Struggling...opinions please!

[sophiagrier]

Hi all,

A little backstory...I'm an RD and I'm currently obtaining my MHS in Human Nutrition. I'm working in the neonatal ICU right now and I'm planning to stay there while I complete my pre-reqs over the next couple of years. I've been set on applying to PA school after I complete my pre-reqs and eventually getting into a neonatal ICU or maybe even a PICU or general inpatient peds unit. However, so many others have told me that it's next to impossible to do NICU as a PA. I know there are some units that have PAs in NICUS (CHOP has a job open now for a NICU PA and there is a post-grad residency in KY). I've been told multiple times, however, that I should instead go to nursing school and eventually get my NP. The issue is, and this is no disrespect whatsoever to nurses, but the issue is that I feel it's a step backwards. I'll already have a master's degree and good experience under my belt as an RD and it feels like I'd be going backwards to lose the semi-autonomy that I have now and get a BSN. Whereas with a MPAS (or whatever master's degree the school I hopefully would be accepted to would offer) I would still retain that semi-autonomy and be moving laterally (IMO). So, what do you all think? If my mind is made up that I definitely want to do Peds/NICU, would you go for NP (eventually...you have to have 2 yrs experience before going back for NNP) or PA? Thanks in advance!

[GatorRRT]

The easy answer: if you're dead set on NICU, go NP. As you've already recognized, there just aren't that many PAs in the neonatal unit. Becoming an RN isn't a step backward at all. Every faculty I've ever worked in had a pecking order as follows: Medical staff, nursing and then allied health (nutrition, rt and rad). If anything becoming a BSN would give you more autonomy then you have now. How exactly is becoming a provider a lateral move for you again??

[B^3andG]

Sophia,

 

I completely understand your struggle. I am an RD, work at children's hospital, and was deciding between NP and PA. I am excited to say I was recently admitted into PA school and start in January. For me, the issue was the nursing model versus the medical model. I don't want to learn nursing care. I also agree that nursing is a step backwards. For me, I prescribe whatever I like to my patients (enteral and parenteral nutrition). My doctors look to me for final say on what nutritional care we provide our patients. Nurses while having a degree of clinical judgement are still bound by the orders that are written. Additionally, to become a NP most programs require that you put in your time as a RN first, which again did not interest me. Most direct entry NP programs are not as well respected, and from what I have researched it is difficult to find a job post graduation.

 

My outlook, if you are willing to move to do what you love go for PA. Don't get a degree in something you have no interest in to do something else. I have no idea what area of medicine I want to work in but I know that in 3 years I'm sure the PA field will have spread out even more giving me even more options. Also my hospital hires PAs for ER, and generalist positions, and the sub-specialties hire them all the time.

 

GatorRRT, often in adult hospitals nutrition is lumped with the other allied health groups, but in peds nutrition is way more complicated. Most doctors and PAs/NPs look to us for guidance on feeds. There are so many different formula types, feeding guidelines, and plenty of admits are related to FTT or GI problems. We get a decent amount of respect in our respective fields.

[B^3andG]

I have autonomy and respect in one specific field of medicine, and I want to know more. I love clinical nutrition, but doing that for the next 25-30 years of my life would be monotonous. I work with a RT who has complete autonomy and respect from our docs when it comes to trach sizes and our social worker is in charge of her social assessments and management of medicaid/social services issues that arise. Most docs get very little training in nutrition or social work and count on others to help out. I will miss being a part of such good multidisciplinary team that let's each other do what they know. I want to learn medicine, and I know many MD/PA relationships that are complimentary of each other and where PAs work with a degree of autonomy and respect (of course with time.) Why didn't I choose MD/DO? Well for one I didn't want to put in the time commitment that I think many that choose PA would put as a reason. Secondly, I like the option of moving around in medicine. I can't think of another field that affords so much flexibility.

[B^3andG]

PAMAC, may want to be a little less sensitive.

[GatorRRT]

No offense intended. My point is, RDs are in the same league as social work, speech path etc; in that while they may require a MS, they aren't even close in terms of overall patient care autonomy that an RN has. This very well may not be the case in the NI, but overall an RN has MUCH more say in how a patient progresses than an RD in every hospital setting. Id hope you could also agree that RD to PA is in no way shape or form a lateral move, unless you're just considering the level of education.

