Suggestions plz about Transition from RN to PA

Nurses General Nursing

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I am going to school for BSN and once I am through that I am on my way to pursuing a PA degree. Does anybody have any suggestions on schools, the transition, and anything else I should know?

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Specializes in ER/Acute Care.

PA schools usually require a few extra prerequisites beyond what a BSN program requires (Biochem, O-chem, Physics, etc.). Your transition is going to vary, depending on the programs you're interested in. I would suggest researching programs, finding a few you're interested in, completing the prerequisites for those programs, and applying from there. I would definitely wait until after completing the BSN to worry about the prerequisites for PA school, unless you can complete them without jeopardizing your grades.

Of course, you could skip all of the prerequisite drama and go to NP school. NPs usually have more autonomy than PAs (practice on their own license, more autonomous decision making, etc.). Of course this varies state to state and board to board, but the salary and job descriptions are usually very similar. It really depends on which provider model (medical vs. holistic) works best for you. Good luck!

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Specializes in Psych.

Why be a PA when you can be an NP. They can work independently from a MD and they make around the same amount of money and get even more respect that a PA.

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Why be a PA when you can be an NP. They can work independently from a MD and they make around the same amount of money and get even more respect that a PA.

The fact that they "get even more respect than a PA" is debatable, especially in the medical community. Physician Assistants typically have three times as much clinical training (in terms of hours) as nurse practitioners. They are licensed by the medical board instead of the nursing board. They can switch specialties at the drop of a hat without having to go back to school. Their didactic education is more extensive in medicine and pathology as opposed to "advanced nursing theory" type courses. Also, autonomy and independence are two different things. Autonomy refers to the scope of practice. You'll find PAs everywhere from 1st assisting in the OR to emergency medicine, to family practice, to psychiatry. Independence indicates whether or not the clinician can practice without supervision.

Not to offend the NP proponents here, but personally I do not think that nurse practitioners are qualified to work independently from a medical doctor because they simply lack the same level of experience as clinicians trained in the medical model such as MDs, DOs, and PAs. The only reason why they are allowed to work independently is because the board of nursing says they can. If they were regulated by the medical board, they would be just as dependent as PA's.

Edit: Also, addressing the post that says "NP's practice on their own license," Physician Assistants do practice under their own medical licenses. Nurse Practitioners practice under their own nursing board license.

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I am going to school for BSN and once I am through that I am on my way to pursuing a PA degree. Does anybody have any suggestions on schools, the transition, and anything else I should know?

The the PA forum

http://www.physicianassistantforum.com/forums/forum.php

There is a discussion about using RN as a stepping stone in the Pre-PA general discussion. The information there is more likely to be accurate.

David Carpenter, PA-C

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Specializes in ER/Acute Care.
Physician Assistants typically have three times as much clinical training (in terms of hours) as nurse practitioners.

The argument that PAs have more 3 times as many clinical hours is extremely debatable.

PAs typically begin school with no prior medical experience; with the exception of "shadowing" hours that some programs require. The prerequisites for many PA programs are a bachelor's degree, GREs, and science coursework comparable nursing school/med school prereqs. Most PA programs last 2-3 years total and require one year of course work and 1-2 years of clinical.

NP programs require applicants to have an active RN license. Most NP programs require a BSN prior to admission, with the exception of bridge programs for the ADN prepared nurse that build in additional undergraduate/graduate course work as well as direct-entry NP programs. RN licensure requires a certain amount of clinical hours before the ATT is processed (which varies state to state) and graduate nurses are allowed to sit for NCLEX. My program requires over 1000 clinical hours at the just at the BSN level. NP programs typically last 2-3 years require approximately one year of course work, 1-2 years of clinical, and an RN license. Being a licensed and experienced RN with several clinical hours in while in school as well as post-graduate professional experience prepares the NP to practice as an independent provider.

I don't see where you've come up with the idea that PAs have 3 times as many clinical hours. If you can explain it, please enlighten us :)

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The argument that PAs have more 3 times as many clinical hours is extremely debatable.

