Hello. I am considering NP and PA school. I have a few years of experience as an ED Tech in a Level 3 Trauma Center in California (busy, but not too intense). Our ED is staffed with PA's no NP's.
I have a few questions about clinical differences between NP's and PA's. I know that PA's seem to have a great ability to work in surgery specialties like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interprets tests, and prescribe meds (at least in 47-49 states). Are there any NP's on this forum who do this? Are there any in California who can comment?
Second. I know that most PA schools have a much longer clinical component than do NP schools. I have been told it is because NP's already have so much clinical experience as nurses. But can you really compare the two? In our ED, the nurses are not making differential diagnoses, determining etiology of disease, etc. etc., they are monitoring the pt's overall state and response to the treatment ordered by the Physician (or sometimes PA). Therefore, does this experience compare to the rigorous training PA's get in diagnosing?
Part of my interest in medicine is the actual procedures themselves. I want to do chest tubes, central lines, suturing, first assistant surgery, etc. etc. Are there any NP's out there who are doing this?
Finally, I know some people (including some nurses) who deride the "nursing diagnosis" concept. Can anyone offer up a brief rationale for how nursing diagnoses are of value to an NP in clinical practice?
i don't disagree that the fnp exam may be "easier" . what if the passing score for the fnp exam was 75% and the passing score on the pance was 50%. my point is, one may be more difficult, you still have a high passing rate. 90% pass the panre with a week review course? and yet we hear how nps and pas are all about the same after a few years. my point is, the panre is more hype than anything else. i have been listening to the pas say for years how they have more credibility because they take an exam every 6 years. it wasn't until the past couple of weeks that i understood what the panre really was and how "everybody passed" . read the thread on the pance in the pa forum http://www.physicianassistantforum.com/forums/showthread.php?t=6580
part of the confusion is the way the panre is graded. each question is assigned a difficulty and the output is expressed as a score. the passing score is then assigned each year as a cutoff. they use a measure called logits (the score changes each year depending on the overall difficulty of the test but the logits remain the same). the cutoff can be as low as 55% of the question for a very difficult test. this is the way all medical certification tests and most professional tests are developed. the nclex uses a different method similar to the gre where the student is asked increasingly difficult questions til they get one wrong then the difficulty lessens until they get one right. this requires a different test development method and is very difficult if not impossible for medical testing (especially those using scenarios).
the overall pass rate of the panre was 93% in 2003. there are a couple of points that you have to remember here.
1. this is a motivated population. if you don't pass you don't work.
2. there is an element of self selection here. those that did not pass the first time may not take it again. those that do not need the certification (certain states) and think they will do poorly may not take it.
3. these are people who have already passed the pance (which is though to be slighty more difficult). so in essence they have earlier mastered the elements of the test.
the overall pass rate is compareable to step pass rates and board certification for physicians (maybe a little higher than boards). this is also compareable to some other professional certifcations. note the pass rates are similar to other professional societies but less than tests that serve to limit entry into a profession such as bar exams.
i was suprised when i reviewed for the parne how much i retained. i think this is similar for most pa's. the ones that had the hardest time will probably be surgical pa's. in the 2002 era there was a pathway ii (open book test) for surgical pa's where half the questions were from general medicine and half the questions were from surgery. pass rate was in the 70% range.
for an excellent article on pa certification i will refer you to this:
i think you ask some valid questions but you really can't compare the two tests. pa's are going to be tested on things that aren't covered in any np program such as surgery. i would assume there are nursing theory questions on the np exam that i would have a hard time with. i have heard that some np certifying orginizations will require recertification. i think this is a good idea. while not perfect the best way we currently have to demonstrate competence is through continuous cme(ce) and recertification.
