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Cideous

Sitting for the Nurse Practitioner Boards as a PA......

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I would say you are living in a made up world. Have you been to an ER or seen who surgeons hire. It's not NPs, it's mostly PAs. My hospital doesn't even hire NPs. In the last 9 yrs I would say there might be 5% in the ER. The places where I see NPs sought out above ERs is do to cosigning.

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I meant to say my hospital doesn't hire NPs in the ER.

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When I wanted to be a PA, I was interviewing for admission when I got into nursing school. That presented me with the choice to pursue a career as a dependent provider, or take the path that would let me be independent. I voted with my feet to go to NP school, made the choice that I could live with for these kinds of specific reasons, and never looked back. PAs made their choice as well, while knowing the limitations that would follow. If you want to change your landscape, nobody else is going to pull you across the finish line, least of all the people that so many here try to put down whenever they feel threatened. Its our victory... we don’t need to share it, so we won’t. What’s in it for NPs to take PAs under their wings with the kind of attitudes present? I ask that with all honesty. How would I sell partnership to my state nursing advocacy organizations if I were to advocate for PAs to come along for the ride?  So while I respect your training, and have good relationships with the PAs that I know and respect, there’s not much that can be done. And I’m not a nursing cool aid drinker. I think most PAs would do well independently.  But NPs will forge ahead alone, just like we came into this world, and it sounds like most folks here recognize the lay of the land on this. The awakening here is starting, several years too late for me to have waited for, but the spark is there, albeit with some significant constraints.
I actually agree mostly with your post actually. I do think it helps that nursing is heavy in management yet PAs aren't.

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14 hours ago, Marinejiujitsu said:

I would say you are living in a made up world. Have you been to an ER or seen who surgeons hire. It's not NPs, it's mostly PAs. My hospital doesn't even hire NPs. In the last 9 yrs I would say there might be 5% in the ER. The places where I see NPs sought out above ERs is do to cosigning.

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Before this thread derails from the whole point of the original question to yet another PAs vs NPs thread like every other slightly related thread, let me clarify two points here. 1: In corporate medicine, surgeons do not hire anyone, they are an employee (and employee #) like any other clinician; MD/DO, PA, NP, RN, RT, and other ancillary staff. They have ZERO say in who gets hired and fired. That's the MBAs and HR's job. 2:  Let's not intermingle facts with anecdotes and personal experiences. If we are, yes, I have been in ERs where NPs are hired. You cannot go from "have you been to an ER that hires only PAs" to..."it's mostly PAs and not NPs." That's contradicting. Don't forget that RNFAs who become NPs also end up in surgery (IN CORPORATE MEDICINE)

Also, surgery and ER are two of the 100+ specialties and subspecialties so...moot point. My hospital doesn't hire NPs in the ER but guess what, only NPs are hired in the ER as hospitalists that handle admitted patients. Both NPs and PAs are required to be cosigned at my hospital, so again, you're ignoring my original point that NPs are sought out because they are a type of advanced practice clinicians regardless of cosigning requirement.  

Question for you though regarding: "The places where I see NPs sought out above ERs is do to cosigning." For hospitals that require co-signatures for both types of advanced practice providers (PAs and NPs), why is that there are more NPs in ICU/NICU/Anesthesia/Flight Medicine settings than there are PAs? 

PS: I am very neutral when it comes to PAs and NPs in the clinical settings - because I have worked with both as a medical assistant and also as an emergency nurse. I am not biased for or against either because this is not my life...this is a means-to-an-end. IDC for title, I only care that my direct deposits clear at 0800 biweekly. If you also read my posts carefully, you'll also notice that I stick to facts and not anecdotes. 

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I like being a PA. We seem well respected in the medical world, and the comments I've heard from other providers, including NP's and MD's/DO's seem to reflect that. We've developed a niche in the procedure and surgical world, as well as being highly valued in other fields for our high standards of education across the board, and for our adherence to the medical model. We also seem to manage a pretty high level of standardization of our education, rather than an education system that is variable in preparation, or in rotations. I see in the future less HCE prior to school, and more of us going into a short residency, which will further delineate us from our NP counterparts. I don't think the solution is piggybacking onto the NP lobby, but rather spearheading our own path, and further developing our own niche.

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So no, I am not living in a made-up world.
Maybe because I work in California where every floor nurse is an NP not working as an NP.

