NPs are killing us

[Lexapro]

4 hours ago, ventana said:

ACNP - 

many ICU's are now staffed exclusively with PA's intead of residents, with proven better outcomes.

Since we are all in the same boat I would propose that it is very unwise and exceptionally poorly thought out to come to a PA specific board and bash PA's.  

I am going to close this thread as it seems to be degrading into simple name calling and has no added value.  I would ask in the future you consider who your audience is prior to posting.

This seems wholly unnecessary and I don't see any name calling?

I agree with ACNPstudent that there seems to be a fundamental misunderstanding of NPs (especially specialty NPs) on this forum. I am a psych NP and while I got about ~800 hours of clinical training they were almost entirely within the realm of psychiatry (inpatient, outpatient, child and adult, geri, addiction, etc.)

I am currently orienting a new hire PA who is temporarily with me at my site before he starts at a different psych hospital where we have a contract. He will be an inpatient psych provider. He did not even have a psych rotation in his PA program, it was apparently just an elective (this blows my mind, but I digress). They hired him because they could not recruit a psych NP, according to the recruiter. He's a nice guy but clearly needs a lot of training before he will be competent with anything beyond basic MDD or GAD. Do I go and bash PA programs now? No, of course not. It's clear to me that we have operated under different training models. I do think he should consider a psychiatry residency. Right now I believe the plan is for the psychiatrists to work extremely closely with him in an attempt to train him up long term.

[Joelseff]

ACNP -  many ICU's are now staffed exclusively with PA's intead of residents, with proven better outcomes.

Since we are all in the same boat I would propose that it is very unwise and exceptionally poorly thought out to come to a PA specific board and bash PA's.  

I am going to close this thread as it seems to be degrading into simple name calling and has no added value.  I would ask in the future you consider who your audience is prior to posting.

 

Hey Ventana, I don't think ACNP or anyone bashed PA's per se. I'll admit the title kinda invited some keyboard fisticuffs but the discussions the past few days have been collegial and IMO enlightening. I hope you don't close the thread. Did I miss the PA bashing within the last few pages?  

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[Joelseff]

The most important class for me, personally, in med school was actually anatomy - actually physically dissecting a a complete body, head to toe, including the separate course where we did the brain, was an experience that was so fundamental in terms of putting stuff together in terms of how the body works that I think it should be required for everybody.  The best 3 months of med school. And I'm not in a surgical specialty, and yet it was still super important. 
I think physiology/ pathophysiology and pharmacology is interesting but honestly you forget a lot of it.  I think you need to know the fundamental physiology of all the systems down cold - like everyone should be able to draw a nephron and know where all the diuretics act and why, or draw the complete cardiac cycle from memory, or understand action potentials and movements of ions across membranes, but very few people can talk about in detail about all the disease states and the complex pathophysiology involved, unless it's in your particular area of specialty.   Like I had to learn it at the time but right now if you gave me a spinal cord level and asked me to draw all the various tracks and predict what injury at each point would do, I'm not sure I'd do much better than chance. 

In primary care and I would assume other specialties, I think A&P, pathophysiology, and pharmacology are the most important in practice. Even if you forgot a clinical exam in bates for say knee pain, if you know your anatomy you can pretty much examine the knee the way you need to in order to elicit a POS or neg response to close in on a working dx. Like you said about the spine. If you just think back on the anatomy (location/level of the vertebrae, laterality, character of the symptoms and dermatome distro etc) you can have a good working dx so when you send them to imaging or a specialist you have a good idea of what it could be instead of "shotgunning" your orders and referrals which I see a lot in PC (from ALL types of providers MD/DO/FNP/PA alike). I prefer to rule out or in as much as I can for the sake of saving time and money for the pt and the system. My specialist collages actually appreciate this and have told me in person. This level of care is what I want my students to provide. It takes work.

Having said that, I will not even presume to have the level of A&P, Pathophysiology etc that Physicians went through in med school. I think there is some minutiae that in practice is not really essential in forming a good working dx. But let snit throw it all out in exchange for a cause effect/algorithm like approach to these topics. Knowing the receptors and their effects etc i think are essentials.

Full disclosure: I brain dumped a lot of this too after PA school but if I need to review it I'm not completely lost.

Does that make sense? [emoji848] (seriously asking because Im on high dose prednisone right now and have goldfish brain lol.



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[lkth487]

Yeah for sure. In practice, I try to make a point to ask the specialists what kind of workup they would like prior to getting their opinion and why - you learn a lot (and once you get them to explain it, a lot of times you figure out that it's nonsense and you can decide not to do it).  

