Becoming an NP with little to no nursing experience?? - page 12

Hello to all!!! I have worked as a parmamedic for 20 years, have a B.A. in Economics, and I wanted to advance my career in healthcare. I was originally looking to pursue the PA route, but for... Read More

  1. by   juan de la cruz
    Quote from KatRN,BSN
    There needs to be uniformity to NP education, just as there should be to RN education....This does not happen in an FNP program, so when FNPs refer patients to speciality practices, they may not have as clear of an idea about what goes on in that speciality
    Sorry, but I don't agree with this. Uniformity in NP programs will make advanced practice nursing an exact copy of PA programs. If that is what you're after, then by no means attend a PA program. I have no problem with an RN wanting to go through the PA route. Advanced practice nursing historically is about being specialized. Just look at the oldest APN role - the CRNA as well as the first NP program in the country which happens to be in Pediatrics.

    "When an FNP refers a patient to a specialty practice, they may not have a clear idea of what goes on in that specialty"... You actually believe this? Ask any FNP and they will prove you wrong. Better yet, ask any NP for that matter. The reason why you refer to another specialty is because you know that the medical problem can not be addressed by your scope of practice and a specialty is best suited to address the problem.

    Quote from KatRN,BSN
    we have to realize that the rest of the world does not hold online programs in high regard
    I do agree with this comment. Not that it matters, my program is completely classroom-based with clinical rotations within the metro area where the university is located. You also have to remember that on-line courses can serve a purpose. For instance, at one point, there is only one Certified Nurse Midwife program in Michigan based at the Univ of Mich in Ann Arbor. Because there was a need to train CNM's in rural areas of Michigan, that school decided to offer on-line programs for interested RN's living in Upper Michigan who have no means of traveling to Southeast Michigan for schooling. I don't know how successful this program was, but this is just an example of how an on-line program can meet the need for providers in an area where there is a lack of expertise in training such providers.
    Last edit by juan de la cruz on Jan 8, '07
  2. by   core0
    Quote from pinoynp
    who cares whether you feel that these are not specializations from a medical standpoint! we np's do not aim to be md's or do's nor claim to have the same training as they do. we are nurses with advanced training in the medical model. these are nursing specializations as far as i am concerned but that does not make us less competent as a provider than you guys are. i remember back in np school, a student said that she has an rn friend who pursued pa studies for her master's. the professor responded by saying "that's going backwards as far as her career". now i understand what she is saying. she is not denigrating the pa profession, she is merely saying that this rn missed her chance to specialize as a nurse since she did not take the np route instead.

    this is the problem with terminology. when speaking about specialty practice are you talking about fnp vs anp or are you talking about an anp working in nephrology? which one is the specialist? you practice nursing, but you exist in a medical world and those words have meaning in medical parlance. as you stated your training is in the medical model, but the terminology used to describe what you do is a mystifying hodgepodge of medical and nursing phrases.

    you can use whatever examples you want. i could point to the three nurses in my class that wanted stronger medical training and in the words of one "no more bs nursing theory". you professor was right if you are looking at advancing your nursing career. the students in my class did not care about their nursing career, they wanted to advance their medical career.

    out-pt fp cardiology! are you kidding me! that is not specialty training in cardiology. that's just barely touching the tip of the iceberg. there is no way that is going to fly with a cardiologist.

    you really need to slow down and read what i wrote. what i was comparing was the training of the pa student and an fnp student (sorry if that didn't come across). the pa student will have more exposure to cardiology through their inpatient medicine and em rotations as well as exposure to didactic material than an fnp student on the average. this goes with the statement that np training depends more on the student and pa training depends more on the program.

    don't even go there! how can you compare your meager months of basic medicine rotations and a few more months of specialty rotation in family practice to that of a full-fledged family practice trained physician. i know how resident rotations work. i have been an rn in a teaching hospital for 14 years. there is no way the two programs compare equally period!

    once again look at what was said. we are comparing training models. fnp and pa. the pa training is modeled on the intern year. i am not comparing this to training for md's. i am comparing this to the model of training for fnp's. to be honest the closest model to fnp training is the old medex pa training which was 3-4 months of didactics followed by an 8 month preceptorship with a single family medicine physician.

    what my point is, is that similar to the intern training the pa training gives more clinically relevant exposure than most fnp programs. in fp you have to be jack-of-all-trades. it is important to recognize not only problems that the patient brings, but problems that the patient doesn't bring up. you have to recognize true emergencies. you are unlikely to see a true surgical belly for example in 3-4 months of fp. you are quite likely to see 2-3 per week on a surgicl service. this is the essence of the internship year - learn what bad looks like and what to do. this is why this model was adopted as the pa model. if you are not exposed to this you may not know what you are looking at. in the fnp model you are dependent on either the student having prior experience with this and being able to integrate this or being lucky with their exposure.

