Mid-Level Providers Education Reqs

elkpark · Feb 10, 2014

BTW, people hate the "midlevel provider" term. It was invented by insurance companies.

There are lots of "direct entry" MSN programs that prepare non-nurses to be NPs. They typically take 2-3 years, so lots of people are not spending six years to become NPs, and have little or no clinical experience of any kind when they start school. Certainly no nursing experience, since these programs only take people who aren't already nurses.

There are different requirements because you are talking about two entirely different disciplines (who happen to do much the same thing after they are done with school). What the PA community chooses to require for entry and educational requirements has nothing to do with nursing and does not reflect one way or the other on nurse practitioners.

IMO, yes, you're overreacting. Sounds like you have some kind of issue with your stepmother.

allnurses Guide · Feb 10, 2014

As above re: the term "mid-level". It's has bad connotations for nurses and MA/PAs as well, some people do find it offensive.

As for the education of PAs, much like nursing, there has historically been multiple levels of entry from diploma to masters. PAs receive sufficient education to pass a board exam for competence in entry to practice. The PA programs I am familiar with are quite intensive and PAs receive considerable clinical hours/training at the end of their academic program (class work is from loaded for PAs unlike most NPs).

Advanced Practice Columnist / Guide · Feb 10, 2014

Yes, there are PA programs offered at the Associate's degree level. They are now quite rare, in fact, the two community college programs in my state are on probation. If the program is fully accredited by ARC-PA, then you can trust that the curriculum meets the standards in any other PA program regardless of degree level. The curriculum does not vary in the PA programs, even between degrees and type of school where it is offered.

classicdame, MSN, EdD · Feb 10, 2014

I agree with OP. PA's do not have near enough education in my opinion.

BlueDevil,DNP, DNP, RN · Feb 11, 2014

Generally speaking, I would not be in favor of AD entry levels, but I do think you are over reacting.

"I hope she doesn't get in" is a terrible thing to say. Shame on you. I take it you would not be interested in attending such a program, but why would you actively hope for a negative outcome for someone to whom you are close and presumably love or at least hold in high regard with great affection?

If the program is accredited, I don't have a problem with it. As she is related to you, she cannot ethically treat you; you are off the hook so far as that is concerned and cannot be expected to establish as a patient. Support your loved one.

And never use the pejorative term "midlevel" if you want to be taken seriously.

futureeastcoastNP · Feb 11, 2014

So I had this realization yesterday that is really baffling me, and I wanted to see what others thought of this situation.
In today's requirements, to become an NP you must already hold a BSN (since NP school is a masters level degree) and have a minimum of (usually) two years inpatient acute care experience, with preference going to ICU/ED/etc. work.
My step mom wants to go to a local PA school, great! But...this PA school is the equivalent of a diploma nurse (you have the option of taking a few extra classes and getting your associates degree at the same time). The requirements for admission are basically the same science classes as those to get into nursing school, plus a minimum of 2,000 (two thousand) PAID clinical experience hours in an approved field (CNA does not count, it must be something with assessment and documentation requirements as well as direct patient care such as EMT/Paramedic, LVN/RN, MA, etc.).
I just find it astounding that in less than four years (assuming it takes you about two years of science pre-reqs and 2,000 clinical hours = 1 year full time with 2 weeks off, and two years for PA school itself) a person can become a PA-C, where the "same" "mid-level" NP has a Masters degree and six years of schooling (including way more than just science classes and those required for the "certification").
Wouldn't it make more sense if all of the "mid-level" providers were required to have the same training level? I mean, these PA students aren't even required to take english classes if I remember correctly! Also, how can someone become a "mid-level" provider when they have never really been a "basic" provider in a hospital setting? An MA working in the back of a doctors office will not have the same experience as someone who has worked bedside in acute care, and certainly won't have the assessment skills, etc. as someone who has worked ED/ICU/Tele/etc.
Also, with "magnet" delegations and hospitals always pushing for nurses to have higher degree levels, why are the PA equiv. not being held to the same standards?
Just my little rant! I have nothing against PA schools that are tied to bachelors programs or masters programs, but these "certification/diploma" programs need to go IMO!
Do any of you think I'm over reacting? Anyone have any comments that I may have missed or a side to this that I'm not seeing? What do you think should be the min requirements for a mid level provider program? (This could include NP or PA). Does this PA program sound like they can turn out competent PAs?
I really don't want to be a witch, but I kinda hope my step mom doesn't get in because I see this type of program bringing down the reputation of mid level providers who have actually EARNED that designation! I honestly am not trying to split NP's and PA's, I just want mid level providers to have the same requirements across the board.

The amount of time someone spends on class is irrelevant, it's about the classes and how much they learn. I really don't think you should worry about a PA program being inferior to an NP program - have you compared the curriculums? While NPs may spend more time in school, the vast majority of that time is spent on nursing theory courses. PAs take much more in depth science courses during their curriculum, for example I have yet to see an NP program that offers immunology or gross anatomy, both of which are common in PA programs. In addition, most NP programs have less than half of the clinical hours of PA programs.

