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


I'm relying on the anonymity of the great big internet and the general size of the universe, I'm nervous to go "out there" with myself. Here's my situation: I started a PA program (master's degree) last year and have not liked it in any way. I have struggled academically, psychologically, financially, etc. I excelled through previous graduate work with A- average through 90-some credit hours, I excelled in my pre-reqs with a 3.85 GPA. And I'm here, supposedly at a major goal and I'm miserable. I hate my classmates, I resent them teaching us outdated information, I hate the waste of time that is our patient lab of 40-some students who see our instructors for maybe 5 minutes (how do we learn how to do an exam in that time?). I'm afraid of the reality of taking out $150,000 debt at my age. At the same time, I am surviving on student loans so I'm going forward with winter semester (and who knows, maybe some miracle will happen?).

My original plan was a second career BSN and go on from there to NP. But the DNP "thing" scared me off and I was seduced by the PA curriculum, more clinical hours, could practice in surgery/psych/internal med/pediatrics/etc. PA was a shortcut to what I thought was interchangable.

Now I see from the other side what the "advance practice" advantage truly is: it's about PRACTICING as a nurse and then going on to advance that practice. Not taking a group of non-healthcare providers and making them fit into a square hole. Now I see what "holistic" care is (or maybe I imagine this is what nursing school is): discussing the impact of a diagnosis pulmonary fibrosis or tuberculosis or AIDS on a patient, their family, their lifestyle, helping guide them through those conditions even after writing the diagnosis on the chart and scribbling a prescription.

As a long time lurker here, I know that PAs and nurses (RNs and NPs) don't always play together well. I am very well aware that nursing school is not a walk in the park and that the NP/DNP "thing" looms on the horizon in some way. I know that many of my classmates are equally stressed (one posted on FB about feeling "suicidal") but they're doing better academically then I am.

If anyone is still listening, do you have any input? Experience? Rumors? I am in the process of applying to one nursing program - only you and two very close friends know about this so don't tell :-). How can I convince an admissions committee (and myself) that I can succeed in a BSN program and that I'm not a PA school reject?

Thanks for your time.

Perpetual Student

Specializes in PACU. Has 4+ years experience.

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.

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.

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

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


Specializes in Cardiac Care.

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!

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!

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

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

Specializes in Critical Care.

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.

@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.


Specializes in Cardiac Care.

. Maybe that Xanax girl is on to something!


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???


First off, congrats on coming to terms with yourself before you put any more money on a degree you feel unhappy with. I, too, came to terms but much later than you. I was a Chiropractic physician for 8 years and was very unhappy. I felt the need to help others on a different level. It took me an entire year to shut down my practice. With student loans up the whazzzo...maxing out at 197K I had no loans available to me for more education. I wanted to be a nurse so my hubby and I paid some out of pocket...but being older and wiser this time around I applied for grants and scholarships and was able to attend.

Don't worry of what others think. Yes, there will be questions as to why you did not continue as you were....I was just honest with people. Some even asked me "Well, why did you work backwards?" I say to be a doctor turned nurse? Best thing I ever done for ME. I enjoy everything about nursing. I do not regret one thing about shutting down and going back to school. I have to be honest....maybe it was an aging thing for me but nursing school was more difficult for me as far as the workload. But you can do it. The only thing I do regret is not dropping out of chiro school when I was 23 years old...I would have saved ALOT of money and time. I am now 40 years old. I received my BSN in 2010 and now researching schools for the DNP program. I truly feel that people need to go with their instincts. You are strong mentally and emotionally....give yourself credit. It takes alot to post what you just did. You put your mind to it and it will be done. Keep me posted. Best of luck to you;)

Nurse Liz;)

Anxious..email me at otimandliz@yahoo.com. I just wrote you a book back in response but it will not let me send pm's to you b/c I haven't posted a minimum of 15 posts...not gonna happen any time soon;/


Dear AnxiousRNtobe

I have to disagree with RN Liz. While she may have made a decision that makes her feel better, you aren't talking about switching from alternative practices to nursing...you're talking about PA vs. NP!

If you haven’t done this already, I would go make an appointment with the administrators of your program. They wouldn’t have accepted you if they doubted you could graduate to be a successful PA. Perhaps they can give you some pointers/advice, etc. to get you through this rough patch. You are half-way in, which means this is where the rubber meets the road. Keep showing up to class to do your best. Put your heart into the program and study like mad! You CAN do it, don’t quit!

Let me make a few other points:

-Are you depressed? There’s no shame in this – if you’re feeling down, perhaps you need to see a doctor to help you get your emotions in order. Don’t make any decisions in the midst of emotional turmoil! Medical help can be short term, even just to help you get some decent sleep. When you're feeling better, THEN you can make life-changing decisions.

