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#1 kymedic25

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Posted 10 October 2011 - 10:52 PM

Good evening. I am looking at "upgrading" my education and career. I've been a paramedic for almost 15 years, ground, CCT, flight, Level 1 trauma ER, etc. I am finishing my BS degree in Emergency Health Services in December. I am looking at PA school or CRNA school. Either way, I am going to have to retake some of my science classes because they are almost 20 years old. Anyway, CRNAs make more money, but they only work in the OR, where PA's don't make as much money (usually) but they don't have to work in one specialty, they can do OR, General practitioner, Internal med, etc.

I am just wanting opinions so I can hopefully make my decision. Those of you that have gone on to one of these professions, please chime in.

Thanks everyone.

Jason
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Jason C. Sargent BS, NREMT-P, CCEMT-P
Des Moines, IA

#2 TexRNmedic

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Posted 11 October 2011 - 12:26 AM

Good evening. I am looking at "upgrading" my education and career. I've been a paramedic for almost 15 years, ground, CCT, flight, Level 1 trauma ER, etc. I am finishing my BS degree in Emergency Health Services in December. I am looking at PA school or CRNA school. Either way, I am going to have to retake some of my science classes because they are almost 20 years old. Anyway, CRNAs make more money, but they only work in the OR, where PA's don't make as much money (usually) but they don't have to work in one specialty, they can do OR, General practitioner, Internal med, etc.

I am just wanting opinions so I can hopefully make my decision. Those of you that have gone on to one of these professions, please chime in.

Thanks everyone.

Jason

Have you looked in to an anesthesia assistant program?
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Wes Seale
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#3 kymedic25

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Posted 11 October 2011 - 02:20 AM

Have you looked in to an anesthesia assistant program?


Yes, I have. That is a consideration as well.
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Jason C. Sargent BS, NREMT-P, CCEMT-P
Des Moines, IA

#4 B. Cornelius RN EMT-P

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Posted 13 October 2011 - 01:21 AM

Keep in mind as an AA you are restricted far more than as a CRNA and restricted to the OR under supervision of a MDA.
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#5 AdamMedic11

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Posted 14 October 2011 - 12:10 AM

I personally would go CRNA. I know you would have to go back and get a BSN probably and I think they require critical care experience, with ER not counting as critical care. But they really are autonomous in local hospitals. I was at a hospital with A.A.'s and they all seemed happy. I can't speak for the differences between them and the CRNA's. The both needed the attending anesthesiologist to induce.

I considered the PA route many times. Currently I'm in the application process for med school. I think what concerns me about being a mid-level is market saturation. I would estimate that 30% of the nurses in the ER are going through an online NP program. In the next couple of years I think there will be more midlevels then there is need. I think also what convinced me not to do the PA route is my career as a medic. I really don't want to enter another profession where I do the same thing as a nurse and get paid less, get privileges restricted by nursing, and fight for justification against nursing. I know, chip on the shoulder. I think I was just worried about spending 2+ years busting my butt in class to be looked down upon by an NP who spent 2 years staring at a computer screen.

In all actuality, do what's going to make you happy. Good luck on taking all the science courses! It's a lot of work to get all the pre-rec's done, but so worth it in the end. We can climb in and out of ditches and lift heavy patients for the rest of our lives.
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#6 BrianACNP

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Posted 14 October 2011 - 02:02 AM

I personally would go CRNA. I know you would have to go back and get a BSN probably and I think they require critical care experience, with ER not counting as critical care. But they really are autonomous in local hospitals. I was at a hospital with A.A.'s and they all seemed happy. I can't speak for the differences between them and the CRNA's. The both needed the attending anesthesiologist to induce.

I considered the PA route many times. Currently I'm in the application process for med school. I think what concerns me about being a mid-level is market saturation. I would estimate that 30% of the nurses in the ER are going through an online NP program. In the next couple of years I think there will be more midlevels then there is need. I think also what convinced me not to do the PA route is my career as a medic. I really don't want to enter another profession where I do the same thing as a nurse and get paid less, get privileges restricted by nursing, and fight for justification against nursing. I know, chip on the shoulder. I think I was just worried about spending 2+ years busting my butt in class to be looked down upon by an NP who spent 2 years staring at a computer screen.

In all actuality, do what's going to make you happy. Good luck on taking all the science courses! It's a lot of work to get all the pre-rec's done, but so worth it in the end. We can climb in and out of ditches and lift heavy patients for the rest of our lives.


I can comfortably say that there will not be market saturation. In fact, there will be a bigger need for advanced practitioners (both PA's and NP's) as health care reform will drive this need in addition to other issues such as the physician shortages and resident work hour restrictions in academic centers. When I first started in my current role 5 years ago, there were probably less 25 openings in our helathcare system and, as of about a month ago, there are now close to 80 openings, only 8 of which are primary care positions. We are actually working on setting up a system-wide advanced practitioner fellowship program.....the need is ever present and growing.

As far as doing the same thing as a bedside nurse and getting paid less, I think you're off base on the role and compensation of advanced practitioners. Both PA's and NP's practice in the medical model of performing H&P's, ordering diagnostic tests, and providing treatment (which is not protocolized but instead based on an evidenced-based approach medical decision making process). This practice is quite different from bedside nursing, which is what I believe you were referencing. Now, I will admit that practice patterns vary, but the vast majority of practices follow this model with varying levels of autonomy. And there are very autonomous & collaborative practices out there...I happen to work in one. Privileges are not determined by nursing bur instead through the credentialing office in the institutions....the credentialing boards are generally represented by physicians and, in some locales, a combination of physicians and advanced practitioners. Nursing is not the deciding factor for privileges.

As far as compensation, I can't speak to every locale. But in general, advanced practitioners are compensated at a higher level than bedside nurses. I'm not sure where you obtained your information that bedside nursing and advanced practitioners earn similar or less wages. At the various times I've reviewed positions in various parts of the country, the salary ranges for advanced practitioners are pretty consistent for the region of the country and consistently higher than bedside nursing.