also consider, from personal experience here, PA programs do constant analysis of their graduates to determine how to best produce graduates who will become certified. Almost all states require certification for initial full licensure so producing grads who dont pass can be VERY bad. So, for example, "if" a program were to do statistical analysis of their graduates and find correlations between grades in certain classes and PANCE scores they can make certain cutoffs to pass. In some instances you have to have an 80% average on all tests in a semester in a class to move on to the next semester. I have seen a class of 50 be reduced to a class of ~30. This way, only the best are taking the PANCE, as David said. I don't think it is necessarily worth hashing out whose test is harder. If you are curious, go to kaplan qbank or a PANCE review book and see for yourself. Thats why I know the little I do about the FNP exam. Its worth seeing for yourself to gain an appreciation for the differences and similarities. I definately noticed a difference in the FNP exam. It was pretty different.
I also have friends who recently took the NCLEX and only had to answer something like 30-40 questions (ive forgotten what they told me) because of the format david is mentioning. I find that kind of interesting and have never heard of that testing method.
also consider, from personal experience here, PA programs do constant analysis of their graduates to determine how to best produce graduates who will become certified. Almost all states require certification for initial full licensure so producing grads who dont pass can be VERY bad. So, for example, "if" a program were to do statistical analysis of their graduates and find correlations between grades in certain classes and PANCE scores they can make certain cutoffs to pass. In some instances you have to have an 80% average on all tests in a semester in a class to move on to the next semester. I have seen a class of 50 be reduced to a class of ~30. This way, only the best are taking the PANCE, as David said. I don't think it is necessarily worth hashing out whose test is harder. If you are curious, go to kaplan qbank or a PANCE review book and see for yourself. Thats why I know the little I do about the FNP exam. Its worth seeing for yourself to gain an appreciation for the differences and similarities. I definately noticed a difference in the FNP exam. It was pretty different.
I also have friends who recently took the NCLEX and only had to answer something like 30-40 questions (ive forgotten what they told me) because of the format david is mentioning. I find that kind of interesting and have never heard of that testing method.
You two are really good on this forum! Do you say these same things on the other forums
The NCLEX is a RN exam not NP. You can fail the exam in as few as 40 questions as well!
I can assure you NONPF and the CCNE do not let NP programs slide, these are nurses after all. To have been a part of nursing for 20+ years is the only way you can really understand what I mean by that. Do you really think nursing programs want graduates who won't perform well as NPs? I know you don't, just as I can't see PA programs wanting an inferior provider.
you two are really good on this forum! do you say these same things on the other forums
the nclex is a rn exam not np. you can fail the exam in as few as 40 questions as well!
it is a valid exam style, but it is hard if not impossible to evaluate critical thinking skills with scenario exams which it is why it is not used for any medical or np (as far as i know) certification.
i can assure you nonpf and the ccne do not let np programs slide, these are nurses after all. to have been a part of nursing for 20+ years is the only way you can really understand what i mean by that. do you really think nursing programs want graduates who won't perform well as nps? i know you don't, just as i can't see pa programs wanting an inferior provider.
i would agree that nonpf doesn't want poor grads. but despite multiple state demands that np's get more pharmacology training they have not increased the training time for pharmacology. there is a definite conflict between access and proficency.
the other point is that nonpf does not control certification any more than paea controls pa certification. pa certification like physician certification is relatively monolithic. with the exception of emergency medicine there is only one certification group for each medical specialty. a similar policy exists for do's. when you look at np certification there are at least two certification organization for a number of specialties. looking further at these organizations there are obvious conflicts. the aanp not only serves as an advocacy group for np's but also certifies them. ancc not only certifies np's but also credentials programs and magnet sites.
i am not accusing these organisations of any wrongdoing, but a certifying organisation must be absolutely free of any type of conflict of interest, percieved or real. to use the pa profession as an example, there are four organizatinos involved. paea is the program association, arc-pa is the certifying organisation for pa programs, nccpa is the certifying organisation for pa's and aapa is the representative organisation for pa's. there are seats for all these organisations on each others boards (for example paea and nccpa have non voting seats in the aapa house of delegates). the nccpa has two aapa representatives on their board, but the board is carefully constructed such that the board is independent of influence from the aapa.
