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?
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.
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.
"To fulfill the remaining biological science course prerequisite, the PA Program recommends courses in genetics, cell biology, molecular biology, embryology, histology, or immunology. "
Having taken genetics, cell biology, molecular biology and immunology, it's safe to say that you would be hard pressed to find a university... especially Duke, that does not require ochem1/2 and calculus for any of these classes. It's simply too important to the base of these classes to not have the o-chem foundation.
And yes, I can see, having taken these classes, how a PA might think differently when considering pharmacology, drug interactions and biochemical process whereas a nurse may not. Yet, as I have already stated above, it doesn't matter. The research shows that the care between EXPERIENCED pa's, np's, and docs is unremarkable when comparing because the results are the same: adequate high-level care. I'm sure there are a lot of PAs that couldn't give a crud about the sciences and are more into the moment of pt. care. Same goes for nps and integrating theory... and there likely are those who do as well... and still... doesn't matter .
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.
Please, enlighten me!
Here you go (keep in mind I mentioned "self-proclaimed" #1 program in the US):
One semester of O-chem (which we had in my BSN program), no calculus and no physics (which we had in my BSN program). Their graduates seem to be doing just fine without those courses.
Getting back to the original question, Univ of North Dakota has an excellent program - lots of units though...roughly 60 compared to most programs which have 45-48.
A couple of other thoughts...my initial degree prior to nursing was in engineering. I've had the "real" general chem, o-chem, p-chem. I've got a minor in math. None of which really makes any kind of difference in learning how to assess, differentially diagnose, or define a treatment regimen. It certainly has no impact on my ability to observe a patient or listen to what they or their family tells me.
At the same time, I totally agree that nursing is awash in theories of defining theories about theories of caring - and NP programs would certainly benefit from more structured clinicals!
The question is, how do you define "competence"....
If you want the same overall competence as an MD, then go to med school - which sounds like a cop out but really isn't. Expect 4 yrs med school, 4 years residency, 2 years fellowship. After 10 years you should be competent - although we've all had experiences with incompetent MDs! While you're in med school, you'll spend approx $50k per year in tuition and will not be able to work. As a resident you'll make about what an RN makes or less.
If you want a high degree of functionality, then work as a nurse for a couple of years, get your NP while you are working and applying what you are learning for about 3 years, then spend another couple of years as an NP in the setting you are looking for. The whole time you'll be making good money and leave work at the end of your shift (36-40hrs vs 80 hours as a resident).
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Getting back to the original question, Univ of North Dakota has an excellent program - lots of units though...roughly 60 compared to most programs which have 45-48.
A couple of other thoughts...my initial degree prior to nursing was in engineering. I've had the "real" general chem, o-chem, p-chem. I've got a minor in math. None of which really makes any kind of difference in learning how to assess, differentially diagnose, or define a treatment regimen. It certainly has no impact on my ability to observe a patient or listen to what they or their family tells me.
At the same time, I totally agree that nursing is awash in theories of defining theories about theories of caring - and NP programs would certainly benefit from more structured clinicals!
The question is, how do you define "competence"....
If you want the same overall competence as an MD, then go to med school - which sounds like a cop out but really isn't. Expect 4 yrs med school, 4 years residency, 2 years fellowship. After 10 years you should be competent - although we've all had experiences with incompetent MDs! While you're in med school, you'll spend approx $50k per year in tuition and will not be able to work. As a resident you'll make about what an RN makes or less.
If you want a high degree of functionality, then work as a nurse for a couple of years, get your NP while you are working and applying what you are learning for about 3 years, then spend another couple of years as an NP in the setting you are looking for. The whole time you'll be making good money and leave work at the end of your shift (36-40hrs vs 80 hours as a resident).
My 2 cents....
I agree with all you said. The OP, however, is torn between PA and NP. I think the OP is actually leaning towards PA based on his posts.
I have read all the posts and agree with many of them, though I think a fundamental element is being lost......these programs, whether NP or PA are designed to produce Entry Levelpractitioners, not experts. Another thing being lost in the national "discussion" is the original "intent" of who would qualify to pursue NP practice...... this would be a Registered Nurse, with years of experience who then decided to return to school and pursue further, advanced education. I don't believe it was ever imagined that we would have "nurses" with literally no experience pursuing NP practice. I'm not taking a swing at anyone here, but this is the point: With years of quality nursing experience and even average advanced education, the NP will soar. With little to no experience, the new PA will outshine simply because of the larger number of clinical hours in the program. It was originally "assumed" that NP's would accumulate some of these necessary "clinical" hours through their work experience. We have gone from the ADN, then BSN then MSN NP model to direct entry, no experience, then NP in 2-3 years model. In time, though, all things do equal out. The largest factor would appear to be the individual. I've seen nurses with years of experience who couldn't pass NCLEX now if life depended on it. I've also seen physicians change orders because the experienced nurse didn't agree with their original course.