I'm not really sure what to make of your final statement, particularly your statement that you don't want to be looked down by a NP that spent 2 years staring at a computer screen. My initial reaction was one of defensiveness at an attempt by you to criticize the NP educational preparation. NP's have more than demonstrated their value in the clinical setting. Many peer-reviewed articles have been published demonstrating the value of NP's. In fact, it's been demonstrated that NP's can provide similar or even better outcomes when compared to physician outcomes by providing the mix of the medical and nursing model. I work with both NP's and PA's at our institution and we all have similar clinical privileges and all have mutual respect. Perhaps looking at the value that both NP's and PA"s bring to health care would be a better approach.


Brian
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Brian, MSN, ACNP, CCRN

#7 BrianACNP

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Posted 14 October 2011 - 02:14 AM

Good evening. I am looking at "upgrading" my education and career. I've been a paramedic for almost 15 years, ground, CCT, flight, Level 1 trauma ER, etc. I am finishing my BS degree in Emergency Health Services in December. I am looking at PA school or CRNA school. Either way, I am going to have to retake some of my science classes because they are almost 20 years old. Anyway, CRNAs make more money, but they only work in the OR, where PA's don't make as much money (usually) but they don't have to work in one specialty, they can do OR, General practitioner, Internal med, etc.

I am just wanting opinions so I can hopefully make my decision. Those of you that have gone on to one of these professions, please chime in.

Thanks everyone.

Jason


Pursuing higher education is a great idea if you're committed to it. In the end, do what makes you happy. Though PA's (and NP's too) make less money than CRNA's, they make a comfortable living....certainly more comfortable a medic salary in general. I've said this in other threads, but if you go into a particular field ONLY for the money, then you're rolling the dice that you may enter a profession and will be generally unhappy. Personally, I'd rather make less money (but a comfortable living) and be happy than just going for the money and end up unhappy.

I'm sure you read my previous post. What I would do is research and talk to PA's/NP's/CRNA's in the state where you plan to work. Find out what restrictions PA's, and advanced practice nurses have for the state where you want to work. In NC, there is not much difference in the clinical practice of NP's and PA's. I think you'll find that the salary ranges are similar. There are not any notable differences in privileging from the state statutes. In other states, you may find differences, some of which may affect your decision. Same goes for CRNA's, (also in the category of advanced practice nurses).

Good luck!

Brian
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Brian, MSN, ACNP, CCRN

#8 kymedic25

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Posted 14 October 2011 - 03:18 AM

Pursuing higher education is a great idea if you're committed to it. In the end, do what makes you happy. Though PA's (and NP's too) make less money than CRNA's, they make a comfortable living....certainly more comfortable a medic salary in general. I've said this in other threads, but if you go into a particular field ONLY for the money, then you're rolling the dice that you may enter a profession and will be generally unhappy. Personally, I'd rather make less money (but a comfortable living) and be happy than just going for the money and end up unhappy.

I'm sure you read my previous post. What I would do is research and talk to PA's/NP's/CRNA's in the state where you plan to work. Find out what restrictions PA's, and advanced practice nurses have for the state where you want to work. In NC, there is not much difference in the clinical practice of NP's and PA's. I think you'll find that the salary ranges are similar. There are not any notable differences in privileging from the state statutes. In other states, you may find differences, some of which may affect your decision. Same goes for CRNA's, (also in the category of advanced practice nurses).

Good luck!

Brian


Thanks Brian. You were very helpful. I have talked with many Pas and have actually shadowed them in the ER as well as worked along side them in a level 1 trauma center. I have also talked with several CRNAs and my cousin has been one for almost 20 years.

I appreciate your candor and will be applying in the near future. Thanks everyone.

Jason
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Jason C. Sargent BS, NREMT-P, CCEMT-P
Des Moines, IA

#9 Scott_in_NH

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Posted 17 October 2011 - 04:52 PM

Keep in mind as an AA you are restricted far more than as a CRNA and restricted to the OR under supervision of a MDA.


I wonder if this statement is true in all states. Doesn't it depend on licensure with the individual states Medical Board? I have been researching the AA-C job a lot lately and from what I found they are pretty much equals to CRNA's in groups where they are used. I have found pain clinics, critical care teams, and Out Patient Centers who use the CRNA and AA-C interchangeably. The only difference I have seen is that a CRNA can perform the induction without an MDA in the room in some states, but in practice this doesn't happen in my area anyway (the MDA walks in and 'supervises" until the airway is secured.
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#10 medic4cqb

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Posted 21 October 2011 - 03:06 PM

[quote name='BrianACNP' date='13 October 2011 - 10:02 PM' timestamp='1318557779' post='27581']
I can comfortably say that there will not be market saturation. In fact, there will be a bigger need for advanced practitioners (both PA's and NP's) as health care reform will drive this need in addition to other issues such as the physician shortages and resident work hour restrictions in academic centers. When I first started in my current role 5 years ago, there were probably less 25 openings in our helathcare system and, as of about a month ago, there are now close to 80 openings, only 8 of which are primary care positions. We are actually working on setting up a system-wide advanced practitioner fellowship program.....the need is ever present and growing.

As far as doing the same thing as a bedside nurse and getting paid less, I think you're off base on the role and compensation of advanced practitioners. Both PA's and NP's practice in the medical model of performing H&P's, ordering diagnostic tests, and providing treatment (which is not protocolized but instead based on an evidenced-based approach medical decision making process). This practice is quite different from bedside nursing, which is what I believe you were referencing. Now, I will admit that practice patterns vary, but the vast majority of practices follow this model with varying levels of autonomy. And there are very autonomous & collaborative practices out there...I happen to work in one. Privileges are not determined by nursing bur instead through the credentialing office in the institutions....the credentialing boards are generally represented by physicians and, in some locales, a combination of physicians and advanced practitioners. Nursing is not the deciding factor for privileges.

As far as compensation, I can't speak to every locale. But in general, advanced practitioners are compensated at a higher level than bedside nurses. I'm not sure where you obtained your information that bedside nursing and advanced practitioners earn similar or less wages. At the various times I've reviewed positions in various parts of the country, the salary ranges for advanced practitioners are pretty consistent for the region of the country and consistently higher than bedside nursing.

I'm not really sure what to make of your final statement, particularly your statement that you don't want to be looked down by a NP that spent 2 years staring at a computer screen. My initial reaction was one of defensiveness at an attempt by you to criticize the NP educational preparation. NP's have more than demonstrated their value in the clinical setting. Many peer-reviewed articles have been published demonstrating the value of NP's. In fact, it's been demonstrated that NP's can provide similar or even better outcomes when compared to physician outcomes by providing the mix of the medical and nursing model. I work with both NP's and PA's at our institution and we all have similar clinical privileges and all have mutual respect. Perhaps looking at the value that both NP's and PA"s bring to health care would be a better approach.