these organisations can and have been at cross purposes. for example several years ago the nccpa decided that they needed to start registering cme for recertification, a task that previously been done by aapa. this led to aapa withdrawing thier board members. this did not affect nccpa decision making and the aapa eventually rejoined (wether this decision was really about the income from cme logging i will leave for others to speculate on).
when i look at credentialling for np's as an outsider it is very difficult to determine what is really going on. there are multiple credentialling organisations which may have different scope of practice. i can also tell you that this is very confusing to hospital credentialling comittees especially with regard to the acnp. as a student of human nature i can tell you that unless there is some other advantage for a certification, students will take the one perceived as easiest. this forces the other certification to make changes that will make it perceived as easier. wether the certification is easier or not is hard to ascertain. this is the reason that multiple certifications are not a positive thing in any profession. this is the race to the bottom that i mentioned in an earlier post.
one interesting item for recertification is that most of the np certification exams i have looked at require the np to be working in the specialty to certify. this may have an interesting effect if hospitals start requiring this with credentialling.
This is in response to the ED tech considering N.P.or P.A. I am a N.P in Maine. I work in a rural E.D. This department is staffed only with NP/PA. We all do the same job. We are responsible for handling/treating anything that comes in. We have physician and anesthesia back up if needed. Prior to working in Maine I worked in CA. as a N.P., in the E.D. and family practice.
As for the respondent that stated that NP's are not independent in any State. This is very untrue. There are several States that NP's have complete independent practice. This information is published in journals such as AJNP each year. Maine is a State that grants independent practice after two years of supervision. There are several practices in this State owned and run by NP's independently. As for working, you can work and do procedures in either profession. However, if you have a goal to practice independently, then you need to go to NP school and move to one of the States that grant independent practice.
This is in response to the ED tech considering N.P.or P.A. I am a N.P in Maine. I work in a rural E.D. This department is staffed only with NP/PA. We all do the same job. We are responsible for handling/treating anything that comes in. We have physician and anesthesia back up if needed. Prior to working in Maine I worked in CA. as a N.P., in the E.D. and family practice.
As for the respondent that stated that NP's are not independent in any State. This is very untrue. There are several States that NP's have complete independent practice. This information is published in journals such as AJNP each year. Maine is a State that grants independent practice after two years of supervision. There are several practices in this State owned and run by NP's independently. As for working, you can work and do procedures in either profession. However, if you have a goal to practice independently, then you need to go to NP school and move to one of the States that grant independent practice.
Thanks... Joe....
First of all welcome to all nurses.com. The American College of Nurse Practitioners and the ANA define independent practice as practice that requires no participation from a physician. There are 8 states that require no physician participation for nursing practice or prescriptive authority. However, Medicare requires a physician collaboration agreement to bill medicare. So the answer here is the same as I earlier posted. As long as you do not bill for Medicare you can have an independent practice in those states as has been stated in a number of posts.
First of all welcome to all nurses.com. The American College of Nurse Practitioners and the ANA define independent practice as practice that requires no participation from a physician. There are 8 states that require no physician participation for nursing practice or prescriptive authority. However, Medicare requires a physician collaboration agreement to bill medicare. So the answer here is the same as I earlier posted. As long as you do not bill for Medicare you can have an independent practice in those states as has been stated in a number of posts.
David Carpenter, PA-C
We have covered the medicare billing in previous posts.....NPs can receive their own medicare and medicaid provider numbers in certain states, and in those states NPs can bill independently w/o physician collaboration.
This debate seems to be just going around in circles.
I like working with both NPs and PAs, but NPs do have totally independent practices in some states. PAs can practice with almost total autonomy, but they still can not practice totally independent... not yet anyways.
We have covered the medicare billing in previous posts.....NPs can receive their own medicare and medicaid provider numbers in certain states, and in those states NPs can bill independently w/o physician collaboration.
