Suggestions plz about Transition from RN to PA

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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?

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...

first of all i never said that pas are trained above the level of an np. your statement was that pas have 3x as many clinical hours is extremely debatable. until the np world comes up with some valid data it really isn't. do pas need as much training as they currently get? no one knows. we have a blueprint that contains the items that a pa needs to know to practice. each program determines what didactic and clinical experience is necessary to meet the objectives. i will say that in my experience np training has much more variation than pa training. does that mean that pa training is above np training, not at all.

secondly, although you are correct about statistics, what you have shown is the power (or lack thereof) of the anecdote. anectdotally i had more than 2700 hours of clinical experience. factually, i can show pa programs that have an average of more than 2600 hours of clinical time and programs that average 1500 hours. however, comparing anecdotes to averages is unlikely to have relevance.

as for counting clinical rn hours into np hours, i fail to see the relevance. we had a student in my class who was a vascular student in another country. his pa hours were counted the same as mine. what counts is clinical hours directly applicable to the role.

david carpenter, pa-c

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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???

Thank you. I think we can now say that we've explored the issue thoroughly and this thread can take its intended course--how to get to PA school from an RN degree. Any posts from this point on that consist of "Why would you go to PA school when you can go to NP school?" are unnecessary and probably deserving of deletion.

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Seriously? No offense but how in the world does nursing experience prepare you to be a medical provider? Um, if I want someone with 4 years of experience of giving medicine from a pixis system to open my tylenol bottle for me, I'll call you. If I want someone to diagnose what's wrong with me you better be sure I want someone who has been trained in pathology, pharmacology, physiology, and medical differential diagnoses. The sad fact is that while NP's may be

"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"

They have no idea what disorders they are missing which masquerade as everyday colds and diarrhea's until it's too late. it's amazing to me that you guys claim your nursing background as experience to be PROVIDERS. You might be an exception, but the vast majority of your nursing colleagues couldn't tell me the difference between carvedilol and atenolol. or even perhaps atenolol and irbesartan no matter how many years nursing experience they have (actually, I've noticed the longer the nurse has worked the less they seem to know about these things being so far out of school) And you want to tell me that 2-4 years of reading a chart without any understanding of why it's done helps you in any way to skip a large portion of your training? When you become an NP your knowledge base has to be lightyears ahead of your BSN degree, lightyears does not equate to 300 hrs trained by those who have gone before you. This line of thinking is irresponsible, astounding hubris, and shows that your priorities are out of line with what it means to be in this profession.

As I've said in another thread, a practitioner is as good as they want to be, some NP's are astounding, some PA's are morons as are some MD's, but the degree to practice independently is MD. Until you have that, our role is as extenders, not independent providers as you allude to.

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As I've said in another thread, a practitioner is as good as they want to be, some NP's are astounding, some PA's are morons as are some MD's, but the degree to practice independently is MD. Until you have that, our role is as extenders, not independent providers as you allude to.

I'm curious as to your background....as you seem to lack knowledge of nursing education, yet refer to our role.

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I'm very familiar with nursing curriculum. I know nurses are taught basic pharmacology and have courses in "nursing diagnosis" (which have very little to do with medical diagnosis). The most useful thing nurses are taught in nursing school that would prepare them to be providers is actually the pharmacology followed by your anatomy and then marginally the physio course work. Are these the area's of nursing curriculum you are referring to that I'm unfamiliar with? When I say "our role" I am a midlevel.

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I'm very familiar with nursing curriculum. I know nurses are taught basic pharmacology and have courses in "nursing diagnosis" (which have very little to do with medical diagnosis). The most useful thing nurses are taught in nursing school that would prepare them to be providers is actually the pharmacology followed by your anatomy and then marginally the physio course work. Are these the area's of nursing curriculum you are referring to that I'm unfamiliar with?

Well, yes my education contains those things. Although, I didn't have any courses in "nursing diagnosis." Threaded throughout all my coursework (my multiple pharm courses, multiple pathophys courses, as well as my nursing care courses, which integrated the pathophys and pharm with nursing care) is the nursing process. Which is really just a framework to analyse a problem by assessing the patient, which is how we identify it of course, so we can devise an intervention to relieve that problem, then measure the result and evaluate the outcome. We use both medical and nursing diagnosis's in this process. The medical diagnosis tells us about the system dysfunction that is currently occurring, the nursing diagnosis talks about the body's response to that dysfunction. I know that I need both kinds of information to care for patients.

Seems like a whole lot of education if my role is just to "get medication from the Pixis and open Tylenol bottles," as you so succinctly stated in an earlier post.

When I say "our role" I am a midlevel.

Hmmm...I don't know of anyone who holds a license that says "midlevel" so I'll ask again, what's your background?

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Specializes in Med Surg.

I'm not trying to change the direction of the OP and previous discussions, but I have a burning question - I'm just curious:

Why is it that there are nurses out there who want to become PAs on the one hand and PAs wanting to become NPs on the other?.