Brian,

I found this article on SCCM this morning while going through my work e-mail. I believe the ABMS is trying to respond to the shortage of critical care specialists with this move. However, I believe you are still correct in that NPs are critical care practitioners will continue to be in demand, as they are well suited for to fulfill the growing job vacancies out there.

Emergency Docs Soon Will Be Able to Certify in Critical Care

At its September meeting, the American Board of Medical Specialties (ABMS) approved a plan that will pave the way for emergency medicine professionals to become certified in critical care medicine. The proposal establishes a co-sponsorship between the American Board of Emergency Medicine (ABEM) and the American Board of Internal Medicine (ABIM), allowing emergency medicine physicians to become board certified in critical care medicine by taking the internal medicine board examinations.

In its 2007 report Hospital-Based Emergency Care: At the Breaking Point, the Institute of Medicine's Board on Health Services recommended that the ABMS "and it constituent boards extend eligibly for certification in critical care medicine to all acute care ... physicians who complete an accredited critical care fellowship," in an attempt to increase the pool of well-trained intensivists in both adult and pediatric practice. The report recognized that intensivists practicing in the emergency department have put a strain on intensive care units.

"I hope this action does create more critical care physicians because our workforce is strained," said Richard N. Nelson, MD, president of ABEM. Specific details on the requirements and eligibility criteria for the ABIM examinations are expected in early 2012, but the move is certain to remove a barrier for emergency medicine physicians who wish to practice critical care.

The Society of Critical Care Medicine will keep members updated on any new developments about this co-sponsorship and will continue to provide resources and tools of value to emergency medicine physicians.

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Steve A., RN, CCRN

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#11 AdamMedic11

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Posted 22 October 2011 - 05:32 AM

I know I'm in a losing battle here, but for fun....

I think we are two very different areas that the demand for mid-levels must be higher than they are here. Our ER employs midlevels and they do great. There are many of them I would prefer to see over physicians. With that said, there are so few mid-level openings while we have been short ER docs ever since I have started here. Our hospitalist group has 1 NP and employs a RN that works her opposite shift doing the same job; H&P and calling the doc. Vascular, ortho, and neuro have mid-levels here as well. A quick job search shows only 6 midlevel openings network wide with 3 being full time. Maybe the mid-level concept hasn't caught on here.

Our hospital just ended weekend package pay for staff this year. The WEP nurses were making more money as an RN than the mid-levels. Probably a sad situation. Many of the nurses here were reluctant to pursue mid-level because it would mean a pay cut with increased responsibility. With the WEP ended, many have gone back to school for the NP route.

Our flight team currently has 2 nurses working on their NP's and the ER has around 8. I've just noticed an incredible boom in the number of nurses doing these programs. I think the desire for higher education is great and to progress yourself professionally is admirable. I just have concern with the method of education. I think many of us on here have complained about the medic-mills being set up just to pump people through and make a profit. I do have some concern with NP programs like this (University of Phoenix and Kaplan) for profit institutions. There still are on-line NP programs from great universities too.

I will say the practical experience an NP walks into school with is great, however some programs require no experience. It is a definite advantage compared to the PA route. However, I still struggle with the lack of science included in the NP curriculum. No classes in Biochem, gross anatomy, micro/immunology ect... I would think the PA anatomy class is different from the anatomy in a ASN or BSN program. My co-workers who are working on their NP have also complained of the same thing, more theory based and lack of science. I'm not arguing for only one or the other but a balance. I do lean more towards allopathy verses nursing theory.

I also still have a problem thinking that on-line classes deliver the same quality education as being in a classroom with an instructor. Maybe it's me personally, but I have taken both, having the instructor to help explain things and insure understanding is a great advantage. I think the in-person classes require more mental engagement than on-line. I know from my experience applying for medical school, some programs do not accept on-line prerequisites.

I do have to apologize for some ranting against the nursing industry. As a person in EMS for 9 years, I've grown to be a little bitter towards the profession. I really considered the PA route. I did have a big concern with the NP vs PA. Nurses will always win. They are too large and organized. In my state a NP can practice independently and even open their own clinic with no physician oversight. PA's can not. I'm not sure where that stands in other states. I'm done trying to justify my job against nursing. I'm done with the limitations placed on me as a medic which serve as nothing more than job preservation for nursing. I didn't want to see that happen to me as a PA.

Kymedic25, I hope you don't let any of my rants make a decision for you. I found my best advice was talking to practicing med-levels and physicians. HEMS is such a great experience to really propel you further into anything you want to do. Just make sure your heart is in it. I know I was worried about being 60 and a medic with a bad back still working in a truck with 2 jobs to support myself. It's great motivation to study extra hard in class.

I know I have probably offended many nurses here. This is just my opinion. It's probably not going to change and I know I'm not going to change any minds.
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#12 zav

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Posted 22 October 2011 - 04:42 PM

I wonder if this statement is true in all states. Doesn't it depend on licensure with the individual states Medical Board? I have been researching the AA-C job a lot lately and from what I found they are pretty much equals to CRNA's in groups where they are used. I have found pain clinics, critical care teams, and Out Patient Centers who use the CRNA and AA-C interchangeably. The only difference I have seen is that a CRNA can perform the induction without an MDA in the room in some states, but in practice this doesn't happen in my area anyway (the MDA walks in and 'supervises" until the airway is secured.



Medic101,

This is a very hot topic on many postings and is debated on many levels. I am a Paramedic with a nurses licenses, i.e. I became a RN then a CRNA a little over three years ago. I have been a NREMT-P and still hold my certification, devoting my career to education and practice. I have many paramedic friends who went the route of AA. I personally have no problem working along any health care provider. I believe that their curriculum is as stringent and intensive as that of the nurse anesthetist. Their back ground before entry may differ which is a hot point of contention amongst some (not me since I'm a college educated paramedic.)

