Competent programs? NP or PA...

Spacklehead, MSN, NP · Oct 19, 2011

The same can be said for any type of degree program. There are great ones, and there are poor ones. You really need to do your research, learn about the program, ask questions, seek out alumni and see how they felt about their education. I would not put my time and money blindly into any educational program without doing research for my own best interest. I, personally, feel my NP program prepared me very well for entry-level practice; however, I also had 10 years of ER/cardiac nursing under my belt, too. Maybe that helped just a little, also? I think so!

SkiBumNP · Oct 22, 2011

Though i'm sure there are some good NP programs out there, I would say look at a PA program.

the BS that NPs have put themselves in by not having national standards, two certifying boards, keeping the word "nurse" in the name, and there are many more i could mention that i feel the old fuddy women have screwed us new NPs.

I would go to PA school. it's too bad i figured this out late in the game. during school I took extra PA classes, now that I am out and working, i don't see much of a difference, though i like the direction the PA community is going with board specialties.

-SkiBum-

I'm deciding whether or not to go the PA or NP route. Yes, NP will have the doctorate level soon. So what. It really means little to me if NP programs are producing incompetent DNPs while PA programs produce competent PA-cs.
My wife is an NP. She had a crap education, crap clinicals, and really wasn't ready to practice once she graduated. This is a nationwide trend. A few months back, I heard top officials on NPR talking about this... they were aware programs nationally provide crap for competency and produce new grad NPs who are incompetent, but they're 'working on it'. This seems to be the case for my undergraduate nursing education, but that is another post alltogether.
So, my question is, is anyone aware of any COMPETENT NP programs in the West/Midwest (i.e. Colorado, Wyoming, Arizona, North and South Dakota, Montana, Oregon)?
This is why I'm considering PA school as well. I've heard TONS of NPs say their PA counterparts got much better training. I'd rather not deal with the incompetency, inadequacy and down right unsafe education I have received again.
Suggestions on competent programs that produce functional NPs?

delabeaux, MSN · Oct 22, 2011

Though i'm sure there are some good NP programs out there, I would say look at a PA program.
the BS that NPs have put themselves in by not having national standards, two certifying boards, keeping the word "nurse" in the name, and there are many more i could mention that i feel the old fuddy women have screwed us new NPs.
I would go to PA school. it's too bad i figured this out late in the game. during school I took extra PA classes, now that I am out and working, i don't see much of a difference, though i like the direction the PA community is going with board specialties.
-SkiBum-

Thank you. Part of my post here IS me researching! My wife, and NP now for 4 years, agrees. She knew nothing as a new grad while the new grad PA had done it all in his clinicals etc.

delabeaux, MSN · Oct 22, 2011

About the only thing that is appealing to me on the NP aspect is they offer doctorate programs... yet I'm not seeing this as a deciding factor seeing as how employeers like competent staff on graduation and training employees to do what they were supposed to learn in school is mundane.

SkiBumNP · Oct 23, 2011

IMHO - The DNP is BS. It doen't give you any more clinical knowledge. it doesn't expand your scope of practice, nor are there any additional guidelines to make the DNPs more unified throughout the county. If the point is to day "I am a doctor" then I think we have a long way to go. If they would make it so the clinical knowledge was equal to a physician then I would be WAY more on board and be first inline to go back to school.

About the only thing that is appealing to me on the NP aspect is they offer doctorate programs... yet I'm not seeing this as a deciding factor seeing as how employeers like competent staff on graduation and training employees to do what they were supposed to learn in school is mundane.

delabeaux, MSN · Oct 23, 2011

Thanks!

My wife agrees. Being a previous micro major, I'm really liking the science involved with the PA program, and the lack of theory!.... I'm a little burnt on theory of caring etc at the moment!

Spacklehead, MSN, NP · Oct 23, 2011

If you don't mind me asking - how long was your wife an RN before becoming an NP? What kind of RN experience did she have? Also, what kind of clinical rotations did she have? Did she arrange them, or did her school arrange them for her? Also, what kind of NP is she? As an FNP, I had clinical rotations in each separate component: Peds, family practice, internal medicine, women's health, OB and geriatrics. I wasn't placed at a family practice office for all of my clinical experiences hoping to see a little bit of peds or some OB (not saying that your wife was). I spent a whole semester (typically 3-4 days per week) in each specialty - for example: during my peds rotation I was with a PNP and a pediatrician - both in low-income urban clinics where I would see many different chronic and acute conditions. For OB/gyn, I was with an NP who worked for an OB/gyn group, so I had more than my fair share of different gyn issues as well as OB patients. I was also at a women's public health clinic in the city. I also spent two semesters with an internal medicine doc who had his own practice and also rounded on patients in a nursing home and in the hospital. While I worked as an RN in the ER, I would spend less busy nights going over labs/X-rays with the docs, or learning from them about the interventions they chose for various conditions. They always loved to teach and would graciously go over things with me if I asked.