[sophiagrier]

First, thank you all for your opinions. I just want to reiterate that I meant no disrespect to nurses in general, much less NICU nurses. They do a phenomenal job and are often looked to by the providers to add input on things that PAs/NPs/MDs simply can not know.

BrittclemRD, I completely agree with you. Part of my issue is the nursing model...I much prefer the medical model. I've looked into direct entry MSN programs and they don't seem well respected nor do they seem to provide the education that I'm seeking. Another issue is being an RN for 2+ years before becoming eligible to go to NNP school. And yes, part of it is taking a step back because I tell the MD or NP what I want and 8 times out of 10, my recommendation is taken. And in a year or so I have a feeling they'll just allow me to order whatever I want (within the scope of my practice obviously).

GatorRRT, I meant lateral as in education.

PAMAC, we don't do what we do because it 'goes to our head'. First of all, it takes time and effort and building a relationship with providers before they will even begin to respect us. I do not, not for a second, believe that nutrition is the end all be all in medical care. It's a small part of the puzzle, but yes, I take pride in what I do and considering how long takes sometimes before providers will listen to dietitians, I get excited when they agree with what I have to say. As I've said before, it's a 'step back' in my opinion (1) because of the degree and (2) because, with regards to the NICU, I feel as though I have a level of autonomy that nurses simply do not have, not because anything has 'gone to my head'.

I really appreciate all of your input! As of now, the one thing that's holding me back from PA is the getting a job part (b/c PAMAC is right...a lot of people in the NICU have no idea what a PA is), but I definitely agree with you, BrittclemRD, part of me really just wants to go for it and, because I have the ability to move, see what happens afterwards.

[Guest hubbardtim48]

PAMAC is always defensive about RNs and the nursing model....just ignore PAMAC....he tired to get into PA school and did not succeed....I think it is hard to get over it....?

[Guest hubbardtim48]

Totally disagree with that GatorRRT. Just like the RT field, one is a "master of a specific area" and RNs are typically the same. RNs work in a specialized field, NICU, PEDS, neuro, CV, IR, Cath, MICU, onco., etc...Their training may seem like a "trick of all trades", but when one starts working they usually work in one area only (unless they float) but still don't bounce around everything. How many RTs do you know that work in ALL areas of the hospital? As a former RT I worked with adults only (ICU/ER), I did not do NICU, PICU, PFTs, sleep, hyperbaric, etc...You can't do it all and even RTs are trained in cardio/pulm, but still are trained, in school, in ALL areas of the hospital.

[Guest hubbardtim48]

So, an oncology nurse does not have a narrow scope or a CV nurse or a dialysis nurse or a peds nurse....? Too me and my wife there is a very narrow window...hit me back up when you do clinicals and actually start working on ONE floor and tell me ALL the different patient populations you encounter...

[andersenpa]

to the OP- if NICU is your goal then NP is going to open the most doors. I wouldn't harbor too much on the degree. There are many PAs who took a "degree cut" to get their PA cert/associates/bachelors; the degree matter far less than the PA-C credential.

If the RN experience issue bothers you (and I can't blame you), look more closely at the DE programs. The one by me has the NP student doing RN work while in the program.

Plus with your previous experince you shouldn't be too far behind when you finish your NNP.

[andersenpa]

People here are getting bogged down with some strange ideas about autonomy and hierarchy between nurses and non-medical clinical staff. Some of this comes from how hospitals categorize their staff. Nursing is almost always in a separate category due to their numbers and history.

That being said- docs, PAs, RDs, pharmDs, DPMs etc all direct their own scope of clinical care. For docs and PAs its the practice of medicine. RDs, nutrition. Nurses practice nursing care and manage the delivery of care ordered by the former groups. One doesn't really have more or less autonomy since they all work in their own scope. There's really no step back or forward unless you are thinking in terms of the practice of medicine, in which case anything other than MD/DO/PA/DPM (and NP if you're not fooling yourself) is "less autonomous".

 

No need to draw lines when there don't need to be any.

I can't remember the last time I opposed an RD order- that's their expertise. I add what I need to in terms of our goals (fluid restriction, protein needs etc) but they direct that component.