  • if you quit, you’ll have to go through the WHOLE interview/acceptance process again. YUCK. Will you have to take pre-reqs again, because your old ones expired? YUCK.
  • PAs have more clinical freedom than nurses. While you are under a physician’s license, you can do procedures and tasks that a nurse can’t and won’t ever be able to do. Yes, advance practice nurses can, but you are very far away from that level of nursing and only 1.5 years away from doing that as a PA
  • $$$$$$MONEY$$$$$$$$$ You will get paid so much more as a PA! Why would you even consider going back to nursing?! Goodness, if I were physically present with you right now, I’d pinch you so you’d wake up! As a PA, you'll come out with a Master's degree, so even if you leave clinical practice, you will have a better footing...please, please please reevaluate before you leave your program.
  • All the negative things you find in the PA program you will find in an RN program. Negativity is a disease that spreads and we have to fight it daily.

My vote is for you to pick up your boot-straps, get the help you need and put your heart/soul into your program.

And then get off the boards to study, which is what I’m about to do! :D

Good luck!

I agree with many of the other posters that you should think about staying in PA school...Although ultimately you have to follow your gut. I have thought about becoming a PA or NP too. It's not easy to get into PA school, so congrats on that! I volunteer at a clinic that has a few PAs and has PA students there for their clinicals. They all have said how hard it was to get through school, BUT the PAs who work there LOVE their jobs. They have tried to convince me to do the PA route not the NP. You have more options as a PA because you don't have to specialize and the PAs at the clinic don't feel like they are chained to a Dr. I know what you're going through really is hard and you got off to a rough start but maybe if you change your thinking to "I want to do this and I can do this" I bet you can complete the program!! Good luck :)

Hi there, I hope your winter session is going along alright if you in fact decided to stay! I generally agree with everyone here since you accomplished a LOT already just getting Into PA school (congrats!). While it may seem like a confusing situation now, the main ideas that calgrrl pointed out are where I stand too: You're basically deciding between PA and NP eventually and at that point, you're 1.5 years away from pretty much doing the same darn thing.

There's something I read from a nurse on here not too long ago, it basically stated how people like to say that nurses have all of this great bedside manner that is so great to go be an NP because of their clinical experience, while PAs and MDs and DOs don't have as much going in. They instead stated that it isn't the experience of the profession (like already being a nurse) that makes the person have great bedside manners and personality, it's the person that comes into a profession and is already like this. Basically, if you're not caring already and interesting in being a great nurse/PA/Doctor etc., then you're probably never going to be! There are plenty of people who go into these professions without the best personality match for it. I really do think people get caught up in the large ideas behind professions and forget that all of these positions have people who are really not great with people and also have those who are AWESOME. It doesn't matter if you're a nurse/doctor/PA/CNA, if you're caring then you'll find a way to do your job more caring than someone who doesn't care about how personal their role is to each patient. I just wanted to throw that in there since you can be a great PA and bring your experiences and care into any situation and then get more comfortable with the more experiences you have. You had mentioned something about how NPs have more of that experience etc., but really it's You that brings the personality and interest to be a great clinician and PAs get great clinical experience compared to NPs and as others mentioned, you're much closer to being in a clinical role and gaining the experience you'd get as an RN but even better because of the fact that you stated you Want to be in an NP/PA role anyways! You're golden, you just have to get really excited again abt. the fact that you've made it, you've made it so much further than so many people, and you just have to know that it's so close to being over and you'll continue to learn your whole life all that stuff that you're learning now, so do your best to get through it :)

I do realize maybe you've decided to drop out by now lol. I hope you haven't, but if you have it's not the end either. Life is SHORT and whatever you decide is really just fine. So much pressure is put on people who might just need a break. So if you made a mistake it's fine too. If you have to be an RN for the next 7 years or more before having enough money to go back to school, and you have to live off of beans and rice before heading back...well shoot...Who Cares! Of course you care, but if that's the only thing that'll work right now because you're on the verge of a meltdown, then that's what needs to happen. It's life, enjoy it, love your family and friends and relax...the world will not end based on what you decide and we'll all be dead soon anyways lol, so enjoy what you have and smile!! seriously!

Also, did you not have to have or also your classmates not have to have any healthcare experience? I was under the impression that now most PA programs require anywhere from 1000 to 4000 hours of direct patient care experience and that it usually has to be some type of direct patient contact for that. I guess I'm trying to touch on the fact that you stated you're not sure about taking people from such varied backgrounds and making them the same. I know it used to be all ex military who'd do PA programs because that's who it was made for, but now days many people are becoming interested and so the experiences that are accepted are varied, so are they really trying to make you all the same? Maybe I didn't understand you, but I've been thinking it's so neat that you get to go to class with people from all diff. healthcare experience because you all bring a different piece of knowledge to healthcare. Maybe it's a mess though I don't know!

Good Luck in whatever you've/are going to decide!