I believe both programs create competent providers, but I think clinical hours before school are even less important for PA students because they have, overall, a better curriculum and better and clinical experiences (they don't ever have to go around finding their own preceptors).

finally, where on earth are you getting your minimum of 2 years ICU experience? That's laughable - the vast majority of Np programs require no experience at all. Are you familiar with Vanderbilts direct entry program? A non nurse can go there and walk out 2 years later with both a BSN and NP degree, starting their career with less than 900 clinical hours TOTAL. I envy the PA profession - their leaders have the balls to actually regulate their curriculum, force schools to find preceptors, etc.

zmansc, ASN, RN · Feb 11, 2014

I have worked with providers with all kinds of initials after their names, some good, some great, some not so good. Some are slow others are fast. Some are all business and others are more touchy-feely. Some can be more genuinely empathetic, where others come off stiff as a board. It has very little to do with what is after the name and a lot to do with who they are internally.

I get the most patient complaints about grumpy unhelpful providers for a PA and right behind him is a NP in our ER. The most compassionate provider is a board certified ER MD, who gets the least complaints for his care. Notice I did not say he was the fastest! Best ER provider to have when the **** hits the fan is a former RN who is now a DO. Is it their initials that make them this way? I doubt it, more likely it's the person inside them that makes them act like this.

There are many paths to provider-dom, each has it's strengths and weaknesses. Each will help you get there, but you have to be dedicated enough to not only get there but consistently improve once you get there.

No need to bash PAs in general or this program specifically as others have said, if it's accredited then I'd expect the PAs from there to be good. I will say though that what you describe is far from what I've seen, and I reviewed many PA programs before I choose this path, so my guess is there are requirements you are either not seeing or miss-informed on.

wheeliesurfer · Feb 13, 2014

Firstly, please excuse my faux pas with the ML wording. In a previous life I was a MA who was a referrals coordinator/billing & coding specialist for an internal medicine/pediatrics physician. I became accustomed to the term then, and our NP's had no problem with the phrase, so prior to being corrected on this board I had not known that the term was "foul".

I know exactly what goes into the program that my step mother is trying to get into, as at one point in time before deciding to pursue nursing instead, I was going to apply to this program. I have seen PA's previously who have graduated from this particular program (several, not just one), and have not liked the knowledge base that they gained. I usually had to see the MD/DO instead to get my needs taken care of. If she doesn't get into the PA program here this year, then she will apply to a different school in another state after her child graduates and she leaves the state. Where they will be living, there are no PA programs that are degree programs, only masters level.

While you all argue that there are many entry points for NP school as well, I have yet to see/hear of a community college based, no diploma issued NP program. Even the program through Vanderbuilt that a pp mentioned, you leave school having earned your masters degree. To me, if I am going to see an advanced practice provider (better term?) that is just under the level of a doctor in practice capabilities, I want them to have an advanced degree like that of NP's. They will have had college level english classes, math classes (not that the CC program doesn't require math), and all that comes along with obtaining a bachelors and masters degree including research papers, a senior capstone or practicum/thesis, etc.

It has nothing to do with HER, and everything to do with the program requirements and my view that an advanced practitioner should hold an advanced degree.

I am not working currently due to a long term disability, and have subsequently had to change my care from the suburban area where I live to the major city about an hour from me since I am now more of a zebra than a horse, and must be seen at a highly regarded teaching hospital/level 1 trauma center. I am hoping one day to get a job in that hospital system, either bedside (if I am physically capable of that type of work again) or in research.

Juan de la cruz, can I ask why the two PA schools through community colleges in CA are on probation now?

elkpark · Feb 13, 2014

While you all argue that there are many entry points for NP school as well, I have yet to see/hear of a community college based, no diploma issued NP program. Even the program through Vanderbuilt that a pp mentioned, you leave school having earned your masters degree. To me, if I am going to see an advanced practice provider (better term?) that is just under the level of a doctor in practice capabilities, I want them to have an advanced degree like that of NP's. They will have had college level english classes, math classes (not that the CC program doesn't require math), and all that comes along with obtaining a bachelors and masters degree including research papers, a senior capstone or practicum/thesis, etc.
It has nothing to do with HER, and everything to do with the program requirements and my view that an advanced practitioner should hold an advanced degree.

Actually, NP programs started out as "certificate" programs that did not award degrees, and turned out perfectly competent and capable clinicians. Over time, as other healthcare provider programs were upgrading their requirements and credentials, it was felt that the programs needed to award degrees, and, slowly, over time, programs converted to MSN programs. CA was the last hold-out and, as recently as within the last decade, still had some certificate NP programs (heck, they may still have some today -- I haven't checked lately). Because of the national certifying organizations' rules, graduates of those programs can only work in CA, and can't get licensed in any other state -- however, no one has ever suggested that they are less prepared or competent as NPs. The PA model was "invented" significantly later than the NP model, and their development is on a different timeline. They are now at the point that NPs were a few decades ago -- many programs are now graduate-degree programs, but there are still some CC programs "out there." It doesn't mean they are less adequately prepared to enter practice. Shoot, there is a lot more consistency across PA curricula than there is across NP programs, as many threads on this site discuss.

You're certainly entitled to your opinion that advanced practitioners "should" hold an advanced degree, but there isn't really any hard evidence to back your position.