Why have you decided to become a NP and not a Doctor?

Specialties NP

Published

Just what the title says.

I agree that online NP programs are more problematic right now than online PA programs.

There are no online PA programs. Not one single PA program exists which takes someone who is not a PA and able to educate them to become a PA. What does exist are online programs which take existing PAs already in practice and allows them to earn a masters degree, but not a single one of those enable someone who is not a PA to become a PA.

Summing up:

Online PA program=does not exist

Online program enabling PAs to earn a masters degree=does exist

And on what premise do you decree that NPs are "reckless"? How many NPs do you personally know to make such an insulting blanket statement about us? Its obvious to everyone that you don't like NPs but your assumption is ridiculous. Over the years, the Institute of Medicine has published papers about NP practice outcomes which prove exactly the opposite of what you are saying. And what medical institution did you earn your degree from that qualifies you to banish us all back to our "roots of nursing?"

I personally know a recent horror story of an NP who went to an all online NP program who killed a patient by failing to recognize this patient was having an MI. She was working in the ED "fast track" and diagnosed this patient with "chest wall strain". During a deposition before the trial date the NP admitted her online NP program did not have any training in emergency medicine and she was not required to do any sort of ER training as part of her NP education.

Six hours after diagnosing the patient with chest wall strain and telling him to use ibuprofen he returned to the ER in full cardiac arrest and died.

All PAs are required to do a five week internship in an ER as part and parcel of their training. Any PA program failing to provide this training and education would lose their accreditation, yet for NP programs it's completely optional. If PAs have more training than NPs then it makes sense that PAs should have more legal abilities than NPs yet PAs don't and NPs do. Somehow the nursing lobby has duped state legislators around the country into passing laws enabling their reckless practice of "advanced nursing".

In order to improve patient safety all NPs must have their DEA numbers frozen and ability to prescribe immediately halted.

Specializes in Family Nurse Practitioner.
I personally know a recent horror story of an NP who went to an all online NP program who killed a patient by failing to recognize this patient was having an MI. She was working in the ED "fast track" and diagnosed this patient with "chest wall strain". During a deposition before the trial date the NP admitted her online NP program did not have any training in emergency medicine and she was not required to do any sort of ER training as part of her NP education.

Six hours after diagnosing the patient with chest wall strain and telling him to use ibuprofen he returned to the ER in full cardiac arrest and died.

.

Can you provide a link? This seems strange as I thought EDs have a chest pain protocol which includes diagnostics that would hopefully avoid this type of tragedy. I would like the link as it is valuable information we can use in an attempt to improve our NP education requirements.

Can you provide a link? This seems strange as I thought EDs have a chest pain protocol which includes diagnostics that would hopefully avoid this type of tragedy. I would like the link as it is valuable information we can use in an attempt to improve our NP education requirements.

It's a story I personally know and there is no link. The case was settled out of court as most malpractice cases are. You speak about a hope to "improve NP education" but you fail to see that the standards are so extremely deficient that NPs are placing patients lives in danger due to their legislative gains and along with what their accreditation lacks.

I personally know a recent horror story of an NP who went to an all online NP program who killed a patient by failing to recognize this patient was having an MI. She was working in the ED "fast track" and diagnosed this patient with "chest wall strain". During a deposition before the trial date the NP admitted her online NP program did not have any training in emergency medicine and she was not required to do any sort of ER training as part of her NP education.

Six hours after diagnosing the patient with chest wall strain and telling him to use ibuprofen he returned to the ER in full cardiac arrest and died.

All PAs are required to do a five week internship in an ER as part and parcel of their training. Any PA program failing to provide this training and education would lose their accreditation, yet for NP programs it's completely optional. If PAs have more training than NPs then it makes sense that PAs should have more legal abilities than NPs yet PAs don't and NPs do. Somehow the nursing lobby has duped state legislators around the country into passing laws enabling their reckless practice of "advanced nursing".

In order to improve patient safety all NPs must have their DEA numbers frozen and ability to prescribe immediately halted.

While I am not the one to usually defend nps, the last sentence just shouts out trolling basically. There are some good np programs and you are right in saying that their education needs to be revamped, but cutting out all of them at once would be silly. N=1 case doesnt prove a point either, and it is odd that they did not have chest pain protocols for patients with chest pain. Where I work part time, I have an EKG in hand before I even get to see the patient, even in the fast track.

NP education overall, is not on par with PA education but the dichotomy you describe is not as prevalent as you describe in regards to extremity.

You are correct in saying it is faulty to have somebody in the ER as a new grad without any orientation (if they did not have orientation that is at fault of the employer) or at least some prior experience.

I had a 4 hour orientation to the ER prior to starting but had 2 years in the hospital and ICU as an NP prior to starting so it wasnt much of a transition. Even new PAs where I work get an orientation, usually the same length as the NPs, but yes, overall PAs, when considering the education path are better suited for ER work.

At least in ER you have a physician there to bounce stuff off of, that was not present in the hospital besides consults. (may be different at different places).