[EMEDPA]

3 hours ago, Lexapro said:

This seems wholly unnecessary and I don't see any name calling?

I agree with ACNPstudent that there seems to be a fundamental misunderstanding of NPs (especially specialty NPs) on this forum. I am a psych NP and while I got about ~800 hours of clinical training they were almost entirely within the realm of psychiatry (inpatient, outpatient, child and adult, geri, addiction, etc.)

I am currently orienting a new hire PA who is temporarily with me at my site before he starts at a different psych hospital where we have a contract. He will be an inpatient psych provider. He did not even have a psych rotation in his PA program, it was apparently just an elective (this blows my mind, but I digress). They hired him because they could not recruit a psych NP, according to the recruiter. He's a nice guy but clearly needs a lot of training before he will be competent with anything beyond basic MDD or GAD. Do I go and bash PA programs now? No, of course not. It's clear to me that we have operated under different training models. I do think he should consider a psychiatry residency. Right now I believe the plan is for the psychiatrists to work extremely closely with him in an attempt to train him up long term.

I believe psych is a required rotation unless things have changed. he may have had a month of crappy psych rotation, but they should have gotten one.

[EMEDPA]

https://www.cathopathic.org/

discuss....

[Joelseff]

https://www.cathopathic.org/

discuss....

Whut... The... Hell?

 

Watch this pass and we still can't change our name [emoji17]?

 

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[Kaepora]

 

2 hours ago, EMEDPA said:

https://www.cathopathic.org/

discuss....

 

2 hours ago, Joelseff said:

Whut... The... Hell?

 

Watch this pass and we still can't change our name ?

 

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So insane. I don't even know what to say except that this has to be an extreme extreme extreme minority and fringe idea. I've never heard of it before. And it's a little embarrassing.

[Kaepora]

4 minutes ago, mcclane said:

 

  Yes, I am ok with these things.  So are MDs, with caveats, as they allow FMGs to take the Steps.

You know what FMG stands for, yeah?

[jwells78]

"The purpose of the ACCP is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a "cathopathic physician" completely equal in every way to our MD and DO counterparts."

 

This is the most rediculous thing I've ever seen.  No discussion needed.

These people are &@&king crazy if they honestly buy into this horsesh$$.

 

[lemurcatta]

On 2/11/2018 at 11:55 AM, ACNPstudent said:

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.

Yup. Educational pathways are different. Undergrad nursing students usually take watered down sciences with the math mostly removed. Including "introductory chemistry" or "chemistry for health professions" or "survey of general, organic, and biochemistry" or "introduction to human anatomy." How many nursing programs require sequences of chemistry/biology for majors, physics, and calculus, and upper division coursework in biochemistry, human genetics, etc (btw, finding a single outlier doesn't moot my point here)?  Nursing coursework is aimed at those seeking to practice as a bedside RN, and it doesn't assume advanced knowledge in the life or physical sciences. 

A full sequence of biology for majors is much more useful than a semester of "pathophys for health care providers/nurses." Want to know a big reason? In those nursing pathophysiology classes, we have to take a lot of time to discuss very basic things like what ions are, what gets through cell membranes via diffusion and what does not, what is oxidative phosphorylation, what is a gene, what are single gene disorders vs complex disease, what does hemoglobin do.. etc. If you removed all the basic biology, you'd have very little actual content left. These courses have to start at a low level because of the low bar for entry. Folks with a robust understanding of molecular and cell biology, genetics, and physiology from a full sequence of general biology will be able to start learning pathology at a much higher level. And they will absorb more. 

[LT_Oneal_PAC]

3 hours ago, lemurcatta said:

Yup. Educational pathways are different. Undergrad nursing students usually take watered down sciences with the math mostly removed. Including "introductory chemistry" or "chemistry for health professions" or "survey of general, organic, and biochemistry" or "introduction to human anatomy." How many nursing programs require sequences of chemistry/biology for majors, physics, and calculus, and upper division coursework in biochemistry, human genetics, etc (btw, finding a single outlier doesn't moot my point here)?  Nursing coursework is aimed at those seeking to practice as a bedside RN, and it doesn't assume advanced knowledge in the life or physical sciences. 

