PA curriculum

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I received this from a friend. I am both envious and ashamed. Imagine no nursing theory, no leadership, no population health, no information systems, no 3 credit course on ethics? No 250-500 hours reported as clinical when in fact they are not clinical hours but are spent working on a paper.

[h=3]Courses[/h]

Honestly, if I wanted to practice in any primary care/family med/outpatient capacity, I would have gone PA.

The NP specialty tracks, however, I think, produce better providers in those specialties (psych, acute care, peds, psych, OB, etc).

PAs are trained as generalists, so they don't have the focused training that those NPs do in those specific specialties (I've seen it first hand - PA programs do not prepare their graduates to practice in ICU, psych, OB, etc). But their education is FAR more in depth than a FNP's, so in comparing those two PA>>>>FNP.

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Specializes in ICU + Infection Prevention.
No 250-500 hours reported as clinical when in fact they are not clinical hours but are spent working on a paper.

WTF is is this deceitfulness real?

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Oh it's very true. My program has about 1500 clinical hours required. 1200 are meaningful. Wonderful learning experiences with an MD or NP in all kind of environments. However, the last three hundred hours are allotted to the CAPSTONE which is indeed a glorified term paper.

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Specializes in CVICU, MICU, Burn ICU.
Oh it's very true. My program has about 1500 clinical hours required. 1200 are meaningful. Wonderful learning experiences with an MD or NP in all kind of environments. However, the last three hundred hours are allotted to the CAPSTONE which is indeed a glorified term paper.

But at least 1200 are real clinical hours. That is more than twice what other programs require. My program was going to require 1000 real clinical hours, and I thought that was good compared to many (but still not enough). Anyway, at least you recognize the limits of your education.... not sure many do. This will go a long way in you figuring out how to shore up weaknesses and learn new things (and practice what you know in theory) that weren't covered in your program.

This is also where the idea of a residency makes sense if you can financially swing it.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I received this from a friend. I am both envious and ashamed. Imagine no nursing theory, no leadership, no population health, no information systems, no 3 credit course on ethics? No 250-500 hours reported as clinical when in fact they are not clinical hours but are spent working on a paper.

Courses

I'm actually not envious of that. The course titles sound impressive but that's not a way to gauge the quality of those courses. I also didn't need all those courses having gone through an Adult ACNP program by choice.

I respect PA's. Their program is set-up in such a way that certain bullet points are covered in a standardized curriculum because the assumption is every student comes in with a variety of previous healthcare experience and the final product should have homogenized training.

NP's historically took a different path by choice. The goal was and has been to produce a specialized nurse provider trained in specific specialty tracks that must comply with approved national certification standards. What's clouding the issue is people assuming that an NP is an NP no matter what. We have different training foci and can't do everything in any field of healthcare.

Our curriculum certainly needs improvement, I won't deny that. I precept newly hired AGACNP's and NP fellows. Our nursing background is both an advantage and a crutch. Some of the biggest struggles for new NP's is the transition from thinking like a bedside nurse to thought processing like a provider. Sometimes years of bedside RN experience makes that transition rougher than someone going straight to an NP role without bedside experience.

That said, we have to accept the consequences of the changes we are proposing...do we want rigor and standardization to the point of not allowing time to work at the same time we're attending the program like the way PA and CRNA programs are set-up? Do we want programs only housed in universities with academic medical centers so that preceptorship is guaranteed?

For the benefit of "natural selection" by letting the weak [programs] die out to make our field less saturated, I would choose the path of making our programs more rigorous but keeping the specialized nature of NP education.

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Specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.

Really this is comparing apples to oranges-yes, both fruit but very different flavors. PA programs mirror physician programs and they are physician extenders by virtue of their training. Most PA's are coming from non-healthcare backgrounds and need to fill in the physician extender role right out of school. NP programs are designed to build upon an existing healthcare background and education b/c you ain't gettin a nursing license with a degree in biology, history, political science, whatever...it's nursing, it's people, it's healthcare. So that's where they start. NP's aren't necessarily tied to physicians and should be trained in a different way to provide general access, teaching, and medications right out of the box assuming they have some healthcare background. I can't say one is better than the other but I would say (since PA's are screaming for DPA as an entry level degree) that DNP programs offer very little incentive to advance ones education for no pay off (i.e. don't expect to be called "Dr", or have increased scope of practice, etc.)

The fundamental problem now is MSN programs are granting entrance for RN's that have never practiced w/o shoring up this difference in background with addt'l educational requirements for equal parity with PA's. So right now it's a mixed bag...does a physician take a chance with a new NP or PA. They will probably feel more comfortable with a PA UNLESS that NP has nursing/patient care experience. Your nursing education will NEVER equal that of a physician/PA in basic sciences so it's a little harder for new NP's to understand the "why's and why not's" of procedures and medicines. Most experienced nurses take very well to the "when's" of prescribing or doing something but fail miserably in understanding the science behind it. Is that understanding necessary in a practical sense of getting the job done? NO! Nevertheless, it is a REAL problem in our graduate education programs. We are more concerned with getting a degree title than we are preparing NP's for public and professional expectations of what it means to be a "doctor" of anything. You have to be able to teach it-if you don't know it, you can't teach it. At least not very well b/c you don't understand it. So it's a problem but it's fixable. Looking at a PA curriculum looks impressive b/c most of you are at least RN's and see more advanced clinical/science classes as part of their curriculum. However, to the public that curriculum is no more impressive than looking at your BSN/MSN requirements. So there are combined roles both can fill and some PA's will have a harder time filling other roles. It's probably a problem that will get addressed with some standardized new title that we can all migrate into in 50 years.