PAs typically begin school with no prior medical experience; with the exception of "shadowing" hours that some programs require. The prerequisites for many PA programs are a bachelor's degree, GREs, and science coursework comparable nursing school/med school prereqs. Most PA programs last 2-3 years total and require one year of course work and 1-2 years of clinical.

NP programs require applicants to have an active RN license. Most NP programs require a BSN prior to admission, with the exception of bridge programs for the ADN prepared nurse that build in additional undergraduate/graduate course work as well as direct-entry NP programs. RN licensure requires a certain amount of clinical hours before the ATT is processed (which varies state to state) and graduate nurses are allowed to sit for NCLEX. My program requires over 1000 clinical hours at the just at the BSN level. NP programs typically last 2-3 years require approximately one year of course work, 1-2 years of clinical, and an RN license. Being a licensed and experienced RN with several clinical hours in while in school as well as post-graduate professional experience prepares the NP to practice as an independent provider.

I don't see where you've come up with the idea that PAs have 3 times as many clinical hours. If you can explain it, please enlighten us :)

On the average a PA student in 2003 had 1153 hours of didactic instruction during the first two phases of PA school. They then had an average of 48.5 weeks of full time clinical instruction during the clinical phase (phase III). The average hours per week were 44. Giving an average of 2100 clinical hours per week. Clinical hours must occur in Family Practice, Pediatrics, Internal medicine (with inpatient component), Surgery (with operative component), Psychiatry, Emergency medicine, and OB/GYN.

Source here:

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/61836

The latest data is still being compiled but I would guess that 1400 didactic hours is going to be the average. Typhon data shows the average clinical hours in some programs above 2600 hours in 52 weeks.

Despite your statement that most PAs typically begin PA school with no medical experience, the average PA student enters a program with 3.6 years of medical experience. There are programs that do not require experience, but most PA students will have some experience.

http://www.paeaonline.org/ht/a/GetDocumentAction/i/66159

There is not a similar resource that I am aware of for NPs. Looking through various program catalogs the average NP didactic portion seems to be around 25 credits. At 18 hours per credit this would equal approximately 450 hours of didactic instruction. The clinical portion is less defined but ANCC requires 500 hours to sit for certification. There are several FNP programs that require 750 but the broad range of posted hours is around 500.

PA didactic hours/NP didactic hours 1153/450 = 2.56

PA clinical hours/NP clinical hours 2100/500 = 4.2

Or PA total hours/NP total hours = 3253/950 = 3.4

Near enough to 3 for these purposes.

Now one important thing to remember is that NPs get their hours in a particular area of advanced practice nursing while PAs train broadly in medicine as mentioned above. A PNP will probably have more hours in pediatrics than a PA depending on the PA program and electives to use an example.

David Carpenter, PA-C

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As you probably already know be prepared to work for a little bit as a RN before applying to PA school (in order to get the patient contact hours that most PA programs require). Best wishes.

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Many PA schools also require contact hours in a health care setting. If you get your RN license and work for a few years, you'll have more than enough contact hours.

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Specializes in ER/Acute Care.
on the average a pa student in 2003 had 1153 hours of didactic instruction during the first two phases of pa school. they then had an average of 48.5 weeks of full time clinical instruction during the clinical phase (phase iii). the average hours per week were 44. giving an average of 2100 clinical hours per week. clinical hours must occur in family practice, pediatrics, internal medicine (with inpatient component), surgery (with operative component), psychiatry, emergency medicine, and ob/gyn.

source here:

http://www.paeaonline.org/index.php?ht=a/getdocumentaction/i/61836

the latest data is still being compiled but i would guess that 1400 didactic hours is going to be the average. typhon data shows the average clinical hours in some programs above 2600 hours in 52 weeks.

despite your statement that most pas typically begin pa school with no medical experience, the average pa student enters a program with 3.6 years of medical experience. there are programs that do not require experience, but most pa students will have some experience.

