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?
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
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.
Well, with what you mention then, I can't honestly explain what happened with your wife's education. It sounds like she had great RN experiences which should have provided her an excellent foundation. Maybe her school just wan't up to par - I don't know.
Interestingly enough, though, what FNP boards did she take? The ANCC and the AANP FNP exams require you to complete the whole exam, no matter how many questions you answer correctly. The computer does not "shut off" after a minimum amount of questions are answered correctly like the NCLEX does.
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.
Indeed. However as times change for newgrad RNs and FNPs (people don't want to hire them). There are undergraduate programs that prepare nurses to be ready to hit the road from day 1, and there are undergrad programs that require a 6 month preceptorship to catch up because the school was incompetent.
I'm not sure it is unreasonable to expect a mid-level provider to be able to function as such without additional training on the job, regardless of their specialty. An FNP should be able for function as one as a new grad. I've yet to see a new grad PA program, but I do see them for FNPs... same goes for all mid-levels. The only mid-level program in nursing I'm aware of that does produce competent providers ready to go on day one is anesthesia. It shouldn't be a stretch for other schools to adequately prepare FNPs... and bachelor level nurses as well.
Well, with what you mention then, I can't honestly explain what happened with your wife's education. It sounds like she had great RN experiences which should have provided her an excellent foundation. Maybe her school just wan't up to par - I don't know.
Interestingly enough, though, what FNP boards did she take? The ANCC and the AANP FNP exams require you to complete the whole exam, no matter how many questions you answer correctly. The computer does not "shut off" after a minimum amount of questions are answered correctly like the NCLEX does.
I think it was the AANP... I could be wrong and assuming she passed the mid-level like the BSN...
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Just to be fair here, I've been an NP since 2004 and have worked alongside new-grad PA's as well. They do not hit the ground running. In their defense, the settings I'm referring to were "specialized" even for most PA program (Physical Medicine and Rehabilitation, Cardiothoracic Surgery). Such specialties I mentioned are not the type of settings PA students spend weeks of clinical rotations on. I said this because for the most part, PA's have a well-rounded training in all aspects of adult and pediatric medicine that combines out-patient primary care and in-patient management similar to a condensed Family Practice residency. The PA's can correct my perception if I'm wrong. Anyway, these new PA's had the same struggles with learning the intricacies of patient management in the specific population involved in those specialties. What I do notice is that the newbie PA's draw a lot of their knowledge of medicine from the learning experiences they obtained from their own PA program. New NP's on the other hand, draw from their own nursing experience more so than what they learned in their NP programs especially those who did the FNP route. However, after about 2 years of experience from both a PA and an NP in the same specialty, one would hardly notice much difference in their competence level.
Doesn't this also really depend on the specialty? I imagine that in a family medicine setting a brand new PA would outperform a brand new NP since the PA received more training hours and had more stringent education. However, I feel strongly that a brand new PA would not do so well compared to a brand new psych NP in a psych setting. I mean, the PA has had a general education while the psych NP's education has been almost entirely focused on psych, including clinical hours, etc. I could be wrong, but I always thought that PA was the way to go unless you know you want to specialize upfront (psych, midwifery, etc.)
In support of your statement, Juan, I have noticed recent adds for critical care PAs/NPs that want PAs who either have critical care PA experience or have completed a PA residency in critical care while they will take a new grad NP with years of critical care nursing experience. PA residencies are becoming increasingly common as PAs continue to specialize. I've also noticed a few critical care NP fellowships/residencies as well. I hope the trend continues. I would love to complete a fellowship/residency after I finish my ACNP.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Doesn't this also really depend on the specialty? I imagine that in a family medicine setting a brand new PA would outperform a brand new NP since the PA received more training hours and had more stringent education.
The reason I could agree with this theory is the reality that most RN's work in in-patient settings where exposure to primary care is limited because that's not the focus of patient management. Bear in mind that this is based on the assumption that there is wide variability in the quality of FNP programs so I wouldn't be so quick to make a sweeping generalization for all FNP's. The program Spacklehead attended and described sounds like it adequately prepares providers to assume a role in family practice.
However, I feel strongly that a brand new PA would not do so well compared to a brand new psych NP in a psych setting. I mean, the PA has had a general education while the psych NP's education has been almost entirely focused on psych, including clinical hours, etc. I could be wrong, but I always thought that PA was the way to go unless you know you want to specialize upfront (psych, midwifery, etc.)
