What do ER's hire more: PA-C, FNP or ACNP ?

[treejay]

Hi all. I am at the pinnacle of a very important decision that needs to be made by this upcoming Friday. I am hoping folks on here can help. I have been accepted to a great PA program and a great direct entry NP Program (accepted to FNP but could switch to ACNP if desired).

Currently, I have a strong interest in emergency medicine. I have worked only a little bit as an EMT and an ER Tech. I love the excitement of not knowing what's coming next and thinking on your feet. The pay is great, and I am very attracted to the flexibility in hours/shifts. But to be sure, there might be other specialties I'm interested in, I'm not sure yet. Primary care is also inviting, as is a hospitalist position, and perhaps international work.

So, first, I need to decide between PA and NP. I know this forum is loaded with discussions on this topic and I've probably read most of them. But it's still not an easy choice. Comparing PA school to direct-entry NP school, the education (in terms on clinical hours and breadth of didactic content) is stronger in PA school. I would come out and be better equipped to work my first ER job (not to mention that there are a number of 12-18 month residencies available for PA's [maybe there are a few for NP's, haven't seen them though]) On the other hand, I relate with the more holistic model of nursing, and also find the possibilities of independence and international opportunities (not to mention possibly more management and academic possibilities) very enticing. However, the fact is the MSN portion of the direct entry only has 700 clinical hours vs 2000+ for the PA program. The NP Program is only 3 days a week and they want you to work as an RN simultaneously.

I also have a hunch that more ER jobs are for PA's but am also aware that many NP's work in ER's too. I plan on living in Washington, Oregon, or California. So does anybody know if ED's on the west coast prefer PA's or NP's?

Secondly, for those that hire NP's, is FNP or ACNP more desirable? Clearly ACNP is better geared towards to ER and acute care in general, I understand that FNP's are sometimes preferred because their scope of practice includes peds and adults.

Any thoughts on my decision or as to who is preferred in the ED setting (especially on the west coast) are much appreciated!

[FNPdude74]

It is totally state dependent, at this time. The NP organizations are pushing for big changes though. One of which is the scope of practice through the national certifying board instead of the states. All 50 states will have the same NP certifications and such.

Right now it is state dependent as well as hospital bylaw and credentialing dependent. In an independent state, the hospital would have to be totally stupid to not credential you as independent if state law allows. That is a huge decrease in liability. Being an employee has no bearing on independent practice.

Here in Alaska (same with Montana when I was there), I have full independent practice, to include admitting my own inpatients.

Hey I'm interested in that national certification. So right now it's state based?

[nomadcrna, DNP, CRNA, NP]

You take a national exam but the states control your practice

[reeya]

NP school is really a watered down version of medical education based on nursing practice. Those who're involved in curriculum development must be smoking high :smokin:or have delusion of grandiosity because they are the same ones fighting tooth and nail with MDs to be independent practitioners with Dr title. It would be fine if the academics were rigorous enough but their grandiosity is obvious because they are more interested in producing tomorrow's healthcare leaders than clinicians justifying fluff classes. I wish we had more clinical hours plus more rotations. Oh well I will just shut up.

[FNPdude74]

NP school is really a watered down version of medical education based on nursing practice. Those who're involved in curriculum development must be smoking high :smokin:or have delusion of grandiosity because they are the same ones fighting tooth and nail with MDs to be independent practitioners with Dr title. It would be fine if the academics were rigorous enough but their grandiosity is obvious because they are more interested in producing tomorrow's healthcare leaders than clinicians justifying fluff classes. I wish we had more clinical hours plus more rotations. Oh well I will just shut up.

I would rather hear from a person who actually went to NP school and then to med school instead from a person who never endured that to share a story of the experience. no, I'm not talking about RN to MD, but an NP to MD. That would be interesting. I'm not saying NP schools curriculum is comparable to the MD curriculum, I can't say anything about that because I really don't know unless someone who did this can tell me. We need stories from the person themselves!

[CCRNDiva, BSN, RN]

Does someone really have to attend both med. school and a NP program to tell that medical school is more in depth than graduate nursing school? Can anyone really argue that the programs are equivalent?

I'm not trying to downplay what nurses do or even what NPs do. I'm a RN and proud of it! I, myself, am applying to ACNP programs now but I do not try to fool myself into believing my education will be on par with a physician. I can't tell you how many posts I've read on this site from graduate NPs who were not taught how to read xrays or interpret labs. I can't tell you how many posts I've read from student NPs complaining about the depth of their clinical/practium component (or the lack thereof) only to get the response that they have the responsibility to teach themselves. Often, we, as nurses, were able to name our years of experience prior to applying to graduate school to bolster our stance but we can't even do that anymore. Several programs allow non-nurses to complete roughly 3 yrs of school to become a NP without ever gaining nursing experience.

