NP Students

[sunny2spot]

To address any question of clerical error, that isn't the issue. The NP student herself told me "it has to be filled out by a doctor" when I asked why she sent her evaluation to the ED director. All correspondence from the school that I have seen (by CC) have come from nurse practitioners from her school.

 

I appreciate your feedback, since I wasn't sure if my frustration was biased, and agree that bringing this issue to the ED director is a decent first step. Hopefully he will be willing to add a note to her school that the majority of the student's hours (keeping in mind that she was >1hr late to 3 shifts and a no-show for 2 other shifts) were with PAs. They should be aware of that if they feel that PAs are inadequate to train their students.

 

As far as staking the claim that failing a student marks a failure on the preceptor's part, I don't think that can be universally applied. Anyone can imagine an instance where a student is entirely disengaged and absorbs nothing, no matter how fantastic the preceptor. I think it is the responsible thing to fail someone if they have not prepared themselves sufficiently to care for someone else's family.

[browndog]

EMED,

 

I understand the difference between NP and PA educational programs and it is my opinion that PAs are better trained clnicians out of school.  I was approached last week by an EMT-P about becoming an NP and I told him to absolutely pursue PA or CRNA route if MD/DO not possible.   Frankly, I wish I had pursued the PA path.  Anyway, I agree with your post about the ridiculously low number of clinical hours required by NP programs. 

 

There is a new organization afoot which I hope will improve the EMNP product.  We, as NPs, need a more rigorous path to EM practice with a solid post graduate certification similar to your CAQ. 

[primadonna22274]

Late 3 x AND 2 NO-SHOWS?!?!

Instant FAILURE. I cannot imagine such a lack of professionalism as a student, certainly not as a practitioner.

My tiny dose of empathy for this student just went out the window!

[KMD16]

^ true. Consider this a failure. Unacceptable.

[Mainer]

"That's pretty typical if you were precepting a primary care student (FNP, ANP, PNP), e.g. if you were precepting an FNP student, ED is not considered "family practice," so allowed hours by the school would be minimal. Some schools allow no ED time at all, or allow it, but it won't count towards minimum clinical hour requirements."-By Upregulated

 

Oh yes, the bastardization of medicine. 

 

This is exactly why NP's are so poorly qualified.  Limited training, limited knowledge, but so effective at advocating for their professional agenda.  IMO, those hoping to practice in family medicine should spend more time in specialty care like surgery, emergency medicine, pediatrics and psych, so forth.  So when a problem comes through the door, you're more likely to recognize it.  You'll see more hernia's, acute abdomen's, breast masses, ect in a 6 week surgery rotation than you will in a 20 year career in family medicine.  Ditto with other specialty rotations.  Of course, the standards in medicine are grossly different than nursing.....sigh. 

 

You'll be a much better primary care provider with training and education in the core specialties.  PA's do more family medicine, internal medicine, and pediatrics than any FNP, ANP, PNP, in addition to their other requirements. 

[SoCalPA]

This further reassures me that I am making the right decision to become a PA vs. a NP. Just a better decision for me personally. I am certain I will be a better clinician.

[zoopeda]

sounds like you attended a quality NP program. some np programs offer 500 hrs total for their entire clinical "year".

this is how one program we have taken students from describes their clinical "year":

Preceptored Clinical Experiences

A clinical component is scheduled during each semester to provide students with an opportunity to apply their learning in the clinical work setting. Students are supervised by a local preceptor who is responsible for assuring that the student is provided with adequate and appropriate learning experiences as close to home as possible. This partnership between the academic and clinical settings not only results in a well prepared family nurse practitioner, but positions the student for employment opportunities after graduation. Students should plan to spend approximately 8 to 16 hours per week in a clinical setting.

 

(This allows someone to complete the entire program with 400-800 hrs of clinical time total if they do rotations 50 weeks/yr....)

 

This is extremely misleading.  NPs specialize; PAs do not.  In other words, sure a PA student works 40 or 50 hours a week in each specialty for 5 or 6 weeks, but they only get a few hundred hours of formal clinical training in each specialty.  At graduation, a PA might have 200-300 hours of pediatric training, but a pediatric NP graduates with 500-600 in just pediatrics.  Same is true of FP, EM, Psych, etc.  I'm actually much more fond of the PA educational and practice model and plan to enroll in a PA program (rather than an accelerated BS->NP program) in May.  But this notion that NPs somehow have diminished clinical training is completely erroneous because of the fact that they specialize while PAs do not.  (Try learning 8 languages in 1 year, full time.  Then try learning 1 language, 12 hours a week, for a year.  Obviously the latter is going to yield stronger immediate results, which is why PAs go on to refine their craft through professional practice.)  Finally, 600 hours vs 2000 hours is NOTHING in the face of a lifetime (tens of thousands of hours) of practice.  Every PA and NP I've interviewed (worth their salt) has admitted no one is fully competent upon graduation and that medicine is truly a lifetime of learning.  Every PA I've shadowed has laid it out: you get an intro in school, but ultimately the real training is on-the-job.  The exact same can be said of NPs.  Bottom line: don't be misled by simple numbers; focus is everything.  