    well, i got news for you. they do the same for pa's here. i know a bunch of pa's in neurosurgery who are not allowed to write the a/p part of their medical history because the physicans do this themselves. they are merely scribes as far as i'm concerned!
    yes, actually i can do you one better. our state medical board ordered an md to hire a pa to do his notes since his handwriting was so illegible. i hope that he retired rather than do this and i hope that the pa's in the state had enough professional respect to decline this job. if there was a left-right continuum for pa's, surgery is far more likely to underutilize pa's. in your case the pa's are probably glorified surgical assistants - who bring in a bunch of money for the doc's. there are also pa surgical assist groups who work only in the er. for what its worth i do not feel that these group follow either the legacy or the spirit of the pa.

    while there are isolated examples of this in the pa world, this seems to be more of a problem in the np world. i see frequent references to the underutilization in np articles on specialty care. another telling statistic is that according to the best available data (from the aapa) 85% of all pa's ever trained are working as pa's. according to the best available data (us department of labor) 1/3 of nurses trained as np's are working as np's. it is also interesting that the two apn professions with training models similar to the pa (crna and cnmw) show employment patterns more similar to the pa than the np. i think that this shows two different models of training. the pa trains a minimally competent medical pratitioner that is able to expand into specialty or surgical practice with some additional training. the np trains nurses in the medical model. the training is sufficent for some to move into primary care or specialty practice, but for some they go back to or leave nursing. in my opinion this is indicative of what i've mentioned above, that pa training is more dependent on the individual program and that np training is more dependent on the individual student.

    david carpenter, pa-c
  3. by   core0
    Quote from mvanz9999
    I really don't understand where people are getting these low figures of months to become an NP. If we're talking about Direct Entry (which is what I believe NP with no nursing experience entails), the months are too low. I know of two schools whose core requirements are between 15 and 22 months. This is just the core nursing curriculum. Then there are additional years of the post master's NP certificate program, the length depending on which specialist track you take.
    Sorry, we're talking contact hours here. PA school is full time usually 6-8 hours per day 5 days per week. NP programs are usually run on an academic semester system with 6-16 hours per week. The average PA program has 1500-2200 contact hours for the didactic portion. The range for NP programs is 500 to 1500 contacts hours and most seem more toward the 500 hour end. You have to remember that the first NP program was 8 months of full time didactic training and 14 months of full time clinical training. This is very simialr to the first PA program. Over the last 40 years the PA program has lengthened the didactic component, while the NP didactic component has shrunk.


    David Carpenter, PA-C
  4. by   core0
    oops double post
  5. by   caroladybelle
    Quote from core0
    Our state medical board ordered an MD to hire a PA to do his notes since his handwriting was so illegible. I hope that he retired rather than do this and I hope that the PA's in the state had enough professional respect to decline this job.
    Okay, this has says something about the medical board. The MD should have been required to take corrective action, to make his handwriting legible. Or to find a reasonable solution at his own behest - preprinted forms, dictation, computer charting, whatever.

    There are very few reasonable excuses for ANY health care practitioner to write illegibly, and it is extremely dangerous, not only for the notes but also the orders to be that poor. To order the MD to get a PA, does not address how this practitioner passed classes, Boards and was permitted to work with this dangerous deficit.

    (And I doubt that nurses would ever be permitted the same latitude).
  6. by   core0
    Quote from caroladybelle
    Okay, this has says something about the medical board. The MD should have been required to take corrective action, to make his handwriting legible. Or to find a reasonable solution at his own behest - preprinted forms, dictation, computer charting, whatever.

    There are very few reasonable excuses for ANY health care practitioner to write illegibly, and it is extremely dangerous, not only for the notes but also the orders to be that poor. To order the MD to get a PA, does not address how this practitioner passed classes, Boards and was permitted to work with this dangerous deficit.

    (And I doubt that nurses would ever be permitted the same latitude).

    i'll admit this was an extreme example. I can't remember all the details ,but the crux was that the board had tried an number of other methods including dictating etc and none of them had worked. He really wasn't a bad practitioner, it was just that his handwriting was so illegible that if he wrote anything down no one could figure out what was written. They go involved initially because a case turned into a he said, she said thing because no one could figure out what he wrote - so even though they didn't think there was a bad act, they were stuck with correcting it. When they went back and it still wasn't fixed, they finally came up with this. From a PA point of view we pointed out this wasn't very good medicine. I think he finally got the hint and retired. The problem was that they couldn't show he was practicing bad medicine (although you could argue that failure to document is bad practice) so what excuse do they have to suspend him? I agree a PA or Nurse would not have been given the same latitude. However, in their defense our state board is one of the toughest in the country and has one of the best diversion programs out there for both bad medical practice and substance abuse.

    David Carpenter, PA-C
  7. by   juan de la cruz
    Quote from core0
    Another telling statistic is that according to the best available data (from the AAPA) 85% of all PA's ever trained are working as PA's. According to the best available data (US department of labor) 1/3 of nurses trained as NP's are working as NP's.....The NP trains nurses in the medical model. The training is sufficent for some to move into primary care or specialty practice, but for some they go back to or leave nursing.
    I hate to say this but I may have to agree with you on the statistic part. However, there are a lot of factors contributing to why that is so. One, PA clinical rotations are arranged with physician groups. On the other hand, some NP clinical rotations are arranged exclusively with APN's (my program included). Our clinical preceptors happen to be NP's or physicians who employ NP's. This gives us a limited exposure to a wider range of physician groups and restricts us to a subset of physicians who are already familiar with the NP role.

