NPs are killing us

[LT_Oneal_PAC]

37 minutes ago, camoman1234 said:

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. 

I won’t belabor the point any longer after this. I’m not saying I had all these high level courses. The name of my course was fundamentals of chemistry (not for science majors) in my prenursing courses as requirement for nursing entry that absolutely covered ions. One could argue the very basics of chem can’t be taught without knowing what an ion is. We covered acid/base disorders and shifts of electrolytes under a class called fundamentals of nursing during a subsection for critical care nursing topics. I didn’t learn about Haldane or Bohr effect or anything high level like that, but I learned a bit about the oxygen disassociation curve and how pH effects on K+ through hydrogen ions charge displacing them. Stuff like that. Basics.

I didn’t take genetics, cell biology, organic, or those other high level courses for PA school either. I had to take gen bio II and inorganic chem I and II.

If you want to point to a lack of hard science in NP education, you can, but the important area is not in the undergrad portion.

[Boatswain2PA]

2 hours ago, LT_Oneal_PAC said:

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.

Most nurses that do interpet ABGs usually do so by simple algorhithms vice understanding the chemistry.  An advanced provider usually interprets the ABGs the same way, but should have the chemistry knowledge to work out the details if it's not a simple case.

My wife went to one of the best RN/BSN programs in the state, and I was very impressed with the amount of "medical knowledge" she learned in her program (was married as she went through).  That being said, I had a much greater understanding of pathophysiology, including chem/biochem, from my undergrad education than she has with her top-of-the-line RN/BSN education.  Unfortunately her programs was also full of utterly useless "nursing theory" classes that took up much of her time/energy.

ACNP - thank you for coming here and sharing your opinion/experiences.  I don't work with ACNPs and didn't realize they had a substantial educational pathway.  Unfortunately I mostly work with FNPs who, often, are woefully lacking in medical education.

A few things I would like to throw into the above conversation:  

-If a psych office hired a PA who didn't focus their training in psyc....well then shame on both of them.  All PA programs are required to have a psych rotation, although it doesn't have to be dedicated psych.  If a PA wants to work in psych (like a PsychNP does), they should take significant psych rotations in their program, otherwise do a psych residency (do those exist?).

-I would suggest the competence of an experienced ICU nurse who went through a ACNP program would be likely be less than that same experienced ICU nurse who went through a PA program and focused their rotations on intensive care simply because of the longer and much more intense education/training.

[DizzyJ]

1 hour ago, camoman1234 said:

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. 

  

Why are you just a “PA” without -C and your wife is an RN, APRN, and FNP-C.....doesn’t FNP-C pretty much cover the RN and APRN anyways.  

[Kaepora]

This will likely be my last comment on this thread as I've already devoted way, WAY too much time to it.  Haha.

My program has a 12 week step-down rotation, a 12 week ICU rotation, and also a 12 week elective that can be filled with critical care as well.  Plus, I have 2x 12 week surgical rotations (the first rotation you have 18 weeks available to get the hours in if you need all that time), and a 12 week hospitalist/IM rotation.

I don't know of any PA program that allows you to devote that much time to critical care medicine.  

There are absolutely things about PA education I prefer, but there are things about NP education I prefer.  I chose the ACNP pathway obviously, for many reasons, but I certainly don't go around the hospital looking down my nose at PAs.  It does seem that a lot of PAs on this forum do just that to NPs, however.

This has been a good debate for the most part, and I'm sorry if I ruffled any feathers due to inadvertent "PA bashing" or "name calling".  Hopefully as time goes on the relationship between PAs and NPs can be a more cooperative one where both parties benefit... but, just to be clear, if PAs and NPs joined up, I believe PAs would be the ones benefitting more-so than the NPs.

[sas5814]

" just to be clear, if PAs and NPs joined up, I believe PAs would be the ones benefitting more-so than the NPs."

 

That was my point originally though the delivery could have been better. There is so much we could learn from how the NPs have performed politically and legislatively and if we don't start learning those lessons we are going to be left further behind.

I never intended this to turn into another "we are better than them" conversation. That has become tedious in the extreme.

[camoman1234]

49 minutes ago, DizzyJ said:

Why are you just a “PA” without -C and your wife is an RN, APRN, and FNP-C.....doesn’t FNP-C pretty much cover the RN and APRN anyways.  