[2234leej]

"That's pretty typical if you were precepting a primary care student (FNP, ANP, PNP), e.g. if you were precepting an FNP student, ED is not considered "family practice," so allowed hours by the school would be minimal. Some schools allow no ED time at all, or allow it, but it won't count towards minimum clinical hour requirements."-By Upregulated

 

Oh yes, the bastardization of medicine. 

 

This is exactly why NP's are so poorly qualified.  Limited training, limited knowledge, but so effective at advocating for their professional agenda.  IMO, those hoping to practice in family medicine should spend more time in specialty care like surgery, emergency medicine, pediatrics and psych, so forth.  So when a problem comes through the door, you're more likely to recognize it.  You'll see more hernia's, acute abdomen's, breast masses, ect in a 6 week surgery rotation than you will in a 20 year career in family medicine.  Ditto with other specialty rotations.  Of course, the standards in medicine are grossly different than nursing.....sigh. 

 

You'll be a much better primary care provider with training and education in the core specialties.  PA's do more family medicine, internal medicine, and pediatrics than any FNP, ANP, PNP, in addition to their other requirements. 

 

@mainer: I've sent you a couple emails/messages but you have not yet responded yet. If you could shoot me back a message it would be greatly appreciated. You're a PA, PT, ATC, PhD, correct? Have you met any good NP's in any of your job settings? There are good and bad NP's out there just like any other healthcare provider. 

 

@Zoopeda: I agree with you. I've definitely had my fair share of conversations with NP's who said their curriculum sucked. This conversation was definitely more frequent within the NP context compared to PA school. But, I've also met NP's who went to a good school and felt prepared to practice. I've heard good things about UC Davis, Rush, Loyola, Vanderbilt, etc. just to name a few. 

 

[EMEDPA]

This is extremely misleading.  NPs specialize; PAs do not.  In other words, sure a PA student works 40 or 50 hours a week in each specialty for 5 or 6 weeks, but they only get a few hundred hours of formal clinical training in each specialty. 

ok, let's talk about "specialization".

these were my clinical hrs for PA school:

Trauma surgery > 600 hrs

Family Medicine > 500 hrs

Emergency medicine > 1000 hrs ( 2 x 5 weeks each in adult and peds em+ 1 x 12 weeks in general em)

OB 200 hrs

Psych 200 Hrs

InPt IM 250 hrs

 

using your logic I have "specialized" in 3 fields as I have as many or more hrs than a typical 500 hr NP program in EM, FP, and Surgery.

There were students in my program who eneded up with similar hours in their specialty of choice by arranging their required and elective rotations well.

I will stack my educational experience against any EM NP or ACNP (800 hr program total), FNP (500 hrs or so), or RNFA program ( a few hundred hrs after RN).

PS Tell a PA who went to Cornell or University of Alabama that they didn't specialize in surgery with their > 2000 hrs in that specialty.

Yes, PA is designed (like medical school) as a generalist medical training, however that doesn't mean someone who wants to specialize can't.

Almost every PA program requires a large preceptorship or extended rotation of 10-16 weeks in FP, making us all(at the very least) FP specialists.

[cinntsp]

This is extremely misleading. NPs specialize; PAs do not. In other words, sure a PA student works 40 or 50 hours a week in each specialty for 5 or 6 weeks, but they only get a few hundred hours of formal clinical training in each specialty. At graduation, a PA might have 200-300 hours of pediatric training, but a pediatric NP graduates with 500-600 in just pediatrics.

This explanation is also somewhat misleading because a PA will have peds exposure in peds, EM, FM, OB(neonates), surgery, psych, etc.

