The economics of PA vs. NP

[subee]

A PA asserts that their futures may be limited by supervising requirements despite lower educational requirements for NP's.

https://www.kevinmd.com/blog/2020/03/whats-the-future-of-the-physician-assistant.html

[Queen Tiye, RN]

A little off topic, but nursing programs should all have the same requirements and offer high quality curriculums. The low standards of some of the programs that I’ve encountered are shocking. On another note, I heard an NP argue that staff nursing is not comparable to the advanced care NPs are trained to give, and lack of RN experience is inconsequential. Is this true NPs?

[KatieMI, BSN, MSN, RN]

58 minutes ago, Queen Tiye said:

A little off topic, but nursing programs should all have the same requirements and offer high quality curriculums. The low standards of some of the programs that I’ve encountered are shocking. On another note, I heard an NP argue that staff nursing is not comparable to the advanced care NPs are trained to give, and lack of RN experience is inconsequential. Is this true NPs?

Bedside nursing as it most commonly practiced has very little to do with advanced practice nursing. Bedside nurses are frequently not stimulated to develop qualities necessary to advanced nursing practice such as critical and analytical thinking, constant widening of the base of knowledge and independence/autonomy and instead pushed into blindly following absolutely senseless policies and forced into formation of working habits which are detrimental for their development as clinicians such as "calling instead of thinking" and following protocols instead of applying analytical skills. Nurses who are smart and open-minded and not "task-oriented" are targeted by their peers and administration as "know-alls", "bookish" and "unsafe" and experience lateral violence and workplace bullying just because they are smarter. Anti-intellectualism runs rampant at bedside even in specialties where clinical/analytical skills are paramount for safe nursing practices.

Being a provider, I honestly can tell that one of the greatest mistakes in my nursing career was spending almost 3 years at bedside. All benefits I got as a result are freedom from student debt and a few really good friends, which is all good but won't make it up for what I endured as a new grad only guilty of knowing more than the rest of the pack.

And, yes, I think that bedside experience can be beneficial but is not mandatory for making a good advanced practice nurse. Smart, independent and knowledge-thirsty should not suffer for what they are just because there is some general opinion without any data supporting it.

[subee, MSN, CRNA]

23 hours ago, KatieMI said:

Bedside nursing as it most commonly practiced has very little to do with advanced practice nursing. Bedside nurses are frequently not stimulated to develop qualities necessary to advanced nursing practice such as critical and analytical thinking, constant widening of the base of knowledge and independence/autonomy and instead pushed into blindly following absolutely senseless policies and forced into formation of working habits which are detrimental for their development as clinicians such as "calling instead of thinking" and following protocols instead of applying analytical skills. Nurses who are smart and open-minded and not "task-oriented" are targeted by their peers and administration as "know-alls", "bookish" and "unsafe" and experience lateral violence and workplace bullying just because they are smarter. Anti-intellectualism runs rampant at bedside even in specialties where clinical/analytical skills are paramount for safe nursing practices.

Being a provider, I honestly can tell that one of the greatest mistakes in my nursing career was spending almost 3 years at bedside. All benefits I got as a result are freedom from student debt and a few really good friends, which is all good but won't make it up for what I endured as a new grad only guilty of knowing more than the rest of the pack.

And, yes, I think that bedside experience can be beneficial but is not mandatory for making a good advanced practice nurse. Smart, independent and knowledge-thirsty should not suffer for what they are just because there is some general opinion without any data supporting it.

Has anyone done a study comparing results from NP's without nursing experience and nurses with no nursing experience? Gives me a headache how you would even design it but it could give a more definitive answer. But, even my own doc just goes through the prompters on the computer to ask me any questions. Since I'm healthy, a robot could do that for me and we are already up to our knees in cookbook practice. Despite the fact that 90% of patients who get penicillin tested because someone told them that they were, are in fact not allergic to penicillin, it was never my practice to push Vancomycin into a patient when they were pen "allergic" when a less problematic alternative was available. It was an on going war with the surgeons for decades until VRSA evolved. So, if we are doomed to the cookbook, I suppose NP with no previous experience would do. But we will never win the the PR war as long as we allow non-practiced, online trained NP's out in the market.

[KatieMI, BSN, MSN, RN]

19 minutes ago, subee said:

Has anyone done a study comparing results from NP's without nursing experience and nurses with no nursing experience? Gives me a headache how you would even design it but it could give a more definitive answer. But, even my own doc just goes through the prompters on the computer to ask me any questions. Since I'm healthy, a robot could do that for me and we are already up to our knees in cookbook practice. Despite the fact that 90% of patients who get penicillin tested because someone told them that they were, are in fact not allergic to penicillin, it was never my practice to push Vancomycin into a patient when they were pen "allergic" when a less problematic alternative was available. It was an on going war with the surgeons for decades until VRSA evolved. So, if we are doomed to the cookbook, I suppose NP with no previous experience would do. But we will never win the the PR war as long as we allow non-practiced, online trained NP's out in the market.

I was also interested. There are no such studies, and I have access to one of the best searching systems in the world.

[egg122 NP, MSN, APRN]

Yale did a study in the 1980s and there are a few more out there. There are some studies- they aren't very rigorous but none of the NP comparison studies are.

[subee, MSN, CRNA]

4 hours ago, egg122 NP said:

Yale did a study in the 1980s and there are a few more out there. There are some studies- they aren't very rigorous but none of the NP comparison studies are.