However, as you stated that are many differences between the two. CRNA are advanced practice nurse practitioners that specialize in the delivery of anesthesia and the care of such patients. In many situations we operate in what is known as an anesthesia model which may include an anesthesiologist, a CRNA, and an AA. However, because we are advanced practice NPs we can also operate independently in the delivery of the anesthesia care in conjunction with the attending surgeon. Many states have recently "opted out" of federal Medicaid billing laws allowing CRNA's to "operate independently." Now before this starts a war where we must measure our urinary output, the CRNA still works under the supervision of the surgeon. However the CRNA is in control of the anesthesia (preanesthetic assessment, anesthesia care, and post anesthesia care.)


Taken from the AANA web page:http://www.aana.com/Advocacy.aspx?id=2573

Fact Sheet Concerning State Opt-Outs
And November 13, 2001 CMS Rule


States That Have Opted Out From the Federal Supervision Requirement Since Publication of the November 13, 2001 CMS Rule Permitting Such Opt-Outs

(16 states as of September 2010)

Iowa opted out of the federal supervision requirement in December 2001.
Nebraska opted out in February 2002.
Idaho opted out in March 2002.
Minnesota opted out in April 2002.
New Hampshire opted out in June 2002.
New Mexico opted out in November 2002.
Kansas opted out in March 2003.
North Dakota opted out in October 2003.
Washington opted out in October 2003.
Alaska opted out in October 2003.
Oregon opted out in December 2003.
Montana opted out in January 2004.
(Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montanaís opt-out, therefore, is currently in effect.)
South Dakota opted out in March 2005.
Wisconsin opted out in June 2005.
California opted out in July 2009.
Colorado opted out in September 2010 (for Critical Access Hospitals (CAHs) and specified rural hospitals).


In other states such as the state where I practice I work in an outpatient facility currently where CRNA's are the only medical provider. We perform our own assessments, determine the patients anesthesia mode / care, can administer regional anesthesia, general, MAC, etc, all without an MDA on premises. Yes, there are still times where I may consult with our company medical director by phone if I have a question, but I feel comfortable in my care, the surgeons and staff do, and most importantly the patients do.

The AA in most states (unless something has recently changed) are licensed however they only have delegated authority - that is the catch. They are not licensed as independent practitioners such as CRNAs and NPs. As such, the States Board of Medicine regulates what and how they can practice. Typically AA's can only work in a facility under direct- meaning that there is a supervising anesthesiologist (per federal billing laws no more than 4 anesthesia providers AAs or CRNAs) under the direct supervision of one MDA at a time. This ratio changes depending on case mix, volume, and other factors. The main point being is that the CRNA can operate independently and bill independently. Much like Brain was stating to another post APNPs operate independently but often in a team environment. We are not out here to replace anyone, only offer services to increase safe, quality, cost effective health care to all.

In some states, regions, cities, hospitals, there is much discord amongst the anesthesia team and providers. This is very similar to what I found working on the ambulance and then when I was flying. But I can tell you that this discord is often "won over" by education and hard work. I have worked in many different anesthesia models and I have found fun in them all. I have had the MDA at the bedside, yep its great to have an extra set of hands to push medications, or help with charting, I've been the only anesthesia provider and had no problems either. Either way CRNA's have the option of practicing in these environments because they are APNP and considered independent practitioners and currently the AA is not (I am not bashing any specific profession there are many political action groups out there that do that already.)

Hopefully, I have clarified any the murky water that this thread has seemed to have brought to the top. If you have any questions please feel free to ask me.


Zav
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Matthew Zavarella CRNA, NREMT-P, MS, CFRN, CCRN, CEN

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#13 Macgyver

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Posted 23 October 2011 - 02:14 AM

My co-workers who are working on their NP have also complained of the same thing, more theory based and lack of science


A common tendency with nursing education at all levels and in stark opposition to most degree medic and PA programs. Also the core reason why in many places Docs get along better with those trained in a medical model of some sort than a nursing model - no matter if PHD or MSN is added to the mix.
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#14 old school

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Posted 23 October 2011 - 03:54 PM

I really considered the PA route. I did have a big concern with the NP vs PA. Nurses will always win. They are too large and organized. In my state a NP can practice independently and even open their own clinic with no physician oversight. PA's can not. I'm not sure where that stands in other states. I'm done trying to justify my job against nursing. I'm done with the limitations placed on me as a medic which serve as nothing more than job preservation for nursing. I didn't want to see that happen to me as a PA.


Well, it is certainly your prerogetive to blame all that is unfair in the world on the nursing profession, but I think that is an inncurate assessment and probably a self-defeating attitude.

I'm curious what "limitations" are placed on you by nursing, and how you've have to "justify your job" against nursing?

FWIW, the limitations that PA's and AA's have (compared to NP's and CRNA's) are entirely self-imposed. If you look into the history of those professions, they were basically invented by the physicians to be "helpers" that the medical associations and state medical boards would still have complete control over. APN's, on the other hand, grew out of a completely seperate, independent profession and fought for the right to be where they are. Nothing has ever been handed to the nursing profession. Paramedicine could learn a lot from nursing history but has always refused to do so.
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#15 BrianACNP

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Posted 26 October 2011 - 07:59 PM

I know I'm in a losing battle here, but for fun....

I think we are two very different areas that the demand for mid-levels must be higher than they are here. Our ER employs midlevels and they do great. There are many of them I would prefer to see over physicians. With that said, there are so few mid-level openings while we have been short ER docs ever since I have started here. Our hospitalist group has 1 NP and employs a RN that works her opposite shift doing the same job; H&P and calling the doc. Vascular, ortho, and neuro have mid-levels here as well. A quick job search shows only 6 midlevel openings network wide with 3 being full time. Maybe the mid-level concept hasn't caught on here.

Our hospital just ended weekend package pay for staff this year. The WEP nurses were making more money as an RN than the mid-levels. Probably a sad situation. Many of the nurses here were reluctant to pursue mid-level because it would mean a pay cut with increased responsibility. With the WEP ended, many have gone back to school for the NP route.

Our flight team currently has 2 nurses working on their NP's and the ER has around 8. I've just noticed an incredible boom in the number of nurses doing these programs. I think the desire for higher education is great and to progress yourself professionally is admirable. I just have concern with the method of education. I think many of us on here have complained about the medic-mills being set up just to pump people through and make a profit. I do have some concern with NP programs like this (University of Phoenix and Kaplan) for profit institutions. There still are on-line NP programs from great universities too.

