PA to RN? (I do know the difference all too well)

Perpetual Student · Jan 8, 2012

I recommend that you keep plugging ahead, study harder, graduate, and find a job in a setting that appeals to you. I think you may be a burnt out and looking at the grass on the other side of the fence. Sure, it may be greener, but ask yourself what is fertilizing it. Look at why you're struggling and work to improve your performance.

You would find a lot of the same negatives such as outdated information, poor instructor to student ratios, etc. in nursing programs, particularly as they buckle down further due to dwindling budgets. Imagine being in a program with similar problems that also provides you with much less clinical experience. You would have to take out a lot of debt to do a BSN and then a DNP, too. By finishing your PA program you'll be able to get working much faster.

Do you really want to work as an RN, which you would have to do prior to making it through a MSN/DNP program? It's very difficult for new graduates to find decent work. Nurse to patient ratios are likely to get worse as reimbursement drops. I'm blessed in that I love my current RN job (PACU), but most of the nurses I know in other departments tolerate theirs at best. And I'm in a pretty darn good hospital. You seem to think that working as a nurse first will be a big advantage. Depending upon what type of job you're able to land and how overworked, and understaffed you are it might not really do all that much to prepare you that you can't get by busting your butt in your PA program's clinical rotations.

Go read some of the threads in the nursing forums to get a feel for some of the negatives of nursing. It's a lot better to deal with an angry drug addict as a PA/NP than as an RN. I don't say that to rag on nursing, but it's important to be honest about the pros and cons.

I think you've got a fantasy of what NP practice is vs. PA practice. The bottom line is that you can't get reimbursed for touchy-feely stuff. That's not to say you shouldn't be sensitive or considerate of all of a patient's needs, but you have to understand that you have to keep the lights on in the practice and be able to make payroll. As reimbursement is slashed further and further, especially for Medicaid and other sources who seem to provide coverage for those in greatest need for more comprehensive care, there is going to be a push to see more and more patients in less time.

caliotter3 · Jan 8, 2012

Have nothing to do with either APN or PA. How close are you to completing this program? The only problem I have with your situation, is that I would hate to lose what you already have invested in it. I always imagine that it is better to have a qualification and never have to use it, than to step away from a qualification. I would be leaning toward finishing the PA course, then after a breather, or some employment time, moving on to the BSN program. But that is my view.

AnxiousRNtobe · Jan 9, 2012

Perpetual Student (I guess I am one too): your theory that I'm suffering a bad case of "the grass is greener on the BSN side of the fence" might be an element of what's going on. I imagine nursing school to not have the things that are driving me crazy about PA (spoiled, superficial classmates, disorganized teachers, cut-throat atmosphere).

Calotter3: I'm facing another year and a half. I have invested a lot of loan money and either way would need a lot more loans.

I guess my issues boil down to:

- very high (20%) failure rate in this program and I am afraid of being one (I have addressed many of my study problems and have a pretty easy load this semester)

- second thoughts about the amount of debt accruing. Would it make more sense to take out less loans and make a somewhat smaller salary?

- does the PA philosophy make sense for me, someone without bedside experience? I realize this is how most PAs and physicians get trained, I'm just having second thoughts about my ability to practice at that level without having a more fundamental set of skills & experience

netglow, ASN, RN · Jan 9, 2012

Op, you might think in this way: As a PA you will be forever tied to your Doc via the 'ol ball and chain. As a nurse you are not tied to them. Sure they write the orders, but then, mostly they are not around. If you get good, they will just ask you what you think you need often. As an NP you still have to have a doc "somewhere" but they soon realize, if you are good, that they can depend on you, and realize that you can take your load and they can take theirs, and you will be pretty much on your own. But I've always thought that PAs get to do only the fun stuff, which is why I often envy them!!!

But, there are a lot of nurses that are just like the classmates you don't like. And nursing, like medicine is a "do it yourself - look it up yourself - don't ask anyone to actually teach you anything" kind of deal.

IDK, maybe you could stick it out? Here is a blog I read, it's just as relevant for nurses, maybe you need to see that we all are really in the same mess:

A Cartoon Guide to Becoming a Doctor: What to do when you're being pimped: An algorithm

AZMOMO2 · Jan 9, 2012

RNs and NPs in practice don't have time to actually sit down and talk to the patients as much as you think they do. Think this way... new grad RNs are currently having ALOT of trouble finding positions in acute care. Would you be happy, with all the knowledge you have from your PA program, as well as the additional BSN you want to pursue, to push a Medcart in a SNF/LTC for 30 residents 40 hours a week?

Nursing school is very similar to what you described within your PA program. Overachiever, competitive, nursing students eat their own, know-it-all, self-entitled, sensitive, catty, mean girls. Instructors cite the powerpoints verbatim, but test on chapter reading, so in a sense you are doing alot of self teaching. Skills labs are short on instructors maybe the ratio is 40:2, clinical experience is a free for all of skills you will probably never get to practice on a real person until after NCLEX, with more careplan nonsense than any actual nursing skills. Disorganized? Ha! You have no idea! The first lesson you learn in Nursing School is you must be flexible but the staff will not!

You are not alone in the feeling that what you perceive as struggling makes you any less likely than your neighbor to either pass or fail the class. In nursing school many people who have had 4.0s in pre-reqs or previous degrees have FAILED. It's hard for those who expect amazing grades to grasp the concept that medical training of any sort, is a by the seat of your pants rollercoaster ride full of ups, downs, twists, turns, some screaming and maybe even some tears.

If advanced practice is what you want... stick it out! You can do anything... supplement your classroom and skills labs with with youtube videos! There are so many skills on there, including examinations! It helps!