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In California, many of the floor nurses make more money for the amount of responsibility and the hours as they would as an NP too. Go to nursing boards and see how many folks there are struggling with the choice to stay in floor nursing or follow the dream to be an NP. That market is a bit of an enigma compared to the rest of the US. The choice can be whether to go from 3 shifts per week and six figures as an RN where you don’t have to take your work home with you, or work 5 days a week and carry a pager for a job where it’s hard to take a day off without over a month or two notice, and you can’t be sick and not have it throw everyone into a tailspin. All that for maybe even a pay cut. They go to school and realize that too late. It’s almost merciful financially for the market there to be tight to break into as a new grad. PAs often have the same problem, but no sweet nursing gig to fall back on. Maybe back to the rig while they wait for an opening if they are lucky.
I know. Nurses make 200k here and the saturation of NPs is still crazy here and they still have hard times finding rotations in school. Most of the NPs I know here don't work as NPs.

But I think the point of this thread was PAs working as PAs have crazy amount of experience working as a provider and it would be a shame for them to have to stop because nursing administrations and nursing laws are strong arming our profession to die.

So, the question is, "Should we work on finding a way to jump ship so we can do what we do?"

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I think what you are asking is reasonable. I guess the tweak I would make to everyone’s perception is that nursing isn’t trying to necessarily strong arm anyone, they are just advocating for themselves, and also that it’s understandable that they aren’t taking anyone along for the ride. I think that’s a different way to look at it than feeling like they are out to get PAs. 
If you look back to the quote from the nurse that was the surgeon general, you’ll see that what she was saying was simply that nurses are going to decide their own scope of practice, and essentially their destiny, without anyone else interfering. They aren’t asking anyone for help, they are telling them what they want and what we can do. PAs could benefit from that approach. Look what it’s got us nurses... a surgeon general saying that... one that is a nurse. Incidentally, she was the second surgeon general that has a nursing background. Richard Carmona also had a nursing degree in addition to his medical training.
Nursing pretty much run the hospitals now. Advocation worked now they are more like a monopoly. Nursing is becoming the equivalent to Facebook for social media. Lol.

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I think the idea of trying to pull PAs into the nursing movement is reasonable, but that involves not only convincing them to take you on, but also begging physicians to let you go. That’s before any concessions that nursing would demand of PAs to allow for it. I don’t see any avenue that doesn’t destroy the power of your training and history. As it is, I don’t see that PAs are suffering anything more than a blow to the ego. There are inconveniences too, but I could have found a way to be really happy as a PA if I had to. But with the advantages that NPs have staring me in the face, even though they are subtle, I’d have always asked myself if I would have liked being an NP better. I honestly love it, and am proud of being my own person, if only in paper. I don’t work for myself or anything like that, but I did make at least $60k more as a new grad psyche NP than I would have as a PA. Had I been an FNP, though, I’d have made the same as my PA peers. So independence isn’t overrated, but you can’t count on it making you happy if you aren’t happy in the first place. If you are so type A that you chafe at the restrictions of being a PA, you’ll probably still find something about being an NP that bothers you. For me, I also didn’t used to think I could get along well with folks well enough to not want an avenue to be on my own if I need, but that changed over the years.
Sheesh, 60k, gosh, your starting to make me feel bad for psyche NPs. I do know a psyche PA making 250k. I do worry oversaturation is going to be an issue for PAs and NPs but I worry with nursing management it will favor the NP. UCSF is heavily favored with NPs due to their management but you do see PAs favored in ER and surgical specialties.

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I'm pleased at the thoughtful dialogue. It is a welcome change from the typical. I'm one of the "old PAs" who thought about NP crossover many years ago. It was simple practicality. There are places that are more NP friendly and there are places that are more PA friendly. Having both certifications would make working where I wanted easier. I'm quite happy being a PA and have no concerns about my job particularly other than the usual corporate stuff.

In another thread not an hour ago I said we need to stop obsessing with NPs and who is doing what and, particularly, we should not take the path of least resistance as we try to improve out lot in life unless it also happens to be what is best for us.

You also touched on another of my recurring themes.... why should the NPs welcome us into their efforts? They have been making their own way for 15 years or more and have been successful while we remained in the warm embrace of our bestest buddies the physicians. Well guess which plan worked out better? So, while I think we should shift gears and start working with someone other than the physician groups, I wouldn't expect a big wet sloppy kiss on the face just because we are changing course.

As PAs we just need to be looking out for our future and stop carrying on about anyone else.