I will say the practical experience an NP walks into school with is great, however some programs require no experience. It is a definite advantage compared to the PA route. However, I still struggle with the lack of science included in the NP curriculum. No classes in Biochem, gross anatomy, micro/immunology ect... I would think the PA anatomy class is different from the anatomy in a ASN or BSN program. My co-workers who are working on their NP have also complained of the same thing, more theory based and lack of science. I'm not arguing for only one or the other but a balance. I do lean more towards allopathy verses nursing theory.

I also still have a problem thinking that on-line classes deliver the same quality education as being in a classroom with an instructor. Maybe it's me personally, but I have taken both, having the instructor to help explain things and insure understanding is a great advantage. I think the in-person classes require more mental engagement than on-line. I know from my experience applying for medical school, some programs do not accept on-line prerequisites.

I do have to apologize for some ranting against the nursing industry. As a person in EMS for 9 years, I've grown to be a little bitter towards the profession. I really considered the PA route. I did have a big concern with the NP vs PA. Nurses will always win. They are too large and organized. In my state a NP can practice independently and even open their own clinic with no physician oversight. PA's can not. I'm not sure where that stands in other states. I'm done trying to justify my job against nursing. I'm done with the limitations placed on me as a medic which serve as nothing more than job preservation for nursing. I didn't want to see that happen to me as a PA.

Kymedic25, I hope you don't let any of my rants make a decision for you. I found my best advice was talking to practicing med-levels and physicians. HEMS is such a great experience to really propel you further into anything you want to do. Just make sure your heart is in it. I know I was worried about being 60 and a medic with a bad back still working in a truck with 2 jobs to support myself. It's great motivation to study extra hard in class.

I know I have probably offended many nurses here. This is just my opinion. It's probably not going to change and I know I'm not going to change any minds.


So, a few comments:

1. With regard to emergency medicine physicians becoming intensivists, I have not read the full article but I did read the same snippet that you received. I do not believe that this will fix the shortage. I think it's here to stay and advanced practitioners will fill the gap. I also think that, as the years move on, you'll see a transition to more autonomous practice for advanced practitioners, especially for APN's who receive their clinical doctorate.

2. AdamMedic, I do not know the area where you work. You are correct that the utility of advanced practitioners (NP's and PA's) are regional throughout the country. Furthermore, you'll find areas where NP's are used more and in other areas, you'll find more PA's. Some of it depends on the exposure of the medical staff to the different disciplines and their bias. Where I work, both NP's and PA's are utilized. Our trauma director personally feels that NP's typically have the bedside nursing experience to bring to the position whereas PA's, particularly new graduate PA's, typically have very little exposure prior to their educational program. It's not true in every case for PA's and, regarding NP's, there are programs that accept new graduate nurses. But for the typical new graduate PA and NP, what I previously described is typically what you see.

3. AdamMedic, with regard to your comments on the NP educational preparation, I'm not sure I agree with your comments. My sense from your comments is that the PA curriculums are more science-based and even perhaps based on evidenced based practice whereas NP programs are similar to the medic mills, as you stated, where NP programs just put through students without any regard to quality. If I misperceived your message, I apologize, but this is the message I received. I can tell you that undergraduate nursing students have to complete general science courses, so there's no requirement to take this again in the graduate program. All NP programs are required to meet certain education requirements to be accredited as a NP program. And for a NP student to sit for their board certification, he/she has to complete an accredited program. NP students receive education in pathophysiology, clinical courses that are evidenced based, pharmacology, etc. I don't know about other board exams, but the ACNP board exam is evidenced based. I have no doubt that PA programs require the same basic science courses that undergraduate nursing programs require.....but it's variable across the different PA programs out there for courses such as biochemistry, organic chemistry, etc (the more advanced science courses). So it's not a requirement through the accrediting body for PA educational programs. They receive no histology education....it's not in their curriculum. They have no time to teach it since it's a two year program. Perhaps you should take the time to research your information instead of just posting on here with profound opinions when you may not be able to back them up.

4. Finally, AdamMedic, it sounds like you have big problem with the nursing profession. If you do, that's fine, but please refrain on ranting on the nursing profession, particularly when your facts aren't correct. And I don't think that you'll find the nursing profession trying to put the PA profession out of work.....there's plenty to go around for all of us. The nursing profession just feels they have something to bring to the table in a role, the NP role, where a combination of the medical and nursing model are implemented. And, again, there's literature to support that outcomes are just as good, if not better, then physician outcomes.

5. Macgyver....I'm not sure where you're basing your opinions....it sounds like anecdotal information from a few you've spoken too. I would argue that you're comments do not reflect graduate APN education. I will admit that I could do without the theory-based education. I got my fill of it in undergraduate. Fortunately, I attended UPENN for my MSN. Their NP program does NOT include nursing theory. It is a rapid paced program that covers all required curriculum content (as per the American Association of Colleges of Nursing) and is evidenced-based. Again, the basic science courses are in the undergraduate years, so there's no need to revisit that information. And the clinical content is evidenced-based. In fact, my internal medicine book was Harrison's Principles of Int. Med and our surgery text was Sabiston's textbook of Surgery (from Duke, I might add--Sean).....texts that medical students and residents learn from. Finally, I think your comment of physicians not getting along well with NP's as well as PA's is off-base. I've not seen this undertone of disrespect for the different professions in the areas where I've learned (philadelphia/Charlottesville),practiced (NC), and participated (National and Regional Chapter SCCM). I can't speak to the rest of the nation.....I don't think you can either.

To the OP, I'm sorry for this tangent...but I felt I had to comment on information and opinion that I feel was not accurate or at least was not representative of the APN education preparation.


Brian
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Brian, MSN, ACNP, CCRN

#16 AdamMedic11

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Posted 27 October 2011 - 10:55 AM

3. I can tell you that undergraduate nursing students have to complete general science courses, so there's no requirement to take this again in the graduate program. All NP programs are required to meet certain education requirements to be accredited as a NP program. And for a NP student to sit for their board certification, he/she has to complete an accredited program. NP students receive education in pathophysiology, clinical courses that are evidenced based, pharmacology, etc. I don't know about other board exams, but the ACNP board exam is evidenced based. I have no doubt that PA programs require the same basic science courses that undergraduate nursing programs require.....but it's variable across the different PA programs out there for courses such as biochemistry, organic chemistry, etc (the more advanced science courses). So it's not a requirement through the accrediting body for PA educational programs. They receive no histology education....it's not in their curriculum. They have no time to teach it since it's a two year program. Perhaps you should take the time to research your information instead of just posting on here with profound opinions when you may not be able to back them up.


