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An interesting discussion by (mostly) nurses on the DNP. I have never seen so many nurses claim they wish they were PAs.


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But But But NPS and PAs are the same, they are both midlevels, they are both reimbursed by medicare at the same rate, they are both grouped together in discussions at all levels.

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JMPA

 

BAN that midlevel word!

 

 

This thread just again confirms my thoughts

 

1- DNP and NP education is FAR inferior to PA

2 - NP lobby is kicking it in congress and winning more then loosing

3 - AAPA has hidden behind AMA and doc's for years and thought they would advocate for us, when in reality they don't care bout us at all

4 - NP<<<<<PA Education - hands down

5 - We need to have a residency year, to burn in the knowledge (we have simply become one more level of provider that HR has to hire and a new grad PA does not posses the skillset to hit the ground running

6 - after 5 yrs clinical practice we should be able to take a test and uncouple  from any physicians and allow for direct billing and 100% practice ownership

 

AAPA is getting better as PAFT is draggin them out of the dark ages

 

 

 

 

*******

The biggest issue at hand is that we are in an INCREDIBLY dynamic time of change, one that will likely not be repeated in our lifetime as we move towards some type of national health care program/system/laws/regulations - If PAs are not included in the very basic foundation of this, while the NPs are and further themselves, we are going to become outdated.. and we will forever be trying to play catch up....

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^^^^^^^  It is a difficult job to drag that org. out of the dark ages but slowly it is happening.

 

We however need a SEISMIC shift and I hope it happens soon.

 

The years and years of imbedding the AAPA with the AMA will be difficult to unhinge. .   It is like trying to actually put term limits on Senators in government but instead the imbedding gets even more weird with unholy alliances.

 

I would love to listen in on the underpinnings of the conversations between these orgs. and their leaders. 

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only the membership can FORCE the AAPA to wake up

 

I did not renew my membership till AAPA actually called me and asked why I had not renewed (just some hired company to make calls, but I did professionally told them what I thought and asked them to pass it on)  

 

I did rejoin eventually, as they are our organization and we MUST fight in congress right NOW

 

Also, every email I get from AAPA I reply to with comments, as well as making comments on their facebook page to always have a fly in the ointment presence - I would recomend everyone else do the same...... 

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Obviously the Reddit thread needs read with caution.  It is largely a rant against shady schools and the nature of the DNP.  Bemoaning the fact that a DNP is not a clinical doctorate is a bit misguided.  As many PAs are quick to point out, the clinical doctorate is an MD and that's that.  There is definitely a branding issue at play when you have DNP "educators" and DNP "NPs" which creates a very confusing atmosphere.  That does strike me as a huge problem.  But it should take about 30 seconds of reading to understand that the DNP is an educator / epidemiology / administration degree and many NP programs are sticking fast to the clinical MSN / NP.

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how will DNP requirements and the potential tuition/debt factor into NP satisfaction ?   Never thought about that before.  I have a family member who did private undergrad university and a DPT at same institution and has 180k+ loan. Not good. Many hospital/universities are cutting fringe benefits and tuition/CME is often one of them.  Not sure I agree that DNP is epidemiology training ... but def gives some education and leadership tools. 

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The original piece in this link is misguided, it is this nurse's fault for not knowing the content of the program they were entering

"Buyer beware"???

 

You entered a program thinking you were going to get some level of in depth pathophysiological and clinical education, yet you got theory and systems analysis. Did you read the curriculum? Talk to the program or their students?

 

Or were you chasing a credential on unfounded basis?

 

Can't really feel bad for them.

 

Funny in a way to hear these RNs/NPs lament about what we all know re: the level of clinical training for PA vs NP

 

That being said....

 

The level of training of the program does NOT define the SITUATION the credential has put the provider in (to practice independent medicine; YES NPs practice medicine).

Stop complaining about your program and pick up a book, get your CME, read like an omnivore on your patients and MAKE your clinical education instead of expecting it to be handed to you.

 

 

It is THAT attitude that has shown me that NPs can easily reach high levels of clinical acumen. I've practiced alongside many of them, and somehow they were able to break free of the restrictive educational shackles of their NP programs!