I know this first hand. My cousin has been a PA in New York for many years now and she recently told me she was "thinking" about becoming a nurse then an NP. She is the second PA that I know of personally who has considered becoming an NP. On the other hand I have also heard nurses say they are "thinking of becoming PAs. I thought NPs and PAs basically do they same thing. I honestly just don't get it.

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Seems like a whole lot of education if my role is just to "get medication from the Pixis and open Tylenol bottles," as you so succinctly stated in an earlier post

The problem is exactly that. you think that the education you are currently receiving encompasses what medicine is. You are taught the absolute very basics of the most basic of disorders, and you feel that this is excellent preparation for being a practitioner. This is dangerous thinking. There are literally hundreds of different things that cause abdominal pain for example, or perhaps "asthma" like symptoms. You are taught about 3 of those differentials as far as treating those disorders and then only at their most basic. There are dozens of mechanisms by which pancreatitis can occur for example, I know you are taught what pancreatitis is, but I also know you are not taught what many of those mechanisms are. Same with COPD, same with cardiac disease, arrythmias, etc. You foolishly think that just because you know what those words mean that you have a solid background in "medicine"

as far as your "treatment plans"

"so we can devise an intervention to relieve that problem, then measure the result and evaluate the outcome."

you are taught to turn the patient, what type of diet they require, what psychosocial issues the patient may be facing and how to be sensitive to those issues. That is hardly medicine. It's very good to know but it is not a framework to build a solid differential diagnosis and treatment plan on. Nursing Treatment plans have nothing to do with the underlying condition and neither are you allowed to perform any significant intervention (towards the underlying physical disorder) without express orders from someone with an MD license or perhaps a midlevel. Which means you could do your job without any independent thought. As hard as that is to believe, I've seen it. Nothing frustrates me more than a nurse who has no idea why she does what I order, have enough respect to keep up with your learning!

I'm sorry. it doesn't make sense, and why would I not use the term midlevel?

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I'm not trying to change the direction of the OP and previous discussions, but I have a burning question - I'm just curious:

Why is it that there are nurses out there who want to become PAs on the one hand and PAs wanting to become NPs on the other?.

I know this first hand. My cousin has been a PA in New York for many years now and she recently told me she was "thinking" about becoming a nurse then an NP. She is the second PA that I know of personally who has considered becoming an NP. On the other hand I have also heard nurses say they are "thinking of becoming PAs. I thought NPs and PAs basically do they same thing. I honestly just don't get it.

Nationally around 7% of PA students are RNs. Given the need for health care experience in many PA programs most program directors look favorably on them. We had three RNs in my class and four in the class ahead of us so my N is small. The reasons ranged from I want a more detailed medical education than NP school would give me, to if I have to take another nursing theory course I will slit my throat. The most common was that they wanted to work in surgery.

Consider this. There is one PA school that gives out a dual PA/FNP cert. There is one school that only took RNs for many years. The ANA was a founding member of the PA certification board and NPs were allowed to take the PA certification exam until the late 1970's. On the other hand if I was to apply for an NP school none of my coursework would apply. This is a fundamental difference between the models. Competence based education vs. degree based education.

There are local variations in how PAs and NPs are used. There are also local variations in pay. Its possible your "cousin" works in an area where PAs are poorly utilized. I've been doing this for 10 years and I've never heard of a PA considering going into nursing so they can be an NP. The more likely route is to go from PA to physician. Nationally around 80 or so PAs do this every year.

David Carpenter, PA-C

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Check out the University of North Dakota. Their PA program only accepts RNs (with the exception of a pilot group of non RNs). Their prereqs are the classes any RN would have.

I wouldn't expect much if any of a pay raise going from RN to PA. Where I work some of the surgical PAs can and do make very good money. However most of the PAs, especially those in primary care make the same or less than RNs working in the same facility ($70-85K)

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Specializes in Med Surg.
nationally around 7% of pa students are rns. given the need for health care experience in many pa programs most program directors look favorably on them. we had three rns in my class and four in the class ahead of us so my n is small. the reasons ranged from i want a more detailed medical education than np school would give me, to if i have to take another nursing theory course i will slit my throat. the most common was that they wanted to work in surgery.

consider this. there is one pa school that gives out a dual pa/fnp cert. there is one school that only took rns for many years. the ana was a founding member of the pa certification board and nps were allowed to take the pa certification exam until the late 1970's. on the other hand if i was to apply for an np school none of my coursework would apply. this is a fundamental difference between the models. competence based education vs. degree based education.

there are local variations in how pas and nps are used. there are also local variations in pay. its possible your "cousin" works in an area where pas are poorly utilized. i've been doing this for 10 years and i've never heard of a pa considering going into nursing so they can be an np. the more likely route is to go from pa to physician. nationally around 80 or so pas do this every year.

david carpenter, pa-c

thanks for the info to you and the other post that responded to my question. it makes more sense to me now. i guess regardless of whether one is an np or a pa, one important thing is knowing how to get the most out of the position/career one chooses.

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