 

Sent from my Nexus 5 using Tapatalk

 

[LT_Oneal_PAC]

This is extremely misleading. NPs specialize; PAs do not. In other words, sure a PA student works 40 or 50 hours a week in each specialty for 5 or 6 weeks, but they only get a few hundred hours of formal clinical training in each specialty. At graduation, a PA might have 200-300 hours of pediatric training, but a pediatric NP graduates with 500-600 in just pediatrics. Same is true of FP, EM, Psych, etc. I'm actually much more fond of the PA educational and practice model and plan to enroll in a PA program (rather than an accelerated BS->NP program) in May. But this notion that NPs somehow have diminished clinical training is completely erroneous because of the fact that they specialize while PAs do not. (Try learning 8 languages in 1 year, full time. Then try learning 1 language, 12 hours a week, for a year. Obviously the latter is going to yield stronger immediate results, which is why PAs go on to refine their craft through professional practice.) Finally, 600 hours vs 2000 hours is NOTHING in the face of a lifetime (tens of thousands of hours) of practice. Every PA and NP I've interviewed (worth their salt) has admitted no one is fully competent upon graduation and that medicine is truly a lifetime of learning. Every PA I've shadowed has laid it out: you get an intro in school, but ultimately the real training is on-the-job. The exact same can be said of NPs. Bottom line: don't be misled by simple numbers; focus is everything.

Take it from someone who attended NP school and left for its lack of rigor, there is no comparison to PA education either didactically or clinically. That is not to say there are not great NPs nor a few good NP programs, but you can be assured that NP training is consistently less than PA training.

[zoopeda]

There are good PA programs and bad ones; good NP programs and bad ones.  It sounds like there are probably more lousy NP programs out there than there are crummy PA programs.  

 

I guess my point is that a few hundred hours, one way or the other, really doesn't mean much in the face of YEARS of experience (specialization?) before and after either school.  An RN who works in family practice for 10 years before becoming an FNP and then going on to practice as an FNP for years more is truly specialized--far beyond any direct-entry FNP or phlebotomist PA (completing 2 rotations in family medicine).  No question, EMEDPA, you have focused your career on emergency medicine (before, during, and after PA school), and that has made you an expert in EM for sure.  (I'm also not at all surprised to learn you've picked up related primary care/fp/peds experience/skill as well.)  But many (most?) PA graduates do not leave school with nearly the hours you have in the ER and instead seek a "well-rounded" rotation schedule.  (This is a big reason why we're seeing so many residencies popping up!)  Again, I'm not slandering the PA training at all; I'm an aspiring PA.  But the sort of default slander and recycled generalizations against the NP profession seem worn-out at best.  I'm not arguing that diversification (PA) diminishes that training as much as I'm pointing out that a simple comparison of "clinical hours" numbers is very much misleading.  I have a feeling the number of clinical hours is far less a problem for NP integrity than is the (lack of) academic rigor.  

 

Thank you for welcoming the debate.  I think ultimately we're not so far apart.  

[db_pavnp]

I feel half of the issue here is that only one of the two professions can have "more" and the decision to be more or less was made intentionally.  The majority of NPs will suggest the difference is minimal to negligible and the majority of PAs will suggest it is significant.  The majority of RNs will suggest their HCE wildly trumps what is commonly accepted to PA programs and the majority of PAs will downplay the RN background.

 

To some strange extent, it feels that PA programs nearly fall over themselves trying to outdo each other's brutality of education perhaps in some vague hope of surmounting the profession's legislative hurdles.  Depending on who you are and where you live, the PA model is either a tempting challenge with a deeper, broader education or an exercise in futility to obtain a license that lacks the same punch as an NP.  The nursing lobby has created a true alternate model to PA programs (or vice versa) in too many ways to begin listing here, but the differences are vast, subtle, and often unadvertised.

[EMEDPA]

  I think ultimately we're not so far apart.  

probably so

[LT_Oneal_PAC]

There are good PA programs and bad ones; good NP programs and bad ones. It sounds like there are probably more lousy NP programs out there than there are crummy PA programs.

 

I guess my point is that a few hundred hours, one way or the other, really doesn't mean much in the face of YEARS of experience (specialization?) before and after either school. An RN who works in family practice for 10 years before becoming an FNP and then going on to practice as an FNP for years more is truly specialized--far beyond any direct-entry FNP or phlebotomist PA (completing 2 rotations in family medicine). No question, EMEDPA, you have focused your career on emergency medicine (before, during, and after PA school), and that has made you an expert in EM for sure. (I'm also not at all surprised to learn you've picked up related primary care/fp/peds experience/skill as well.) But many (most?) PA graduates do not leave school with nearly the hours you have in the ER and instead seek a "well-rounded" rotation schedule. (This is a big reason why we're seeing so many residencies popping up!) Again, I'm not slandering the PA training at all; I'm an aspiring PA. But the sort of default slander and recycled generalizations against the NP profession seem worn-out at best. I'm not arguing that diversification (PA) diminishes that training as much as I'm pointing out that a simple comparison of "clinical hours" numbers is very much misleading. I have a feeling the number of clinical hours is far less a problem for NP integrity than is the (lack of) academic rigor.

