What would you do? Advice Needed

[EMEddie]

Hello Everyone-

I am asking for honest and sincere advice from you guys whom might have been in my dilema position. I am a new grad working in critical care. Before going into my nursing program [An ADN/ASN] I was attending a university major in Public Health; currently I only need 3 classes to complete this B.S. in Public Health. In terms of experience, I worked as an EMT prior to becoming an RN.

I am looking into my future and trying to see which of the following roads I would like to take. I would like to become a midlevel provider because of their big role in society and I love the clinical/disease process. I have looked into CRNA, but honestly I dont see myself in an OR all day being in the back of the patient controlling drips/sedation and such things; to me this would be very monotonous.

I am debating in either going into a Masters Program in PA or NP. I like how PAs follow a more disease process rather than so many nursing theory stuff and how it seems that as a PA you can virtually jump to any specialty ranging from family practice, to ER, to orthoepedics, to surgery, to ICU, to other medical subspecialties as compared to NPs whom are simply more known to do family medicine. I know of some NPs who do ER and ICU, but these are ACNP, rather than FNPs.

Its know that there is a lot PA residencies that further specialize you in an area as compared to NPs where the program basically trains you in a program, yet in the real world makes it much more difficult to jump specialties than PAs. I would like to do ER, ICU, but also Family Practice. I honestly love nursing, I have learned so much and there is much more I will be learning ,so this in now way is disrespect to the nursing progression.

The dilemma is if I should go back to school, finish my B.S. in Public Health and obtain a minor in Biology and then apply to PA school. Or, finish my B.S. in Public Health and also enrolled in a RN-BSN program? I know I can still apply to PA schools with a BSN degree, but I feel that if I take the extra "science' classes in the minor in Biology it would look better to the admission personnel.

I am very confused on what to do; I like PA for the reasons mentioned, but I understand that an NP can practice in the same role, except with the specialty jumping ability. I am not saying I will be jumping continously, but would hate to do FNP, start family practice and then 10 years later not being able to transition into lets say ICU or Rheumatology as easy as a PA could.

What could you advise me? Now that you have taken this path, what do you sincerely regret of being an NP/PA etc?

Thanks in advance.

[Corey Narry, MSN, RN, NP]

NP will give you the flexibility of getting the BSN and MS or MSN while still working as a nurse and finishing at your pace. You also have the option for ADN to Master's. PA programs will require full time commitment so it will be hard to work at the same time.

While the PA option is attractive because the training allows you to work in any specialty, people who say they can jump from any specialty to the next is not being realistic. I am saying this for both PA and NP colleagues. In your example, there is no way a PA doing Family Practice for 10 years can easily jump to an ICU role. There's far more qualified providers to pick than someone who haven't stepped inside an ICU for 10 years! On the other hand, Family Practice to Rheumatology might not be too far of a stretch.

[SCSTxRN]

You might keep in mind, too, the add on certifications available after finishing your FNP - if, in 10 years, you wanted to go ICU, you could do an ACNP add on in about a year - update with current information - while still working in your FNP role.

On the other hand, if you have any leanings toward independent or pseudo independent practice as a care provider, as an experienced FNP you can open a clinic in several states; a few with no input from MD. As a PA, you have to be supervised by a doctor. No minute clinic type things.

FNP can cross train to rheumatology; actually almost any adult specialty that manages chronic but controlled disease, by finding a doc willing to train - same as PA.

If you love nursing, I'd stick with nursing TBH. We've got a strong lobby and a good foothold in public opinion and policy at the moment, and we have our own regulatory boards. I don't think PA is going anywhere, but they do exist at the whim of BOM in every state.

[nursetim, NP]

Don't be fooled, we practice medicine. There I said it. The sacred cow has now been slain. If we didn't, why would we need any input from the board of medicine at all. In most state BOM controls our practice. So we do, in fact, practice medicine. PAs get more traditional medical training than we do. I would rather there be one program. If you have BSN after your name, you come out as an NP. If you have any other letter behind your name that has nothing to do with nursing, you come out as a PA. Identical training.

[TraceyMarino]

I disagree with nurse Tim. It is not identical training. IMHO, PA training is more rigorous and robust than NP school. There. I said it.

PA school is basically medical school, that stops at GY3. NP school includes alot of classes that have nothing to do with practicing medicine.

I recently attended the Fitzgerald AANP review class, and spent 3 days asking questions and listening to other NP grads ask questions. It was obvious from the questions and comments from many NP grads, they have little understanding of pathophysiology. I myself am acutely aware of the holes in my own training, including ortho, radiology, pathophysiology, and I am righting this on my own.

NP's have always had the "I have X years of experience as an ER nurse, ICU nurse, etc..." to fall back on. And truly, this experience is invaluable in becoming a great provider. I think direct entry NP programs will destroy this advantage.