I love what I do and I'm looking forward to advancing in practice but sometimes I think we are running the risk of looking foolish and alienating ourselves from physicians in the quest to be independent. We need physicians and physicians need us. Only when we, as professionals, and I mean physicians included, learn to respect each other as valued, collaborative members of the healthcare team, will we be truly able to solve the present health care problems in our country.

[nomadcrna, DNP, CRNA, NP]

Attend a GOOD NP program then talk about what kind of depth they may have or not have. Btw I've seen physicians who cantread an xray. You have a wide varibility in both programs.

Does someone really have to attend both med. school and a NP program to tell that medical school is more in depth than graduate nursing school? Can anyone really argue that the programs are equivalent?

I'm not trying to downplay what nurses do or even what NPs do. I'm a RN and proud of it! I, myself, am applying to ACNP programs now but I do not try to fool myself into believing my education will be on par with a physician. I can't tell you how many posts I've read on this site from graduate NPs who were not taught how to read xrays or interpret labs. I can't tell you how many posts I've read from student NPs complaining about the depth of their clinical/practium component (or the lack thereof) only to get the response that they have the responsibility to teach themselves. Often, we, as nurses, were able to name our years of experience prior to applying to graduate school to bolster our stance but we can't even do that anymore. Several programs allow non-nurses to complete roughly 3 yrs of school to become a NP without ever gaining nursing experience.

I love what I do and I'm looking forward to advancing in practice but sometimes I think we are running the risk of looking foolish and alienating ourselves from physicians in the quest to be independent. We need physicians and physicians need us. Only when we, as professionals, and I mean physicians included, learn to respect each other as valued, collaborative members of the healthcare team, will we be truly able to solve the present health care problems in our country.

[TakeBack]

It is interesting how different the states are. I am about to start working in Maine where NPs are required to have a supervising physician for their first 24 months of practice and then can be independent once they have that experience. I think that kind of system makes a lot of sense.[/quote']

I think most PAs would appreciate a similar model. We often talk about what the experience requirement should be for those PAs who could practice independently (appropriate fields- PC, peds, occasional medication, women's etc) and the consensus is usually 3-5 yrs.

[TakeBack]

Attend a GOOD NP program then talk about what kind of depth they may have or not have.

Therein lies the problem- lack of standardization in NP education.

NP culture seems to thrive on the evidence that NP care has been shown to be noninferior to physicians- yet there is no clamor for applying the same objective standard to their education. If you want national uniform legislation then you need what docs (and *ahem* PAs) have- national standards for educational programs.

I read a post here recently from an NP (student I beleive) who insisited that because the majority of students in the program were former unit/tele nurses, they didn't need to cover ECG analysis, chest auscultation etc because those concepts had already been "mastered" as nurses.

Training an RN is different that training a diagnostic clinician.

If the basis of the argument is that you need to know if the NP went to a "good" program or not, then the quality of the NP product will always be suspect.

Not something that I would go around advocating immediate independent practice over.

[reeya]

I would rather hear from a person who actually went to NP school and then to med school instead from a person who never endured that to share a story of the experience. no, I'm not talking about RN to MD, but an NP to MD. That would be interesting. I'm not saying NP schools curriculum is comparable to the MD curriculum, I can't say anything about that because I really don't know unless someone who did this can tell me. We need stories from the person themselves!

Have you looked at 1st 2 yrs of med school curriculum which includes all science classes....genetics, embryology, histology, pathology, clinical A&P, microbiology, virology, biostatistics etc (most of them with labs). They dont learn their anatomy on powerpoint slides, they learn on cadavers. Have you looked at 1st yr NP program curriculum across the nation....1st yr NP classes include research, nursing theory, poilcy program implementation, community health/epidemiology, advance nursing role. Now do you have to go to both schools to compare the curriculum??

MD have 3 yrs of residency with minimum of 2-3 yrs of clinical clerkship. NP has 600-800 hrs of clinical. How can you justify to compare both the programs ?? Tell me one medical school that is offered online..none!! How many NP schools are online...many, including health assessment !! NPs just need a reality check.

[FNPdude74]

Have you looked at 1st 2 yrs of med school curriculum which includes all science classes....genetics, embryology, histology, pathology, clinical A&P, microbiology, virology, biostatistics etc (most of them with labs). They dont learn their anatomy on powerpoint slides, they learn on cadavers. Have you looked at 1st yr NP program curriculum across the nation....1st yr NP classes include research, nursing theory, poilcy program implementation, community health/epidemiology, advance nursing role. Now do you have to go to both schools to compare the curriculum??

MD have 3 yrs of residency with minimum of 2-3 yrs of clinical clerkship. NP has 600-800 hrs of clinical. How can you justify to compare both the programs ?? Tell me one medical school that is offered online..none!! How many NP schools are online...many, including health assessment !! NPs just need a reality check.

