Anyone NOT have enough exp before NP school?

core0 · Dec 10, 2009

I realize this discussion is about experience related to NP school but I simply can not resist.
I do not see anywhere in ANDIELLISON's post where she limited her discussion to Florida. Yes, Florida is one in a handful of states that impose heavy regulation of NP's. It is only one of two states, Alabama being the other, who do not allow controlled substance prescriptive authority to NP's. The other 48 states have granted authority to NP's in varying degrees.

First of all welcome to allnurses.

On December 09, 2009, the New York Times published an article about NP's. "Numbering roughly 125,000 nationwide, more than 3/4 of NP's train in primary care, making them the largest group of non-physician primary care providers, according to a study by the American College of Physicians". This same article lists the states that currently allow NP's to practice independently, without physician involvement, at 22.

I would encourage you to critically examine statements such as those by the NY Times. Numbers have been discussed here before. The real number of NPs working as NPs is probably around 80,000, very close to the number of PAs in practice. This is confirmed by the Medicare payment numbers that show payments to NPs approximately 5-10% above those for PAs. As far as the second statement, yes 75% of NPs are trained in primary care (depending on how you define it you could claim that more than 90% of new grads are trained in primary care). However, when you look at where those NPs work, the best data (advance for NP) shows that around 40% work in primary care. This is similar to the percentage of PAs that work in primary care (37%). Overall this largely mirrors the percentage of the physician workforce which is around 35% in primary care. Of particular concern is that the NP and PA workforce (as indicated by advance and the AAPA studies) are following the physicians and moving increasingly into primary care.

As far as independent practice that has been discussed extensively here. I believe that the correct number of states is 13 if you are willing to avoid Medicare.

To the person who originally posted, most PA schools will accept students with little or no healthcare experience whereas NP schools require all applicants to be currently licensed as an RN and have several years nursing experience. The education process is very different as are the roles of PAs and NPs. What role you choose to assume depends on how autonomous you want to be.

Once again the devil is in the details. Approximately 1/3 of PA schools require HCE, 1/3 prefer HCE and 1/3 do not address it. Despite this the average amount of HCE by PAs in the 2008 cycle was 5400 hours. If you extrapolate to include non-CASPA programs its probably over 6000 hours.

As I am sure others will soon point out there is no requirement for any nursing experience to apply for NP programs. There are multiple programs that are direct entry with students proceeding immediately into their NP program without any nursing experience. This again has been discussed ad nauseum. Some students have had no problems getting jobs out of a DE program others have had significant difficultly. YMMV.

Autonomy has also been discussed here at length. There are equal opportunities for both professions. In the end its going to depend on the situation you find yourself in.

To go back to the OPs question, the consensus here seems to be that its going to depend on you. My one comment is that what we in the PA profession grapple with is that not all experience is equal. For example if you have two students one with 20 years as a CNA and the other with 2 years as an RN how do you evaluate this? Even within this realm different students will take different things away from the experience. When we interview whether someone is a PA or NP we look for critical thinking skills. We have seen applicants (NP or PA) with considerable HCE who did not have good critical thinking skills and new grads with limited prior HCE that showed great critical thinking skills. From the PA perspective I have seen students that could have used more HCE (from a maturity and seasoning point) and I've seen students that spent time in prior HCE because they were comfortable instead of moving on. In the end its going to depend on what you are comfortable with.

David Carpenter, PA-C

TakeBack · Dec 10, 2009

Takeback, I see that you are also a PA. What are you doing on a nursing forum?

I moderate at PA Forum, we have RN & NP members, and often have discussions on PA-NP issues. I read here to see another side of it- of course threads relevant to advance practice nursing and how it relates to PAs.

When I see posts that are glaringly biased or inaccurate regarding PAs I feel obligated to respond.

I will agree with your other mod posts that these forums should be and feel inclusive of all providers, don't you think?

TakeBack · Dec 10, 2009

All I did was repond to a post that questioned why the writer could advance more quickly as a PA vs a NP. As I stated, I thought a joined a forum for nurses. I will not post again. These two PA's did not like what I had to say and ganged up on me.

No, I'd say you were addressing a primarily nurses forum- and felt you were "speaking to the base"- and got called on, IMHO, unnecessarily denigrating PAs. You feel that PAs are a lesser clinician due to dependent practice. I disagree. And you have yet to address any of the questions I asked.

Trauma Columnist · Dec 10, 2009

Thanks for the brisk debate everyone....

Now, lets get back to the original topic.

Thanks everyone.

zenman · Dec 11, 2009

I moderate at PA Forum, we have RN & NP members, and often have discussions on PA-NP issues. I read here to see another side of it- of course threads relevant to advance practice nursing and how it relates to PAs.
When I see posts that are glaringly biased or inaccurate regarding PAs I feel obligated to respond.
I will agree with your other mod posts that these forums should be and feel inclusive of all providers, don't you think?

Yes I do. FYI, I post more on student doctor than here. And I might argue some things with coreO but not rules and regs. I think he studies them for fun!

Cardiology EP NP · Dec 12, 2009

So in going back to the original posting of this thread...I recently landed an NP job with almost four years of RN experience. Some people might say that's not enough, but for me, I think it's been plenty. You see, before I went to nursing school, I had 10 years of healthcare experience in different capacities. I worked as a nursing care tech, medical assistant in a physician office and I also worked as a medical social worker for a few years so I really didn't think I needed 10 plus years before going to NP school. But, I'm glad I have the experience I got as an RN because I think it contributed to my job offer. Also, I feel like I have gained some very valuable experiences where I have worked as an RN on a very busy cardiac unit with an extremely high acuity level. So, I had the chance to care for many types of patients with varying illnesses. Experience is always good. It never hurts and I think employers do take into consideration where you have worked and the experiences you have had.