A full sequence of biology for majors is much more useful than a semester of "pathophys for health care providers/nurses." Want to know a big reason? In those nursing pathophysiology classes, we have to take a lot of time to discuss very basic things like what ions are, what gets through cell membranes via diffusion and what does not, what is oxidative phosphorylation, what is a gene, what are single gene disorders vs complex disease, what does hemoglobin do.. etc. If you removed all the basic biology, you'd have very little actual content left. These courses have to start at a low level because of the low bar for entry. Folks with a robust understanding of molecular and cell biology, genetics, and physiology from a full sequence of general biology will be able to start learning pathology at a much higher level. And they will absorb more. 

Disagree somewhat. Nursing schools typically require science major courses with exception of the chemistries, which were the only courses I had to take for PA entry with everything else being up to par. Those chem courses also did not help later in PA studies over my intro courses. Nursing school itself had some pretty rigorous courses.

I could elaborate on problems I do see in graduate nursing education, but I don’t think it would be constructive.

Lets be mindful that NPs, while our competitors in the job market, are not our enemy. Especially not as individuals. They aren’t the reason why we are lagging behind legislatively and they haven’t done anything we wouldn’t do if we had their lobby power and numbers in admin positions. We don’t have to break them down to get ahead. We should work together. Worked well for the DOs and MDs many decades ago. This comment was not directed at any particular poster.

 

[Joelseff]

"The purpose of the ACCP is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a "cathopathic physician" completely equal in every way to our MD and DO counterparts."
 
This is the most rediculous thing I've ever seen.  No discussion needed.
These people are &@&king crazy if they honestly buy into this horsesh$$.
 

It's not "people" it's literally one dude. They posted his LinkedIn profile on SDN (gangsta). He was a military medic not sure which branch but he claims both Army AND Air force[emoji19] he got a BS from university of Phoenix and his DNP from University of AZ and gas been working in EP for a whopping THREE WHOLE YEARS! Though he is advocating for Primary care NPs to be catatonic... Ermmm.. Catophiliic... Ugh... U know what I mean!

His work profile was also linked but that site seemed to have taken it down. The SDN thread was hilarious they went ape$#! T! Only one post mentioned PAs lol so I was cool hahahaha...

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[Joelseff]

Disagree somewhat. Nursing schools typically require science major courses with exception of the chemistries, which were the only courses I had to take for PA entry with everything else being up to par. Those chem courses also did not help later in PA studies over my intro courses. Nursing school itself had some pretty rigorous courses. I could elaborate on problems I do see in graduate nursing education, but I don’t think it would be constructive.

Lets be mindful that NPs, while our competitors in the job market, are not our enemy. Especially not as individuals. They aren’t the reason why we are lagging behind legislatively and they haven’t done anything we wouldn’t do if we had their lobby power and numbers in admin positions. We don’t have to break them down to get ahead. We should work together. Worked well for the DOs and MDs many decades ago. This comment was not directed at any particular poster.

 

 

I agree! The NPs in the trenches are not our enemy though their lobby is single minded in the promotion of THEIR professional agenda only. As it should be I suppose. I think AAPA or whoever we choose to represent "US" needs to do the same to some extent. We need to push for PAs to "have a seat at the table" when it comes to policy. I hate how we are left out of all the laws and benefits given to providers when we are also providers. We don't get meaningful use, QIP bonuses, and really not much recognition in the general public. The "Each One Reach One" approach we've been doing that is wining pts and colleagues one at a time has largely not worked for the past 50 yrs. The whole "just keep doing right by your pt and showing them your worth and one day they'll come around" mantra may work for individual PAs at their sites but has not on a national level. 

I hate degree creep but I DO think we need a doctorate level degree just for the simple reason of parity. Many PAs are so against that and that attitude of not willing to change is why we are where we are 50 yrs later. We are the same age as NPs but you gotta give it up to them. They saw what they wanted and they didn't ask nicely. They took it like some gangsta $#! T

 

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Edit: I just read this and I laughed to myself... Gotta apologize. I'm on pred and just watched a bunch of Dave Chappelle stand up. I don't however take back the meaning of my post.

 

Good night PA forum... [emoji6]

[Kaepora]

8 hours ago, lemurcatta said:

...like what ions are, what gets through cell membranes via diffusion and what does not, what is oxidative phosphorylation, what is a gene, what are single gene disorders vs complex disease, what does hemoglobin do.. etc. 

Ok, if you didn't learn these kinds of basics in high school there is a problem.

My first degree was cellular and molecular biology and I can't say I feel too far ahead of my fellow NPs who "just" got their BSN. So I can walk you through a Fischer esterification mechanism or draw a molecule with only the NMR spectroscopy signal. Super helpful. 

Again, nurses learn more in their BSN programs than PAs like to give them credit for and everything I learned in my previous degree is not exceedingly helpful. 