AnxiousRNtobe · Jan 9, 2012

Wow, you have all given me a lot to think about. In my mind, you were going to describe the lush green valley of nursing school (that's how my NP colleagues remember it from years back), where instructors have practical experience (and not dementia), you learn practical skills, hard work pays off with high grades, students don't resort to Xanax and Zantac for anxiety and ulcers that develop (one girls' secret to test taking is a half milligram of Xanax, I have CostCo sized bottles of Zantac). I do want the advance practice role and I have seen PAs and NPs doing exactly the same thing with exactly the same amount of "supervision" from the physician. I've always liked nurses at every level (LPN, ADN, BSN, NP, DNP) and maybe part of my shock was that I don't socially like my classmates. I felt so overwhelmed last semester and didn't make changes in my program or changes in my study habits until so late that I couldn't bring my grades up in the time left. I think for me it's this constant fear of failure that started on day 1 and all I see in front of me is more years of that fear. Maybe that Xanax girl is on to something!

Trauma Columnist · Jan 9, 2012

AnxiousRNtobe: I'm an APN (not NP, but CNS) and work in a large practice where we have NPs and PAs. The PAs report the same exact problems that we as APNs have: lack of time, increased workload pressure, increasing responsibility, etc..

School is school, no matter what degree you are studying. Believe me, 2 years after you graduate, you won't remember any classmates name and won't care. (At least thats the way it has been for me.)

Since you only have 1 1/2 years left and if you leave this program and go into a nursing program, you are going to incur even more debt.

My advice: hang in there, look for a first job that offers a solid orientation (mine was 5 months long with didactic from the MDs and clinical time) and is supportive to new grads.

brandy1017, ASN, RN · Jan 9, 2012

In my understanding students in a PA program usually do not have the healthcare experience that an RN has going into an NP program. It is basically a shortened version of medical school. Is that how your program is?

What are you struggling with exactly? If you can pin down your problem areas then you can focus on strengthening them. Would recommend a study group of your peers if possible. Is the problem books? memorization? or performance anxiety in clinicals?

I would search for supplemental resources for my problem area. Check you tube and the internet also. If it is about clinicals, performance anxiety is normal and some have it worse than others. If you feel awkward you can review tapes such as physical assessments, etc. You may have to talk to your doctor or a counselor for either medication or counseling to deal with the performance anxiety, also self hypnosis tapes can sometimes help. I was great with bookwork but had terrible performance anxiety that made nursing hell for me in the beginning. Clinicals weren't bad because the instructors were kind and fair, but floor nursing is no walk in the park. Eventually you are able to overcome performance anxiety as you gain confidence and skill, remember it took time and practice to ride a bike, or type, or play the piano or whatever. You are going to feel awkward and clumsy at first and there is no why around it. You just have to go thru that phase and know you will gain skill and confidence and the anxiety will eventually lessen and go away!

Is it the general atmosphere where you are being called out and asked questions and made to feel stupid if you don't have the answer? I believe that can be a real issue in med school and probably also PA school, trial by fire. You just have to accept it and realize everyone else is walking the gauntlet and know when you are finished it will be behind you.

I wouldn't quit. I would persevere after analyzing my weak areas and coming up with a plan to improve. You said yourself you are not the only one struggling. Can you get some advice from your advisor?

Also I'm sure you must have to pass some sort of board like nurses do. I would look into review books for the board and study the pertinent sections as you take your coursework, usually tests are similar to boards to prepare you to pass it and be able to practice.

Regarding student loans you are stuck between a rock and a hard place. PA school is usually not designed for students to work during the program, it is too intense. If you quit now you will still have a lot of loans I'm sure and how will you pay them back? What sort of job could you get? What sort of job have you had so far? Private loans don't qualify for income based repayment, only govt and with high student loans you must be stuck in private loans. You must stay current on all your student loans as they have no consumer protections and no bankruptcy option. If you have HEAL loans and default you would not be able to work for anyone on medicare, etc. If you default they can take away your license to practice.

If you finished the program you would probably be in a much stronger position to stay current on your loans and be able to pay them off.

♑ Capricorn ♑ · Jan 9, 2012

@AnxiousRNtobe: Stick it out, and finish what you started, is what I say. After you graduate and start working as a PA, only then, will you really know if nursing school is in your future. Its very easy to doubt ourselves when we are going through a difficult program, there are always the "what if's". I'd focus on making your PA school work for you. Learning how to better cope with stress and anxiety, will help you. There was a reason why you wanted to attend PA school, try to remember why and hold on to that.

AZMOMO2 · Jan 10, 2012

. Maybe that Xanax girl is on to something!

Exactly!

AnxiousRNtobe · Jan 10, 2012

I'm afraid that I've done too much damage to my GPA. I feel like I started out badly and am having trouble recovering my confidence, let alone my interest. And even though I always thought NP training was pretty much the same as PA. I always read about the role of the "advance practice nurse" vs PA training. Now I see where taking people with such varied backgrounds and trying to make them the same is maybe not the best way to create a healthcare provider.

My problems with school are basically with memorization. In anatomy, I had a lot of trouble with the rote memorization of all that material (arterial/venous/ducts paths, 150 or so muscle origin/insertion, bones, organs, etc). I eventually learned to make tables or draw the organs and write the out over and over and over in different colors until I could write it out from my head. The rest of my problems stemmed from trying to catch up grade-wise because it took me half the semester before I learned how to memorize.

I don't know what the answer will be. I am in such a better position to see the strengths and weaknesses of each training. Why oh why didn't I become a nurse in my 20s???