Also, I am pretty sure jules understands better than any of us that NP education is deficient from many programs, but going "lol all npz need to be banned from all practice asap" is silly.

I hope you dont think that PAs come out of school ready to pounce on patients from every specialty rotation they did in school as experts in each field. Once I am done with med school Ill have around 7000 hours of clinicals just from that and wont be considered an expert in anything. That greatly shadows the 2500 that PAs get. Ill leave out my prior NP experience of around 7000ish too since I am an odd case.

I still wont call myself an expert in anything, even at that point, even with all As and one of the highest MCATs and GPAs in my class. still not even close to an expert.

Always be cautious, not matter what your degree might say on it.

There are no online PA programs. Not one single PA program exists which takes someone who is not a PA and able to educate them to become a PA. What does exist are online programs which take existing PAs already in practice and allows them to earn a masters degree, but not a single one of those enable someone who is not a PA to become a PA.

Summing up:

Online PA program=does not exist

Online program enabling PAs to earn a masters degree=does exist

I realize that. I think you are misunderstanding because I am actually agreeing with you that online NP programs are worse than the post-masters online PA programs. I can sense that you don't think a comparison should even be made there and that's a valid point. The point I (was trying to) make is that online training is not just a nursing problem because other professions are starting to turn to online degrees as well. You are right that online PA programs don't currently exist, but one at a very reputable school anticipates accepting its first cohort in 2018: Update on Yale PA Online Degree Program > Physician Associate Program | Medical Education | Yale School of Medicine

They are not yet accredited, but given the following quote from their site, it seems they have reason to believe that they will be soon: "The ARC-PA allows us to accept applications and offer admission to prospective students pending the accreditation decision." If you click on the link and navigate to the "September 2015" letter you will also see that during preliminary meetings many expressed concern regarding "the potential negative impact on the reputation of the PA community". Sound familiar?

I will say again that I agree with you that online training is primarily an NP issue right now. However, I believe the problem is becoming broader than that, as evidenced by growing interest among the PA community. As such, it needs to be examined from multiple perspectives.

If you're interested in reading more about the PA community's response to the Yale program (sorry if this is overkill but I just think this is very fascinating): Controversial online PA program to move forward

I personally know a recent horror story of an NP who went to an all online NP program who killed a patient by failing to recognize this patient was having an MI. She was working in the ED "fast track" and diagnosed this patient with "chest wall strain". During a deposition before the trial date the NP admitted her online NP program did not have any training in emergency medicine and she was not required to do any sort of ER training as part of her NP education.

Six hours after diagnosing the patient with chest wall strain and telling him to use ibuprofen he returned to the ER in full cardiac arrest and died.

All PAs are required to do a five week internship in an ER as part and parcel of their training. Any PA program failing to provide this training and education would lose their accreditation, yet for NP programs it's completely optional. If PAs have more training than NPs then it makes sense that PAs should have more legal abilities than NPs yet PAs don't and NPs do. Somehow the nursing lobby has duped state legislators around the country into passing laws enabling their reckless practice of "advanced nursing".

In order to improve patient safety all NPs must have their DEA numbers frozen and ability to prescribe immediately halted.

Sorry, but I find it very difficult to believe this. I used to worked in trauma/critical care in hospitals for quite a while as an RN and I have never seen or heard of anything like this. Ibuprofen for chest pain---with no workup at all sounds suspicious---even for the most incompetent clinician. Even as an RN, there is a chest pain protocol that we immediately follow before we alert the provider for orders. You don't have to have any specialty training in emergency medicine to know this. It is a part of every RN's routine assessment to observe for and report these signs and symptoms, and, in certain situations, call a rapid response code. During my RN clinicals I was taught that complaints of acute chest pain should be presumed as cardio-respiratory in nature until it is ruled out. I've never met nurses who believed otherwise.

Recognizing and managing chest pain is one of the basic things taught in ACLS. I would love to see a link to a published report of this incident. That its anecdotal makes it even more suspicious. It seems strange that the triage nurse in an ER would 'fast track' a chest pain. Fast tracking is usually for minor stuff---not for people with acute chest pain. No bloodwork for elevated cardiac enzymes and no 12-lead EKG---despite the patient's complaints and apparent distress? They would at least keep the patient in the ER holding or transfer to a telemetry unit for 24 hour observation while they complete the workup. Even med surg RNs know these things.

I suspect that you are trolling, but I don't know so I will give you the benefit of the doubt.

RockyMay seems to strongly dislike NPs and I have to wonder if she joined this site just to argue that NPs are incompetent. I can't find a way to quote her past posts and put them here with the quote function, but here are some of the things she has said (I copy/pasted):

She frequently makes very strong statements against NPs/nurses...

- "Sounds like you want to throw every test in the book at the PT. That's both unnecessary and also inappropriate, but it's common in NPs." (March 11, 2016)

- "NPs utilize more resources than PAs or MDs as a result of their inferior training and lack of preparation for the autonomous practice of medicine" (March 11, 2016)

- "Welcome to nursing, Michelle. You will never meet a nastier group of people" (June 8, 2016)

- "Most clinical training sites loath taking NP students due to their extreme lack of preparation and knowledge." (June 8, 2016)

- "MD/DO>PA>>>>>>>>>>>>>NP" (August 3, 2016)

... and then of course, everything she has said on this thread

It is also very unclear what type of clinical degree/license she has.