[CoastalPalm]

9 hours ago, lemurcatta said:

Yup. Educational pathways are different. Undergrad nursing students usually take watered down sciences with the math mostly removed. Including "introductory chemistry" or "chemistry for health professions" or "survey of general, organic, and biochemistry" or "introduction to human anatomy." How many nursing programs require sequences of chemistry/biology for majors, physics, and calculus, and upper division coursework in biochemistry, human genetics, etc (btw, finding a single outlier doesn't moot my point here)?  Nursing coursework is aimed at those seeking to practice as a bedside RN, and it doesn't assume advanced knowledge in the life or physical sciences. 

A full sequence of biology for majors is much more useful than a semester of "pathophys for health care providers/nurses." Want to know a big reason? In those nursing pathophysiology classes, we have to take a lot of time to discuss very basic things like what ions are, what gets through cell membranes via diffusion and what does not, what is oxidative phosphorylation, what is a gene, what are single gene disorders vs complex disease, what does hemoglobin do.. etc. If you removed all the basic biology, you'd have very little actual content left. These courses have to start at a low level because of the low bar for entry. Folks with a robust understanding of molecular and cell biology, genetics, and physiology from a full sequence of general biology will be able to start learning pathology at a much higher level. And they will absorb more. 

That's what your nursing pathophysiology course was like?  Sounds horrible.  Mine was on...actual pathophysiology.  What you mention should have already been covered in prerequisite biology and chemistry courses, let alone in high school.  

[SedRate]

On 2/12/2018 at 2:03 PM, lkth487 said:

The most important class for me, personally, in med school was actually anatomy - actually physically dissecting a a complete body, head to toe, including the separate course where we did the brain, was an experience that was so fundamental in terms of putting stuff together in terms of how the body works that I think it should be required for everybody.  The best 3 months of med school. And I'm not in a surgical specialty, and yet it was still super important. 

If I remember correctly, you went to PA school and then ended up going to medical school, right? Did you not have a cadaver lab in PA school? My program did, and I agree that it was extremely helpful for cementing your knowledge, especially for hands-on, visual learners like myself. At least until I graduated and forgot it all :-)

[camoman1234]

4 hours ago, ACNPstudent said:

Ok, if you didn't learn these kinds of basics in high school there is a problem.

My first degree was cellular and molecular biology and I can't say I feel too far ahead of my fellow NPs who "just" got their BSN. So I can walk you through a Fischer esterification mechanism or draw a molecule with only the NMR spectroscopy signal. Super helpful. 

Again, nurses learn more in their BSN programs than PAs like to give them credit for and everything I learned in my previous degree is not exceedingly helpful. 

"Ok, if you didn't learn these kinds of basics in high school there is a problem." This is definitely not true for at least my area. I went to a high school in a very rural area and we did not even have college transfer credits when I went to school (I graduated high school in 2004). My wife went to a private boarding academy (graduated in 2007) and was salutatorian. She took genetics, organic I, physics prior to going to her BSN program (at a very well renowned) hospital/medical school. She graduated top 10% of her BSN class. She literally never once got taught about ions/chemistry/etc in her BSN school. Lots and Lots of theory and she even complained to me multiple times that the ASN (at the local community college) were more advanced than her on the floor and in IVs, etc as all they were learning was nursing theory and med math. So, your level of BSN education is vastly different than PA school education and I know for a fact that BSN programs have to meet a standard like PA programs and you do not learn all this "hard sciences" in nursing school.   

[Cideous]

2 hours ago, Sed said:

If I remember correctly, you went to PA school and then ended up going to medical school, right? Did you not have a cadaver lab in PA school? My program did, and I agree that it was extremely helpful for cementing your knowledge, especially for hands-on, visual learners like myself. At least until I graduated and forgot it all :-)

I absolutely had a full cadaver dissection in PA school as well.  If your program didn't, you got screwed.

[LT_Oneal_PAC]

2 hours ago, Sed said:

If I remember correctly, you went to PA school and then ended up going to medical school, right? Did you not have a cadaver lab in PA school? My program did, and I agree that it was extremely helpful for cementing your knowledge, especially for hands-on, visual learners like myself. At least until I graduated and forgot it all :-)

I don’t think he was in PA school before, and I don’t think he’s saying that we don’t have gross anatomy. It reads to me just a statement that he thought it was a great class.

