most states PA's do. Overall, I see more flexibility in the NP role, however, I want to be clear in that I work with both and healthcare is fortunate to have all of us. I don't ever get into turf isues over NP vs PA as we are all needed. At our medical school in ND, the PA program requires that the applicants are nurses- I find this very interesting, I believe because they want them to have that previous healthcare experience.

I do think PA's and NP's both receive excellent education, One other issue is that of your preceptor, that makes all the difference in the world as to how you will fair in grad school. I was fortunate as my preceptor was a walking medical school and a walking pharmacy also, just brillant so my student NP experience was awsome, some of my colleagues had preceptors that could have cared less if the student was there and they were not interested in teaching them much, in that light, that student will have a hard time. I think the preceptorship makes all the difference in the world regardless of what program one attended.