http://www.paeaonline.org/ht/a/getdocumentaction/i/66159

there is not a similar resource that i am aware of for nps. looking through various program catalogs the average np didactic portion seems to be around 25 credits. at 18 hours per credit this would equal approximately 450 hours of didactic instruction. the clinical portion is less defined but ancc requires 500 hours to sit for certification. there are several fnp programs that require 750 but the broad range of posted hours is around 500.

pa didactic hours/np didactic hours 1153/450 = 2.56

pa clinical hours/np clinical hours 2100/500 = 4.2

or pa total hours/np total hours = 3253/950 = 3.4

near enough to 3 for these purposes.

now one important thing to remember is that nps get their hours in a particular area of advanced practice nursing while pas train broadly in medicine as mentioned above. a pnp will probably have more hours in pediatrics than a pa depending on the pa program and electives to use an example.

david carpenter, pa-c

thank you for your thorough explanation with citations. you've obviously made this point before :) work is slow tonight, so i thought i'd take a crack at your argument...

you have confirmed that at first glance, pas are trained above the level of an np. this is of course, ignoring the previous clinical hours the rn obtained at the adn/bsn level as well as previous experience as a licensed health professional (which is required to pursue a traditional np program).

traditional np programs are designed to build upon the existing education and experience of an rn so that he or she can practice in a provider role.

so, i would argue it is appropriate for pa's to have slightly more clinic hours; as they typically enter the field as unlicensed students with previous health experience in support roles such as unit clerks, shadowing other mds/pas, or work as a cna/mt/phlebotomist (averaging 3.6 years in 2008). this does not compare to previous clinical hours and professional experience as a licensed nurse. if the clinical hours obtained during the rn education is considered (which they should be in this discussion, given the nature of the design of np programs), things are considerably balanced.

yes, nps are not trained as generalists and do have to return to school if they make significant specialty changes (peds to adult). yes, nps also have a limited role in surgical specialties. but the fact still remains that nps are trained to practice at the level of independence that is appropriate for the specialty they are educated in. so a licensed family practice np is perfectly capable of managing the care needs of most patients who don't require the high acuity specialty care that only an md can provide. yes, nps can do this independently; as long as the independence practices are within the scope of advanced nursing practice for the state the np practices in. nps also have subspecialties such as cardiology, orthopedics, emergency, etc (i am currently being educated by doctorate trained nps who practice in all of the aforementioned specialties). it is also important for nps to know the limits of their practice and refer when appropriate.

the np degree is graduate degree, which in most accredited educational institutions requires at least 30 hours of graduate level coursework. the program i am pursuing (fnp) requires 45 didactic credit hours (with your consideration of 18 hours per week, per credit hour). it also requires 800 clinical hours. there is no existing report that i am aware of that compiles np data comparable to what you have cited (as you mentioned earlier).

which leaves the following comparison:

pa didactic hours/np didactic hours 1153/810= 1.42

pa clinical hours/np clinical hours 1700/800 = 2.12

(it appears you were using the means and the actual mean for all regions is approximately 1700, according to the data you shared)

pa total hours/np total hours = 2853/1610= 1.77

if you were to add in the 1000 hours of clinical experience and 60 credit hours (with 15 of those hours composed of graduate coursework) from the bsn program i am in; the numbers shift significantly towards the np route.

but of course, we all know the quote about stats “there are lies, darn lies, and then statistics” ;)

thanks again for sharing! i look forward to hearing more of your thoughts in the future...

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It's like beating a dead horse at this point, but let me put it this way.

Required and optional courses for BSN at my local University (University of North Carolina http://nursing.unc.edu/degree/bsn/pdf/bsn_course_list.pdf):

253 Individual Development across the Lifespan (2)

261 [061] Nursing Role in Normal Nutrition (2).

354 Discipline of Nursing II (1).

360 Concepts, Processes, and Skills for Evidence-Based Nursing (4).

361 Pathophysiology (3).

362 Pharmacology across the Lifespan (3).

364 Nursing Care of Adults with Major Health Problems, Part I (6).

366 [066] Health Assessment (3).

369 [069] Physical Assessment (3).

371 Introduction to Nursing Research (3).

377 [077] Research in Nursing Practice (3).

