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NPs are killing us


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This forum is turning into another SDN. People talking bad about other professions and patting themselves on the back with out anyone checking them, and most times before they even start PA school. Saying scribe experience is just as good if not better than RN experience. Scribes have no accountability. They write the stuff down that the doctors says and the doctor reviews it and approves it. If they fuck up someone either catches it or they have an error in the patient chart. RN, RT, Paramedic, Corpsman if you mess up there are real consequences. Thus puts the emphasis on really learning and knowing what you're doing. In rotations if a preceptor just has you shadowing them your not getting the full experience because you're never held accountable to your knowledge. If your going and seeing patients and then reporting back to your preceptor and they pimp you on what you asked and didnt ask and what you were looking for, the learning is much more significant due to the responsibility. 
Speaking of "alternative facts" here you are presenting an opinion as if its true. Do you know for certain that every PA program has more clinical hours than every NP program. You've never gone to PA or NP school. You've never been a PA or NP, so how can you judge what the correct "rigor" is. You also cant speak on the "rigor" of a school because you havent attended a "large" amount of their programs. The true BS is you making stuff up off of what you've heard other people say or off of very very limited anecdotal experience. Not to mention that less clinical time is even necessary due to two reasons 1. NPs have specific titles and field of practice such as FNP or ACNP. 2. They have real experience before coming into PA school. Taking Pharmacology in their program isnt the first time they've heard the names of these meds.
I love my corpsman but until we see how scribes operate more and more as they filter in our field. We can't knock them. I have 1 scribe PA at my shop whom I can vouch for , others I can't. Hes changed my opinions about scribe work priot to the PA field. Only time will tell about the typicak scribe. Overall, it's the person not the title. I'm just saying all experience isn't all rainbows and butterflies that we make it out to be (RN, Paramedics, Scribes, whatever)

The true downfall of NP and PA is putting brand new PAs/NPs in the front of these rural ERs with no supervision and making them see as many patients and discharging them as fast as they can.

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Why to family MD/DO do rotations in ED, Gen surg., Rheum, Ortho, Endo, Plastics, Neuro, ENT, etc. Cause it makes on well round as well PA/FNPs/MD/DO are in primary care so they should be aware of most cases or at least seen one or heard of one. Your argument is very flawed about FNPs, my wife is an FNP and she is in primary care so why should she not have different rotations (which she did not have ER or gen. surg) and it shows with her DDx. When I was on my  ED rotation I rotated with a first year Rheumatology resident. So why was he in the ED for 4 weeks?  

 

I never can stress this enough! Thanks for posting this! I leaned the MOST from my inpt rotations (GI and liver transplant service with a panel of pts shared by a team made up of a fellow, a couple residents, a MS3/Sub-I and me) we managed very complicated pts and it made me a very well rounded and, I would argue, much more capable provider in outpt IM/FP. My school had the benefit of having uts own teaching hospital which I think ALL provider training should really incorporate during clinicals. It does not replace a formal residency but it gives you a great start. Like I always say the first 3-5 years of practice IS/SHOULD be our residency as PAs and NPs

 

Edited to add that when I was rotating with my inpt teams (GI liver tx/and Pediatric Trauma for my surgical rotation) I got treated an dumped just as hard as the MS3s/Sub-Is I worked with. They didn't care that I was "only" a PAS-2. They saw a white coat and fresh meat and attending pimped us all.

 

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14 minutes ago, Marinejiujitsu said:

I love my corpsman but until we see how scribes operate more and more as they filter in our field. We can't knock them. I have 1 scribe PA at my shop whom I can vouch for , others I can't. Hes changed my opinions about scribe work priot to the PA field. Only time will tell about the typicak scribe. Overall, it's the person not the title. I'm just saying all experience isn't all rainbows and butterflies that we make it out to be (RN, Paramedics, Scribes, whatever)

The true downfall of NP and PA is putting brand new PAs/NPs in the front of these rural ERs with no supervision and making them see as many patients and discharging them as fast as they can.

