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please critique- RN to PA

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I remember walking down the hallway of the hospital following my sister, Alyssa's, footsteps as I had done most of my life. I didn’t know where we were going exactly, but my mom prepared us to the best of her ability. She told us that our sister, Sarah, was sick. My mom kept a positive attitude reassuring us that everyone was working hard to make her better. We came to a haltering stop. I was ten, too young to really comprehend what was going on. However, I quickly observed how quiet the halls were; it made me uneasy. Alyssa grabbed my hand before we entered the room and we faced her together. Lying in the bed, she looked tiny. Her face gaunt and pale, almost lifeless, the drugs had swallowed her whole. Before I knew it, I was walking down the hallway of the hospital, staring at the ground following Alyssa’s footsteps yet again. This would serve as my first memory in the hospital.


Unlike many, I didn’t know that I wanted to go into the medical field at a young age. My childhood experience in the hospital left a sour taste in my mouth that would last for years to come. The irony of this situation is that years later, I would choose to go to nursing school, following Alyssa’s footsteps yet again, and I’d dedicate the next two years of my life to the hospital.  

When I was growing up college seemed unattainable. My mom raised my three sisters and I single-handedly while my dad battled an addiction to heroin. Needless to say, I learned relatively quickly that if I had any desire of graduating from a university, I would need to get there on my own. I worked hard in high school in hopes of being awarded a scholarship that would help me achieve my goal of becoming the first college graduate in my family. Fortunately, my hard work did not go unnoticed and I was offered a full-ride tuition scholarship, which was the first step of attaining my goals.



I started college similar to many freshmen, eager for my future with no idea where I was headed. I had a science mind; I had no desire for writing or literature. I didn’t want to go to business school and the thought of a desk job bored me; I craved human interaction and constant challenge. I reviewed my options with Alyssa, she mentioned nursing, which was what she was studying. I was apprehensive initially. I didn’t know if I could work in the hospital, every time I considered it, I replayed that day in the hospital; the only memory of the hospital I had. However, It seemed that whatever Alyssa did, I was never far behind. She played soccer, so I played soccer. She had long hair, so I never cut mine. Growing up in school I was always, “Alyssa’s little sister,” a big name to live up to because she was nothing short of a genius. We were two peas in a pod, only two years apart. Ultimately, I continued on the path that I always had, following Alyssa’s trail; I decided to pursue a career in nursing.



The career of nursing is a selfless one. One, which you constantly fulfill the personal needs of your patients, meaning your own needs often remain unmet. Working as a nurse was humbling and a constant learning experience. I loved my patients, but I wasn’t getting the satisfaction out of my career that I longed for. I found myself wanting to be on the forefront of my patients’ care. However, nursing taught me more than I could have ever imagined.


I will never forget my very first patient of nursing school. She was a woman with history of rheumatoid arthritis and had an above the knee amputation two years prior, admitted for cellulitis of her remaining foot. I remember feeling overwhelmed because my first day of clinical was also my fifth day of nursing school. I can’t remember another time in my life where I felt as unprepared as I did walking into her room that day. Nevertheless, I shook off my nerves and gave her a bath turning her side to side making sure to relieve the pressure from her being bed bound. When breakfast trays were delivered, I fed her as her hands were too contracted to feed herself. I walked out of her room feeling as though I had overcome a challenge for my first day. I reported back to my instructor and checked in on my patient a half hour later. Her husband had come to visit. I introduced myself as her student nurse before asking her, “how are you doing?” She didn’t have a chance to respond before her husband leaped out of his chair and stood up with a stern voice, “If you had one leg do you think you would be skipping around jumping for joy?” I was taken back, but managed to answer his question. I replied, “No sir, that’s not what I meant. I just meant is there anything I can get her right now?” He looked at me his eyes narrowing, “well then, THAT is the question you ask.” I could feel my eyes welling up with tears. I responded, “ok.” He didn’t stop there, “I’m a very pervasive person; Do you even know what that means?” I didn’t and I shook my head no. He took a step closer to me and said, “then you should probably leave the room and go Google it.” Relieved, I let myself out of the room and burst into tears. With little experience at that time, I was unprepared to handle an aggressive family member such as him. However, after working in the hospital for a year and a half a situation such as that could not touch me now. In that moment, I had never felt so belittled by someone. I couldn’t understand how someone could treat you as if you were incompetent after you had cared for their loved one all morning. This experience is not uncommon for a nurse and it is certainly not uncommon for a physician assistant. Later that morning, a man in a white coat approached me. He asked if I was the student nurse taking care of the patient in room 405. I told him yes; not sure what to expect after the day I’d been having. I was surprised when he introduced himself as the physician assistant working with my patient. He continued on and told me he walked into the patient’s room and made the same “mistake” by asking the patient how she was doing. The husband reacted to the PA’s question similar as he had when I asked the question, “We just had a talk with the student nurse about this question, that is not the question you ask.” The PA told me he wanted to clarify that the question I asked was by no means wrong. He went on further to say that a situation such as the one I had just experienced would be a difficult situation for anyone to handle let alone when you were brand new to a profession. I didn’t know a whole lot about physician assistants prior to this experience however; I was surprised by how compassionate the physician assistant was. He took the time to find me and talk to me about my encounter with an angry family member. It became apparent to me that I might want to pursue a career as a PA after nursing school. This was a team of medical professionals that I wanted to be apart of. If nursing school had taught me anything it was how to interact with not only patients, but their family members as well.  As a physician assistant, it is crucial that we are able to interact with both patients and their family members in a composed way.


