I'm very interested in becoming an NP soon (FNP or PMHNP), but I want to go to a very rigorous program. I'm very concerned with always providing the best care for my patients and so I want to go to a program where I will learn the most. It seems a lot of "diploma mill" type schools have opened for NPs, and I need help weeding them out!
I look through a few curriculums for NP programs and I'm kind of worried I won't learn enough. I see a lot of "fluff" classes on nursing theory/public health type things - and while these are definitely important, I feel that most of the NP program I've found just don't have enough strong science courses. I want to really work hard, take a lot of deep courses on diagnosis, pathophysiology, pharmacology, immunology, etc. Anyone go to a program like that?
Regardless of your program, do you feel you graduated with a very sound knowledge of how to diagnose and treat most patients on day one or did you feel completely lost?
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
It always surprises me when the whole "PAs get more training" topic comes up. PA schools have more hours because their scope of practice is wider. PAs are generalists and NPs specialize. Also, their training is absolutely not superior in every circumstance. A psych NP, for example, receives far more psych training than a PA. I'd rather see a CNM for OB care than a PA, as well. It's a different educational approach and one isn't necessarily better than the other.
I like your answer. This is really what's different with NP training and the reason why we're calling it Advanced Practice Registered Nursing. We already have the generalized education, across the lifespan blah blah blah during the RN component of our programs. Regardless of whether it's a direct entry program or a traditional NP program, that RN component doesn't change. As NP's we have our own specialty foci in our training. It is what it is like I always say.
Does this model put us at a disadvantage in terms of market forces in employment trends where a provider with a generalized training and greater degree of flexibility is required? maybe. Personally, I've never run across that issue because one, I know what kind of practice I enjoy (Adult Acute Care) and two, I never had issues finding a job in the specialty I love (Critical Care).
Those who are "undecided", "I don't know if I want to work in the hospital all my life", "I'm not sure what kind of job I want as a provider" should seriously consider the PA route for the flexibility it offers. That is a perfectly reasonable decision in my opinion.
I've spoken with some PAs who are concerned that the ease of changing specialties may diminish in the future, as PA residencies and specialized training (including certification exams) become more and more commonplace. Things will be interesting in the future for both fields, imo.
Lot's of variables here but in the military PA program students have a 3 week block of observing, yes observing, psych providers. One of my work buddies was a PA before going back to school for her NP. She's considering trying to set up some type of more formal training for the PAs. In contrast the FNP's at the NP school I went to had to take a separate psychopharm course as well as a course in psychopathology which was great considering so many primary care patients have mental health problems.
Indeed, lots of variables. I'd venture to guess that those are the [very rare] exception rather than the norm. A glance at the curriculum at few PA programs shows that they all include didactic coursework in behavioral medicine and/or psychiatry, psychopharmacology included in the pharm courses (which is the same in the vast majority of NP programs I've seen), and a 4-5 week rotation in psychiatry, with objectives clearly demonstrating that the student must learns how to function as a provider on that service (i.e. diagnosing and managing psychiatric patients), and not merely observe. While certainly not approaching the didactic and clinical specialized focus of psych NP programs, I think it's safe to say that the average PA program provides a solid introduction to psychiatry to allow them to practice, obviously with close mentorship until competency is demonstrated (as is the case with any new grad clinician). Heck, the psych units at my hospital in NYC are staffed by PAs, I'm sure as competently as those staffed by NPs elsewhere.
I've spoken with some PAs who are concerned that the ease of changing specialties may diminish in the future, as PA residencies and specialized training (including certification exams) become more and more commonplace. Things will be interesting in the future for both fields, imo.
I agree (this very topic is being discussed at PA Forum). It seems that as time passes, there are more PA residencies, and more CAQs (specialty Certificate of Added Qualifications. They have exams in cardiothoracic surgery, emergency medicine, hospital medicine, nephrology, orthopedic surgery, pediatrics, and psychiatry). While the generalist PA education would allow them to enter into any specialty in theory, it seems like jobs in certain specialties will look for candidates with experience in that specialty already. There definitely will be further exciting developments for both the NP and PA professions in the near future. Here in NY, there's a push for independent practice with the NP Modernization Act, which would allow NPs with greater than 3 years or 3600 hours of professional experience to be independent providers (those below the threshold would still need collaborating physicians. Essentially an on the job residency, if you will), and that's pretty exciting.