Yes I looked at the curriculum for various meds schools. Pretty standard. But I've never experienced them. I was going the MD route and studied the requirements to get into a med school a few years ago, but decided to go the FNP route. Still contemplating to see if it's worth it to go med school since NPs are getting to do more now days and there are also opportunities for residencies and fellowships for NPs. I actually worked in a med school cadaver anatomy lab as an MDs assistant (pretty cool and I love these hard sciences) so I got to actually see a lot of the inner parts (after embalmment of course )

I'm not trying to justify that NP school is comparable to MD school. I just want to know a person's experience. I agree that the NP curriculum is not standardized across the nation as it should be with the inclusion of more clinical practice oriented courses. That was what I was hoping the DNP to be, but it doesn't seem like it's going that way (again as others said, another large topic that's being discussed! or closed...). Now days I'm hearing about DNPs doing fellowships in emergency medicine (for 1-2 years) after they finished their DNP degree and with past experience as a emergency RN. This is a lot of training in my opinion even though RN training is different than NP training. Now the DNP just has to take a step further in becoming a expert diagnostician in the ED.

[reeya]

Therein lies the problem- lack of standardization in NP education.

NP culture seems to thrive on the evidence that NP care has been shown to be noninferior to physicians- yet there is no clamor for applying the same objective standard to their education. If you want national uniform legislation then you need what docs (and *ahem* PAs) have- national standards for educational programs.

I read a post here recently from an NP (student I beleive) who insisited that because the majority of students in the program were former unit/tele nurses, they didn't need to cover ECG analysis, chest auscultation etc because those concepts had already been "mastered" as nurses.

Training an RN is different that training a diagnostic clinician.

If the basis of the argument is that you need to know if the NP went to a "good" program or not, then the quality of the NP product will always be suspect.

Not something that I would go around advocating immediate independent practice over.

I guess you are referring to me. I didnt insist the need to not cover ECG/auscultation. What I said was NP is "advance practice nursing"...that builds on RN skills. Mind you RN just dont wipe the butts..they are also very knowledgeable especially those who have yrs of experience in acute care. Now what good it would be to teach a MICU, SICU RNs what a MI looks like on EKG?? Guess what they already know it !!! What a diastolic murmur sounds like...they already know it !! They dont need to be taught how to auscultate or how to read EKG.. but rather they learn pathophysiology of why/how it happens. Thats why NP school that requires RN to have at least a yr of acute experience skips basic clinical skills...IV skills, wound care skills, NG tubes etc to add a few.

If a patient has a MI, is the MI on strip gonna look different if a RN reads or per your argument diagnostic clinician reads it?? FYI, an experienced RN is very knowledgeable and yrs of experience does matter. Sometimes they tell new residents what they should do next. ANP is advance nursing practice...those who say RN experience has nothing to do with NP school because it is medical education... i just think they are confused. Good for them if they can do without it.

[reeya]

yes i looked at the curriculum for various meds schools. pretty standard. but i've never experienced them. i was going the md route and studied the requirements to get into a med school a few years ago, but decided to go the fnp route. still contemplating to see if it's worth it to go med school since nps are getting to do more now days and there are also opportunities for residencies and fellowships for nps.

without basic science foundation and same par clinical hours (600-1200 dnp vs. 16,000 hrs) it would certainly be different !!

i actually worked in a med school cadaver anatomy lab as an mds assistant (pretty cool and i love these hard sciences) so i got to actually see a lot of the inner parts (after embalmment of course )

you worked as an md assistant, you did not learn in depth like a md. it is like comparing rn and cna.

i'm not trying to justify that np school is comparable to md school. i just want to know a person's experience.

what does experience has to do when the model of education is entirely different. you would put grueling 4 yrs of med school, 3-4 yrs of residency, 2-5 yrs of fellowship if you want to specialize as a md. as a np, you have your np license at the end of 2 yrs. personally, all my family members wanted me to go to md route but i ditched out because i didnt wanted to be in school for next 8 yrs.

i agree that the np curriculum is not standardized across the nation as it should be with the inclusion of more clinical practice oriented courses. that was what i was hoping the dnp to be, but it doesn't seem like it's going that way (again as others said, another large topic that's being discussed! or closed...). now days i'm hearing about dnps doing fellowships in emergency medicine (for 1-2 years) after they finished their dnp degree and with past experience as a emergency rn.

ok, tell me the names of that dnp program that has er residency as a part of their curriculum?? most np fellowships are offered through employers and only few hired will get the opportunity. it is not like residency in medical school where everyone gets the opportunity.

this is a lot of training in my opinion even though rn training is different than np training. now the dnp just has to take a step further in becoming a expert diagnostician in the ed.

i agree, dnp needs to realize and overhaul its education/clinical requirements.