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I don't think scribes make bad PAs. Most of what you need to know about being a PA is taught in school. I'm saying that when you compare NP school to PA school you have to compare RN to scribe or someone with no experience

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I love my corpsman but until we see how scribes operate more and more as they filter in our field. We can't knock them. I have 1 scribe PA at my shop whom I can vouch for , others I can't. Hes changed my opinions about scribe work priot to the PA field. Only time will tell about the typicak scribe. Overall, it's the person not the title. I'm just saying all experience isn't all rainbows and butterflies that we make it out to be (RN, Paramedics, Scribes, whatever)

 

The true downfall of NP and PA is putting brand new PAs/NPs in the front of these rural ERs with no supervision and making them see as many patients and discharging them as fast as they can.

 

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We love you marines too! [emoji106] I will say I would rather have a scribe PA who went through the rigor of PA school than an NP who did not put time in the basics (patho, pharmacology, A&P etc).

 

The one who posted they had it in undergrad I suppose is an atypical NP case. Like I said i currently have an FMG MD in NP school now who is stellar but typically, my experience has been pretty dismal with NPs and their approach to those "basics." there have been some fair to middling PA students but when told to study specific things I need them to learn like arachadonic pathway, RAA, clotting cascades etc they do it without griping and one NP student I had i complained to their site advisor who sided with the student so I dismissed the student.

 

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6 minutes ago, Joelseff said:

We love you marines too! emoji106.png I will say I would rather have a scribe PA who went through the rigor of PA school than an NP who did not put time in the basics (patho, pharmacology, A&P etc).

 

The one who posted they had it in undergrad I suppose is an atypical NP case. Like I said i currently have an FMG MD in NP school now who is stellar but typically, my experience has been pretty dismal with NPs and their approach to those "basics." there have been some fair to middling PA students but when told to study specific things I need them to learn like arachadonic pathway, RAA, clotting cascades etc they do it without griping and one NP student I had i complained to their site advisor who sided with the student so I dismissed the student.

 

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Not atypical at all. It's in all RN programs. Patho, A&P, and pharm is in NP school. More mis information.

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Why to family MD/DO do rotations in ED, Gen surg., Rheum, Ortho, Endo, Plastics, Neuro, ENT, etc. Cause it makes on well round as well PA/FNPs/MD/DO are in primary care so they should be aware of most cases or at least seen one or heard of one. Your argument is very flawed about FNPs, my wife is an FNP and she is in primary care so why should she not have different rotations (which she did not have ER or gen. surg) and it shows with her DDx. When I was on my  ED rotation I rotated with a first year Rheumatology resident. So why was he in the ED for 4 weeks?  
I think primary care should definitely have a rotation in the ER, maybe they wouldn't send us bull crap that we tell them to go back to your primary care to work up. Although, this could be just a medical punt to the ER in my area.

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Not atypical at all. It's in all RN programs. Patho, A&P, and pharm is in NP school. More mis information.

You are comparing undergrad RN patho etc to graduate provider level Patho etc?

 

I'm Filipino. Everyone in my family are either RNs or in RN school. And I have spoken wuthering them about even pharmacology. I had one tell me apap is an NSAID. I had one tell me during a family emergency that the person who fainted is likely hypoglycemic so wā strong to force 9range juice on the guy and he wasn't even diabetic let alone on Insulin...

 

Apples and oranges HM2

 

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4 minutes ago, Marinejiujitsu said:

I think primary care should definitely have a rotation in the ER, maybe they wouldn't send us bull crap that we tell them to go back to your primary care to work up. Although, this could be just a medical punt to the ER in my area.

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It could be a CYA thing or a "we don't have appointment available" and the patient throws a fit about how they can't wait till tomorrow. So they say if it's that bad you should go to the ER. Situation 

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It could be a CYA thing or a "we don't have appointment available" and the patient throws a fit about how they can't wait till tomorrow. So they say if it's that bad you should go to the ER. Situation 
Omg. The crap they send you wouldn't believe. Lol. At least the ones here. I want to shoot myself sometimes.

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You'll generally find a rather large difference in an RN who attended a university BSN program to one that attended a diploma program or a foreign nursing program. 

My BSN program had a pharmacist teach our pharm and a PhD in molecular and cellular biology teach our pathophys. The first semester (of 2) of grad level pharm was taught by a pharmacist as well.