I am a PA-C and a nurse (RN) gets her masters in nursing to become a NP which makes her/him Advanced Practice RN then you go into psych, midwifery, family, peds and that is where you get your FNP-C or FNP-BC (depends on what board test you take, there are 2 of them ANCC or AANP). 

[lkth487]

4 hours ago, LT_Oneal_PAC said:

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.

Yeah I didn't go to a PA school and the PA school associated with my residency institutio definitely has gross anatomy.  I was just saying it's a great class. 

[MidwesternTexan]

I was lucky enough to have cadaver dissection in my 'Gross' class.  That was in '92- UTMB- Galveston TX.

I agree with all the previous posts about the title of the thread.  I'm getting REALLY tired when I hear people say NP, when they really mean- APP provides the role, etc.

Todd Bouton, MS, PA-C

[lkth487]

I can't believe we are talking about high school classes.  I wanted to be a carpenter coming out of high school so I'm pretty sure the only chemistry education I got was from the local dealer.  

[Kaepora]

1 hour ago, camoman1234 said:

I am a PA-C and a nurse (RN) gets her masters in nursing to become a NP which makes her/him Advanced Practice RN then you go into psych, midwifery, family, peds and that is where you get your FNP-C or FNP-BC (depends on what board test you take, there are 2 of them ANCC or AANP). 

 Gosh darn it I just can't help myself here. 

 

APRN is an umbrella term that includes midwives, practitioners, anesthetists, etc. You get your master's degree - which would be your FNP/CRNA/ACNP/etc degree - and pass the respective boards. 

[LT_Oneal_PAC]

3 hours ago, lkth487 said:

I can't believe we are talking about high school classes.  I wanted to be a carpenter coming out of high school so I'm pretty sure the only chemistry education I got was from the local dealer.  

 

[camoman1234]

3 hours ago, ACNPstudent said:

 Gosh darn it I just can't help myself here. 

 

APRN is an umbrella term that includes midwives, practitioners, anesthetists, etc. You get your master's degree - which would be your FNP/CRNA/ACNP/etc degree - and pass the respective boards. 

Thanks for repeating me.

[LT_Oneal_PAC]

6 hours ago, Boatswain2PA said:

Most nurses that do interpet ABGs usually do so by simple algorhithms vice understanding the chemistry.  An advanced provider usually interprets the ABGs the same way, but should have the chemistry knowledge to work out the details if it's not a simple case.

My wife went to one of the best RN/BSN programs in the state, and I was very impressed with the amount of "medical knowledge" she learned in her program (was married as she went through).  That being said, I had a much greater understanding of pathophysiology, including chem/biochem, from my undergrad education than she has with her top-of-the-line RN/BSN education.  Unfortunately her programs was also full of utterly useless "nursing theory" classes that took up much of her time/energy.

ACNP - thank you for coming here and sharing your opinion/experiences.  I don't work with ACNPs and didn't realize they had a substantial educational pathway.  Unfortunately I mostly work with FNPs who, often, are woefully lacking in medical education.

A few things I would like to throw into the above conversation:  

-If a psych office hired a PA who didn't focus their training in psyc....well then shame on both of them.  All PA programs are required to have a psych rotation, although it doesn't have to be dedicated psych.  If a PA wants to work in psych (like a PsychNP does), they should take significant psych rotations in their program, otherwise do a psych residency (do those exist?).

-I would suggest the competence of an experienced ICU nurse who went through a ACNP program would be likely be less than that same experienced ICU nurse who went through a PA program and focused their rotations on intensive care simply because of the longer and much more intense education/training.

You won’t get any arguments from me about fluff courses.  I wish I could forget about care plans and nursing “diagnoses”. Blech...

[Kaepora]

6 hours ago, camoman1234 said:

I am a PA-C and a nurse (RN) gets her masters in nursing to become a NP which makes her/him Advanced Practice RN then you go into psych, midwifery, family, peds and that is where you get your FNP-C or FNP-BC (depends on what board test you take, there are 2 of them ANCC or AANP). 

 

42 minutes ago, camoman1234 said:

Thanks for repeating me.

Not repeating - clarifying. Much of what you've been posting makes very little sense. Maybe it's grammar/syntax and a lack of punctuation. But maybe you just dont know what you're talking about. 

