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Discussion

APRN Education

Nursing student here and I have a question. 

Why does nurse practitioner education require specialization, for example FNP vs pmhnp, when PAs have a general education and can work within any specialty? When moving NP education to the doctorate level wouldn't it have been beneficial to encompass all major areas of practice so NPs could better compete with PAs? 

Thank you for the responses, 

Tommac

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    Is this a school project? LOL. Well, the historical beginnings of both professions took different turns through the years to what it is now, hence, the structure and training is different.

    PA's started at Duke in 1965 when a physician there conceived a role that would fill the gap between a physician and a nurse. The PA's of the time were male and were ex-military corpsman who already had some form of advanced medical training. There was a nursing shortage then and the sentiment was that the new role should not take away from the current pool of nurses at the time.

    NP's started around the same time in 1965 when Loretta Ford, a nurse, and Dr. Silver started a program at the University of Colorado to train nurses for the primary care provider role in pediatrics in underserved urban areas and rural communities. Few years after that, another Peds NP Program began at Boston College.

    The NP concept kind of already started as a specialty-based training from the beginning. Family NP programs didn't start until the 1970's. ACNP programs became an offshoot of the Adult CNS role and the first ACNP programs came later in the early 1990's. Not sure about PMHNP's and the others but overall, the NP specialties are rather newer.

    There are pros and cons to generalist training that PA's have that NP's don't. I think this is something that will be an astronomical task to even change much less have a conversation about. I personally am satisfied with the specialized nature that NP's offer but it does need a bit of tweaking to meet real world situations.

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    Thank you for such a detailed response. 

    Not an assignment. We covered scope of practice, types of healthcare providers, state requirements and authority. It's weird not just the requirements but also state to state. I graduated with my bs in math a couple years after the recession and job security has been mediocre. I just started my RN this semester ( luckily I applied before before covid was an issue) and was looking at all the options. I have become more weary however when programs push more and more gradute schooling ( it's just the debt I really enjoy learning) or when there is another profession that has greater flexibility than can fill you niche. I've seen organizations exploit these flexibilities in the past. I was only looking to see if there was a general opinion about the future of nursing education and maybe career outlook. 

    Thanks, 

    Tommac 

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    I cannot comment on the future of NP or PA's. I can comment on current general trends, without extrapolating to future directions of either discipline.

    NP's can practice independently in most states; other states require some sort of collaboration with a physician, though there is lobbying in these states to allow for more independence. PA's always have to practice under physician oversight, though there is lobbying in many states to change the PA's scope of practice to provide more independence. There are some residencies/fellowships in both. PA's have more flexibility with their post-graduate training, while NP's do not. For example, if a PA wanted post-graduate training in dermatology, then as a first assist in surgery, no problem. If a PMHNP got tired of psych and wanted to do cardiology, he/she would have to go back and get trained in another primary care NP specialty first (FNP, Adult NP, etc).

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    As stated above in regards to independence - I believe this is a large factor in requiring specialization. Similar to an MD who has to specialize in a field. You won't see an ophthalmologist perform cardiac surgery, likewise in the NP realm. 

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