379 [079] Leadership in Nursing Practice (3).

382 Family-Centered Genomic Health Care (1).

454 Discipline of Nursing III (1).

470 Public Health Nursing (5).

472 Nursing Care of Infants, Children, and Their Family (5).

477 Psychiatric Mental Health Concepts for Broad Clinical Application in Nursing (5).

479 Maternal/Newborn Nursing (5).

Practicum requirements.

You're saying that these courses in nursing, not medicine, plus these courses prepare someone to be a fully independent practitioner? There's only one graduate-level 3 credit Pathophysiology class to take plus the undergraduate level patho class. Nurses follow the doctor's orders. They get more than enough experience doing that. However, I have yet to see any classes like Evidence-Based Medicine, year long Diagnostic Methods course, year long Clinical Medicine course, year long pharmacology/therapeutics, or any other intense medical courses that PA's have to take. (Duke University PA program schedule.) So while it is true that nurses get plenty of on the job training working as nurses, they don't miraculously sprout the ability to diagnose complex illnesses and determine courses of treatment. That's what graduate level courses are designed to do. However, I'm just not seeing it here. There's certainly not the same clinical requirements. Even if you add up BSN clinicals (which is not the same thing as clinicals in the provider role) to the NP practicum, PAs still have more instruction inside the classroom and out.

The way I look at it is this: If one is so ambitious that one cannot work under the supervision of a physician, one should be a NP. If it's about the medicine, science, and patient care, become a PA. PA school is half of Medical school. NP school is a second nursing school. I don't really see much need to continue this debate. You're very dead set in your ways. I don't mean to insult anyone who still thinks that nurse practitioners have the same skill set as those trained in the medical model, but I believe that NPs are simply RNs that spent a little more time in nursing school. I would trust them to give tylenol to a patient with muscle aches.

Edit: Also, PA programs don't typically consider shadowing to be "healthcare experience." PAs come from all corners of healthcare--nurses, CNAs, lab techs, surgical techs, radiography techs, paramedics/EMTs, etc. Healthcare experience is REQUIRED FOR ADMISSION. Most matriculants have more than just a couple of years of experience wiping noses in a long-term care facility as you seem to think. So, by your own logic, if experience in allied health/nursing is enough to "build upon to become a provider," then why are PAs not allowed the same? You say that nursing education plus experience plus NP education is better than nursing/allied health education plus experience plus PA education (which apples to apples is more exhaustive and intense than NP school). That doesn't make sense to me.

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The argument that PAs have more 3 times as many clinical hours is extremely debatable.

PAs typically begin school with no prior medical experience; with the exception of "shadowing" hours that some programs require. The prerequisites for many PA programs are a bachelor's degree, GREs, and science coursework comparable nursing school/med school prereqs. Most PA programs last 2-3 years total and require one year of course work and 1-2 years of clinical.

NP programs require applicants to have an active RN license. Most NP programs require a BSN prior to admission, with the exception of bridge programs for the ADN prepared nurse that build in additional undergraduate/graduate course work as well as direct-entry NP programs. RN licensure requires a certain amount of clinical hours before the ATT is processed (which varies state to state) and graduate nurses are allowed to sit for NCLEX. My program requires over 1000 clinical hours at the just at the BSN level. NP programs typically last 2-3 years require approximately one year of course work, 1-2 years of clinical, and an RN license. Being a licensed and experienced RN with several clinical hours in while in school as well as post-graduate professional experience prepares the NP to practice as an independent provider.

I don't see where you've come up with the idea that PAs have 3 times as many clinical hours. If you can explain it, please enlighten us :)

As a practicing NP, I can guarnatee you that PAs have more didactic and more clinical time than NPs. Its as simple as black and white. All you need to do is compare any NP program side-by-side with a PA program and you will have your answer. Prior helathcare experience as a bedside RN cannot be construed as "clinical" time. At that point, the RN is not training at the level of a NP. It's not the same experience. I would love to have had the same didactic program as the PA schools, its far superior to NP school. Questions???

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