Benifits and drawbacks to the midlevel position

Dreamer-RN · May 24, 2008

jzzy88, in regards to your pa questions, i suggest to take a look at the "pa forum" discussion forum. i believe many of your questions are answered there.

salaries are dependent upon the region/state. advance reported the following information:

2008 salary breakdown for pas (there is a section on pa salaries on this page):

http://physician-assistant.advanceweb.com/

2007 salary breakdown for nps:

http://nurse-practitioners.advanceweb.com/editorial/content/editorial.aspx?cc=105177

i understand your struggles. nursing is a second career for me too (previous career in computer science/it industry). i did struggled with whether i wanted to do the np, pa, or md route. i love the hard sciences and enjoy the intellectual challenges these courses offer. my favorite nursing course is pathophysiology. i enjoy understanding the disease and physiological processes.

the md route was rule out when i came to the conclusion i will be approaching 50 when everything is said and done, including taking on significant amounts of student loan debt. it was not worth it at my current age.

i also wavered between np and pa. i ended up on the nursing track and overall, am very happy with this route. i do go through times of feeling unsatisfied with some of my courses because i want to dig deeper into the pathology and physiology. i satisfy my curiosity by taking time during my summer break to read further on these subjects from other resources.:nuke: it can only add onto making me a better nurse in the long run. finally, i am sure all the core nursing courses have a purpose, despite some aspects of them turn me off.

the one challenge i have with pursuing the np route, thus far, is i desire to be a surgical np (desire to first assist during surgeries as part of my job function). there are not many nps practicing in such roles and pas do dominant this arena. however, i know there are nps functioning as first assists throughout the country and therefore, i am determined to become a future acnp/crnfa.

djc1981 · May 24, 2008

Instead of worrying about who gets more respect (that's subjective), think about what you really want to do, the time it will take, the resources you have, and your overall career objectives. You keep saying you want the medical model of teaching, so by all means choose the PA route. It sounds like you already have your mind made up. We don't need or want any NP's who are bitter about choosing something they didn't want. So by all means, please choose PA.

amzyRN · May 25, 2008

Instead of worrying about who gets more respect (that's subjective), think about what you really want to do, the time it will take, the resources you have, and your overall career objectives. You keep saying you want the medical model of teaching, so by all means choose the PA route. It sounds like you already have your mind made up. We don't need or want any NP's who are bitter about choosing something they didn't want. So by all means, please choose PA.

Thanks much for the insight. I haven't made up my mind yet. I wish nursing went into more depth with bio-science, because I was a biosci major so it would be nice to use the stuff I learned, but I like the psychosocial and spiritual aspects that nursing tries to include. I'm not a reductionist so I think the bio-sci is only a small part of the picture and that we cannot entirely sum up or understand human response to illness. I don't like how medicine seems to focus on biology only and a drug as a fix for illness. It takes some of the spiritual elements of it, like the "laying on of hands" and stuff like that. I'll make up my mind at some point, but regardless of what path I choose, I don't regret studying nursing and pursuing the RN. The contact with patients and medical staff at the hospitals I've been training at, has been some of the most rewarding moments of my entire life. Thanks for all the help.

allnurses Guide · May 26, 2008

Where did you get the idea that nursing does not go "deep enough" into A&P or pathophysiology? There is no line over which nurses are not permitted to step as it's "doctor territory" haha.. you can learn just as much as you want.

After 10 years in ICU, I often go and seek out further information about things which interest me. That's nursing to me, beyond wiping someone's feverish brow.

The benefit of nursing as a career - to me, anyhow - is that it can be whatever you make it. The more knowledge you have, the better. Noone is going to tell you to pipe down because you're a nurse, if you make a suggestion about patient care based on your clinical knowledge.

Choose what interests you, and then make it your own.

amzyRN · May 26, 2008

Where did you get the idea that nursing does not go "deep enough" into A&P or pathophysiology? There is no line over which nurses are not permitted to step as it's "doctor territory" haha.. you can learn just as much as you want.
After 10 years in ICU, I often go and seek out further information about things which interest me. That's nursing to me, beyond wiping someone's feverish brow.
The benefit of nursing as a career - to me, anyhow - is that it can be whatever you make it. The more knowledge you have, the better. Noone is going to tell you to pipe down because you're a nurse, if you make a suggestion about patient care based on your clinical knowledge.
Choose what interests you, and then make it your own.