Finally, yes, PA's are aligned with the AMA, and doctors. NP's balk at this, and get their hair up about being able to "practice independently". However, if you ever want to advance your career, medical schools are taking, and will be taking PA's as direct entry into medical school. This will be the AMA's answer to the provider shortage---just let all the PA's go to medical school and cut them a huge financial break. NP's will NOT be allowed this advantage.

If you want to advance your career, go to PA school.

[nomadcrna, DNP, CRNA, NP]

Simply not true.

Show me medical schools that take PAs as "direct entry". LOL

Maybe you could call the AMA and give them your solution because I have heard nothing about it from any reputable source, ie: letter all the PAs go to medical school.

Do you really think PAs come out of school understanding ortho and being proficient at radiology? No, they come out with a basic medical education. They get OJT experience in whatever specialty they go into.

I've seen bad NPs and I've seen bad PAs. I discovered that it is not the initials after your name that make a good practitioner.

I disagree with nurse Tim. It is not identical training. IMHO, PA training is more rigorous and robust than NP school. There. I said it.

PA school is basically medical school, that stops at GY3. NP school includes alot of classes that have nothing to do with practicing medicine.

I recently attended the Fitzgerald AANP review class, and spent 3 days asking questions and listening to other NP grads ask questions. It was obvious from the questions and comments from many NP grads, they have little understanding of pathophysiology. I myself am acutely aware of the holes in my own training, including ortho, radiology, pathophysiology, and I am righting this on my own.

NP's have always had the "I have X years of experience as an ER nurse, ICU nurse, etc..." to fall back on. And truly, this experience is invaluable in becoming a great provider. I think direct entry NP programs will destroy this advantage.

Finally, yes, PA's are aligned with the AMA, and doctors. NP's balk at this, and get their hair up about being able to "practice independently". However, if you ever want to advance your career, medical schools are taking, and will be taking PA's as direct entry into medical school. This will be the AMA's answer to the provider shortage---just let all the PA's go to medical school and cut them a huge financial break. NP's will NOT be allowed this advantage.

If you want to advance your career, go to PA school.

[Corey Narry, MSN, RN, NP]

Don't be fooled we practice medicine. There I said it. The sacred cow has now been slain. If we didn't, why would we need any input from the board of medicine at all. In most state BOM controls our practice. So we do, in fact, practice medicine. PAs get more traditional medical training than we do. I would rather there be one program. If you have BSN after your name, you come out as an NP. If you have any other letter behind your name that has nothing to do with nursing, you come out as a PA. Identical training.[/quote']

There were programs like that in California at one point. Stanford and UC Davis had PA and FNP students in one program. The nurses earn the FNP and also has the option to sit for the PA boards. We still have grads of those programs who have both PA and NP credential. Nursing politics and regulation has affected those programs and they have now officially been separated at UC Davis and Stanford dropped the FNP option and is just offering PA now.

[Alisabeth, BSN, MSN, DNP]

I think you would do very well as a PA or NP. You have to pick the program that fits you the best, and I would take the length of completion into consideration. I wanted to reply to your post because I want to make sure you know NPs can jump to different subspecialties very easily. I am a Family NP. My main/favorite specialty is surgery, specifically neurosurgery. However, I am a travel/locum tenen NP and have worked in multiple specialties in my various contracts including ER/urgent care, family practice, orthopedics, neurology, In surgery and Orthopedic/neurology I also work and round in the ICU. I just didn't want you to think you would be stuck in only family practice, if you became an NP or FNP. I have met many other NPs in my travel assignments who have also worked in multiple subspecialties as well. Whether you go for PA or NP, you will do great. Good luck!

[%63theend]

You already know the nursing model. I'd stick with that.

[BlueDevil,DNP, DNP, RN]

Well, what is the NP act like in your state? Are you willing to move? That is a fairly important issue. If you live in Florida or, what is it, Alabama (?) with the other really horrific NP act? If you are stuck in a state like that, you might as well be a PA because there is little to no advantage to being a NP. If you live in one of the states with a better practice act, then giving up the tremendous advantages offered by a good NP practice act to play second fiddle and be controlled by the AMA when your education prepares you to do so much more than that is lunacy.

Both are fairly flexible when it comes down to it. Unless you know you want a surgical specialty, which would strongly point to PA as a better choice in most instances, in an otherwise equivocal practice area, it shouldn't matter much. If your present background gives you an advantage in nursing then I'd head in that direction.

[EMEddie]

Thanks everyone for the great advice given; really appreciated!

Juan De La Cruz- UC Davis still has the FNP/PA program, the only thing now is that it has been moved to the Master's Program level for both. I talked to the Admissions Director a few days ago. Stanford on the other hand, only has the PA program.

[Corey Narry, MSN, RN, NP]

Juan De La Cruz- UC Davis still has the FNP/PA program, the only thing now is that it has been moved to the Master's Program level for both. I talked to the Admissions Director a few days ago. Stanford on the other hand, only has the PA program.

Great! that's an awesome campus with a respected medical center. I assume the program is well regarded.