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?
Its more than just the hours its the type of experience. The Canadians went to 750 hours after they studied this, but there have to be requirements to get certain types of experience. Some programs are good about this and mandate so many peds hours, so many adult hours etc. Others don't seem to care. I know one FNP that did her entire rotation in an ER without a peds unit. The school didn't seem to care.
Without standard for both the programs and the students the hours are meaningless. Read the stuff from the Texas BON about students that did their entire clinicals in a Botox clinic and understand why the real need is for standards before increasing hours.
David Carpenter, PA-C
You are absolutely right, the FNP clinicals need to be done in the various specialties, peds, IM, urgent care, OB/GYN, etc. It just blows me away that these standards aren't already mandated by the certifying bodies.
You are absolutely right, the FNP clinicals need to be done in the various specialties, peds, IM, urgent care, OB/GYN, etc. It just blows me away that these standards aren't already mandated by the certifying bodies.
The problem is that certifying bodies shouldn't have to mandate this. If one did then whats to prevent people from going to the other certifying body. The certifying bodies should be in the position to be able to accept any graduate from an approved program. The real problem is there is no accrediting agency for NP programs. They are accredited as part of either NLNAC or CCNE accreditation of their MSN programs. Notice that the two APN specialties that have a single certifying organization also have seperate credentialling agencies that enforce the standard of those APN specialties (CNM and CRNA). In the current case the certifying organizations are being forced in some cases to verify that the student has the required hours. A process that would be unecessary if there was an actual NP program accrediting agency. Different problem, same tune.
Specializes in ER and family advanced nursing practice.
Its more than just the hours its the type of experience. The Canadians went to 750 hours after they studied this, but there have to be requirements to get certain types of experience. Some programs are good about this and mandate so many peds hours, so many adult hours etc. Others don't seem to care. I know one FNP that did her entire rotation in an ER without a peds unit. The school didn't seem to care.
Without standard for both the programs and the students the hours are meaningless. Read the stuff from the Texas BON about students that did their entire clinicals in a Botox clinic and understand why the real need is for standards before increasing hours.
David Carpenter, PA-C
David, I agree with that, and these days we have to specify everything which is fine. At least in the program I am in now I am required to do a mix of adult and peds rotations and within those rotations I am required to have a good mix of acute, chronic, and well check. Having said that, I still feel like we should have more hours, and yes more of the RIGHT kind of hours. I will go out on a limb here. Maybe we should drop a class (or two or three) about F. Nightingale and M. Leininger and add some more clinical time. That is not to say ignore the theorists (no really... I mean it...stop laughing), but that is covered quite sufficiently in undergrad nursing, and if need be can be covered again in MSN/PhD educator tracks.
The problem is that certifying bodies shouldn't have to mandate this. If one did then whats to prevent people from going to the other certifying body. The certifying bodies should be in the position to be able to accept any graduate from an approved program. The real problem is there is no accrediting agency for NP programs. They are accredited as part of either NLNAC or CCNE accreditation of their MSN programs. Notice that the two APN specialties that have a single certifying organization also have seperate credentialling agencies that enforce the standard of those APN specialties (CNM and CRNA). In the current case the certifying organizations are being forced in some cases to verify that the student has the required hours. A process that would be unecessary if there was an actual NP program accrediting agency. Different problem, same tune.
David Carpenter, PA-C
Unless something has changed within the past 5 minutes, the ANCC and the AANP are the only entities that certifiy FNP's in the USA.
Specializes in Emergency/Trauma/Critical Care/Rescue.
Like a lo of individuals on this board I had the same problem. So not being able to make up my mind (or whats left of it)--- I got both (NCCPA and AANP). Guess my schitzophrenia just got to all of me AGAIN (LOL). I do practice on my NP licence- a lot less paperwork for the beaucrats and aggrevation.
David, I agree with that, and these days we have to specify everything which is fine. At least in the program I am in now I am required to do a mix of adult and peds rotations and within those rotations I am required to have a good mix of acute, chronic, and well check. Having said that, I still feel like we should have more hours, and yes more of the RIGHT kind of hours. I will go out on a limb here. Maybe we should drop a class (or two or three) about F. Nightingale and M. Leininger and add some more clinical time. That is not to say ignore the theorists (no really... I mean it...stop laughing), but that is covered quite sufficiently in undergrad nursing, and if need be can be covered again in MSN/PhD educator tracks.
Ivan
Good call on the type of hours and the need for more of them in place of the fluff that makes no sense to include in a clinical program (i.e. "theory" courses)
Hmmm someone mentioned a bridge program for PA to MD???
With market demand and with market confusion what is going to happen if we can't all get along?
With market demand and with market confusion what is going to happen if programs don't standardize?
I guess it wouldn't be a bridge but what would happen if the models from both PA and NP worlds were combined while removing the fluff... Have paid residencies so students don't have to live under bridges during school.
or as an alternate
(I posted this on another thread but it looks like it would do just as good here):
Schools with both medical and nursing programs (if it has a PA program include them also):
A&P classes with both NP students and Medical Students (mandatory)
Microbiology with both NP students and Medical Students (mandatory)
Advanced Pharmacology with both NP students and Medical Students (mandatory)
Genetics and Embryology with both NP students and Medical Students (mandatory)
Advanced assessment with both NP students and Medical Students (mandatory)
Procedures with both NP students and Medical Students (mandatory)
Some type of business class (Coding, billing, etc.) with both NP students and Medical Students (mandatory)
Theory and Research Applications with both NP students and Medical Students (mandatory)
Medical ethics with both NP students and Medical Students (mandatory)
I realize all the clinicals can't be the same but with 4 year programs there should be some time for some shared clinicals that can apply to both NP students and Medical students.