I still have to disagree with you that a BSN takes the same basic science courses that a pre-PA student may take in undergrad. For a BSN at Luther College in Decorah IA a BSN's basic science class would be: A&P (non-bio major level), General Chemistry 1 semester, Nutrition, Micro (bio major level) and "Great Ideas in Natural Science". As far as requirements for NP programs. Vanderbilt allows students with a BA/BS non-nursing to apply. Requirements as follows:

c.If you have earned a BA or BS in a discipline other than Nursing, you must have successfully completed 11 hours of natural science including courses in Microbiology, Human Anatomy, and Human Physiology; Statistics; Nutrition and Developmental Psychology.

I don't see any chemistry requirement. I also could not find anything in the NLNAC as far as requirements for masters level nursing pre-reqs either.



You are 100% right that the ACR-PA sets no standards for pre-reqs for PA school. I challenge you to find me a master's level PA program that doesn't require Organic Chem and at least 1 upper level bio class (Cell, Molecular, Genetics). When I was looking at PA schools I had my compiled spreadsheet of the schools I was interested in and their requirements. I could not find one that didn't at least require 2nd semester O-Chem, which I had not taken in undergrad. It is why I had to go back to complete my chem requirements. For example, the University of Iowa requires Gen Chem 1 and 2, one semester of O-Chem and 1 Sem of Biochem. It's actually quite brilliant due to most chemical mechanisms taught in O-Chem 2 are used in Biochem and getting an A in Biochem without taking O-Chem 2 would be next to impossible.

I'm sorry, if it does come down to the matter of opinion, it IS my opinion that the PA requirements are much more rigorous in the sense of difficult/challenging science course work. I'll have that opinion.

As far as Histo, here is Vanderbilt's curriculum for ACNP:

305B Advanced Health Assessment Applications for Acute Care Nurse Practitioners 1
305F Advanced Health Assessment and Clinical Reasoning for the ACNP 3
306A Advanced Physiologic and Pathophysiologic Foundations of Acute Care 4
307C Advanced Pharmacotherapeutics for Acute Care Nurse Practitioners 3
340A Pathophysiology and Collaborative Management in Acute Care I 3
14
SPRING - SEMESTER II
340B Pathophysiology and Collaborative Management in Acute Care II


Where is the histo portion?

Another question. How do you truly grasp the mechanisms of pharmacology without a foundational course in biochemical and molecular biology concepts. Second messenger systems and pathways ect... Granted you could make the argument that in the real world it doesn't matter if you know the science: you give med A for condition A. I just think there is some benefit for knowing the science and the why behind your practice. I'm in Biochem right now and it's the most fascinating as far as practical application to the small knowledge I have of medicine (more interesting to me than physio). I enjoy learning the why behind things. No rational but science.

Again, I really don't mean for any disrespect towards the NP profession. It's been my experience that the initials behind the provider (MD, DO, PA-C, ACNP, RN, EMT-P) doesn't determine the quality of care, the provider them self does. I just have my opinions on the quality and philosophy on education. It's no secret I do hold my grudges against nursing: have made it pretty obvious. I don't know your past and you may have been an EMT-P in the past before nursing. As a flight medic working with nurses where we have equal privileges and responsibilities but different paychecks and professional treatment, it wears on you. I am personally scared of joining the mid-level ranks only to find myself in the same scenario I am know. It has made an impact in my future career considerations.
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#17 zav

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Posted 28 October 2011 - 12:33 PM

I still have to disagree with you that a BSN takes the same basic science courses that a pre-PA student may take in undergrad. For a BSN at Luther College in Decorah IA a BSN's basic science class would be: A&P (non-bio major level), General Chemistry 1 semester, Nutrition, Micro (bio major level) and "Great Ideas in Natural Science". As far as requirements for NP programs. Vanderbilt allows students with a BA/BS non-nursing to apply. Requirements as follows:

c.If you have earned a BA or BS in a discipline other than Nursing, you must have successfully completed 11 hours of natural science including courses in Microbiology, Human Anatomy, and Human Physiology; Statistics; Nutrition and Developmental Psychology.

I don't see any chemistry requirement. I also could not find anything in the NLNAC as far as requirements for masters level nursing pre-reqs either.



You are 100% right that the ACR-PA sets no standards for pre-reqs for PA school. I challenge you to find me a master's level PA program that doesn't require Organic Chem and at least 1 upper level bio class (Cell, Molecular, Genetics). When I was looking at PA schools I had my compiled spreadsheet of the schools I was interested in and their requirements. I could not find one that didn't at least require 2nd semester O-Chem, which I had not taken in undergrad. It is why I had to go back to complete my chem requirements. For example, the University of Iowa requires Gen Chem 1 and 2, one semester of O-Chem and 1 Sem of Biochem. It's actually quite brilliant due to most chemical mechanisms taught in O-Chem 2 are used in Biochem and getting an A in Biochem without taking O-Chem 2 would be next to impossible.

I'm sorry, if it does come down to the matter of opinion, it IS my opinion that the PA requirements are much more rigorous in the sense of difficult/challenging science course work. I'll have that opinion.

As far as Histo, here is Vanderbilt's curriculum for ACNP:

305B Advanced Health Assessment Applications for Acute Care Nurse Practitioners 1
305F Advanced Health Assessment and Clinical Reasoning for the ACNP 3
306A Advanced Physiologic and Pathophysiologic Foundations of Acute Care 4
307C Advanced Pharmacotherapeutics for Acute Care Nurse Practitioners 3
340A Pathophysiology and Collaborative Management in Acute Care I 3
14
SPRING - SEMESTER II
340B Pathophysiology and Collaborative Management in Acute Care II


Where is the histo portion?

Another question. How do you truly grasp the mechanisms of pharmacology without a foundational course in biochemical and molecular biology concepts. Second messenger systems and pathways ect... Granted you could make the argument that in the real world it doesn't matter if you know the science: you give med A for condition A. I just think there is some benefit for knowing the science and the why behind your practice. I'm in Biochem right now and it's the most fascinating as far as practical application to the small knowledge I have of medicine (more interesting to me than physio). I enjoy learning the why behind things. No rational but science.