More specifically, nursing does not go into A and P and patho b/c it does not explore disease processes or bodily functioning on a microscopic level. When I took biochemistry in college, by the end of the class I understood metabolism of our cells, how vitamins work in chemical processes, how the kidney and liver work, and maybe a few more things that I can't remember now (it's been over 10 years since that class). Organic chemistry which was taken before biochemistry in order to understand why electrons flowed in certain directions forming and breaking chemical bonds with other carbon containing compounds that make up our bodies. It wasn't just broad concepts that I had to know and the exams weren't multiple choice teaching to a board exam (NCLEX) and at the end of these classes I had a basic understanding of how the body worked on a chemical level. I think in depth medical science would tie that all in together so that a person might grasp if even for one moment an appreciation for the complexity of the body and how processes are absolutely brilliant. Nursing does not go this far, not in their bachelors degree program at least. It would be great if masters and doctoral programs could go deeper into bioscience is all I'm saying. But maybe it's not entirely necessary and a general understanding is all that is required, but to appreciate the life science, I think we must take a closer look while not saying that the closer look is everything. Check out the urea cycle, citric acid cycle, vesicle budding and vesicular transport, etc...These are basic concepts in cell biology that I think a physician may be able to explain and understand more than a nurse would. I may be wrong though. And it is those complexities that I like and those complexities are where drugs often exert their effect. Would a nurse know how botox works in detail for example? Just one example. Let me know if I am wrong. And thank you all for your ideas and comments, I appreciate all of them lots!

BTW

why would it be wrong or to include this kind of depth in nursing programs?

elkpark · May 26, 2008

BTW
why would it be wrong or to include this kind of depth in nursing programs?

Well, my answer (and certainly not a definitive answer, JMHO) is that it's not that it's wrong, but it's not necessary for the practice of nursing and there's already too much stuff that's being shoehorned into the limited amount of time allotted to basic nursing education. Now, if nursing school were four years after a baccalaureate degree, like medical school, there would be plenty of time to delve into every little detail of human physiology and chemistry. But I don't hear anyone suggesting that we make a four-year graduate degree the entry-level into basic nursing practice ... Nursing education is already a constant agonizing over "need-to-know" vs. "nice-to-know," and faculty curriculum committees spend a significant amount of time debating and considering "what can we omit." There's lots of stuff that it would be nice to include in nursing curricula, but that would mean very significant changes in how nursing curricula are constructed and implemented. As it is now, the pressure from all sides is to make nursing curricula shorter, not longer.

But, as ghillbert noted, there's nothing stopping individual nurses from seeking out additional knowledge.

hypocaffeinemia, BSN, RN · May 26, 2008

BTW
why would it be wrong or to include this kind of depth in nursing programs?

Most people wouldn't be able to handle it.

The level of knowledge regarding pathophysiology and treatment modalities is incredibly superficial in my ADN program. Yet, a significant portion of the class is struggling with it and just barely have their heads above water.

I've found it frustrating, because I seek a deeper understanding than what is typically provided. Any exploratory questions of mine are often met with "Look it up" as a response from my instructors-- which I do. Later on when I explain in greater detail a particular process, my peers just look at me with blank looks and ask me why and how I know that.

Having a prior biology degree helps, too, but if it weren't a money/time/family life thing I wouldn't hesitate to go to medical school after I graduate simply to build on what I know. Here's hoping an NP program will satiate my desires.

amzyRN · May 27, 2008

Well, my answer (and certainly not a definitive answer, JMHO) is that it's not that it's wrong, but it's not necessary for the practice of nursing and there's already too much stuff that's being shoehorned into the limited amount of time allotted to basic nursing education. Now, if nursing school were four years after a baccalaureate degree, like medical school, there would be plenty of time to delve into every little detail of human physiology and chemistry. But I don't hear anyone suggesting that we make a four-year graduate degree the entry-level into basic nursing practice ... Nursing education is already a constant agonizing over "need-to-know" vs. "nice-to-know," and faculty curriculum committees spend a significant amount of time debating and considering "what can we omit." There's lots of stuff that it would be nice to include in nursing curricula, but that would mean very significant changes in how nursing curricula are constructed and implemented. As it is now, the pressure from all sides is to make nursing curricula shorter, not longer.
But, as ghillbert noted, there's nothing stopping individual nurses from seeking out additional knowledge.