Edited by sas5814
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On 6/13/2019 at 12:56 PM, Lightspeed said:

I did make at least $60k more as a new grad psyche NP than I would have as a PA. 

Marinejiujitsu, you feel bad for that?  Ok... I'd like to know where you're working and what salary you're making because shoot, I'll move.  

I just wanted to chime in and say Lightspeed tore up this thread.  Nice job.  Said it better than I.  

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Marinejiujitsu, you feel bad for that?  Ok... I'd like to know where you're working and what salary you're making because shoot, I'll move.  
I just wanted to chime in and say Lightspeed tore up this thread.  Nice job.  Said it better than I.  
I work in northern California making 200k+ in emergency medicine.

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On 6/13/2019 at 9:15 AM, Marinejiujitsu said:

I know. Nurses make 200k here and the saturation of NPs is still crazy here and they still have hard times finding rotations in school. Most of the NPs I know here don't work as NPs.

 

Sounds to me like these NPs do not know how to negotiate. I make $150/hr at my 1099 job in this area.

Edited by Lexapro
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Saying you make that in NoCal, when a RN is easily clearing 6 figures, is less than impressive.  Come to Pittsburgh and a new grad NP or PA can really rake it in at UPMC with salaries starting at $65K.  In this area, at other hospitals, $120-130 would be the absolute top of the pay scale after years in practice, and probably working your arse off. 

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Saying you make that in NoCal, when a RN is easily clearing 6 figures, is less than impressive.  Come to Pittsburgh and a new grad NP or PA can really rake it in at UPMC with salaries starting at $65K.  In this area, at other hospitals, $120-130 would be the absolute top of the pay scale after years in practice, and probably working your arse off. 
Yep. True that. I completely agree. Some RN make over 350k but that's hecka overtime. That's why I think NPs dont stay in the workplace as an NP up here. RNs know how to work the system not taking OT unless double time. They are a smart species. Lol.

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35 minutes ago, Lightspeed said:

According to the AAPA, there are no fewer than 23 PA programs in Pennsylvania. There probably aren’t even that many RN schools there.

Seriously????

 

Gawd, I thought Texas had a lot, lol.  That's insane.

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Hey guys, I've never posted here before and I know this is the middle of a hot debate but I need some advice and this thread is making me question a lot.

I just got accepted to a good accelerated BSN program in state with hopes to go NP, but I also have all my pre requirements for PA applications this cycle and my apps are almost ready to turn in. Which route should I take NP or PA? Which is quicker/cheaper at this point? I have a decent shot of getting into a standard pa school and I don't particularly like the city the BSN program is located in but I already work as a CNA in a hospital and like the floor work as long as it's short term. I am also nervous for the gap year I would have to take if I do PA starting next summer but PA has always been my dream and I applied to the BSN program on a whim. I see myself working family practice or something with international public health.

Edited by kelsey0123

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If you want to a NP then do that, given that you already have an accepted seat to RN school.

If you want to be a PA and you definitely have a competitive application/stats then skip the ABSN and apply to PA school. There's no such thing as a standard PA school. BSN programs are no way close to as competitive as PA programs. 

From my calculation so far based on state schools (avg 30K for undergrad)

  • PA is 4-5 years undergrad + 2-3 years MS-PA = 6-8 years + 80-130K in student loans.
  • NP 4 years BSN + 2 years MSN = 6 years + 40-80K in student loans
  • NP 4 year BS/BA + 1-2 years ABSN + 2 years MSN = 7-8 years + 140K+ in loans*
  • DNP 4 year BSN + 4-6 years BSN to DNP = 8-10 years + LOL in student loans*
  • DNP 4 year BS/BA + 1-2 years ABSN + 4-6 years BSN to DNP = 9-12 years + LOOL in student loans*

* these programs are not worth it unless the school award scholarships based on academic merit or other qualifications that practically pay for 70% of the education*

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NP.....then straight into a residency to actually learn something.  Take your boards and never have to re-cert again.  Not to mention if you want to hang your own shingle out you can never do that as a PA.  Within 5 years there is a good chance NP's will have at or close to full autonomy in most states while we all sit around spending a million bucks debating is being an "Assistant" bad........gawd.

Edited by Cideous

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19 hours ago, Kaepora said:

Saying you make that in NoCal, when a RN is easily clearing 6 figures, is less than impressive.  Come to Pittsburgh and a new grad NP or PA can really rake it in at UPMC with salaries starting at $65K.  In this area, at other hospitals, $120-130 would be the absolute top of the pay scale after years in practice, and probably working your arse off. 

