NP with no experience vs. PA with no experience

kanzi monkey · May 1, 2009

The direct entry NP program at my school doesn't require any healthcare experience at all. It DOES require working as an RN for at least 9 months before completing the master's level. The PA program requires healthcare experience prior to entering the program (though I'm not sure what qualifies specifically since I went the NP route). I don't think it's common for a PA or an NP to start practicing in the provider role without any healthcare experience. NPs will obviously usually work as an RN for awhile.

Does anyone know what type of work a PA usually does before taking on the PA role?

core0 · May 1, 2009

The direct entry NP program at my school doesn't require any healthcare experience at all. It DOES require working as an RN for at least 9 months before completing the master's level. The PA program requires healthcare experience prior to entering the program (though I'm not sure what qualifies specifically since I went the NP route). I don't think it's common for a PA or an NP to start practicing in the provider role without any healthcare experience. NPs will obviously usually work as an RN for awhile.
Does anyone know what type of work a PA usually does before taking on the PA role?

Programs vary widely in what type of medical experience that they will accept. The Duke program published a snapshot of their program two years ago. On page seven they compare types of medical experience:

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/25449

This is pretty representative. MAs and EMTs probably make up the majority of prior health care experience. Military medics were initially the majority of matriculants but are a much smaller percentage now. Nursing remains steady at 5-10%.

To the OP, medical experience requirements vary widely by program. Around 1/3 of the programs require medical experience, 1/3 encourage it, and one third do not address it. Even with that the average student has around 3 years of direct or health care related experience. Within programs that require health care experience (HCE) the requirements vary from more than 2000 hours of paid direct patient care to 100 hours of paid or volunteer experience. For information on PA applicants:

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/25459

The programs that do not require health care experience are statistically longer than programs that do require health care experience. Most if not all programs discount HCE as direct experience for PA programs. I'm not aware of any program that gives advanced credit for previous coursework. For example the pharmacist in our class still had to take pharmacology. This largely reflects the diversity of backgrounds that PA students bring. By teaching every student to the same standard they may duplicate educational experience but they ensure that the standard is met. The difference between HCE programs and non HCE programs is largely based on geography and the programs experience. Programs that value HCE think that it allows the student to participate in the health care environment quicker, programs that don't value HCE don't think that this is the case.

Remember that on the average PA students will have 1400 didactic hours and 2100 clinical hours. Non HCE programs average 2200 clinical hours and 1600 didactic hours. They are also more likely to place students in clinical situations in their didactic year.

David Carpenter, PA-C

sunshine0509 · May 1, 2009

Thanks for your detailed response.

Mid-level practitioner graduate programs were very popular for my graduating class this year. Lots doing direct entry NP or PA school.

Most of my classmates who got into PA school were either PT aides, nursing majors or volunteered. I can think of one that was a school EMT. Schools I can think of that they are attending are PCOM, Philadelphia U and Arcadia.

So I am still curious is it true these new graduate PA's will be able to receive jobs but a new graduate NP will have to work as a RN? And if so why?

core0 · May 2, 2009

Thanks for your detailed response.
Mid-level practitioner graduate programs were very popular for my graduating class this year. Lots doing direct entry NP or PA school.
Most of my classmates who got into PA school were either PT aides, nursing majors or volunteered. I can think of one that was a school EMT. Schools I can think of that they are attending are PCOM, Philadelphia U and Arcadia.
So I am still curious is it true these new graduate PA's will be able to receive jobs but a new graduate NP will have to work as a RN? And if so why?

My experience is limited but there are two reasons that I see. Speaking strictly of new grads, the first is that nurses tend to evaluate NPs on their nursing experience. The hours in NP school are limited and non-standard so its hard to evaluate the NP education. They tend to fall back on the nursing experience. On the other hand PAs tend to largely discount previous experience and concentrate on the quality and depth of the clinical rotations.

The other is the difference in the salaries. Someone going from an MA position to a PA position will have an obvious increase in salary. On the other hand the difference between a nursing salary and a new grad NP salary may not be that much. In both the markets I've worked as a PA none of organizations I worked with would hire DE NPs. Interesting the organization I work for now will not hire NPs without two years of full time work as an RN (despite having a DE program). The nurse managers really disparage these programs.

The other issue that I see is skill perishability. If you go work as an RN for two years to get experience what happens to the NP skills. We had an application from someone that had graduated from NP school five years ago and hadn't ever worked as an NP. The application didn't get very far.

YMMV on this. There have been posts here about new grad DE NPs getting plenty of job offers. Hasn't been my experience. In my last job you could throw a rock through the ICU and hit 5 NPs working as RNs for a variety of reasons.

David Carpenter, PA-C

westcoastgirl · May 10, 2009

The nurse managers really disparage these programs

that may sadly be part of the problem right there. In my personal experience, newly graduated PAs seem better prepared with procedures as another poster had said in some other thread, we wasted time in our programs in nursing theory classes and on master's thesis.

I have encouraged our MAs to apply to both PA and NP programs based on what they want to do, can afford etc. For me personally I have additional skills that would fit well with an administrator type of job some time in the future, and I saw that many of those positions here on the west coast going to RNs and NPs.

If I knew I wanted to go work in Ortho (or some other procedure heavy specialty) I would have applied to PA school.

danceluver · Sep 14, 2010

I am interested to know if anyone else has opinions about this? I am currently in the same position and deciding whether or not to go PA or DE NP programs? Has the market changed much during this past year? Quality of clinical hours for NP programs-specifically things like WHNP or PNP? OP what did you eventually decide to do?

allnurses Guide · Sep 15, 2010

I graduated from a DE NP program in 2009, have never worked as an RN, and had no trouble getting an NP job. I've been working for a little over a year now and have had no trouble performing my job. I had a lot of healthcare experience in another field, which I think has definitely helped me, but there were others in my class that had little to no previous health care experience and are doing just fine as NPs. At the time I graduated, there was no demand for RNs in my area, but a high demand for NPs. I'm not sure if that's changed now, as I haven't been job hunting. My DE program was extremely rigorous, and I took it upon myself to do more clinical hours than what was required, just for my own edification. My experience is that you have to be very much of a self starter to succeed in a DE program and as a new NP. You're not going to learn everything you need in school and clinicals, so you have to make the effort to do a lot of learning on your own. I still study a lot, and probably always will. I can't speak to the advantages of becoming a PA over an NP, as I never really looked into PA programs. I would recommend meeting with faculty/staff at schools for both of these prgrams, and see which one you're better suited for. Good luck!!

danceluver · Sep 15, 2010

HI,

Thanks for the reply. May I ask where you currently reside that it was no problem getting a job as an NP? I guess it may be region specific? But that sounds fantastic! I am assuming you went to Boston College for your NP program? What i have heard is that networking during clinicals is what really helps, true? What sort of HCE experience prior did you have?

allnurses Guide · Sep 15, 2010

I live in the Greater Boston area. None of my FNP classmates had any trouble getting jobs when we graduated. The timing was perfect; MA had recently mandated health care coverage for all residents and practices were hiring NPs to help alleviate the primary care provider shortfall. My health center just hired 3 new Boston College grads this summer (yes, I went there, too). One of them had done her clinical at my health center and she recommended 2 classmates for our other open positions. Clinicals are a great way to network for jobs. I had one job offer from one of my clinical sites, but it really wasn't what I wanted. My previous health care experience is in laboratory medicine-lots of years in the clinical, research, and administrative aspects.

ImThatGuy, BSN, RN · Sep 18, 2010

I'd go with PA if you're wanting an entry-level, midlevel career. One definite perk about the field is that you don't enter into any one specific specialty.