NP's and docs

I have read a LOT of distain from doctors and medical students when it comes to the NP profession. I'm not sure what kind of graduate program I want to do yet but I am worried about NP because I hear a lot of docs complaining about the NP. It ranges from thinking they lack training, to vowing never to hire them and "hating" them. I was wondering if you see this in clinical practice?

Thanks

I will start by saying that I am not an NP. Hate is a strong word! The two issues that I see docs having problems with NP's on are

1. Independence- most docs think that the idea of someone being ready to practice independently after a BSN, 1 year of classroom, and 400 hours of clinical rotations is preposterous. Most people believe this, but the ANA still fights this loosing battle.

2. Eduation- There is a lack of educational standard in the NP profession. You can find NP programs ranging from 9 months to 2 years, with varying amounts of clinical experience, none more than 600 hours that I have seen.

Physicians have at least 1 year of full time rotations as a senior medical student along with at least 3 years of residency. PA's have at least 2000 hours of clinical rotations.

I haven't heard any docs say they hate NP's. I have heard the word "adversarial" from my boss. He used collegial in the same conversation when referring to PA's. I am not trying to flame, just giving my opinion on the problem that Mikey has seen. It is a valid one.

Hope this helps,

Pat

2. Eduation- There is a lack of educational standard in the NP profession. You can find NP programs ranging from 9 months to 2 years, with varying amounts of clinical experience, none more than 600 hours that I have seen.

Physicians have at least 1 year of full time rotations as a senior medical student along with at least 3 years of residency. PA's have at least 2000 hours of clinical rotations.

A couple of comments on this. By and large, the NP education requirements ARE standardized at the Masters level (there is a push to go to the doctorate, but whether it happens remains to be seen). Nowhere outside of California (that I am aware) will you find a 9-month certificate program to be a nurse practitioner. The certificate NP is only good in CA - if the person moves to another state, they can no longer practice as an NP.

The 600 hours is a minimum requirement in many specialties, certainly not a maximum.

PAs are not experienced practitioners when they enter their programs. RNs already have MANY logged hours of clinical experience by the time they enter their NP programs. Most of them are already experienced nurses (many programs are beginning to require experience to enter), but even if they are not, they have clinicals in their RN programs. Theoretically, a PA student could enter a program with no clinical experience (not a PA, never applied to a PA program, so cannot attest to how feasible that really is.)

A couple of comments on this. By and large, the NP education requirements ARE standardized at the Masters level (there is a push to go to the doctorate, but whether it happens remains to be seen). Nowhere outside of California (that I am aware) will you find a 9-month certificate program to be a nurse practitioner. The certificate NP is only good in CA - if the person moves to another state, they can no longer practice as an NP.

The 600 hours is a minimum requirement in many specialties, certainly not a maximum.

PAs are not experienced practitioners when they enter their programs. RNs already have MANY logged hours of clinical experience by the time they enter their NP programs. Most of them are already experienced nurses (many programs are beginning to require experience to enter), but even if they are not, they have clinicals in their RN programs. Theoretically, a PA student could enter a program with no clinical experience (not a PA, never applied to a PA program, so cannot attest to how feasible that really is.)

OK. So the number of clinical hours is standardized? I see that Duke offers about 600 hours of clinical time, which is the most I have seen, and is also from quite a reputable school, for both NP's and PA's. The PA program at the same school offers 2000+ hours. The local schools around my area offer about 400 total, which is where I made my reference to.

Glad to hear that 9 month program is not the norm!

Being an experienced nurse gives you exellent experience on how to care for patients. I was an RN prior to going to PA school, as I have said before. being an RN is a great start, but does not give someone the experience needed to "shortcut" the clinical experience in the practitioner role. As an RN, you learn how to take and carry out orders, of course insuring that they sound OK and will not harm the patient. You (We) were not taught how to recognize the nuances of different disease processes, or how to work up and treat these illnesses. Making these decisions is big time, and requires significant training. It is NOT like being an RN. So, as an RN who has completed PA training and have been out about 5 years, I still don't buy that "experienced nurses need less training". Most nurses don't buy it either.

As for PA admission requirements. PA's are generally experienced upon coming into the program, some are even nurses (like me :) ) You are correct that "theoretically" a person can get into a PA program without experience. It does happen some, but in my opinion, shouldn't. I am totally against that, as it is against what the PA profession was started for. It was started to take highly experienced people, and move them into a clinician role. In reality, most PA students come in with a bachelor's degree and some pertinant clinical experience. RT, PT, OT, pharmacist, RN, ENT, paramedic are some that come to mind. Think about this.... There are about 500+ applicants every year to the program I graduated from, for 30 spots. A few of those don't make it through the hardcore science cirriculum in the first year. What I am saying, is that the admission people at the PA schools have a lot of people to pick from. It is highly competitive and usually ends up selecting the people with degrees and experience.

Hope this helps,

Pat, RN, PA-C

I don't know too much about a lot of other NP programs, but the one I will be starting is completed in 2 years(including summers) if you go full-time and 3 years(including summers) if you go part-time. The total number of hands-on clinical hours at practicum sites is 770. In order to get accepted, you needed at least one year of clinical experience as an RN.