Lastly, is this a question of competence or confidence with new grad NP's vs new grad PA's? PA's seem to come out and project the confidence and necessary "arrogance" for their new position while NP's seem to struggle with letting go of the nursing role. Graduate PA's see themselves as having been unleashed on the world with a new found authority, a gain; Too often graduate NP's see themselves as moving from the status of a top-notch nurse, to that of a newbie NP, a loss. The competence level is probably the same, but the confidence level sure is not. Perhaps that's where new NP's should focus.
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
I have read all the posts and agree with many of them, though I think a fundamental element is being lost......these programs, whether NP or PA are designed to produce Entry Levelpractitioners, not experts. Another thing being lost in the national "discussion" is the original "intent" of who would qualify to pursue NP practice...... this would be a Registered Nurse, with years of experience who then decided to return to school and pursue further, advanced education. I don't believe it was ever imagined that we would have "nurses" with literally no experience pursuing NP practice. I'm not taking a swing at anyone here, but this is the point: With years of quality nursing experience and even average advanced education, the NP will soar. With little to no experience, the new PA will outshine simply because of the larger number of clinical hours in the program. It was originally "assumed" that NP's would accumulate some of these necessary "clinical" hours through their work experience. We have gone from the ADN, then BSN then MSN NP model to direct entry, no experience, then NP in 2-3 years model. In time, though, all things do equal out. The largest factor would appear to be the individual. I've seen nurses with years of experience who couldn't pass NCLEX now if life depended on it. I've also seen physicians change orders because the experienced nurse didn't agree with their original course.
Lastly, is this a question of competence or confidence with new grad NP's vs new grad PA's? PA's seem to come out and project the confidence and necessary "arrogance" for their new position while NP's seem to struggle with letting go of the nursing role. Graduate PA's see themselves as having been unleashed on the world with a new found authority, a gain; Too often graduate NP's see themselves as moving from the status of a top-notch nurse, to that of a newbie NP, a loss. The competence level is probably the same, but the confidence level sure is not. Perhaps that's where new NP's should focus.
^^^
THIS
As a new provider you face a depth of knowledge unlike ever experienced. The most important thing you should ask yourself is how your 1st job as a NP/PA will help develop you into a COMPETENT, EXPERIENCED provider.
Clinical inertia and clinical acumen are the ying and yang of medicine. You develop these two only through EXPERIENCE. Improving on those two concepts each and every time you treat a patient is what makes a provider competent. You can't be competent without experience. And you certainly can't get that experience in "school" or by arm chair quaterbacking.
My advice to you is go the PA route. So when you crash and burn your first time out as a provider you spare the nursing profession for your shortcomings. We all have them. We all crash and burn.
As a new provider you face a depth of knowledge unlike ever experienced. The most important thing you should ask yourself is how your 1st job as a NP/PA will help develop you into a COMPETENT, EXPERIENCED provider.
Clinical inertia and clinical acumen are the ying and yang of medicine. You develop these two only through EXPERIENCE. Improving on those two concepts each and every time you treat a patient is what makes a provider competent. You can't be competent without experience. And you certainly can't get that experience in "school" or by arm chair quaterbacking.
My advice to you is go the PA route. So when you crash and burn your first time out as a provider you spare the nursing profession for your shortcomings. We all have them. We all crash and burn.
Some just do it more spectacularly than others.
Lol. Now this is getting silly. Let's just be frank and admidt that there are $hit NP programs out there.
Furthermore, one CAN go straight from BSN to MSN-FNP. Schools are slowly changing it, but it's a fact.
An NP SHOULD out-preform a PA as an ENTRY level provider. But they don't. Even with 'years' of clinical experience, schools are still graduating NPs who do not know the first thing about being an NP. Which is why I had the first post. While I realize there are many, many poorly ran NP programs, such is the case with undergraduate RN programs, I am looking for programs that focus on competence and not $hit theory that really is about as meaningful as your above post.
It is not about 'confidence'. That argument is really underselling all nurses, claiming they're scared and just can't handle it. Really? If that's the stance and outlook you want to take as a nurse then so be it. If anyone is confident, it SHOULD be the nurse with 5+ years experience. Surely that trumps any length of clinical time any PA has had. But it doesn't. Nursing is not a mid-level practice. While the experiences may be helpful, they're still nursing experiences. Why schools think that 1.) this makes up for less time, and 2.) they can focus on theory instead of actual care and produce incompetent providers is beyond me.
This is not some mystery, so to think so is to fool yourself. On NPR 4 months ago, they had the directors of the ANA and other top nursing organizations on Talk of the Nation. They expressly acknowledged the lack of education and clinical experience NPs graduate with and they stated they are 'working on it'... they also had several PAs and MDs call in to comment on it.