This debate seems to be just going around in circles.
I like working with both NPs and PAs, but NPs do have totally independent practices in some states. PAs can practice with almost total autonomy, but they still can not practice totally independent... not yet anyways.
Not really germane to the discussion (as is much of the last 25 pages) but here is a good article on NP billing. Page 5.
In most states PA's have any 4 year degree, volunteer medical hours and then take a rigorous 2 year medical school program. After passing certification their licensure is attached to an MD's and they are an extension of that MD. Yes, there is a component of surgical assist included in the programs. And yes, they can be considered hard to get into and rigorous. But the bottom line is there is a difference of observing as a tech and functioning in a full medical capacity.
To give a sense of what an ARNP difference is, and not a general nurse, it is important to know the nursing levels first.
There are several levels of nurses. There are LPN's with 1 year experience to pass meds and work in a team capacity with RNs. They have a limited scope of practice that allows them to only perform certain skills/tasks. Their ability to give patient health education is limited to protocols. Focus is on skills. However, they have to have a certain number of direct patient hours and function in that role before passing for licensure.
There are ADNs w/2 year degrees (usually a bit more because of prereqs) who focus on skills, assessing the patient (LPNs aren't qualified legally to do this level of care), they deliver meds, they perform IV skills, etc...All of this is apart of their rigorous program which includes lectures and clinicals. Later they must pass a licensure exam for an RN.
There are BSN's w/4 year degrees (also usually more) who do all of the above that an ADN program has but critical thinking and team leading and greater care delivery is apart of this program. They have 3 years of clinicals or more caring for patients and coordinating care with the medical team. They can give patient information on their own and also determine if a Healthcare provider's orders should be carried out. They do not diagnose but they know what signs and symptoms are apart of a diagnosis and they monitor labs and report abnormals as well as provide patient family teaching and support. They also must pass a licensure exam. In addition, they carry out complex patient treatments and can become certfied in specialties of OB/GYN, surgery, Emergency medicine, wound care, lactation, oncology, cardiology, critical care, etc.. after taking advanced classes (beyond the BSN level) and sit for specialty certification.
To become an ARNP, you must acquire your masters and take specialty courses that are approximately 7-8 quarters in length fulltime. You determine whether you are going to be an OB/GYN, Family practice, Peditric, geriatric, adult, acute care, psychiatric etc...ARNP with your particular field of study. Most programs require you to have been a full time medsurg BSN RN for 2 years before entering their program. The program often doesn't include a surgical assist component because it is understood that most BSN programs include that in their rotations. The program is rigorous and includes study in assessment, diagnosis, treatment, pharmacology, and fulltime clinicals for 3-6 quarters. Your preceptor and clinical experience can make or break your education.
ARNPs are usually quite well rounded who view a whole patient verses one built merely on the disease model. We look at the balance of the patient and also hold them up to a disease model as well. We diagnose, treat, perform procedures (which vary where you practice) and prescribe most medicines MD's do (except in a few states), and in most states are not tied to a MD's license. We have more experience than PA's. We have a different style of approach in terms of being more likely to look at lifestyle and nutrition in addition to disease and medications. We are great at prevention but can also function as specialists too (I hold wound specialist and family practice certifications).
Why might MD's hire a PA? Because they were developed by the AMA, ARNP's came from a nursing tract (but please do not call us "nurses") MD's historically have been unhappy with ARNPs because they have not been able prevent them from functioning independently (like most PA's).
Now, that said, have I met some fine PA's? Yes! Have there been some ARNP's less clued in? A few. That is true of MD's too. If you want to do school fast and be supervised and learn under a medical model, o.k. If you want more of a wholistic medical model focus but a longer course of study and experience, then be an ARNP. Wherever you go, the program, the mentors, and what you put into it is what counts. But think about this, how would you feel if you knew your MD "rushed" through med school?