I understand that there's a lot to cover, nursing is a very very broad field, so in depth would make it longer. I would be into doing a doctoral program in nursing that was more bio-medical, but that would be too much like med school for some people. For some learning on ones own certain things is not possible. That includes me, but I've never tried to teach myself before. Some types of knowledge are best acquired through being taught. Thanks much.

amzyRN · May 27, 2008

Most people wouldn't be able to handle it.
The level of knowledge regarding pathophysiology and treatment modalities is incredibly superficial in my ADN program. Yet, a significant portion of the class is struggling with it and just barely have their heads above water.
I've found it frustrating, because I seek a deeper understanding than what is typically provided. Any exploratory questions of mine are often met with "Look it up" as a response from my instructors-- which I do. Later on when I explain in greater detail a particular process, my peers just look at me with blank looks and ask me why and how I know that.
Having a prior biology degree helps, too, but if it weren't a money/time/family life thing I wouldn't hesitate to go to medical school after I graduate simply to build on what I know. Here's hoping an NP program will satiate my desires.

Are you going to go to a masters program after? PA school is an option too

SteveNNP, MSN, NP · May 27, 2008

In my undergrad, as well as my current grad program, we did go deep into microbiology, vesicular transport, the lactate-pyruvate pathway, bio-organic chemistry, the clotting cascade, etc....

I can't remember if you are a nurse yet, but when you graduate and have anywhere from 1-12 patients to be responsible to care for, the important points of micro and biochem come to mind, but the finer points which you're speaking of are left out. When you're compressing your pt's chest so hard you can feel ribs crack, but have a good compression pulse while pushing drugs and fluids in order to get them back, you're not running through the conversion of the pt's metabolism from aerobic to anaerobic in your head. I'm not a physician, but I'm pretty confident that most docs are not House, MD. Unless a researcher or diagnostician, I would venture to guess that with the array of diagnostic equipment and tests available, most physicians do not sit around and try to diagnose on a molecular/chemical level. Say a physician sees an acute brain infarct on CT. He's probably thinking about the inflammatory process and cerebral edema that's headed his way. Not the individual cell and molecular responses that cause those results. It's kind of like "skipping ahead" to the "good part." Today's highly acute medical arena doesn't really allow for it, which is why it isn't focused on in a lot of programs. That's why most nursing schools require prereqs before entry to NS. Too much to study in too little time. If nurses had 8 years of education before practicing, there would be plenty of time for all that. I'm not saying it isn't important, I'm just being the devil's advocate for the practical aspect of healthcare.

JMHO

amzyRN · May 27, 2008

I'm not a nurse yet, 5 months to go in my accelerated BSN program. I feel that in my program we are not going into depth and maybe it's because it's accelerated. Still I think they could go into more depth with the patho, like the why and how, rather than just memorize this and these lab values are used to diagnose it. Well, what are these values used to diagnose it and how does it have to do with the patho, I often wonder. When someone asks something about it, sometimes the professor will say I don't know, you have to look it up. I had one professor say to us, you don't have to know as much as a physician, blah blah. Well we have to interact with physicians and if we don't know enough as students we get criticized by some physicians and nurses too. In order for me to feel comfortable I need to know why certain lab values correspond to the disease process, etc. I don't like just memorizing things and not understanding them b/c when someone asks me why I don't want to say I don't know, go look it up. And I think it's even worse for students in my program that don't have a biology background b/c they are left memorizing more stuff that they don't understand. When something is understood there is less memorizing and more reasoning and I think it makes a better clinician. For example if a practitioner gives the RN a bad order, the RN should know it and refuse, if they don't know they put their patients at risk. I'm glad to hear your programs were good. And it makes me hopeful for grad school, that these topics will be explored more thoroughly. Thanks much.