So, the one's 'crashing and burning' are new grad NPs. Why? Because their schools failed to teach them what mattered. Yes, it does 'eventually' even out, after the NP gets a year or two of catch up. This shouldn't be the case. NP schools should be producing qualified providers, not NPs who need two years of clinical remediation because they had crap for schools and clinicals, but boy can they tell you about the 'Theory of Caring'.
So, again: My original post was looking for NP schools that produce competent NPs. However you want to rationalize the majority incompetence that even the ANA validates as being factual is up to you... while the ANA is 'working' on getting better clinical hours and didactics, I'm looking for any schools that are there already.
So, to those who are aware of them, post away. To those who are offended at reality... see the above post!
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
Lol. Now this is getting silly. Let's just be frank and admidt that there are $hit NP programs out there.
Furthermore, one CAN go straight from BSN to MSN-FNP. Schools are slowly changing it, but it's a fact.
An NP SHOULD out-preform a PA as an ENTRY level provider. But they don't. Even with 'years' of clinical experience, schools are still graduating NPs who do not know the first thing about being an NP. Which is why I had the first post. While I realize there are many, many poorly ran NP programs, such is the case with undergraduate RN programs, I am looking for programs that focus on competence and not $hit theory that really is about as meaningful as your above post.
It is not about 'confidence'. That argument is really underselling all nurses, claiming they're scared and just can't handle it. Really? If that's the stance and outlook you want to take as a nurse then so be it. If anyone is confident, it SHOULD be the nurse with 5+ years experience. Surely that trumps any length of clinical time any PA has had. But it doesn't. Nursing is not a mid-level practice. While the experiences may be helpful, they're still nursing experiences. Why schools think that 1.) this makes up for less time, and 2.) they can focus on theory instead of actual care and produce incompetent providers is beyond me.
This is not some mystery, so to think so is to fool yourself. On NPR 4 months ago, they had the directors of the ANA and other top nursing organizations on Talk of the Nation. They expressly acknowledged the lack of education and clinical experience NPs graduate with and they stated they are 'working on it'... they also had several PAs and MDs call in to comment on it.
So, the one's 'crashing and burning' are new grad NPs. Why? Because their schools failed to teach them what mattered. Yes, it does 'eventually' even out, after the NP gets a year or two of catch up. This shouldn't be the case. NP schools should be producing qualified providers, not NPs who need two years of clinical remediation because they had crap for schools and clinicals, but boy can they tell you about the 'Theory of Caring'.
So, again: My original post was looking for NP schools that produce competent NPs. However you want to rationalize the majority incompetence that even the ANA validates as being factual is up to you... while the ANA is 'working' on getting better clinical hours and didactics, I'm looking for any schools that are there already.
So, to those who are aware of them, post away. To those who are offended at reality... see the above post!
Okay........no need to get offended.
Really, go the PA route. I don't disagree with you on the fact of NP students POSSIBLY benefiting from more clinical hours or structured standardized clinical rotations.
So until NP programs get to where you think they should be, the decision seems obvious. The PA route seems to be your measuring stick. Go with it.
Best of luck with your remaining associate nursing studies.
Since we're getting off track and trying to quantify this conversation to my education, my Bachelor studies finished 2 years ago, in microbiology, my 1st associates in biology was 2 years before that, concurrent with an associates in chemistry...
Having attended a less than adequate ADN program, and having talked to 10+ people in the local area from 3 different areas that were experienced nurses and weren't happy with their experience, I wanted to find an adequate program.. Granted they're great now, but they weren't when they began.
So, no. PA isn't my measuring stick. It is many other NPs, and other healthcare providers.
Which is why I made the original post (this is getting repetitive, is it not?)
The ANA recognizes that many schools are producing less than adequate providers who must be remediated.
There surely are programs that don't require this.
I'm looking to find them.
You can defend the inadequacy of nursing until you're blue in the face, and that won't change the fact that the ANA itself recognizes national educational needs for improvement.
So. Did you graduate from a competent NP program? If so, post here. If you'd like to argue in circles... then I guess post here too if you're bored and really have nothing to contribute...
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
Again, no need to be offended or get defensive.
#1. I'm not defending whatever the nursing profession you think is lacking in advanced nursing education. I'm simply stating an obvious alternative.
#2. You're post starts off dismissive of NP programs in general. If you don't like the tone in response to your posts, make note of how you lack tactfulness in this one.
#3. I have met individuals with a PhD, MBA, JD's that couldn't tell me how to treat a patient with a paraesophageal hernia or a simple UTI. Does a degree in anything give that individual the capacity to fully comprehend what being a provider is? Does that make them incompetent? No, just not astute or knowledgeable to the intricacies of specialized medical knowledge.
Even if by association to someone that is a provider the answer is still no.
#4. I don't recall reading where you mention what specialty of advanced practice you plan on taking on. Be more specific with your request, you might get the answer you're looking for.
#5. The IOM report contradicts whatever message you're referring to the ANA responding to in an NPR interview.
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delabeaux, MSN
85 Posts