Calling all future DNP students - what a great topic for research. Of course, now the issue becomes muddled with MSN vs DNP. I will by six feet under by the time this has any answers:)

[FullGlass, BSN, MSN, NP]

On 6/22/2020 at 6:49 AM, subee said:

But we will never win the the PR war as long as we allow non-practiced, online trained NP's out in the market.

The question of whether or not NPs should have RN experience has been beaten to death already on this forum. While additional research might be interesting, there have been a few studies that found no difference between NPs with or w/o RN experience. Get over it.

Currently, almost all ACNP programs do require RN experience. That makes sense.

Primary care NP programs do not require RN experience, because RN experience isn't really relevant to the outpatient environment.

RN experience is not going to impress critics of NPs. What we need are NP residencies. For an NP, NP experience trumps RN experience.

[DrCOVID, DNP]

On 6/22/2020 at 2:00 PM, subee said:

Calling all future DNP students - what a great topic for research. Of course, now the issue becomes muddled with MSN vs DNP. I will by six feet under by the time this has any answers:)

PhD***... DNP are supposed to be integrating research to practice and facilitate change/nursing leadership, not conducting research experiments. My cohort picked DNP because we wanna be terminally educated providers. None of us wanted to be "in research." DNP is meant to be clinically focused and needs a more beefy clinical/scientific curriculum.

[KatieMI, BSN, MSN, RN]

24 minutes ago, adammRN said:

PhD***... DNP are supposed to be integrating research to practice and facilitate change/nursing leadership, not conducting research experiments. My cohort picked DNP because we wanna be terminally educated providers. None of us wanted to be "in research." DNP is meant to be clinically focused and needs a more beefy clinical/scientific curriculum.

I am really sorry, but when I read current guidelines/search Uptodate/find and read articles about a subject/sit in committee and offer solution for a problem based on available research and implement all that in my current practice, doesn't it mean that I am "integrating research into practice", or what? I do not need additonal year or two in school and $$$$ spent to know how to do that. I already know how to do it with just MSN.

[myoglobin, ASN, BSN, MSN]

No way should PA's have IP. To allow them such would no doubt endanger patients exposing them to unproven practitioners without a sufficient evidence base. The NP model incorporates both the nursing paradigm, along with traditional allopathic perspectives that provide outcomes beyond what can be proven from other disciplines. Most of all allowing more practitioners to have IP might engender my income base and that absolutely cannot be tolerated to do so would pose a danger to the very basis of civilization. Nothing short of allowing ratio laws beyond California could pose such a danger to the Republic. No doubt we should lobby state legislatures and federal politicians to oppose such a dangerous development and even subvert whatever professional organization represents PA's (as the ANA does nurses and has itself been subverted to be against ratio laws.). Every man/woman wants to be a monopoly of one or few indeed, were it up to me I would have been the only guy that women in my high-school were allowed to date (no doubt I still wouldn't have had a girlfriend) which is why governments should endeavor to allow as much free competition as possible.

[DizzyJ DHSc PA-C]

3 hours ago, myoglobin said:

No way should PA's have IP. To allow them such would no doubt endanger patients exposing them to unproven practitioners without a sufficient evidence base. The NP model incorporates both the nursing paradigm, along with traditional allopathic perspectives that provide outcomes beyond what can be proven from other disciplines. Most of all allowing more practitioners to have IP might engender my income base and that absolutely cannot be tolerated to do so would pose a danger to the very basis of civilization. Nothing short of allowing ratio laws beyond California could pose such a danger to the Republic. No doubt we should lobby state legislatures and federal politicians to oppose such a dangerous development and even subvert whatever professional organization represents PA's (as the ANA does nurses and has itself been subverted to be against ratio laws.). Every man/woman wants to be a monopoly of one or few indeed, were it up to me I would have been the only guy that women in my high-school were allowed to date (no doubt I still wouldn't have had a girlfriend) which is why governments should endeavor to allow as much free competition as possible.

Obviously, you have no understanding of the PA profession and no literature to support your outrageous statement. Endangering patients?!?! A provider who does 500 hours of clinicals, they scheduled on their own, is endangering patients.

[DLS_PMHNP, MSN, RN, NP]

On 6/26/2020 at 6:57 PM, myoglobin said:

No way should PA's have IP. To allow them such would no doubt endanger patients exposing them to unproven practitioners without a sufficient evidence base. The NP model incorporates both the nursing paradigm, along with traditional allopathic perspectives that provide outcomes beyond what can be proven from other disciplines. Most of all allowing more practitioners to have IP might engender my income base and that absolutely cannot be tolerated to do so would pose a danger to the very basis of civilization. Nothing short of allowing ratio laws beyond California could pose such a danger to the Republic. No doubt we should lobby state legislatures and federal politicians to oppose such a dangerous development and even subvert whatever professional organization represents PA's (as the ANA does nurses and has itself been subverted to be against ratio laws.). Every man/woman wants to be a monopoly of one or few indeed, were it up to me I would have been the only guy that women in my high-school were allowed to date (no doubt I still wouldn't have had a girlfriend) which is why governments should endeavor to allow as much free competition as possible.

I too would be curious to see the literature to back this up. I have worked alongside MANY competent PA-Cs and have learned plenty from them. I have have every bit of respect for them too I don't understand your animosity. Seriously.