You said a nurse gets their master's degree to become an NP, which makes that person an APRN. This is true. But then you said they then go into psych, family, peds, etc. They don't get their masters and then choose a specialty. The masters degree and population focus is one in the same.  And you only get the FNP-C or FNP-BC if you are a family NP. Not for psych, peds etc. 

I forgot to un-subscribe to the thread so I kept getting sucked back in. 

[2234leej]

44 minutes ago, LT_Oneal_PAC said:

You won’t get any arguments from me about fluff courses.  I wish I could forget about care plans and nursing “diagnoses”. Blech...

The MSN curriculum is a couple steps away from being really solid. Having gone through the curriculum at Rush in Chicago, some classes were outstanding (patho, women's health, critical care, etc.). I'm not sure if it was because it is within a hospital system that made it really good (might be different for someone who goes to a non-hospital based program). The fluff classes obviously suck, both in terms of quality and financially. Ha literally like flushing money down the drain. In either case, as a future NP, I hope to collaborate with you guys in the future. Both professions are outstanding. I took classes for physical therapy with PA students, so I know the quality of the students is really high (better than your average NP). Though, I think it is important to note that NPs are coming out with studies demonstrating quality care that is equal to that of PCPs. Granted, some of these studies are not super robust or high-high quality. Nonetheless, it goes to show that regardless of the MD/DO medical training (hard sciences and all the rotations), that nurses can provide good care with their nursing training (i.e. holistic care principles + fluff + medical training).

[camoman1234]

On 2/14/2018 at 9:19 PM, ACNPstudent said:

 

Not repeating - clarifying. Much of what you've been posting makes very little sense. Maybe it's grammar/syntax and a lack of punctuation. But maybe you just dont know what you're talking about. 

You said a nurse gets their master's degree to become an NP, which makes that person an APRN. This is true. But then you said they then go into psych, family, peds, etc. They don't get their masters and then choose a specialty. The masters degree and population focus is one in the same.  And you only get the FNP-C or FNP-BC if you are a family NP. Not for psych, peds etc. 

I forgot to un-subscribe to the thread so I kept getting sucked back in. 

Oh it's grammar. I see what your talking about "that is where you get your FNP-C or FNP-BC." Shall I add PNP, WHNP, AGNP, etc. I should not have said "then go into", but I am not stressing over it as it is not that big of an important topic for me to edit my post. You get it. My name says a lot about me, I honestly have horrible grammar, did not get a good high school education and lived/grew up in a very rural, redneck area. My wife does make fun of me all the time, but hey I work in a rural health clinic of a town of 600 and I speak their language. I just don't fit into the dressing up nice, wearing a tie, driving a nice car, or have great grammar, I am just a back woods PA-C :) 

[Joelseff]

Oh it's grammar. I see what your talking about "that is where you get your FNP-C or FNP-BC." Shall I add PNP, WHNP, AGNP, etc. I should not have said "then go into", but I am not stressing over it as it is not that of an important topic for me to edit my post. You get it. My name says a lot about me, I honestly have horrible grammar, did not get a good high school education and lived/grew up in a very rural, redneck area. My wife does make fun of me all the time, but hey I work in a rural health clinic of a town of 600 and I speak their language. I just don't fit into the dressing up nice, wearing a tie, driving a nice care, or have great grammar, I am just a back woods PA-C :) 

Don't feel bad brother. I grew up in the hood. (Richmond and Vallejo California look em up if you're not familiar) I'm actually a HS dropout! [emoji44] I straightened up in the Navy, realized I was always an intelligent yet extremely lazy person before then. Graduated with distinction in Corps School, continued in college afterwards and the rest is history... It's not how you start but how you finish that matters!

 

I also have fat thumb syndrome and find myself editing my posts multiple times after I hit the send button (which is usually followed by a face-palm!) lol.

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

[Lexapro]

On 2/12/2018 at 11:33 PM, EMEDPA said:

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.

It was optional for him. He got some number of "psych" hours during his family med rotation but was not required to actually have a psychiatry rotation where he worked with psychiatrists in a treatment setting that focused on psych. He is not well prepared for his role as a psych inpatient provider, obviously.