When I mentioned to do your research, I meant to really look into the programs to see where the students do their clinical rotations, what their first-time pass rates are on the certifying exams, where their graduates have found jobs (and how long it took). Did many graduating NP students already have offers upon graduation? How many clinical hours are required for graduation? Do they only require the bare minimum to sit for the ANCC/AANP or do they require a lot more? These are answers you most likely WON'T find here on a message board. My 2 cents - if you are not already an RN, then consider going the PA route; if you are already an RN with several years' experience, consider the NP route. Best of luck with which ever you choose.

Advanced Practice Columnist / Guide · Oct 23, 2011

Spacklehead, you took the words out of my mouth. I'm sure there are many NP programs that do not have the clinical resources nor the faculty expertise to provide a well-rounded education in the specific NP specialty program they are offering but there are also exceptional programs that have a commitment to producing competent providers for each NP specialization offered. It is indeed a weakness of our training (as SkiBumpNP also alluded to) that we lack the competency-based standardization, the stringent accreditation process, and the generalist training that PA programs offer. But the NP option works well with a subset of individuals: nurses who have years of clinical experience at the bedside to build up on or any individual who already have a modest understanding of the pathophysiologic bases in medical management. I also find it frustrating that there is a perception that FNP programs prepare the NP for "everything". Yes, the training involves management of individuals and families and this means all ages of patients but the focus is still primary care. There is no going around that.

Spacklehead, MSN, NP · Oct 23, 2011

I completely agree, Juan. I really do believe a lot of new nurses go into NP programs thinking they will be taught "everything" they need to know in order to function in any type of setting. It's just not the case. Now, I am only going by my FNP program, for that is all I have experience with - but it most definitely did build off of the assumption that I had a strong foundation in nursing already (my program did not accept new grads). FNP programs truly just teach you to be generalists who function in the outpatient family practice setting (not how to provide care for that patient if they need acute care in a hospital setting). If you want to specialize, you really need to find a program that provides that option; or find an employer who is willing to provide a lot of on-the-job training and support (an example here would be going into derm).

Just as a side-note - the same goes for physicians, also. For example, I would much rather my children see a pediatrician/PNP than a family practice doc/FNP for their routine care. They are trained to pick up on the subtleties that a generalist might not be familiar with (due to lack of exposure) for that specific population. Just a preference of mine, not a knock against FNP's or FP docs.

delabeaux, MSN · Oct 23, 2011

If you don't mind me asking - how long was your wife an RN before becoming an NP? What kind of RN experience did she have? Also, what kind of clinical rotations did she have? Did she arrange them, or did her school arrange them for her? Also, what kind of NP is she? As an FNP, I had clinical rotations in each separate component: Peds, family practice, internal medicine, women's health, OB and geriatrics. I wasn't placed at a family practice office for all of my clinical experiences hoping to see a little bit of peds or some OB (not saying that your wife was). I spent a whole semester (typically 3-4 days per week) in each specialty - for example: during my peds rotation I was with a PNP and a pediatrician - both in low-income urban clinics where I would see many different chronic and acute conditions. For OB/gyn, I was with an NP who worked for an OB/gyn group, so I had more than my fair share of different gyn issues as well as OB patients. I was also at a women's public health clinic in the city. I also spent two semesters with an internal medicine doc who had his own practice and also rounded on patients in a nursing home and in the hospital. While I worked as an RN in the ER, I would spend less busy nights going over labs/X-rays with the docs, or learning from them about the interventions they chose for various conditions. They always loved to teach and would graciously go over things with me if I asked.
When I mentioned to do your research, I meant to really look into the programs to see where the students do their clinical rotations, what their first-time pass rates are on the certifying exams, where their graduates have found jobs (and how long it took). Did many graduating NP students already have offers upon graduation? How many clinical hours are required for graduation? Do they only require the bare minimum to sit for the ANCC/AANP or do they require a lot more? These are answers you most likely WON'T find here on a message board. My 2 cents - if you are not already an RN, then consider going the PA route; if you are already an RN with several years' experience, consider the NP route. Best of luck with which ever you choose.

My wife was (and is) a BSN RN for her undergrauate. Her only 'floor' for 10 years was float pool, which included medical, surgical, oncology, surgical, neurology, telemetry, med/surg (overflow), pediatrics, ER, and ICU.

She is an FNP. She had to arrange her own clinicals, but they had to be in each specialty as you said. She did a 3 year program and would typically work for work 36 hours from Friday to Sunday night, Clinicals were 4-5 days a week, 8-12 hours depending on patient loads etc. She had two lectures per week and would typically leave from those to go to clinicals again...

Her class had a 100% pass rate, every one found jobs within 6 months, my wife immediately. She also passed the RN and FNP boards with the fewest number of questions possible... I envy that.

She... and sevaral NPs from several areas around the country that now live here have told me the same thing, they all more or less have felt the PAs had better clinical training, which prompted me to ask.

Me personally, I am finishing up an ADN program and will be done with my BSN in 1 year due to a previous degree. I have previous medical exp as a medic fir 7 years and a float CNA for 4... and based on that I'm certain I want more than the floor., so I will be a new RN provided I luck out and find a job in this economy which has a moratorium on new grads.

Perhaps, like the undergrad RN program, we could cut out some of the, 'Theory of how to make a theory for caring theories', and put a tad more science in its place?

Spacklehead, MSN, NP · Oct 23, 2011

See next post.