Again, I really don't mean for any disrespect towards the NP profession. It's been my experience that the initials behind the provider (MD, DO, PA-C, ACNP, RN, EMT-P) doesn't determine the quality of care, the provider them self does. I just have my opinions on the quality and philosophy on education. It's no secret I do hold my grudges against nursing: have made it pretty obvious. I don't know your past and you may have been an EMT-P in the past before nursing. As a flight medic working with nurses where we have equal privileges and responsibilities but different paychecks and professional treatment, it wears on you. I am personally scared of joining the mid-level ranks only to find myself in the same scenario I am know. It has made an impact in my future career considerations.



AdamMedic11,


1.Why do you offer so much resistance to those who have walked down the road you want to begin, are actively working in the field, and have knowledge of the topic? The job market speaks for itself concerning the issues that have been discussed. Since you challenged Brian it took me only 5 minutes to find the following :

2. A grade of ďBĒ or better for the following prerequisite courses [courses must be completed by June 1st prior to the August matriculation]:
General Biology with lab (two terms)
General Chemistry with lab (two terms)
Anatomy with lab (one term)*
Physiology (one term)
Microbiology (one term)
General Psychology (one term)
English (one term)
*If taking Anatomy with Physiology, both Anatomy and Physiology I and II with lab are acceptable to fulfill the requirement for Anatomy and Physiology.
These are the admission requirements for a Masters level program in Pittsburgh, PA. So, as you see there are many different prerequisites and different curriculums. Iím sure you can find NP programs that have different requirements. I can tell you as one who took all the organic and biochemistry classes yes helpful but the real learning came in pharmacology class. Thatís where the applicable aspects of pharmacology could be put together. Once you actually complete a program of study I would like to see what your thoughts are, rather then you current rants on why this is better than that.

3. If you look closely at the PA profession up to 4 or 5 years ago there were still associates degree PA / SA programs out there. And up until 2 years ago PA programs in the Northeast still were only offering a Bachelorís degree. With the push for prescriptive authority those programs have now moved to Masterís preparation. Your comments about the chemistry are as you stated yoru opinion. However, I can tell you they are not grounded in solid facts / data to support your conclusion. If you look at the pharmatherapeutics class taught this is where the application of science and medicine are melted into one pot. Look at what has transpired in the educational model for physicians over the past 5-10 years. That model has moved to a practical based where students are taught the basic sciences in small blocks along with medical diagnosis and treatment. No longer do most medical schools run the first two years as straight basic sciences then allow the students to integrate their education the first time they are on rotation in their 3rd year. Very similar the pathophysiology and pharmatherapeutics classes integrate the basic science foundation that the RN already has from their previous education. Equally important this class builds on their knowledge from clinical practice and integrates the basic science aspects of the advanced pharmacology, chemistry, physiology, etc. I can tell you I just spoke to a close friend of mine who is a Pharm D. who teaches both NP and PA students at an esteemed program here in PA. And he says that without a doubt the NP have a better knowledge coming into the his course, grasping the information, and applying it, then his PA students. He attributes this to their undergraduate pharmacology and basic science course work, their work experience, and the student selection. So, I have to say that he has been teaching the course for over 10 years to both so his opinion is more than opinion its true scientific observation.

4. I donít know what your exposure to the role of the PA / NP is? It seems like you are focused on the critical care ED / ICU environment. Advanced Practice Nurses ( NP, CNS, Midwife, CRNA) work in just about every facet of medicine that is available. If you look at Nurse Practitioners there are numerous areas of specialization including ED, Intensivists, Pediatrics all with a critical care background. If there was such a disparity in the MD/NP model this would never happen. I have practiced for a number of years and only noticed the disparity when egos and attitudes come into play.

If you are so concerned about being caught up as a midlevel practitioner, frustrated then I would recommend continuing your undergraduate education and making the attempt at medical school. However, I can tell you that for those of us who have completed our education and are actually practicing we enjoy our jobs. If you see that a PA program offers you the education that you want I say go for it. However, donít try to compare apples and oranges, and overall you need not to try to cause despair between the two professions until you have actually become one of the two. Who knows some try you may want to become a nurse?


Zav
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Matthew Zavarella CRNA, NREMT-P, MS, CFRN, CCRN, CEN

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#18 JLP

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Posted 28 October 2011 - 01:16 PM

I still have to disagree with you that a BSN takes the same basic science courses that a pre-PA student may take in undergrad. For a BSN at Luther College in Decorah IA a BSN's basic science class would be: A&P (non-bio major level), General Chemistry 1 semester, Nutrition, Micro (bio major level) and "Great Ideas in Natural Science". As far as requirements for NP programs. Vanderbilt allows students with a BA/BS non-nursing to apply. Requirements as follows:

c.If you have earned a BA or BS in a discipline other than Nursing, you must have successfully completed 11 hours of natural science including courses in Microbiology, Human Anatomy, and Human Physiology; Statistics; Nutrition and Developmental Psychology.

I don't see any chemistry requirement. I also could not find anything in the NLNAC as far as requirements for masters level nursing pre-reqs either.



You are 100% right that the ACR-PA sets no standards for pre-reqs for PA school. I challenge you to find me a master's level PA program that doesn't require Organic Chem and at least 1 upper level bio class (Cell, Molecular, Genetics). When I was looking at PA schools I had my compiled spreadsheet of the schools I was interested in and their requirements. I could not find one that didn't at least require 2nd semester O-Chem, which I had not taken in undergrad. It is why I had to go back to complete my chem requirements. For example, the University of Iowa requires Gen Chem 1 and 2, one semester of O-Chem and 1 Sem of Biochem. It's actually quite brilliant due to most chemical mechanisms taught in O-Chem 2 are used in Biochem and getting an A in Biochem without taking O-Chem 2 would be next to impossible.

I'm sorry, if it does come down to the matter of opinion, it IS my opinion that the PA requirements are much more rigorous in the sense of difficult/challenging science course work. I'll have that opinion.