 I mean I'd much rather make 250-300k with no nights or OT in the bay than 65k in PA, but to each their own. It is true that RNs make a lot here, but the only RNs I know who make over 150-175k are working like 60+ hours weekly, holidays, nights, doubles, etc.  I prefer to make a lot and work as little as possible, tbh.

Edited by Lexapro

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19 hours ago, kelsey0123 said:

Hey guys, I've never posted here before and I know this is the middle of a hot debate but I need some advice and this thread is making me question a lot.

I just got accepted to a good accelerated BSN program in state with hopes to go NP, but I also have all my pre requirements for PA applications this cycle and my apps are almost ready to turn in. Which route should I take NP or PA? Which is quicker/cheaper at this point? I have a decent shot of getting into a standard pa school and I don't particularly like the city the BSN program is located in but I already work as a CNA in a hospital and like the floor work as long as it's short term. I am also nervous for the gap year I would have to take if I do PA starting next summer but PA has always been my dream and I applied to the BSN program on a whim. I see myself working family practice or something with international public health.

I was 2 semesters from finishing my RN when I got picked up for PA school.

 

As for the NPs working as RNs I have known a couple. One that sticks in my mind just wasn't well equipped to be a provider. It is a long complicated story but she had the worst time coming up with a good diagnosis and plan and after a while the stress was too much and she just went back to nursing.

And big money? Like most things it has a lot to do with location. I lived in a fairly rural area about 45-50 miles out of Dallas and many many nurses would drive into Dallas every day for work because the pay was about double for most of them. Then there was a bit of the reverse...nurses who worked things like NICU or neuro ICU in Dallas making good money who lived near me because you could buy a nice 3000sf house in a nice neighborhood for 150k. Dallas money, rural expenses.

Everyone's currency is different. I'm getting older and I want max bucks for minimum stress. 

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We all talk shop endlessly and know the ropes. You never saw my smiling face for an extra shift unless I was guaranteed double time and something else like a gift card for $100-150. They send out texts begging for bodies to show up for OT, and everyone waits until they dangle some extra nice incentives. The powers that be know that you’ll boycott them if they reneg on a pre arranged agreed upon shift. 
I think that $350k, even under the most optimum circumstances for a nurse, represents a lot of misery. I believe there are folks that pull that off, but that’s like the RN olympics right there. I know a married RN couple in Northern California who both make around $160k each, without a lot of OT. Tons of time off too. 
True. The couple nurses I knew that made that kind of money pretty much lived at the hospital. I cant complain because they were some of the best nurses and just shy of retirement. I think it's so stupid that they would pay double so much and not want to hire people without experience when they can just bite the bullet and staff more to train the nurses. Its crap that there are so many nurses here that cant find jobs for 1-2 yrs because they dont have experience.

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22 hours ago, Cideous said:

NP.....then straight into a residency to actually learn something.  Take your boards and never have to re-cert again.  Not to mention if you want to hang your own shingle out you can never do that as a PA.  Within 5 years there is a good chance NP's will have at or close to full autonomy in most states while we all sit around spending a million bucks debating is being an "Assistant" bad........gawd.

PAs in North Dakota can open their own practice after a certain number of years in practice (I think 2 years?) thanks to the OTP legislation that was passed there 🙂

A3219AB2-08F9-477B-B179-EDF924018D59.png

Edited by PA-C
Added photo excerpt from NDAPA

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1 hour ago, PA-C said:

PAs in North Dakota can open their own practice after a certain number of years in practice (I think 2 years?) thanks to the OTP legislation that was passed there 🙂

A3219AB2-08F9-477B-B179-EDF924018D59.png

While that is fantastic, I see Zero evidence of that happening anytime soon in Texas, Florida, NY, California, Oregon ......Etc.  So I guess if you are choosing to be a PA now over an NP and want to move to North Dakota....Then yes, you have a shot at the shingle.  However, if you want to live anywhere else.....

Edited by Cideous

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It is happening at a faster pace than I ever thought it would. The states you mention are , indeed, being dragged down by organized medicine. I can't speak for any other state but Texas will probably get OTP after American Somoa and Guam. The only upside is there is about zero chance of NPs getting independence and leaving us behind. 

ND did this very quietly. There wasn't any chatter or requests for support just BOOM...look what we did. Great work.

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