I just want to add that I was in no way trying to imply that PAs do not work in psych or that they're not competent to work in psych (especially after being trained up). I was merely attempting to point out that psych NPs focus is entirely psych (well the basics of physical health + psych) and it is more in depth (including psychotherapy training, multiple psychopharm and psych assessment courses, etc.), so broad statements like "PAs get a better education" don't really make sense when you consider the variation among the professions. Though I personally find that among midlevels (hate that term), I see far more NPs working in psych than PAs. Anyway, I think both the NP path and PA path are great and I hope to see more collaboration between the two professions in the future.
Many of the educational paths are "Evolving" and changing. PA schools used to primarily be for Military Medics coming out of service, a place for them to use their skills and advance their education to provide primary care in much needed shortage areas. Now, many accept just about anybody with a few weeks of CNA experience and good grades. Is their education more rigorous? I still think it is school specific and how much a student is engaged and learning and reading. Nothing stops anybody from picking up a clinical medicine book if they want more knowledge. Are they better prepared to hit the ground running? Again, I think it just really depends. There are good and bad in every profession, I've had MDs that I wouldn't trust ever again. But they made it through medical school. I think the constant comparing and bashing of other professions is ego driven and pathetic. Get out there and read and learn and grow ... it's about the patient it's not a ******* contest.
A brick and mortar school may not necessarily be superior. Washington State University offers an FNP at a brick and mortar class, but most classes can be taken on-line. You must arrange your own clinical rotations, and this comes with several problems. Locally, NP students compete with MD and PA students for preceptors, and the MD and PA schools arrange the experiences for their students. The preceptors are not paid for the time spent with the student so they have no incentive to interrupt their busy practice to mentor a student. The NP students are left begging for preceptors, some of whom back out at the last minute, leave the student high and dry.
WSU has also had financial difficulties in the past several years. Two years ago, the Washington governor severely cut money to the universities, and as such the faculty had to take an across the board pay cut of 10%. The tuition has increased over $300 a credit in just 18 months. The program hemorrhaged professors until it is almost impossible to tell who actually is a professor for the program.
WSU has a doctorate in Pharmacy, but the NP pharmacology course is taught by an NP. I actually quit the class because rigorous pharmacology was not taught and I felt it I would be unsafe to prescribe when I hit clinicals. The course was taught from the following perspective: here is the disease, here is how to diagnose the disease, and here is the drug to prescribe. This is not anything that cannot be looked up in Epocrates, and in no way is sufficient for a practitioner who must understand the interaction of medications at a cellular level.
In addition, the school didn't want to pay for models when it came to pelvic exams or prostate checks. The instructor herself was the model for the speculum exams - ARGH. Huge breach of professional boundaries. And the prostate check model was a hard plastic dummy. There was a posting by the PA school on the nursing school board looking for models for both exams, and the PA school would pay $50 for 5 exams.
I have withdrawn from this less than acceptable school and have been accepted to another highly rated program, where the school arranges the clinical rotations. Since I begin in the fall, I cannot comment on the quality of their education but will be happy to do so after I have completed a few terms.
On the subject of DNP - OHSU's DNP program is one additional year. It is not fluff classes, but nine months of clinical residency and a clinical inquiry project (thesis).
Corey Narry, MSN, RN, NP
8 Articles; 4,475 Posts
I like your answer. This is really what's different with NP training and the reason why we're calling it Advanced Practice Registered Nursing. We already have the generalized education, across the lifespan blah blah blah during the RN component of our programs. Regardless of whether it's a direct entry program or a traditional NP program, that RN component doesn't change. As NP's we have our own specialty foci in our training. It is what it is like I always say.
Does this model put us at a disadvantage in terms of market forces in employment trends where a provider with a generalized training and greater degree of flexibility is required? maybe. Personally, I've never run across that issue because one, I know what kind of practice I enjoy (Adult Acute Care) and two, I never had issues finding a job in the specialty I love (Critical Care).
Those who are "undecided", "I don't know if I want to work in the hospital all my life", "I'm not sure what kind of job I want as a provider" should seriously consider the PA route for the flexibility it offers. That is a perfectly reasonable decision in my opinion.