To NP or to PA?

[clandestine2]

Probably half way through my BSN program I knew that I wanted to pursue becoming a midlevel practitioner. To keep my options open I decided to take PA/Med School prereqs while finishing my final year of nursing school. I graduated nursing school and continued to take my prereqs while working between neuro and ortho med/surg floors. Fast-forward a few semesters and upon completing the core 9 prereqs (Chem I & II, Biology I & II, genetics, Physics I & II, Ochem I & II), approximately 18 months after graduating nursing school, I decided to go ahead and begin the journey of applying to PA school. I mean I had done all this work, so I must go ahead and apply… Right?!? So CASPA… let me say it again CASPA! So just a little information on the application process, CASPA is well organized, but it costs quite a bit to get your package ready through CASPA. Additionally, each school costs to apply to even if they are linked to CASPA. To make it short, I applied to 15 PA schools, fees ended up being about 2K when all is said and done. Fortunately, I was a first round invite to three schools in my top 5 and I accepted my first offer. Everything falling into place as planned. Now I waited about 10 months before the first semester began. If you are keeping track I've now been a practicing nurse about 2.5 years at the start of the PA program.

Ahh… PA school (as an RN), starting the first semester felt familiar and what I expected, actually it felt too familiar. I had an odd feeling about the material, so much of it felt completely like a repeat of nursing school. After the first semester (which I got all As), I had a strong feeling that this was not for me”; I arranged a meeting with the program director and withdrew from the PA program (in excellent standing, with the option of returning the following year). So I'm feeling lost at this point, I revisited what my motivations and desires were for pursuing becoming a midlevel, and why I chose PA. Sadly, in hind site I think I chose PA because I was, and I know many nurses have been, insecure about the level of knowledge I had as a nurse. It came to my attention, while in the PA program, the education nurses receive in their programs in addition to practical clinical experience is so very valuable, and I realized that I had not appreciated this.

If one types in PA vs. NP vs. MD vs. DO etc. into Google you will undoubtedly run across posts (especially on studentdoctor.com) really bashing NPs. I had done the same searches a few years ago and was easily swayed by the brutal attacks on NPs at which time for me, the NP pathway was not even a consideration. It is so important to note that I am coming specifically from the point of view of a nurse, as I do believe that the PA education and practice is excellent and they do indeed provide excellent service, BUT they are not anymore educated or prepared than NPs. That is something that became so obvious, as a PA student the assumption in the curriculum is that the student has null medical knowledge and experience, this is where the fish out of water” came for me personally.

NURSES LEARN THE MEDICAL MODEL! Although our focus is on the nursing model the medical model and the nursing model interweave in the sense of the science and it has to do so in order for nurses to know when and why to reach out to the PCP. This is KNOWLEDGE gained through clinical practice, as I have never worked with a nurse who did not share the inquisitive nature of any other scientist and was not greatly interested in new disease processes or treatments, even researching and reading on their super short breaks or on lunch (yes they do exist). My point here is that knowingly or not, nurses learn the medical model, nurses learn treatments, nurses learn diagnostic methods, and nurses can often times anticipate interventions. THIS IS VALUABLE KNOWLEDGE, learned in the clinical setting. Reflect back on the education curriculum of the PA and the assumption that they have null experience and knowledge medically.

So… I started an NP program, I am wrapping up my first semester and it feels like hand in glove for me. The approach to the education and curriculum incorporate the existing knowledge of the nurse. I feel like I am building on the knowledge I already have, versus starting from a null position. In many ways my insecurities led me down a road that cost me time and money and in the end I realize that it is essential to recognize when that is occurring, and not to allow it to take over. So, if you are considering PA or NP as a nurse, I would highly recommend going the NP route, as it is designed to build on what you already know, and YOU KNOW A LOT.

[TakeTwoAspirin, MSN, RN, APRN]

We have somewhat parallel experiences. I too started with PA school and realized it was not for me for much the same reasons. Being a NP is a really comfortable fit for me. Much as you, I found it to be as good a fit as a hand in glove. While I learned a lot from my PA education, one of my biggest regrets is that I should have quit sooner. It was an expensive mistake for me, especially as I relocated to go.

Personally, I think that all the MD vs. PA vs. NP vs. "whatever" is based on insecurity. I don't feel the need to put other practitioners down in order to feel good about myself. I am good at what I do. I have a thriving practice. My patients adore me and they know I would do anything for them. I don't need an MD or any other letters after my name to know that what I do counts; what I do is valued; and what I do makes me happy.

Good luck!

Good luck to you.

[Farawyn]

I'm not going for either, but there is a great thread further on down the page called BSN to PA. You guys should check it out.

[anh06005, MSN, APRN, NP]

It's interesting to read about nurses going to a PA program! I did FNP and in some ways wish I'd done PA. I know the first semester or two would likely be a repeat of info but I'd have liked the variety of clinical settings in the later semesters and I'd have loved the medical focus in earlier semesters rather than nursing theory and research.

I did enjoy my NP program. Just not the first few semesters. Once I hit the 3 P's I was much happier. I guess I always felt PA school focused more on 3 P's.

Anyway it's interesting to read the opinions! It is a very individualized choice on NP, PA, MD, DO, etc. and there is no real right or wrong. There's good and bad in each bunch but I'm trying to be one of the good ones and expand my knowledge during my first few years (I'm thinking of it like a residency).

[OnlinePersona, LPN]

You write so articulately. You should totally be a writer for allnurses.com or some magazine, I for one will totally read it.

I love that you wrote this, I'm graduating nursing school in a few months and my dream is not really to be in practice as a prescribing factor but have the ability to do so if wanted. My goal is to be a psych NP or PA. I myself read the studentdoctor forums and got discouraged about the NP model.... but now I know what to do :-)

Thank you