    Two, the MSN degree that you obtain for an NP track can open doors not only in clinical practice but in other areas as well. I know a lot of RN's who have an MSN with an NP specialization but are working in management, CNS role, nursing education, etc. I assume the MSPAS or MPAS degree you guys get limits you to clinical practice as a PA but you are welcome to correct me if I am wrong.

    Without any research to back up my claim, I do feel that the NP role is becoming recognized more among physicians at least here where I live. My entire ACNP class did not have a problem getting jobs within 6 months of graduation. During my job hunting, I interviewed with a couple of physicians who were specifically interested in hiring an NP rather than a PA. When I asked their reason for this, their response was "an NP is more patient-centered in their practice than a PA". Please don't take this as a negative remark on your profession. I am just giving examples.

    I happen to have graduated from a university with a medical school, a PA program, as well as multiple NP tracks, CRNA, CNS, and CNM programs. I see a lot of the PA and medical students in the hospital where I work but I am noticing that a lot of the PA students are now being precepted by PA's rather than residents or attending physicians. I don't know if this is an isolated occurrence.
    Last edit by juan de la cruz on Jan 9, '07
  8. by   bluesky
    Quote from core0
    The problem is that there is no consistency in NP education. You state that in you program you spend thousands of hours in clinical time, but this is far from the norm. Most programs have around 500 clinical hours which is the minimum. There are those that go above that but there is no consistent format. Your comparator groups residents and PA students have at a minimum three years of progressive training for residents and one year of training for the PA's. Also this is medical training that covers the spectrum of medicine from psychiatry to surgery. This depth of training is largely lacking from NP programs. So to compare the clinical NP training to these groups doesn't fly. There are very good NP's out there, some working outside their original training, but this relies more on the nurse than the training.

    David Carpenter, PA-C
    So, one can safely assume that on average, PAs are better clinicians because their training is more rigorous. Of Course! How could I not have observed the innate inferiority ( generally, not specifically, of course) of the nursing professional... I have been enlightned.


    Thank you.
    Last edit by bluesky on Jan 9, '07
  9. by   mvanz9999
    How come every single thread about Advanced Practice Nurses ends up being an argument about PA vs. NP? There's a sticky for this.

    The focus of the thread is NP with little to no nursing experience. Nowhere does the OP talk about PAs. This is not about PAs or who is better or who gets more education. That has been done to death.
  10. by   juan de la cruz
    Quote from mvanz9999
    How come every single thread about Advanced Practice Nurses ends up being an argument about PA vs. NP? There's a sticky for this.

    The focus of the thread is NP with little to no nursing experience. Nowhere does the OP talk about PAs. This is not about PAs or who is better or who gets more education. That has been done to death.
    Sorry mvanz, we did get out of topic for a while there. I might have gotten carried away with my responses but it's just that I get fired up when others make it look like NP's are inferior. At least, that's how I took the intent of the posts. Will shut up about this from now on.
  11. by   core0
    Quote from mvanz9999
    How come every single thread about Advanced Practice Nurses ends up being an argument about PA vs. NP? There's a sticky for this.

    The focus of the thread is NP with little to no nursing experience. Nowhere does the OP talk about PAs. This is not about PAs or who is better or who gets more education. That has been done to death.
    This eventually does lead back on to topic. I think the point I was trying to make is that because of the educational model, an NP without significant nursing experience will be at a disadvantage. The common thread is that NP school builds on nursing experience. Compare and contrast that with other educational models. The other disadvantage that I see for a student without nursing experience is that they may not understand how medical systems work and may not make contacts that allow them to get jobs after graduation. At least in my market, jobs are almost solely through word of mouth.

    David Carpenter, PA-C
  12. by   core0
    Quote from bluesky
    So, one can safely assume that on average, PAs are better clinicians because their training is more rigorous. Of Course! How could I not have observed the innate inferiority ( generally, not specifically, of course) of the nursing professional... I have been enlightned.


    Thank you.
    I am assuming that you are being sarcastic. Are there superb NP clinicians out there - of course. Are PA's on the average better clinicians than NP's - no data on this. There is ample data on what happens to PA students after graduation. Their employment status is tracked, salary surveys are collected etc. There is no compareable data on what happens to NP's. If I had to guess I would say that one quarter never enter the NP workforce, one quarter muddle a long and eventually leave the workforce, and half enter the work force and stay for some period of time. I think that the half that stay in the work force are by their nature the best clinicians. This is the real difference, that there is a variety of self selection among NP's that probably doesn't occur in the PA world. Hopefully this is somewhat enlightening.

    David Carpenter, PA-C
  13. by   sirI
    to preserve continuity of the thread, let's stay on topic:

    becoming an np with no nursing experience??

    here are the threads for discussion of np/pa:

    http://allnurses.com/forums/f34/diff...pa-164046.html

    http://allnurses.com/forums/f34/clin...pas-83016.html

    thanks!!!

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