As far as Histo, here is Vanderbilt's curriculum for ACNP:

305B Advanced Health Assessment Applications for Acute Care Nurse Practitioners 1
305F Advanced Health Assessment and Clinical Reasoning for the ACNP 3
306A Advanced Physiologic and Pathophysiologic Foundations of Acute Care 4
307C Advanced Pharmacotherapeutics for Acute Care Nurse Practitioners 3
340A Pathophysiology and Collaborative Management in Acute Care I 3
14
SPRING - SEMESTER II
340B Pathophysiology and Collaborative Management in Acute Care II


Where is the histo portion?

Another question. How do you truly grasp the mechanisms of pharmacology without a foundational course in biochemical and molecular biology concepts. Second messenger systems and pathways ect... Granted you could make the argument that in the real world it doesn't matter if you know the science: you give med A for condition A. I just think there is some benefit for knowing the science and the why behind your practice. I'm in Biochem right now and it's the most fascinating as far as practical application to the small knowledge I have of medicine (more interesting to me than physio). I enjoy learning the why behind things. No rational but science.

Again, I really don't mean for any disrespect towards the NP profession. It's been my experience that the initials behind the provider (MD, DO, PA-C, ACNP, RN, EMT-P) doesn't determine the quality of care, the provider them self does. I just have my opinions on the quality and philosophy on education. It's no secret I do hold my grudges against nursing: have made it pretty obvious. I don't know your past and you may have been an EMT-P in the past before nursing. As a flight medic working with nurses where we have equal privileges and responsibilities but different paychecks and professional treatment, it wears on you. I am personally scared of joining the mid-level ranks only to find myself in the same scenario I am know. It has made an impact in my future career considerations.


Hey Adam11 - I am going into a PA program myself shortly, so I couldn't ignore this discussion. Let me offer three thoughts: (a) I'm personally not interested in a "my letters are better than yours" contest. First, it's not helpful; PA and NP are two routes, both of which are needed, for non-physician providers to use their experience and education as a step towards a more advanced role. I've worked with both PA's and NP's (never worked with a CRNA, though, we don't have them here) - most are very capable and knowledgable, some are screw-ups, just like any other field. Second, PA's, like paramedics, can not afford to get into a pointless pissing contest with NP's, because we'll both just waste energy we should be spending on getting the system to make better use of both of us. (B) some programs, both in NP and PA, are stellar and really prepare one well. Others are not so much. Until both fields standardize their requirements in the way (most) med schools did years agos, that's going to be a fact of life; you're still going to get out of school what you put into it, and there will still be marginal candidates who get through, just like there are always a few god-awful boneheads who successfully graduate med school. you made a good point which you should repeat to yourself: "the initials behind the provider (MD, DO, PA-C, ACNP, RN, EMT-P) doesn't determine the quality of care, the provider them self does.". I have worked with many RN's who are fantastic providers; I've unfortunately also worked with many who are grade-A f***-ups, but this also applies to medics, RT's, MD's, etc. © Don't confuse the political machinations and turf wars of professional lobby groups with the providers themselves. The RN professional lobby group here is always trying to argue that RN's can replace medics with no specifically EMS education, that PA's aren't necessary, that RN's can become equivalent to RT's with only a brief "orientation",that every RN is a potential NP, etc, while also trying to force every person who wants to be an RN to follow the "back to school with the high-school kids for 4 years, regardless of education or experience" . I personally get tired of the "let us in but we'll keep you out" argument that the RN lobby uses towards other health fields, BUT most RN's don't hold these views, and most RN's I know are supportive of the role of other providers. There are practical reasons why one might do an NP vs a PA or vice versa; neither makes one an MD; both offer a role with more responsibility than either a medic or an RN. In the long run, I expect that the "go-from-nothing-straight-to-everything" model of medical school is increasingly going to have to give way to a more modular education model that in a couple of decades might even bridge other providers to some sort of MD-equivalent. We simply we can't produce enough MD-equivalent providers the way things work now, and it's only going to get worse.
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#19 emrn

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Posted 28 October 2011 - 02:08 PM

The RN professional lobby group here is always trying to argue that RN's can replace medics with no specifically EMS education, that PA's aren't necessary, that RN's can become equivalent to RT's with only a brief "orientation",that every RN is a potential NP, etc, while also trying to force every person who wants to be an RN to follow the "back to school with the high-school kids for 4 years, regardless of education or experience" . I personally get tired of the "let us in but we'll keep you out" argument that the RN lobby uses towards other health fields, BUT most RN's don't hold these views, and most RN's I know are supportive of the role of other providers.



Good post, JLP. Thank you for throwing in that disclaimer, too. As a nurse, I am weary of trying to defend myself from the stereotypical perception that I don't think anyone else has a claim on health care except an RN. I think there's room here for all of us. I don't have a problem with other professions matriculating to a nursing degree without going back to school with a bunch of 19 year olds for four years; I don't have a problem with RNs matriculating to RT/paramedic without repeating the same undergrad courses, either. Of course, I think that RNs, paramedics, RTs...well, basically all of us....need to approach our professions with a college degree, anyway. I think we would all understand each other a little better if we shared more similarities - imagine how well we would work together if we all had the same first two years' of allied health prereqs and spent the second two years specializing in our separate/comparable fields. I think there would be a lot less infighting among us, frankly, and we would be able to use our energy better to work for our places within the healthcare system.







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#20 medic4cqb

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Posted 29 October 2011 - 12:15 PM

Of course, I think that RNs, paramedics, RTs...well, basically all of us....need to approach our professions with a college degree, anyway. I think we would all understand each other a little better if we shared more similarities - imagine how well we would work together if we all had the same first two years' of allied health prereqs and spent the second two years specializing in our separate/comparable fields. I think there would be a lot less infighting among us, frankly, and we would be able to use our energy better to work for our places within the healthcare system.


Emrn,
Excellent point and I agree that having a common base in the background sciences would further build the relation between the varied HCPs. Although we still have our specialties I.e.; RRTs being the experts in respiratory care and RNs being generalists who can specialize as well, PMs being excellent prehospital care providers... we all could benefit from sharing the same strong foundation in sciences and general liberal arts that make some providers with that sort of background so strong. Now, there's also the point that some providers are just not as strong clinically as they are academically and vice/versa, but that common background allows for easier communication and understanding between providers; more importantly it gives individuals a better understanding of just what the hell they're doing to people.

A mind is a terrible thing to waste, that's why knowledge is power. Just my $0.02
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Steve A., RN, CCRN

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