[Marinejiujitsu]

This will likely be my last comment on this thread as I've already devoted way, WAY too much time to it.  Haha.
My program has a 12 week step-down rotation, a 12 week ICU rotation, and also a 12 week elective that can be filled with critical care as well.  Plus, I have 2x 12 week surgical rotations (the first rotation you have 18 weeks available to get the hours in if you need all that time), and a 12 week hospitalist/IM rotation.
I don't know of any PA program that allows you to devote that much time to critical care medicine.  
There are absolutely things about PA education I prefer, but there are things about NP education I prefer.  I chose the ACNP pathway obviously, for many reasons, but I certainly don't go around the hospital looking down my nose at PAs.  It does seem that a lot of PAs on this forum do just that to NPs, however.
This has been a good debate for the most part, and I'm sorry if I ruffled any feathers due to inadvertent "PA bashing" or "name calling".  Hopefully as time goes on the relationship between PAs and NPs can be a more cooperative one where both parties benefit... but, just to be clear, if PAs and NPs joined up, I believe PAs would be the ones benefitting more-so than the NPs.

It's not PAs that look down on NPs. It's the beauty of the keyboardwarrior. Don't act like it's not the same on the nursing forums. They totally bash PAs and the physicians. And on SDN they totally bash PAs and NPs but they one up us eating their own.

Sent from my SM-N950U using Tapatalk

[camoman1234]

8 hours ago, Joelseff said:

Don't feel bad brother. I grew up in the hood. (Richmond and Vallejo California look em up if you're not familiar) I'm actually a HS dropout! I straightened up in the Navy, realized I was always an intelligent yet extremely lazy person before then. Graduated with distinction in Corps School, continued in college afterwards and the rest is history... It's not how you start but how you finish that matters!

 

I also have fat thumb syndrome and find myself editing my posts multiple times after I hit the send button (which is usually followed by a face-palm!) lol.

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

Thanks man. That means a lot. I lucky did not drop out of high school, but our drop out rate was > 50% and the rate of students who attended college (not graduated) was < 25%. I do wonder sometimes how I made it, but I reflect back a lot on how I can help my children and others. Nice to hear that we had similar hurdles, but from different backgrounds. 

[lkth487]

Guys - what are we even talking about?  I think most of us, definitely me, would fail my ochem 2 or physics 2 final exam.  SN2 reaction of organocuprates? Let's derive keplers third law from the inverse square law? What? 

 

I think this is a bit of a d*** measuring contest that won't go anywhere.   There's always a deeper level of understanding.  The question is what is the level required to adequately make treatment decisions.  Like ok step one is recognizing and treating seizures. Step two might be understanding what happens to brain function in seizures? Third might be to know everything about action potential generation in the neuron.  The fourth might be to be able to detail all the channels in each part of the brain. The fifth may be to figure out the structure of each protein as they make up those channels.  After that you can figure out the chemical interactions that go into proteins.  Then you can talk about why electrons move around and then you can talk about string theory and how electrons form.  

 

We were talking about seizures right?  There's always going to be more you can learn. Whether you took intro to chemistry or physical chemistry for doctorate students, there's always more.  This profession is about constantly learning. If you're the type of person who's curious and will look things up and is constantly wanting to learn more even about the things that you "know" you're going to end up being a better and more complete provider for your patients.  A guy who took super duper advanced pathophysiology in graduate school but hasn't looked up anything in the last twenty years is going to be terrible.  

 

After a while, things equalize even if you started off at different points at the beginning or even at the end of your formal training. And then it's all about you.  All the knowledge is publically available - it's up to you to have the motivation to utilize it.   It's kind of what I was saying in the thread about why I don't care how much clinical experience you have coming into school.  You can learn anything you want - I'd rather have a person who is intellectually curious and motivated - that's more important to me than coming in with any specific piece of knowledge or experience. 

[CAdamsPAC]

On 2/13/2018 at 2:33 AM, EMEDPA said:

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.

In my mind, doing FP s a Psych rotation!!

[SedRate]

8 hours ago, CAdamsPAC said:

In my mind, doing FP s a Psych rotation!!

Working in trauma is also a psych rotation.

[lkth487]

Pediatric GI is definitely a psych rotation.  

[CAdamsPAC]

12 hours ago, Sed said:

Working in trauma is also a psych rotation.

But on Trauma it's the Surgeons not the patients who are nutcases!!