I have read a LOT of distain from doctors and medical students when it comes to the NP profession. I'm not sure what kind of graduate program I want to do yet but I am worried about NP because I hear a lot of docs complaining about the NP. It ranges from thinking they lack training, to vowing never to hire them and "hating" them. I was wondering if you see this in clinical practice?

Thanks

They'll grow out of the turf war thoughts. As soon as they realize they can be off more often and make more money if they have a good NP working with them then they'll welcome good NPs. The med students haven't had a chance to realize this yet so most of them will have this opinion. I am a NP and in the midwest we are welcomed as most of the docs out here in rural area are spread thin and welcome the help. As long as you know your limitations and when to ask for help or refer it is really arbitrary how much education and experience you have. Of course, the more ed/exp you have the less you'll have to ask/refer, but knowing where that knowledge limitation is is most important.

I have read a LOT of distain from doctors and medical students when it comes to the NP profession. I'm not sure what kind of graduate program I want to do yet but I am worried about NP because I hear a lot of docs complaining about the NP. It ranges from thinking they lack training, to vowing never to hire them and "hating" them. I was wondering if you see this in clinical practice?

Thanks

Ask these same people what they think of PA's?

If they say the same thing, then they have a God complex.

If they say they like PA's, I would guess it is one of the two things I listed in my previous post.

Pat

You (We) were not taught how to recognize the nuances of different disease processes, or how to work up and treat these illnesses. Making these decisions is big time, and requires significant training. It is NOT like being an RN. So, as an RN who has completed PA training and have been out about 5 years, I still don't buy that "experienced nurses need less training". Most nurses don't buy it either.

Pat, RN, PA-C

I am a FNP and totally agree. I went into FNP knowing that I would be disappointed in the training (although it was much worse than I expected). I did it because of the lobby power and the law differences as I want to do my own thing ASAP and in my state right now, FNPs can and PAs can't without a doc. Actually, I just want to figure out how to make a whole lot of money and work much less. )

I have lived in many regions of the country. It really seems to be a regional thing. I have been at institutions that lean toward pa's and others that lean toward np's. I think that alot of it is not that all of the physicians have worked with one or the other but alot of talk. It also seems to matter what programs are around in the region. The pa program in montana was not as highly thought of as getting your np. One whole group of surgeons got rid of their pa's never to go back because of one person and a bad experience, which is ignorant because you have good and bad in any profession. The cardiology group in the same clinic had one for every provider but most were np's a few pa's. Not very forgiving either way but seem to be based on alot of ancedotal stories.

I have lived in many regions of the country. It really seems to be a regional thing. I have been at institutions that lean toward pa's and others that lean toward np's. I think that alot of it is not that all of the physicians have worked with one or the other but alot of talk. It also seems to matter what programs are around in the region. The pa program in montana was not as highly thought of as getting your np. One whole group of surgeons got rid of their pa's never to go back because of one person and a bad experience, which is ignorant because you have good and bad in any profession. The cardiology group in the same clinic had one for every provider but most were np's a few pa's. Not very forgiving either way but seem to be based on alot of ancedotal stories.

I agree with everything you said here. A lot of it is just what the docs have experience with, bad or good.

Pat

I work in a busy rural ED, which takes second year PA students for a clinical rotation. These students considered themselves quasi MD's because they take the same level classes for their general education. Most of them are cocky and lack clinical knowledge because they have never worked with patients before. Thus, they run around the ED with their palm computers looking for information and are most of the time in the way. I am a second year NP student with 20+ years in the clinical arena. I have talked to many of these students and it seems they are taught from the start in school to disdain and question the ability of NP's to care for patients independently. Hence, they have the same opinion posted before about the NP's level of education.

There are three of us, RN's, finishing MSN/FNP degrees at the same time working for this agency. Thus, the nursing managers fully support us. However, I haven't seen any support coming from medicine. I guess there is no easing of the segregation of NP's and PA's, but the bottom line is that they are both midlevel providers.

I work in a busy rural ED, which takes second year PA students for a clinical rotation. These students considered themselves quasi MD's because they take the same level classes for their general education. Most of them are cocky and lack clinical knowledge because they have never worked with patients before.

I am sorry to hear about this and am embarrassed that these people will be entering my profession. This is most certainly not the norm. I also precept PA students and have never seen that. You will hear stories similar to this from people who train both NP's and PA's.

My advice is to "set them up" to look foolish in front of a few attendings, obviously not to compromise patient care. Sounds like they need to be put in their place.

Pat

I have never worked with MD's who profess to 'hate' NP's. If this was the norm there would be many fewer NP's in both the US and Canada. In fact the numbers of NP's continues to grow. In my experience when you truly come down to it, it amounts to a turf war. MD's never complained when NP's were found mainly in rural or remote settings or in areas that the docs themselves did not want to practice, now that NP's can be found just about everywhere including some areas and specialties that can be more lucrative they are much more vocally anti-NP.