Best of luck. kimmercris MSN, ARNP, WOCN edmonds, WA
In most states PA's have any 4 year degree, volunteer medical hours and then take a rigorous 2 year medical school program. After passing certification their licensure is attached to an MD's and they are an extension of that MD. Yes, there is a component of surgical assist included in the programs. And yes, they can be considered hard to get into and rigorous. But the bottom line is there is a difference of observing as a tech and functioning in a full medical capacity.
In the general consensus, Physician Assistants hold a Masters of Science in Physician Assistant Studies. However, for this profession, educational requirements are inconsistent and sometimes inadequate. There really is no general requirement. Today, for degrees in Physician Assistant Studies, programs at the associates, baccalaureate and graduate levels exist, as well as certificate of completion programs. Nurse Practitioners, on the other hand, are required to possess a minimum of a masters degree in, I believe, all 51 states. The program, while indeed rigorous and challenging, is not medical school. PA's are required much of the same educational curriculum as physicians, but it's generally not as in-depth nor does the material encompass the same information. As far as licensure goes, Physician Assistants are required to pass national certification for initial licensure and then again every two years to maintain their license, I believe. PA's hold their own license to practice medicine, however practice is required to be under the supervision of a licensed physician with a collaborative agreement in place. This agreement varies from state-to-state depending on that particular state's board of medicine and their statutes.
To give a sense of what an ARNP difference is, and not a general nurse, it is important to know the nursing levels first.
There are several levels of nurses. There are LPN's with 1 year experience to pass meds and work in a team capacity with RNs. They have a limited scope of practice that allows them to only perform certain skills/tasks. Their ability to give patient health education is limited to protocols. Focus is on skills. However, they have to have a certain number of direct patient hours and function in that role before passing for licensure.
Licensed Practical Nurses (or Licensed Vocational Nurses in California and Texas) generally receive one year of education (sometimes 14-16 months, depending on the program) and upon graduation are eligible to sit for the NCLEX-PN licensure examination. As with any nursing licensure, their practice limitations are based upon their state's board of nursing rules & regulations as well as facility-specific protocols. Their scope of practice is generally more limited than that of a registered nurse, but this depends greatly on their specialty of practice. For example, an LPN in family medicine, geriatrics or an office-based practice very well may indeed perform the same exact functions as a registered nurse in that same setting. Pertaining to patient education, their role would be likely limited (if it is, in fact, limited at all) by the facility in which they practice nursing, not their ability as nurses.
There are ADNs w/2 year degrees (usually a bit more because of prereqs) who focus on skills, assessing the patient (LPNs aren't qualified legally to do this level of care), they deliver meds, they perform IV skills, etc...All of this is apart of their rigorous program which includes lectures and clinicals. Later they must pass a licensure exam for an RN.
This is fairly accurate, however I'll add their educational curriculum also encompasses critical thinking, patient education, parental feeding, pathophysiology of disease and disease process, and much more.
There are BSN's w/4 year degrees (also usually more) who do all of the above that an ADN program has but critical thinking and team leading and greater care delivery is apart of this program. They have 3 years of clinicals or more caring for patients and coordinating care with the medical team. They can give patient information on their own and also determine if a Health care provider's orders should be carried out. They do not diagnose but they know what signs and symptoms are apart of a diagnosis and they monitor labs and report abnormals as well as provide patient family teaching and support. They also must pass a licensure exam. In addition, they carry out complex patient treatments and can become certfied in specialties of OB/GYN, surgery, Emergency medicine, wound care, lactation, oncology, cardiology, critical care, etc.. after taking advanced classes (beyond the BSN level) and sit for specialty certification.
Again, critical thinking skills are very much apart of an associates (ADN) program. Additionally, you are correct in that baccalaureate programs generally do incorporate more "team leading" (management/administration) education into their programs than the associate degree programs, but saying the delivery of care is greater in RN's with a bachelors than those with an associates is completely erroneous, in my opinion. Upon successful completion and graduation of either an associates or bachelors program, the person sits for the same licensing examination--the NCLEX-RN.