....however, I am envious of the OR/ER rotations that would be helpful to everyone I think. My NP program forbade me from getting preceptors in specialties...so, where do I work now? A specialty...thanks for nuttin...

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Specializes in Family Nurse Practitioner.
But at least 1200 are real clinical hours. That is more than twice what other programs require. .

Mine were 500 for PMH and 500 for FNP, I was initially practicing with only 500 clinical hours.

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I just want to reiterate that while I think PA programs produce a better primary care provider than FNP programs do, I do not believe they produce a provider able to practice in a specialty the way that NP tracks do.

The local PA program in my area trains for primary care. The only inpatient rotation their students receive is a 6 week surgery rotation, the rest of their rotations are mostly outpatient (except EM but that isn't really an inpatient rotation either IMO). Their psych, OB and pediatric training is 1 day a week for 1 semester didactic training, with a single 3 week rotation in that specialty during their clinical year. While acute care NPs, psych NPs, pediatric NPs and women's health/CNMs devote their entire training to those populations. These PA students have no hospitalist/IM rotations, ICU or inpatient specialty rotations.

3 weeks of training in those specialty areas does not prepare one to practice upon graduation. CRNAs, PMHNPs, CNMs, NNPs, PNPs, etc train rather in depth to care for those specific patient populations. So when you look at clinical time for those areas NPs surpass PAs by quite a bit.

I do think PAs have a better structured curriculum for training generalist providers, and FNP programs should be structured similarly. All NP programs should have a gross anatomy. And all ACNP programs should include surgical training, rather than having separate RNFA programs.

They are different models of education and I think each has their merits and drawbacks. I trained alongside PA students during my inpatient clinicals and I can tell you that the ACNPs are far better trained for inpatient management than PAs.

If NP programs unanimously required a gross anatomy and FNP programs increased their clinical hours, then there would be no question that NPs are better trained. But specialty NPs are already better prepared for those roles.

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I just want to reiterate that while I think PA programs produce a better primary care provider than FNP programs do, I do not believe they produce a provider able to practice in a specialty the way that NP tracks do.

The local PA program in my area trains for primary care. The only inpatient rotation their students receive is a 6 week surgery rotation, the rest of their rotations are mostly outpatient (except EM but that isn't really an inpatient rotation either IMO). Their psych, OB and pediatric training is 1 day a week for 1 semester didactic training, with a single 3 week rotation in that specialty during their clinical year. While acute care NPs, psych NPs, pediatric NPs and women's health/CNMs devote their entire training to those populations. These PA students have no hospitalist/IM rotations, ICU or inpatient specialty rotations.

3 weeks of training in those specialty areas does not prepare one to practice upon graduation. CRNAs, PMHNPs, CNMs, NNPs, PNPs, etc train rather in depth to care for those specific patient populations. So when you look at clinical time for those areas NPs surpass PAs by quite a bit.

I do think PAs have a better structured curriculum for training generalist providers, and FNP programs should be structured similarly. All NP programs should have a gross anatomy. And all ACNP programs should include surgical training, rather than having separate RNFA programs.

They are different models of education and I think each has their merits and drawbacks. I trained alongside PA students during my inpatient clinicals and I can tell you that the ACNPs are far better trained for inpatient management than PAs.

If NP programs unanimously required a gross anatomy and FNP programs increased their clinical hours, then there would be no question that NPs are better trained. But specialty NPs are already better prepared for those roles.

I'll make two points. Either you don't have a complete view of the PA program rotations or they are violating ARC-PA standards. Each student must have supervised clinical rotations in:

a) family medicine,

b) internal medicine,

c) general surgery,

d) pediatrics,

e) ob/gyn and

f) behavioral and mental health care.

In addition supervised clinical experience must occur in the following locations:

a) outpatient,

b) emergency department,

c) inpatient and

d) operating room.

So if the PA students do not have inpatient/IM rotations the program is violating ARC-PA standards. In addition most programs have one or two elective rotations that can be tailored to student wishes. My program operated under older guidelines but we had 8 mandatory rotations (FP x 2, IM, Surgery, EM, OB/GYN. Psych, Peds) each 5 weeks (average 40-80 hours per week) and one elective rotation. I will also point out there is no requirement for ACNPs for example to have any ICU rotations.

http://www.arc-pa.org/wp-content/uploads/2016/10/Standards-4th-Ed-March-2016.pdf

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Specializes in Psychiatric and Mental Health NP (PMHNP).

Some of you may find this of interest: UC Davis Betty Irene School of Nursing offers a dual NP and PA program:

M.S. — nurse practitioner and physician assistant dual-track program

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Specializes in Neurology, Psychology, Family medicine.

The thing I find most interesting is that UC Davis NP program is 111 credits for a MSN, while many schools are in the 40's-50's. While I will admit credits does not mean overall quality. One could come to the conclusion that their expectations and degree of knowledge presented must be higher than a school with 40 credits for the same degree.

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The thing I find most interesting is that UC Davis NP program is 111 credits for a MSN, while many schools are in the 40's-50's. While I will admit credits does not mean overall quality. One could come to the conclusion that their expectations and degree of knowledge presented must be higher than a school with 40 credits for the same degree.

It just comes down to how schools figure credits. For didactic 1 hour x 16-18 weeks = 1 credit. For clinical 3-6 hours x 16-18 weeks = 1 hours. UC Davis is on the lesser end of PA programs in California but still around 1600 didactic and 1800 clinical hours. It depends on how the school figures the credits. Some have lots of credits and charge less. Some just figure 18 credits per semester and charge more.

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