Maybe from the get-go if we/they have to learn together when we/they get out and go play in the sandbox we/they will play together in a more friendly manner.
Hmmm someone mentioned a bridge program for PA to MD???
With market demand and with market confusion what is going to happen if we can't all get along?
With market demand and with market confusion what is going to happen if programs don't standardize?
I guess it wouldn't be a bridge but what would happen if the models from both PA and NP worlds were combined while removing the fluff... Have paid residencies so students don't have to live under bridges during school.
or as an alternate
(I posted this on another thread but it looks like it would do just as good here):
Schools with both medical and nursing programs (if it has a PA program include them also):
A&P classes with both NP students and Medical Students (mandatory)
Microbiology with both NP students and Medical Students (mandatory)
Advanced Pharmacology with both NP students and Medical Students (mandatory)
Genetics and Embryology with both NP students and Medical Students (mandatory)
Advanced assessment with both NP students and Medical Students (mandatory)
Procedures with both NP students and Medical Students (mandatory)
Some type of business class (Coding, billing, etc.) with both NP students and Medical Students (mandatory)
Theory and Research Applications with both NP students and Medical Students (mandatory)
Medical ethics with both NP students and Medical Students (mandatory)
I realize all the clinicals can't be the same but with 4 year programs there should be some time for some shared clinicals that can apply to both NP students and Medical students.
Maybe from the get-go if we/they have to learn together when we/they get out and go play in the sandbox we/they will play together in a more friendly manner.
:twocents: heres my 2 cents for what it is worth, rather than go by clincial hours how about the number of patients, and diagnosis we see. i know some days i will be at my clinical site for 8 hours, see only 8 patients. but i get credit for 8 hours. some days i see 30 or more. some days less. i dont think it is so much the hours that you spend but the number and type of patients that you see. i know a student in one program, not mine who counts her drive time 45 minutes each way 3 times a week as clinical time. in 16 weeks she has 72 hours of clinical time for driving. and she only has to do 160 hours for her semester. i am allowed one hour to count as clinical for write-ups etc. now that i am almost done, i pick the patient's i want to see, because i need that certain exposure, sometimes my preceptor will hop in and say hey i know this one is only a routine health visit but go see that patient i think you will find it interesting. just my thoughts on that issue.................
:heartbeatthe question is not are they going to let you do it, but who is going to stop me:heartbeat
that's interesting because my clinical time only counts actual patient care time. If a patient no shows, i can't count that time, can't count lunch, can't count drive time from site-to-site. the result is 1000 hours total of patient care time in family practice (and i don't think that is enough - as i have noted here and elsewhere) unlike the "clock-time" some professions use where sleeping, eating, meetings, and lectures are all counted in the "15,000" hours that are claimed for which they are paid.
:twocents: heres my 2 cents for what it is worth, rather than go by clincial hours how about the number of patients, and diagnosis we see. i know some days i will be at my clinical site for 8 hours, see only 8 patients. but i get credit for 8 hours. some days i see 30 or more. some days less. i dont think it is so much the hours that you spend but the number and type of patients that you see. i know a student in one program, not mine who counts her drive time 45 minutes each way 3 times a week as clinical time. in 16 weeks she has 72 hours of clinical time for driving. and she only has to do 160 hours for her semester. i am allowed one hour to count as clinical for write-ups etc. now that i am almost done, i pick the patient's i want to see, because i need that certain exposure, sometimes my preceptor will hop in and say hey i know this one is only a routine health visit but go see that patient i think you will find it interesting. just my thoughts on that issue.................
:heartbeatthe question is not are they going to let you do it, but who is going to stop me:heartbeat
most if not all pa programs use either a pa or web based program to count patient encounters. it logs patients and included age, medical condition and time in the encounter. do np programs not use these?
No my program only counts the hours =yes I do have to account for the number of patients seen, dx, etc....yes some programs use a web based program as this other student uses. but she still counts the drive time etc. I think it is more important to count acutal patient care time, the numbers you see, etc. Rather than actual hours that you spend twiddling your thumbs. thank god I figured this out early on and make the most of my time in clinic, it is my money and i have a preceptor who makes darn sure I am no wasting time any way my 2 cents again. Yes i could probably slip by and just do the minimum but then again , time is money......
:twocents: heres my 2 cents for what it is worth, rather than go by clincial hours how about the number of patients, and diagnosis we see. i know some days i will be at my clinical site for 8 hours, see only 8 patients. but i get credit for 8 hours. some days i see 30 or more. some days less. i dont think it is so much the hours that you spend but the number and type of patients that you see. i know a student in one program, not mine who counts her drive time 45 minutes each way 3 times a week as clinical time. in 16 weeks she has 72 hours of clinical time for driving. and she only has to do 160 hours for her semester. i am allowed one hour to count as clinical for write-ups etc. now that i am almost done, i pick the patient's i want to see, because i need that certain exposure, sometimes my preceptor will hop in and say hey i know this one is only a routine health visit but go see that patient i think you will find it interesting. just my thoughts on that issue.................
ANPFNPGNP
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