That is why it is important for someone interested in either careers (PA or NP) to weigh the pros and cons of going into either route. I am an ACNP with experience in Med/Surg, ER, and ICU as a bedside RN. The ACNP was a natural progression for me as an advanced practice nurse. My bedside experience made going to school easier and it also made learning the role once I was in clinical practice easier. I still had a learning curve when I started working as a provider in the ICU but it is certainly not as steep if I had not been a nurse in this setting before.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
In support of your statement, Juan, I have noticed recent adds for critical care PAs/NPs that want PAs who either have critical care PA experience or have completed a PA residency in critical care while they will take a new grad NP with years of critical care nursing experience. PA residencies are becoming increasingly common as PAs continue to specialize. I've also noticed a few critical care NP fellowships/residencies as well. I hope the trend continues. I would love to complete a fellowship/residency after I finish my ACNP.
I've worked in three different ICU settings in three different hospitals two of which are in large tertiary settings where the ICU's are staffed by Intensivists + NP's and no PA's. The other setting is a community hospital where the model was Intensivists + PA/NP mix. Providers can be hired straight out of school in all those ICU's. The PA's transitioned quite well to the role though the nurses definitely had an advantage with their pre-existing knowledge of ICU protocols (i.e., writing orders for vasoactive meds, vent bundles, bowel regimens, electrolyte replacements protocols, etc.). Both struggled equally with learning to place lines and other invasive procedures. I think fellowships and residencies are beneficial for both types of providers.
I think they are beneficial as well. Hopefully these fellowships and residencies will become federally funded as physician residencies are (most likely a long shot though). It would've been great if dnp programs were set up to offer an additional clinical residency or fellowship (in place of the current capstone requirement and additional research requirements) that would offer time and training to hone clinical skills.
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?
I'll say it again...all professions are theory driven so you better have one otherwise you're a trade school graduate.
I came out of NP school and went straight to work locums tenons which is usually reserved for people with a few years of experience. I did psych so wanted more than what PAs get in psych, and less of other required rotations. In my area of practice caring, ie., provider-patient relationship can often trump science.
But there can certainly be improvement in our field, that's for sure.
I'll say it again...all professions are theory driven so you better have one otherwise you're a trade school graduate.
I came out of NP school and went straight to work locums tenons which is usually reserved for people with a few years of experience. I did psych so wanted more than what PAs get in psych, and less of other required rotations. In my area of practice caring, ie., provider-patient relationship can often trump science.
But there can certainly be improvement in our field, that's for sure.
Dang it... I hate when my quick replies are lost .
There is a difference between nursing theory and scientific theory... does it matter? Obviously not, based on so many papers showing that NP care is as competent... experienced NP care... is as competent as their PA/MD counterparts
Does it matter that many NP programs don't require a full year of organic chemistry, math up to calculus, biochemistry, physics... again obviously not. Many pt's prefer their NPs over their MDs/PAs... but this can come down to the individual. There are caring nurses, doctors and PAs. And there are non-caring NPs, PAs and MDs... (I like ellipses)
Given the many variables between the two, nursing theory vs. scientific theory, what programs expect etc, etc, etc, I choose to truncate said variables and focus only on competence on graduation. Again. I would rather be a competent practitioner in the family practice setting on graduation, rather than have my DoN... and need a year of shadowing to become competent.
I suppose I will select a few schools and repost later with what students from said schools think before I choose to go on.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
Does it matter that many NP programs don't require a full year of organic chemistry, math up to calculus, biochemistry, physics... again obviously not.
Should it matter if NP programs require those prereq's or not when the self-proclaimed #1 PA program in the USA does not? Just wondering.
.
Spacklehead, MSN, NP
620 Posts
Well, with what you mention then, I can't honestly explain what happened with your wife's education. It sounds like she had great RN experiences which should have provided her an excellent foundation. Maybe her school just wan't up to par - I don't know.
Interestingly enough, though, what FNP boards did she take? The ANCC and the AANP FNP exams require you to complete the whole exam, no matter how many questions you answer correctly. The computer does not "shut off" after a minimum amount of questions are answered correctly like the NCLEX does.