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bottom line though - even though they are not as well trained (and I think "fluffy" is an excellent term!), they get treated better than we do on the job. plus they are in their own ranks with nurses, and most nurses are not very friendly to PAs. they are much nicer to their own. so we get beat up from the top and the bottom, they get treated better at both ends

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^ The above is so true. Given the trend of things with respect to sudden recent legislation in favor of NP.

 

I honestly do think that it is just a matter of time that all PA will report to DNP. I know some would argue that this could be seen in primary care and less so in specialty/subspecialty. The point is, things are not looking good in our favor.

 

In NY state at least, NP pursuing DNP and those that already are DNP runs around with a chip on there shoulder. At least, many that I've met. And, I don't blame them! In there favor is the recent legislation passed in NYS.

 

Some, I have to constantly battle with them because they are in administration or lead mid-level provider and thinks they have the authority to tell me how to manage my patients. Hard work doesn't cut it sometimes. It all about politics. Politics in medicine to be precise. You add lobbying power and you're golden.

 

The quality of our training isn't a selling point anymore. It is becoming more easier to hire an NP than PA. This in part due to NP relentless lobbying machine both state and federal level. We would soon be extinct or we will be hiding in specialty under an MD with no voice.

 

An MD friend said to me recently how annoyed it's becoming that he had to constantly sign off his PA chart, the non ending chart review and so many other crap just to keep his PA. His words not mine.

 

There would comes a time when states law binding PA would be invalidated. Honestly, it already is given each respective hospitals bylaws. Am I just making baseless prediction? I may! Maybe not or I may simply over exaggerating. Bylaws are drafted by hospital right? My heart bleed for our profession. Enough said!

 

Join PAFT!

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I barely did anything in my clinical time, which was minimal (approximately 16-20 hours/wk x 36 weeks). There were some really stupid, not smart people in my classes who somehow graduated with me.

 

 

Wow, you don't say.

 

The DNP is a fluffy degree, with really no discernible difference from the PhD.

 

Oh just except that silly 4 year research project and dissertation defense thing.....oh and 3 years of actually being in a program.

 

Now, why is this a strategic political move? Because NPs strive for autonomy. We want to eat from the same plate as physicians without the same training. So, if we can push NPs to get their doctorate of nursing practice then we can all say we are Doctors and The Man can't tell us that we have a limited education. "I'm Dr. Nurse. I learned all about how Hispanics generally receive less care than white people, that is why I can prescribe medicine now. Now let me DECIDE YOUR FATE." 

 

 ^Absolutely true. The DNP has and always will be a political power play for more autonomy. It sets them up to be in management positions, giving them more authority but circumventing all the important sh*t they don't actually know.

 

 

Personally I dont think PAs will ever answer to DNPs---not clinically anyway. I can absolutely see them climbing into clinic or organizational management however and having de facto authority over employed PAs.

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Personally I dont think PAs will ever answer to DNPs---not clinically anyway. I can absolutely see them climbing into clinic or organizational management however and having de facto authority over employed PAs.

 

 

 

Wow, you don't say.

 

Oh just except that silly 4 year research project and dissertation defense thing.....oh and 3 years of actually being in a program.

 

 ^Absolutely true. The DNP has and always will be a political power play for more autonomy. It sets them up to be in management positions, giving them more authority but circumventing all the important sh*t they don't actually know.

 

 

Personally I dont think PAs will ever answer to DNPs---not clinically anyway. I can absolutely see them climbing into clinic or organizational management however and having de facto authority over employed PAs.

 

 

yeah, that phD being the same as DNP shows a TOTAL lack of understanding of what is in a phD

 

 

I have worked with 3 long term NPs recently, and all three times I have been amazed at the lack of basic knowledge and ability to develop a Ddx - yeah no way I as a PA will EVER report to an NP as a medical supervisor..... maybe administrative but that is it.