It's obviously not a rehash of the same material. Use your heads. 

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1 minute ago, Joelseff said:

Yeah you made it sound like they didn't need it k NP school because they took it on RN school...

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Oh I didn't mean to make it sound like that. They take two different patho classes. Is NP patho comparable to PA? I'd say that differs by school to school due to the professor teaching it. Our professor was a pathologist who would go through a 200-250 slide PowerPoint in 2-3 hours once a week. I didn't really care for his method of teaching but others did 

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Here I'll just lay it out... Here is a local school by me with both an FNP and MSPAS program.

PA Program curriculum

www.samuelmerritt.edu/physician_assistant/curriculum

FNP curriculum

www.samuelmerritt.edu/nursing/fnp_nursing/curriculum#hybridfull

Just compare the curricula...


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Oh I didn't mean to make it sound like that. They take two different patho classes. Is NP patho comparable to PA? I'd say that differs by school to school due to the professor teaching it. Our professor was a pathologist who would go through a 200-250 slide PowerPoint in 2-3 hours once a week. I didn't really care for his method of teaching but others did 
Not sure if it was you that posted it but there was a post about basic clinical sciences were done in RN school and, I may have read it wrong but I thought it was alluding to the fact that NP students don't need those basics Because they already had it in RN school. Or maybe I read two different posts and merged them but my point is providers need provider graduate level clinical sciences and instruction to give them the best possible chance to continue to grow in "informal residency" the first 3-5 yrs of practice and I just have not seen anything from NP schools and their FNP students (my FMG student us an exception) that I have trained for. I actually an not training NPs anymore because of this. My current NP is my last NP student.

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2 minutes ago, Joelseff said:

Not sure if it was you that posted it but there was a post about basic clinical sciences were done in RN school and, I may have read it wrong but I thought it was alluding to the fact that NP students don't need those basics Because they already had it in RN school. Or maybe I read two different posts and merged them but my point is providers need provider graduate level clinical sciences and instruction to give them the best possible chance to continue to grow in "informal residency" the first 3-5 yrs of practice and I just have not seen anything from NP schools and their FNP students (my FMG student us an exception) that I have trained for. I actually an not training NPs anymore because of this. My current NP is my last NP student.

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Anecdotal evidence is great and all, but, it doesn't really prove anything does it. 

I am the first NP my preceptor (a surgeon) for this semester has had, and he said he can't wait to have more after having me. I certainly don't think I am anything special.

To each their own. You are perfectly within your rights to refuse NP students. I wasn't aware PAs were able to precept NP students in the first place though? The BON in my state doesn't allow it which I think is ridiculous but that's for another thread.

Ultimately, there's no difference in outcomes between NPs and PAs. If there were the health care landscape would be quite different.  

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3 minutes ago, Joelseff said:

Not sure if it was you that posted it but there was a post about basic clinical sciences were done in RN school and, I may have read it wrong but I thought it was alluding to the fact that NP students don't need those basics Because they already had it in RN school. Or maybe I read two different posts and merged them but my point is providers need provider graduate level clinical sciences and instruction to give them the best possible chance to continue to grow in "informal residency" the first 3-5 yrs of practice and I just have not seen anything from NP schools and their FNP students (my FMG student us an exception) that I have trained for. I actually an not training NPs anymore because of this. My current NP is my last NP student.

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Thats unfortunate. I've met 3 amazing NPs that I've worked with. As a Corpsman I've met awesome PA's. As an LVN in San Diego I met two very shitty PA's. One of them saw patients off of the doctors panels, pretty much same day visits. She refused to see anyone over 80 and anyone under 10. She refused anyone with abdominal pain that wasnt new. She would finish most of the note including diagnosis before she went in and saw the patient. The other PA wasnt that bad, but I was a male stand by for her doing a Inguinial hernia exam and she had the patient lay down and then pretty much missed the entire inguinial canal (looked more like she was checking around the femoral area. She then said she didnt feel anything so here is some NSAIDS and you need to stretch. Just last week I saw a follow up patient in Family med that went to the UC and saw a PA. He was diagnosed with Viral Sinusitis x 3 days and then given amoxacillin. Some shitty PAs and NPs out there. 