[Guest hubbardtim48]

No, I am tired of you talking crap to people so I am fighting fire with fire. Just be positive and the comment to jmiller was just not right...a monkey could read what he was saying and know exactly what he was meaning. You just live to give low blows to various people and to the RDs those comments were also not right. explain to me how RNs have soooo much autonomy and make calls and/or do a "nursing diagnosis." I have never heard, seen any nurse doing this, like anderson said RNs do nursing care and coordinate care from all the orders being given to them...ER RNs might have some autonomy because they know the docs, but floor nurses or ICU nurses take orders, "Care" for the patient and coordinate care from docs, RTs, RD, PT, OT, whatever....You just think nursing is the best think since sliced bread and you bash everyone on how better nursing is and blah blah blah...I think nursing is GREAT, but there are always limits, small scope of practice, regulations, etc...to any profession. Why do you think there are so many allied health professions out there? Everyone can't know everything....give up your nursing hype and just work as a team and every other profession is JUST as GOOD as an RN. BTW UND is a great program and I like the online part. Knocking nursing is something I don't try to do, I just hate when you hype up everything because nursing as been around for a while and you think it is the best career in the entire world and nothing compares to it...you need to be around RNs more and work as one and you will seen soon how RNs are humans and have jobs just like all the other allied health prof. in the hospital. Also, you get made when someone thinks it is a step back to get an RN degree. That was one of several reasons why I did not do NP...get over it and move on...quit crying because not everyone like nursing theory...I don't really care that UND took RNs from 1972-2006...all I care about is that I got in and the rest is history....again give up the nursing model for every argument.

[Guest hubbardtim48]

Read UNDs program history...BTW RTs didn't have had licensure for only 25 or so years....Hair dressers had a state licenses before RTs did so how could RTs even apply to UND PA program when they didn't even have a license to practice RT...Also, people don't even know what we do and that is why it took soooo long to get us into the health care realm and into the eyes of advanced practice programs (perfusion, PA, AA, etc).

[andersenpa]

No, I am tired of you talking crap to people so I am fighting fire with fire. Just be positive and the comment to jmiller was just not right...a monkey could read what he was saying and know exactly what he was meaning. You just live to give low blows to various people and to the RDs those comments were also not right. explain to me how RNs have soooo much autonomy and make calls and/or do a "nursing diagnosis." I have never heard, seen any nurse doing this, like anderson said RNs do nursing care and coordinate care from all the orders being given to them..

 

Nurses have protocol driven tools to allow them to deliver care within scope. They are not technically the ones ordering it.

One common tool is SBAR- situation, background, assess, recommend. They use this method of communication and enact care plans to stabilize the situation.

So in a sense there is a nursing diagnosis, just not the "capital D" diagnosis that we use in medical practice.

[eewee]

There is actually a Neonatology PA residency at the University of Kentucky. Looks like they take two PAs a year. Check it out: http://www.appap.org/Programs/tabid/58/Default.aspx I can't link to the page for some reason but it's the 6th one down on page 5.

 

Update: link to the UK website: http://www.mc.uky.edu/pediatrics/PA/link2.asp

 

For some reason, there are certain branches of medicine that are NP dominated and certain ones that are PA dominated. OB/GYN, for example, is NP dominated at least where I live. Looks like NICU is as well. Ortho and emergency medicine are PA dominated. The channels for becoming an independent practitioner in the NICU are already set up for nurses. It's a little more elusive for PAs because we don't have the special programs, besides the one residency in Kentucky.

 

Like someone mentioned, NICU is high acuity, high stress, high risk...so it's a pretty long road to get into it from any angle. It's a 3 year fellowship after a 3 year residency for MDs/DOs.

 

Good luck! Being a NICU PA or NP would be amazing! :smile:

[andersenpa]

when i read the first few posts on here, it sounded like something from SDN, where you read things like "i could never be a physician assistant.... i need to have more autonomy than that, because im so used to being in charge". just seemed silly... especially given the narrow scope involved. yeah, folks do what you say when it comes to nutrition questions... because they arent RDs. they rely on pharmacy, RT, Lab, PT, all the way down the line.... all of us autonomous.

 

now not caring for nursing theory vs the medical model... i can appreciate that. its clear that "respect", and letters beside the name are important factors for you. but is that going to frustrate you as a PA?

 

The OP doesn't want to pay for a step back in degree

Not exactly the same thing as "letters beside the name are important factors for you"

And respect is important to all of us, whether a nurse, PA or doc.

 

The OP clearly has a different (and perhaps more informed) view of autonomy in patient care...

