Direct Entry GRADUATE NPs

core0 · Feb 23, 2008

Just to stir things up a little more this was discussed on the PA forum:

http://www.advancedpracticejobs.com/ClinicalConcepts/index.php

I find this at odds with my experience and the experience of Ms. Flinter in her discussion of the NP residency. Having trained PAs in a new job it takes a new grad PA about 6-12 months to get comfortable depending on their background and the setting. It takes an experienced PA 2-6 months to get comfortable depending on their background and the setting. I don't see how this will help, but its probably a symptom of either practices not having enough time to mentor new employees and new grads not having confidence in their skills.

David Carpenter, PA-C

jjjoy, LPN · Feb 23, 2008

As you increase the number of slots for such programs (direct-entry mid-level provider programs) and as such programs become more well-known and as interest in such positions grow (perceived strong, stable income in a respected role with "only" 2-3 of formal training (compared to MDs with their well-known average 6+ years to practice) and as the demand for mid-levels grows (cost-effectiveness), you'll start to get a wider spectrum of students applying for such programs and being accepted. These students not only tend to have less previous health care experience but they also may not be as strongly self-directed as the traditional NP/PA student in regard to taking on health care roles. After all, the traditional NP/PA student either had health care experience or was especially motivated to find their way into a mid-level program when they weren't so well-known. They knew they were exceptions to the norm and knew they'd have to work extra hard to prove themselves.

But now, not having related health care experience isn't so unusual. The applicants, then, expect the training program to thoroughly prepare them... after all, the schools wouldn't allow inexperienced folks to apply if their program weren't geared towards inexperieced students, right? Such programs wouldn't be allowed to exist if they didn't prepare the students well enough, right? But it is a relatively new thing to have such a large percentage of inexperienced students graduating. There may have always been a few programs around like that or a few students allowed in, but they were the exception. So we don't yet know how these changes will play out. The fact that a service like Clinical Concepts was developed seems to reflect a new need in health personnel training.

The difficulty of such transitions probably also reflects the demands of today's health care environment itself. The ever present demand to cut costs means a push for mid-levels in a capacity that they haven't been used before. So there is no training mechanism already in place to deal with the increased usage of mid-levels. Add to that the general health care wide issue of stretching staff more and more, leaving less time for training (preceptors) and learning (new grads).

Miss Mab · Feb 25, 2008

/
I will reply to this as I don't think that it is completely accurate:
PA programs have always been divided roughly between those that require experience and those that don't. Currently the PA programs are roughly divided into thirds with 1/3 requiring experience, 1/3 recommending experience and 1/3 with no experience requirements.
David Carpenter, PA-C

Oh, I do apologize as clearly I was incorrect.

I wasn't aware that historically 2/3 of PA programs do not require any patient care experience. I mistakenly thought this was a new trend.

My bad,

Miss Mab

boston-kevin · Feb 25, 2008

butch228,

Thanks for all the details. I really appreciate it. The reason I tried to revive this topic is that I've noticed a few MGH grads that have been working as floor nurses for quite some time and have not been able to secure NP jobs. (I haven't questioned them ad nauseum about why they haven't gotten one, so I shouldn't guess) but one of them said she was told she didn't have enough experience. She was pretty young and started the direct entry right after undergraduate. Her current job was pretty reluctant to hire her (although they did) because they didn't want to train her and then she'd leave a year later possibly for an NP job.

Anyway, I felt that a structured residency (not required, but for those who want one) would be a great way to enhance clinical knowledge. I just figured in a traditional residency, someone is really looking out for your education rather than on-the-job oversight and if things get busy your mentor/boss/colleague won't have all the time to spend with you as you'd like.

Personally, I think if people want to work as an RN after graduation, that's fine as I'm sure it will provide great experience. You do learn a lot by spending so much time at the bedside seeing how diseases/problems progress through the lifecycle. But since the program claims to graduate you as a full-fledged NP, one should be able to secure such a job after graduation. If not, I feel the program needs to fill whatever experience gap there is so one can obtain that NP job.