[LT_Oneal_PAC]

2 hours ago, camoman1234 said:

"Ok, if you didn't learn these kinds of basics in high school there is a problem." This is definitely not true for at least my area. I went to a high school in a very rural area and we did not even have college transfer credits when I went to school (I graduated high school in 2004). My wife went to a private boarding academy (graduated in 2007) and was salutatorian. She took genetics, organic I, physics prior to going to her BSN program (at a very well renowned) hospital/medical school. She graduated top 10% of her BSN class. She literally never once got taught about ions/chemistry/etc in her BSN school. Lots and Lots of theory and she even complained to me multiple times that the ASN (at the local community college) were more advanced than her on the floor and in IVs, etc as all they were learning was nursing theory and med math. So, your level of BSN education is vastly different than PA school education and I know for a fact that BSN programs have to meet a standard like PA programs and you do not learn all this "hard sciences" in nursing school.   

I’m sorry that she had such a poor experience. I’m not sure how she made it through intro inorganic chem or learn about ABG interpretation or acid/base disorders, which is mandatory, without knowing what a hydrogen ion is or bicarbonate.

nursing school sciences is certainly not up to the rigor that is necessary for advance practice, but I’ll give mine credit. They made damn sure, annoyingly so, I knew the difference between respiratory/metabolic acidosis/alkalosis.

[Kaepora]

3 minutes ago, LT_Oneal_PAC said:

I’m sorry that she had such a poor experience. I’m not sure how she made it through intro inorganic chem or learn about ABG interpretation or acid/base disorders, which is mandatory, without knowing what a hydrogen ion is or bicarbonate.

nursing school sciences is certainly not up to the rigor that is necessary for advance practice, but I’ll give mine credit. They made damn sure, annoyingly so, I knew the difference between respiratory/metabolic acidosis/alkalosis.

Thank you. There's only so much ignorance I can take. I'm losing my interest in this conversation as I'm just repeating myself over and over. 

[camoman1234]

44 minutes ago, LT_Oneal_PAC said:

I’m sorry that she had such a poor experience. I’m not sure how she made it through intro inorganic chem or learn about ABG interpretation or acid/base disorders, which is mandatory, without knowing what a hydrogen ion is or bicarbonate.

nursing school sciences is certainly not up to the rigor that is necessary for advance practice, but I’ll give mine credit. They made damn sure, annoyingly so, I knew the difference between respiratory/metabolic acidosis/alkalosis.

She did not have a poor experience, you are reading is wrong. She did not have inorganic chem in nursing school, do nursing schools even have a classes called this? Acid base balance does not require inorganic chem to learn it...look at paramedics or respiratory therapist, they don't require inorganic as a prereq to get into those schools. She definitely knew what a H- ion was or HCO3- is, but NOT from nursing school. She took chem. I and I as well as organic chem I (300 level, NOT a survey) in undergrad prior to nursing school. So of course she knew what those were. I know acid base very well, but learned it prior to PA school and I am not an RN. 

[camoman1234]

57 minutes ago, ACNPstudent said:

Thank you. There's only so much ignorance I can take. I'm losing my interest in this conversation as I'm just repeating myself over and over. 

Not ignorant, your not listening. I am a PA and my wife is a RN, APRN, FNP-C, so I am VERY aware of what PAs and NPs do, learn, think, speak, act, etc... You didn't learn organic chem, physical chem, biochem, molecular biology, advanced genetics, etc in nursing school cause all BSN programs are accredited by 2 organizations: 

Two national organizations accredit nursing education programs:

• The Accreditation Commission For Education in Nursing (ACEN) accredits all types of nursing education programs including master’s, baccalaureate, associate’s and diploma
• The Commission on Collegiate Nursing Education (CCNE) accredits programs that offer only master’s and baccalaureate level nursing degrees

So the curriculum is standard for all professions: RN/FNP/PA/MD/DO/PT/OT/EMT, etc.

Just because you got a degree in your undergrad that was the same degree I got, doesn't mean your nursing school taught you this. Show me the curriculum of YOUR BSN program so I can see all these advanced classes that my wife did not get. 

  

[LT_Oneal_PAC]

1 hour ago, ACNPstudent said:

Thank you. There's only so much ignorance I can take. I'm losing my interest in this conversation as I'm just repeating myself over and over. 

I wouldn’t be too discouraged. We are all subject to biases and cognitive editing Definitely read “Thinking fast and slow” and “The Righteous Mind.”

logically though we need to see that all the arguments that we have presented here against each other are the same arguments that MDs use against us, so there is a dissonance in our logic here. We have to remember we have to use evidence and not anecdote.