- "I am about to graduate from PA school." (March 9, 2016)

- "I am *NOT* a PA. I am more nursing experience then most people here!" (June 22, 2016)

- "Nope, I am *definitely not* a PA. You misread my post." (June 22, 2016)

I don't disagree with everything she says and if people have strong opinions regarding the relative competency of PAs and NPs it's perfectly fine to express that in a respectful way. However, RockyMay's statements are very inflammatory and inconsistent and I believe she is trying to get us riled up (and speaking for myself, I hate to say it's working). I honestly forgot what the initial question in this thread was because I've gotten so distracted/off topic by RockyMays statements. I guess I "took the bait", so to speak :banghead:

RockyMay: I am sorry for whatever experience you went through that made you hate NPs so much. I would really like to know where this hate stems from, because it seems quite personal to me. I understand if you don't want to share, and you probably don't, but is there any chance you could clarify the following:

- Under what license are you practicing? Did you go to/complete NP school? Nursing school?

- What do you hope to achieve by expressing such hostility towards NPs on this website?

I personally know a recent horror story of an NP who went to an all online NP program who killed a patient by failing to recognize this patient was having an MI. She was working in the ED "fast track" and diagnosed this patient with "chest wall strain". During a deposition before the trial date the NP admitted her online NP program did not have any training in emergency medicine and she was not required to do any sort of ER training as part of her NP education.

Six hours after diagnosing the patient with chest wall strain and telling him to use ibuprofen he returned to the ER in full cardiac arrest and died.

All PAs are required to do a five week internship in an ER as part and parcel of their training. Any PA program failing to provide this training and education would lose their accreditation, yet for NP programs it's completely optional. If PAs have more training than NPs then it makes sense that PAs should have more legal abilities than NPs yet PAs don't and NPs do. Somehow the nursing lobby has duped state legislators around the country into passing laws enabling their reckless practice of "advanced nursing".

In order to improve patient safety all NPs must have their DEA numbers frozen and ability to prescribe immediately halted.

BS. This patient wouldn't even make it past the triage nurse to fast track. Every hospital in the country would do an EKG on this patient before any advanced provider even laid eyes on them. "Chest wall strain". What a load of crap. Any RN, heck, any nursing student or nurses aid would assume MI until proven otherwise. And of course it's unverifiable. Just a story you heard. Sure.

Look, every person on this site can tell you an anecdote of a terrible decision made by any other class of providers. It doesn't mean anything. If NPs were indiscriminately killing off patients it would be clear and action would be taken.

Further, the University of Wisconsin has an online program:

  • Distance Track, part-time, 36-month distance education (DE) track; students achieve 80% of PA training in their home communities. Lectures and discussions held asynchronously through the SMPH Video Library and UW course management system.

And, as stated above, Yale is attempting to start an online program as well. So there's that.

RockyMay, you need to just reign it in because you're coming off as a crazy person. Yeah NP education needs a revamp. Totally agree. But, they are not reckless, uneducated, murdering imbeciles as you seem to think.

Also, I love the post with all the quotes. Haha.

BILLS.

Well my story has similarities to others so here I go. I grew up in Jamaica and sadly I didnt have the family support to pursue higher education. I was to work in the family business end of story. I did very well in HS and saw my best friend go to medical school, we were suppse to do it together. She of course was smarter and me more doubtful of myself and lacked the confidence. So I eventually mirageted to the US to major in business/finance...hated being being a cubicle handling other people's money ...I do love it but my own money ...lol. I dropped out off college and worked in jobs to make ends meet. Eventually, my support group which are my best friends from childhood to this day suggested nursing based on my personality. So I said why not? I had tried finance and computers ...nothing else to lose. I worked as a CNA and then went to nursing school and now I am in my NP program. If I had the push and confidence I would have gone to medical school, even toyed with the idea before my starting my MSN program. But, I am older and more mature (at least I think so) married with 2 small ones. I do love my nursing job and would like to be more effective so I decided NP was the route for me. Do I regret not going to medical school? No, because my path in life has taught me many lessons. I will however be the best nurse and eventually NP I can be as well as being the most supportive parent I can be so my kids will be able to achieve their dreams.

I would go to medical school but I'm 42 and don't want to finish residencies when I am 50 and have more than $500K in loans plus interest and lost income for the years not working while in medical school. I work in emergency medicine and for what it's worth many of the residents I speak to regret the avenue they took, saying it wasn't worth giving up so many years of their life. That made me wonder. I graduate from NP school this year. I took this route because it costs much less, I don't have to give up a decade of my life, and my wife and I wouldn't be able to pay our mortgage. The reason I didn't go PA is the school is ONLY full-time that I know of in my area and I cannot go without a job during that time. I have no regrets.

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