Regarding deliverance patient education, this can be successfully executed by a registered nurse holding either an ADN or a BSN. Furthermore, it is a critical function of the RN at both educational levels to identify and recognize any inconsistencies, contraindications or otherwise harmful practices to their patients and refusal to carry out these orders is utterly necessary.
It is correct to say registered nurses do not diagnose (at either education level), except for nursing diagnoses as determined and set forth by the North American Nursing Diagnosis Association, as this would be against the law, being deemed practicing medicine without proper licensure. Registered nurses at the AS and BS level are educated in pathophysiology, microbiology, anatomy & physiology, etc., and therefore are capable of correctly identifying disease-specific signs & symptoms and effectively monitoring lab values, some diagnostic procedures and other critical functions for proper and complete beside care.
Lastly, while some certifications, depending on the level of certification (CEN-- Certified Emergency Nurse, for example) require a bachelors degree, they do not require additional classroom education at the college level. There may be a certification-specific class or course, but that would be the extent of it. Another example, through the American Nurses' Credentialing Center, an RN at the associates level can attain certification (RN,C) while at the undergraduate level, he/she can attain board certification (RN,BC).
To become an ARNP, you must acquire your masters and take specialty courses that are approximately 7-8 quarters in length fulltime. You determine whether you are going to be an OB/GYN, Family practice, Peditric, geriatric, adult, acute care, psychiatric etc...ARNP with your particular field of study. Most programs require you to have been a full time medsurg BSN RN for 2 years before entering their program. The program often doesn't include a surgical assist component because it is understood that most BSN programs include that in their rotations. The program is rigorous and includes study in assessment, diagnosis, treatment, pharmacology, and fulltime clinicals for 3-6 quarters. Your preceptor and clinical experience can make or break your education.
ARNPs are usually quite well rounded who view a whole patient verses one built merely on the disease model. We look at the balance of the patient and also hold them up to a disease model as well. We diagnose, treat, perform procedures (which vary where you practice) and prescribe most medicines MD's do (except in a few states), and in most states are not tied to a MD's license. We have more experience than PA's. We have a different style of approach in terms of being more likely to look at lifestyle and nutrition in addition to disease and medications. We are great at prevention but can also function as specialists too (I hold wound specialist and family practice certifications).
Nurse Practitioners don't necessarily have more experience than Physician Assistants, though they do have more education in some cases--but, that's still very specific to the person.
The general requirement for acceptance to a Nurse Practitioner program would be a Bachelors of Science in Nursing with practice experience--the experience requirement does vary from school to school, though. As you stated, in addition to the full course load with their undergraduate degree, graduate students in the NP tract must also complete courses in advanced pathophysiology, advanced pharmacology, advanced physiology, disease diagnosis and treatment, history & examination, advanced treatment modalities and much more. The curriculum is very specific to the type of program (Family NP, Pediatric NP, Psychiatric NP, Geriatric NP, etc.), as well. The programs are intense and can be very intimidating. It takes a great deal of respect, discipline and willpower to successfully complete a nurse practitioner program.
Why might MD's hire a PA? Because they were developed by the AMA, ARNP's came from a nursing tract (but please do not call us "nurses") MD's historically have been unhappy with ARNPs because they have not been able prevent them from functioning independently (like most PA's).
Many states require APNs to hold licensure as RNs as well as APN licensure. We are always a nurse first before an APN. Being a nurse is part of our profession.
Now, that said, have I met some fine PA's? Yes! Have there been some ARNP's less clued in? A few. That is true of MD's too. If you want to do school fast and be supervised and learn under a medical model, o.k. If you want more of a wholistic medical model focus but a longer course of study and experience, then be an ARNP. Wherever you go, the program, the mentors, and what you put into it is what counts. But think about this, how would you feel if you knew your MD "rushed" through med school?