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Anecdotal evidence is great and all, but, it doesn't really prove anything does it. 
I am the first NP my preceptor (a surgeon) for this semester has had, and he said he can't wait to have more after having me. I certainly don't think I am anything special.
To each their own. You are perfectly within your rights to refuse NP students. I wasn't aware PAs were able to precept NP students in the first place though? The BON in my state doesn't allow it which I think is ridiculous but that's for another thread.
Ultimately, there's no difference in outcomes between NPs and PAs. If there were the health care landscape would be quite different.  
You're correct anecdotes aren't the best evidence and I try to avoid them but in this case that is all I have. I precepted for 4 different universities and have had several NP/PA students come through them... I am making my observations based on (yes I know anecdotal) these observations and interaction.

Kind of in the same vein, i can judge a pts propensity to not adhere to a tx plan, diet, modality whatever due to a lack of understanding of the need for it, socioeconomic and intelligence barriers etc. So those pts i can almost pinpoint who's going to need more handholding and repeated followups etc for them to get it.

I do the same for my students. While I usually cut the training wheels on them at some point while they're with me, some need more of that handholding. In my i suppose limited sample size it happens to be the NP students that need more "retooling" than the PA students. u know what I mean? Now as one charged with training these providers, I have to make a judgment on who would be ready/more ready for the next step (yes I know anecdotal data but data nevertheless). My current NP student is a firecracker and she will admit her training comes mire from her MD training than her NP schooling and I am not surprised. I'm sure she would as well if she went PA but I remember we had 8 FMG in my class and 3 failed out so.... Again anecdotes I know I kmow.

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8 hours ago, HmTwoPA said:

My program requried 3 units of patho. The first program I saw after typing in Nurse practioner programs on google is OHSU and they have 6 units of pharm in their program which is the same as mine. Again these are not "facts", I just disproved that "fact" by looking at the very first program that popped up. 

I guess if my experience as a Corpsman with 1/5, 3D LAR, and the wing has taught me anything its that if a school enrolls students in their program with no HCE or HCE that never required them to put a stethoscope in their fucking ears. They might want to teach a few more weeks of Physical exam skills than NP school lol. 

 

Why would a FNP need 2000 hours of clinical experience? What are they going to do with a rotation in ER, Gen surg, and 3 electives? They are getting an FNP, Family Nurse Practitioner. 

It’s really quite unfortunate that you either being deliberately dense, or I am abysmally failing to convey, the simple statement that on average, NP programs dedicate less time to basic sciences. I’m actually going to point you to the 2018 PAEA didactic curriculum survey available on their website, please do take a look: http://paeaonline.org/research/curriculum-survey/, and also cross reference links provided by ProSpectre. 

You accused me of arguing using anecdotes earlier, yet you attempt to point to one NP program as a way to falsify a statement such as the one italicized above. It simply does not follow that because one PA program and one NP program have similar pharm hours, all must also. So no, you have disproven nothing. 

 

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Reviewing the titles of courses is not a functional way to compare curricula for a myriad of reasons.

The titles were not my point, though the NP class titles left me scratching my head on a few... but the frequency of the courses. In the PA program they get more of pharmacology and patho and other sciences throughout the program but you'll prob say that doesn't matter either. That's cool ? 

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4 minutes ago, Joelseff said:

The titles were not my point, though the NP class titles left me scratching my head on a few... but the frequency of the courses. In the PA program they get more of pharmacology and patho and other sciences throughout the program but you'll prob say that doesn't matter either. That's cool ? 

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I know that my continuing to say this will not change any minds on this board, but, I'll keep at it.

PAs need more of this in school.  Nurses are assumed to have a certain level of knowledge and understanding upon entering a NP program.  Again, I had a year of pharm and pathophys in undergrad.  I already know the major classes of medications.  I know the common medications prescribed for disease states and the pathophysiology of the disease states.  The dosages, their MOA and the most common side effects.  I've studied them and then administered them as a nurse both in clinical and working in the unit.  

The educational pathways are different for a reason.  You can't compare apples to oranges.

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