Of course, the first person I told about the change of heart with my career was Alyssa. She urged that it would make more sense to be a nurse practitioner after being educated from a nursing standpoint for two years, but that if I was serious about it, I should do some more research to figure out what it was that I really wanted out of a career and furthermore, whether or not a career as a physician assistant would fulfill those needs.


During my second semester of nursing school, I began working as a patient care technician (PCT) on a general surgery unit in hopes of gaining more experience. Whether I chose to be a nurse practitioner or a physician assistant, I needed more experience in the hospital than I was getting from my clinicals. Nursing school taught me how to keep my patients alive. Working in the hospital taught me rather quickly what nursing was and what nursing was not. The nursing profession is really multiple jobs wrapped into one career. You are the patient’s voice, the patient’s waitress, the patient’s scribe, the patient’s confidant, the patient’s personal care taker, and even the patient’s hairdresser. When I made the decision to go into nursing I didn’t realize how little control I would have over my patient’s care, even though I was constantly at the bedside. While I worked as a PCT, I had exposure to nurses, physicians, nurse practitioners, physician assistants, surgery residents, and occupational therapists. I worked side by side with these health professionals on a daily basis and was able to gain a better understanding of what each discipline brought to the table. There were a few things I knew for sure: I enjoyed the patient interaction from floor nursing, but I wanted more responsibility. However, I did not want all of the responsibility, which led me to quickly rule out medical school. This was no surprise; I’d consult with Alyssa on every important decision I had to make in my life, similar to how a PA collaborates with a physician in regards to a patient’s care. I began shadowing physician assistants on my off days at the hospital. I was able to gain a better understanding of PAs and what they did on a day-to-day basis and it seemed like a perfect fit. The analytical aspect of the PA career intrigued me the most. I enjoyed listening to my patients and figuring out what was going on with them, what could be ordered to help with their symptoms, and even further what was going on inside of them to cause their symptoms.



To my surprise, one of the PAs I shadowed had also been a nurse in her previous career. That day I watched her perform an aortic valve replacement as first assist. This was something I could see myself doing. Not only was she able to spend time in the OR, but she also spent her mornings rounding on critical care units interacting with her patients. She really had a career that was the best of both worlds. This for me was the difference between a PA and NP and the deciding factor as to why I wanted to pursue a career as a PA rather than an NP. The surgical opportunities were available for a PA, but few and far between for an NP. Additionally, I enjoyed my rotations in nursing school on surgical units, pediatric units, and. As an NP, I would be required to choose a specialty and stick to it whereas a PA can move freely between disciplines, which would entertain my expansive array of interests.



Alyssa used to tell me that our lives are defined by opportunities, even the ones we miss. Choosing a career in nursing wasn’t a missed opportunity; rather it helped to define my life. Nursing was a stepping-stone for me, helping me to decipher what it was that I wanted out of a career and what that career was; a physician assistant.   

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Honestly, I would cut the majority of the first four and a half paragraphs - it is way too long for CASPA, and way too long to keep any committee's interest. I did really like your last paragraph, though. Keep revising, you'll get there. 

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