Now that the MSN programs for NPs will come to an end as of 2015, I don't know how that will affect things, but from the looks of the MGH curriculum, it doesn't seem like they are adding a ton more clinical exposure for the MSN to DNP bridge program.

Thanks again for all the info!

boston-kevin · Feb 25, 2008

Miss Mab,

Thanks for adding to the conversation. I know for the MGH direct entry program direct patient experience isn't necessary but many had some sort of patient-care experience. I think PA programs run the gamut, but when I looked at those, most had a decent requirement of DIRECT patient experience (1,000 hours or more). To my knowledge a traditional "residency" type program doesn't exist for PAs either.

As for mid-level education, the MSN degree for NPs will come to an end as of 2015. NPs will be required to get DNP degrees. I haven't heard that there will be a residency type program for the new DNP graduates either.

I personally think they could be useful for those who want such an experience and I hope the government realizes they could be useful and start implementing them.

boston-kevin · Feb 25, 2008

Kensington,

To my knowledge there are no NP residency programs. I am hoping to start one locally with the MGH and their program.

If anyone out there knows of one, please share the info!!

Thanks!

boston-kevin · Feb 26, 2008

David,

I must say you always seem to have great information. The link to the article about NP residencies was great. I have been searching OVID for research about RN-to-NP vs. direct NP graduates and differences in experience and the possible need for "residency" programs for the direct entry people.

As I have said in other earlier replies in this thread, I am trying to get something started at MGH here in Boston but if these residency programs won't have federal (or at least state) money attached, they might be a hard sell as some practices financial margins are razor thin.

Thanks for providing that link.

On the note of that other training program you found, it seems a little sketchy to me. It seems one would have to pay them for the program. Sort of a "fee for service" type arrangement. I wonder if they are accredited by any educational organization. I'd almost be willing to pay an extra year of tuition if someone were willing to work closely with me while I get up-to-speed.

Thanks again for all the useful info!

core0 · Feb 26, 2008

david,
i must say you always seem to have great information. the link to the article about np residencies was great. i have been searching ovid for research about rn-to-np vs. direct np graduates and differences in experience and the possible need for "residency" programs for the direct entry people.
as i have said in other earlier replies in this thread, i am trying to get something started at mgh here in boston but if these residency programs won't have federal (or at least state) money attached, they might be a hard sell as some practices financial margins are razor thin.
to answer your above question there are pa residencies (or as they prefer post graduate programs). there are currently 41 programs producing about 110 graduates per year. to attend the program you have to be licensed so the program can bill for the pa. this means that surgical programs are probably a money maker for the hospital (for the most part). most pay less than 1/2 the normal starting salary to "compensate" for the loss of productivity.
further information can be found here:
http://www.appap.org/prog_specialty.html
this was somewhat controversial within the pa profession and there was a lot of debate on whether to recognize these programs. the arc-pa made the decision to credential them to provide consistency and student protection.
all of them are in specialty medicine, usually in areas where the pa is above the average. for primary care for pas at least there is ample opportunity to get experience in critical need areas. there are a number of programs that get extra money on condition that they train a certain number of pas to work in underserved areas. other programs require the students to work at least one rotation in an underserved area.
thanks for providing that link.
on the note of that other training program you found, it seems a little sketchy to me. it seems one would have to pay them for the program. sort of a "fee for service" type arrangement. i wonder if they are accredited by any educational organization. i'd almost be willing to pay an extra year of tuition if someone were willing to work closely with me while i get up-to-speed.
thanks again for all the useful info!

i would agree that the program seems sketchy. i don't see the utility. but there are always players on the margins that take advantage of insecurity. we'll have to see where it goes.

i will keep looking for the article on residency. i think it was in one of the aanp smart briefs. from what i remembered the author (who i think was the same one as the article) had cobbled money together mostly from the state with some federal grant money to fund the residency. one argument that you could make for a residency is simply increase the school hours if the school is not producing the desired product. while the certification programs state the minimum hours for certification there is nothing that say a program cannot exceed that (and there are a few that do).

another way to fund it would be to get acgme money. one of the proposals in aanp last year was to take some of the residency money that currently goes to imgs and use it to fund a pa residency. on the surface i find this fairly unrealistic.

david carpenter, pa-c