[Planteater]

Any chance you two (PAMAC and hubbardtim48) would consider just putting each other on your ignore lists? Just askin' :heheh:

[Guest hubbardtim48]

I know about SBAR and as an RT I use a protocol everyday for vents, treatments, etc...but that doesn't make me better than another profession...again it is just how PAMAC is stating stuff and how "nursing diagnosis" can be misinterpreted...I just think nursing is trying to hard to be bigger and better...I focus on the patient/family and could care less about my education and degrees. I think that is where nursing rubs me the wrong way is they lobby to "look good and competent" on every issue. Just like the DNP...How many RTs, EMTs, OT, PT etc do you hear talk about how great they are? No on really cares about how great you are or how much you know...they only care when they know that YOU care....

[Guest hubbardtim48]

I am guessing not because we weren't even licensed...so how can you recognize someone in a health care field when they aren't licensed? It takes time to build a profession....i.e. like the PA or AA profession...Do u know what RTs do? Do you know what AAs do?

[Guest hubbardtim48]

Nah...I like PAMAC as a person...we probably won't ever see eye to eye...no sweat off my back....I just like wasting time at work when I am not busy....

[Guest hubbardtim48]

See everyone we are GETTING along!!! :) God is great!!!! :)

[sophiagrier]

I want to make it very, very clear. My issue with PA vs NP in the NICU is NOT about 'letters behind the name'. It's NOT about being in charge. I've never been in charge as an RD...I thought I made that clear. I just said, in my position, in the NICU, I have semi-autonomy. I'm not in charge because I run everything I do by the MDs and NNPs, it just so happens that they typically take my recommendations. And, to me, going back to be an RN, I would lose that autonomy b/c in the NICU (which I'm in that environment every day), the RNs are simply taking orders. They may add an 'oh, he's not feeding as well.' or 'he's a bit more lethargic today' or 'he's bradying/desatting a lot more than normal'...but they don't typically offer recommendations or suggestions. They say their piece and that's it. But, please, please, do NOT distort my words to make it seem as though I'm only after letters after my name or I'm some egotistical RD who things I'm the 'queen of the castle' simply because MDs take my recommendations. That's not the case. I was asking for suggestions and I appreciate all of them, whether positive or negative, but I don't appreciate my words being twisted and assumptions being made about my character or motives.

[andersenpa]

I know about SBAR and as an RT I use a protocol everyday for vents, treatments, etc...but that doesn't make me better than another profession...again it is just how PAMAC is stating stuff and how "nursing diagnosis" can be misinterpreted...I just think nursing is trying to hard to be bigger and better...I focus on the patient/family and could care less about my education and degrees. I think that is where nursing rubs me the wrong way is they lobby to "look good and competent" on every issue. Just like the DNP...How many RTs, EMTs, OT, PT etc do you hear talk about how great they are? No on really cares about how great you are or how much you know...they only care when they know that YOU care....

 

Well for one I think we should all care equally about patients AND our education. Where we are able to position ourselves in the citizenry of practitioners is dependent upon how we are perceived by outside forces. And THEY think about education and degrees, like it or not. Stubbornly clinging to competency based practice only may kill us.

[sophiagrier]

There is actually a Neonatology PA residency at the University of Kentucky. Looks like they take two PAs a year. Check it out: http://www.appap.org/Programs/tabid/58/Default.aspx I can't link to the page for some reason but it's the 6th one down on page 5.

 

Update: link to the UK website: http://www.mc.uky.edu/pediatrics/PA/link2.asp

 

For some reason, there are certain branches of medicine that are NP dominated and certain ones that are PA dominated. OB/GYN, for example, is NP dominated at least where I live. Looks like NICU is as well. Ortho and emergency medicine are PA dominated. The channels for becoming an independent practitioner in the NICU are already set up for nurses. It's a little more elusive for PAs because we don't have the special programs, besides the one residency in Kentucky.

 

Like someone mentioned, NICU is high acuity, high stress, high risk...so it's a pretty long road to get into it from any angle. It's a 3 year fellowship after a 3 year residency for MDs/DOs.

 

Good luck! Being a NICU PA or NP would be amazing! :smile:

 

Thank you! I was aware of this program and have looked into it. The fact that there is a program out there like this gives me hope that there's a need for NICU PA's or else it wouldn't even me an option!