 

Thank you for welcoming the debate. I think ultimately we're not so far apart.

There is no doubt that the individual trumps any initials after their name.

[Guest Paula]

The other issue at hand is that PA and NP programs are becoming direct entry and both will have less  candidates who have a HCE background as the "old guard" PA and NP candidates had back in the 70s, 80s, and 90s.   So at some point there will be no comparison for the prior HCE that NPs say they have and PAs say they have. 

 

The quality of both professions will lie on the backs of the individuals who get licensed in either profession AND the quality of candidates the Adcoms pick for their programs.

[zoopeda]

The 0-500 hour HCE prereq schools are unfortunate indeed...

[db_pavnp]

Both camps appear to be willing to reduce the HCE required.  It would be interesting to ask a selection of programs how they justify it.  I would wager that they believe they can mold an individual with zero HCE into a provider and they have the exam pass rates and employment of graduate rates to prove it.

[Mainer]

As I said before, the thought process that an NP "specializes" again illustrates what I refer to as the 
"bastardization of medicine".

 

To suggest that you "specialize" in 500 hours of clinical training lacks insight and understanding. 

Basically, you're drinking the KoolAid.  Np's have both limited education and clinical training and have managed to market this as "specialized".  

 

By this same standard, PA's "specialize" in peds, general surgery, EM, Family medicine, Internal Medicine, Psych....all of which I have close to or more than 500 hours of clinical training (FM 800 , IM 400, Peds 400, Surgery 700+, Psych 500, EM 500, OB, 200, Women's health 300)  Santa knows, I didn't specialize in anything. 

 

Physicians specialize by virtue of their post medical school education....also known as residency in which they complete 8-20,000 hours of formal clinical training and didactics depending on their field.  They complete this specialization after a generalist education in medical school (similar to PA).  I find it somewhat peculiar that one could somehow "specialize" without first completing a generalist education first.   The whole point of this post, NP's don't specialize (at least not by the standards of medicine).

[db_pavnp]

NPs have portions of generalist education.  NPs are specialized in the sense they do not participate in extraneous rotations.  What NPs consider extraneous, you consider valuable.

 

And to turn a phrase, PAs have both limited education and clinical training and have managed to market this as "generalized".

[LKPAC]

An RN who works in family practice for 10 years before becoming an FNP and then going on to practice as an FNP for years more is truly specialized--far beyond any direct-entry FNP or phlebotomist PA (completing 2 rotations in family medicine).  

 

I believe that prior HCE is very important and necessary before PA school.  One place NPs lose me is that they say they have FP (or other) experience before NP school.  Yes, but being a nurse is a very different mindset than practicing medicine.  We had an NP student recently with many years of nursing before NP school, yet she struggled with DD and deciding a treatment plan.  When she knew what to do, she didn't understand the why.  

 

There is a leap of understanding and thought processes that must occur when becoming an order giver in the practice of medicine, even after many years of being an order taker.

[db_pavnp]

On one hand, you believe HCE is very important, but on the other hand, you provide an example where HCE didn't help at all.  What is the take home?

[LT_Oneal_PAC]

On one hand, you believe HCE is very important, but on the other hand, you provide an example where HCE didn't help at all. What is the take home?

That the type of experience is important and that the individual is important. I have rarely met a floor nurse and never a outpatient clinic nurse who had any deeper understanding of their work or orders. Often the nurses I met who did were critical care nurses and some times ER, depending on the acuity the ER sees. Even then, the person becomes important because I've seen 10 year ICU RNs who would be massive failures in basically any undertaking because they were just lazy. Same goes for pre PAs.

 

The best scenario will always be a motivated individual with HCE, but both are important.

[zoopeda]

When she knew what to do, she didn't understand the why.  

 

 

I've met MDs who claimed to know what to do and really didn't seem to know why beyond "it's protocol."  Intelligence and HCE are two different things.  

[PACdan]

Both camps appear to be willing to reduce the HCE required.  It would be interesting to ask a selection of programs how they justify it.  I would wager that they believe they can mold an individual with zero HCE into a provider and they have the exam pass rates and employment of graduate rates to prove it.

 

Also a declining applicant pool of "10k+ hr. career changers" left. They've been steadily exhausted by either going to PA school or deciding against it. I think it was inevitable that the applicant pool would become younger, the more the # of schools grow and as the awareness of the profession increases.

 

What NPs consider extraneous, you consider valuable.

 

I don't see how more training time in varied specialties could ever be considered 'extraneous'.

Unless one did not have it and was simply looking for a way to diminish its value for self-interest.