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^ The above is so true. Given the trend of things with respect to sudden recent legislation in favor of NP. I honestly do think that it is just a matter of time that all PA will report to DNP. I know some would argue that this could be seen in primary care and less so in specialty/subspecialty. The point is, things are not looking good in our favor. In NY state at least, NP pursuing DNP and those that already are DNP runs around with a chip on there shoulder. At least, many that I've met. And, I don't blame them! In there favor is the recent legislation passed in NYS. Some, I have to constantly battle with them because they are in administration or lead mid-level provider and thinks they have the authority to tell me how to manage my patients. Hard work doesn't cut it sometimes. It all about politics. Politics in medicine to be precise. You add lobbying power and you're golden. The quality of our training isn't a selling point anymore. It is becoming more easier to hire an NP than PA. This in part due to NP relentless lobbying machine both state and federal level. We would soon be extinct or we will be hiding in specialty under an MD with no voice. An MD friend said to me recently how annoyed it's becoming that he had to constantly sign off his PA chart, the non ending chart review and so many other crap just to keep his PA. His words not mine. There would comes a time when states law binding PA would be invalidated. Honestly, it already is given each respective hospitals bylaws. Am I just making baseless prediction? I may! Maybe not or I may simply over exaggerating. Bylaws are drafted by hospital right? My heart bleed for our profession. Enough said! Join PAFT!

 

no. politics is everything in medicine and nurses have a lot of experience with that. we are a much newer profession. nurses know how to be "in charge" and I doubt they are going to want to let that go to a bunch of medical-model trained upstarts. nurses can be just horrible. I've been driven out of jobs by them, sabotage after sabotage. unreal. I do think RNs are extremely valuable and well-trained and I would give my eye-teeth to have the knowledge and skill of a crack ICU nurse, but they can also make your life hell, and so much of it behind-the-scenes you don't know what hit you until you feel the door hitting your ass. 

 

politics is rampant...in everything, but yes, in medicine, and it is really hard to learn how to play the game. that has been half of my personal "battles" in trying to succeed as a PA, is maneuvering the invisible and insidious politics, finding out how booby-trapped everything (was) after the fact....I suck at politics.

 

if I was on "survivor" I'd be the first one voted off, hands down, bc I don't know how to "play the game". I just take everything and everyone at face value, because that's how I am. I assume everyone else is straightforward too.

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no. politics is everything in medicine and nurses have a lot of experience with that. we are a much newer profession. nurses know how to be "in charge" and I doubt they are going to want to let that go to a bunch of medical-model trained upstarts. nurses can be just horrible. I've been driven out of jobs by them, sabotage after sabotage. unreal. I do think RNs are extremely valuable and well-trained and I would give my eye-teeth to have the knowledge and skill of a crack ICU nurse, but they can also make your life hell, and so much of it behind-the-scenes you don't know what hit you until you feel the door hitting your ass. 

 

politics is rampant...in everything, but yes, in medicine, and it is really hard to learn how to play the game. that has been half of my personal "battles" in trying to succeed as a PA, is maneuvering the invisible and insidious politics, finding out how booby-trapped everything (was) after the fact....I suck at politics.

 

if I was on "survivor" I'd be the first one voted off, hands down, bc I don't know how to "play the game". I just take everything and everyone at face value, because that's how I am. I assume everyone else is straightforward too.

 

I'd suggest trying to learn the game of workplace politics, because you will never escape it, unless you are truly self-employed. That doesn't mean you have to actively PLAY it, but once you understand the game, it's easier to see things coming and avoid them. It sucks but every interaction is a move on the board. It helps to try and think ahead.

 

Some places are worse than others, of course, and I think hospitals are the WORST for politics in the medical profession. When I was a surgery PA I dealt with the same thing. I thought I could just quietly do my job and all would be well, but it's not really that simple. I noticed that all the floor nurses liked me because we could work together to get someone discharged (and they were less b*tchy in general), but some of the OR nurses HATED me...partly because I didn't really know what I was doing and partly because I stepped on a few toes in the process and they just had me on their hit list from day one. Those OR nurses are part of the reason I lost that job. It was ultimately for the best, but nurses can make or break you in some settings.

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Yup, politics, workplace ones really suck.  I'm playing a game of chess right now at my job and so far we are in a tied match.  Their move is next, mine is all planned out on how to win the game.  

 

Unfortunately winning sometimes entails leaving the job. 

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