Best of luck. kimmercris MSN, ARNP, WOCN edmonds, WA
Nurse Practitioners, Physician Assistants, Physicians, Nurse Anesthetists, etc., all have their place in the health care delivery system. We work together as a collaborative unit to provide the best care we possibly can to our patients because they deserve nothing less. Whatever profession someone may choose, be proud of yourself for what you've accomplished and practice your skill to your best abilities. We all have our place in medicine and if we can work as a team, without thinking one profession is better than another, or thinking you're superior to someone else, our patients will benefit in the end and that's what really counts. Best of luck to all and well wishes for good health.
I am not sure why you felt the need to pick apart what I wrote. It should be understood that all levels of nursing start at the college level--in no way did I attempt to imply an LPN's 1 year curriculum was based upon "experience". Licensure does not occur until program requirements are completed and national boards are passed.
It should then also be understood that a PA continuing on from a bachelor's degree would be entering into a master's level program. Never meant to imply otherwise.
Yes, we should work together. Yes, there are differences in philosophy. No, it is no longer appropriate for the generic term "nurse" to be applied solely to ARNPs or APNs as this confuses the public and is unaware of the details and differences in scope of practice.
That said, my reply to the person posing the question was to delineate that there is a marked difference between what he/she viewed in her experience in the ER for what RNs were practicing and how an ARNP would be practicing.
The goal is to educate and allow for choice. In no way did I attempt to "slam" anyone in the medical field. Hope this clears things up.-kimmercris
Wow! Lots of thoughts about advanced practice. I am glad to be in advanced practice nursing, but if there had been a choice of a PA school closeby, I would have done that instead. I liked the fact that the PA programs offer more clinical training and less topics in research and Nursing history! I work alongside MDs DOs PAs and NPs in an ER setting. I do think my ER nurse background has as much to do with my success in practice than any specific thing I learned in NP school.
core0
1,831 Posts
part of the confusion is the way the panre is graded. each question is assigned a difficulty and the output is expressed as a score. the passing score is then assigned each year as a cutoff. they use a measure called logits (the score changes each year depending on the overall difficulty of the test but the logits remain the same). the cutoff can be as low as 55% of the question for a very difficult test. this is the way all medical certification tests and most professional tests are developed. the nclex uses a different method similar to the gre where the student is asked increasingly difficult questions til they get one wrong then the difficulty lessens until they get one right. this requires a different test development method and is very difficult if not impossible for medical testing (especially those using scenarios).
the overall pass rate of the panre was 93% in 2003. there are a couple of points that you have to remember here.
1. this is a motivated population. if you don't pass you don't work.
2. there is an element of self selection here. those that did not pass the first time may not take it again. those that do not need the certification (certain states) and think they will do poorly may not take it.
3. these are people who have already passed the pance (which is though to be slighty more difficult). so in essence they have earlier mastered the elements of the test.
the overall pass rate is compareable to step pass rates and board certification for physicians (maybe a little higher than boards). this is also compareable to some other professional certifcations. note the pass rates are similar to other professional societies but less than tests that serve to limit entry into a profession such as bar exams.
i was suprised when i reviewed for the parne how much i retained. i think this is similar for most pa's. the ones that had the hardest time will probably be surgical pa's. in the 2002 era there was a pathway ii (open book test) for surgical pa's where half the questions were from general medicine and half the questions were from surgery. pass rate was in the 70% range.
for an excellent article on pa certification i will refer you to this:
http://www.pahx.org/pdf/nccpa_history_article.pdf
i think you ask some valid questions but you really can't compare the two tests. pa's are going to be tested on things that aren't covered in any np program such as surgery. i would assume there are nursing theory questions on the np exam that i would have a hard time with. i have heard that some np certifying orginizations will require recertification. i think this is a good idea. while not perfect the best way we currently have to demonstrate competence is through continuous cme(ce) and recertification.
david carpenter, pa-c