PA, NP, MPH, MD/DO...

[Ridryder 911]

I don't think he was saying that the nursing mindset in general needs to change. I believe he meant that a nurse who enters primary care as, for instance, an FNP or a PA, needs to shift gears to a different mindset, and that is very true. That does not mean that he/she needs to lose those positive mental attributes that make nursing practice what it is. It just means that your overall focus does need to change. What he is saying is that, just like a medic must totally change his attitude in order to practise as a nurse, a nurse must totally change his attitude to practise as a primary care giver (physician/extender). As a person who has made both transitions, I would fully agree with that.

I would also agree with you that, if general primary care is where you want to go, that an FNP -- generally speaking -- has an edge over a PA, in that he has a much broader foundation to build upon, resulting in a little better attention to detail. However, as was already stated, FNP is the only post-grad nursing specialty that really compares to NP, as all others are very specificially focused specialties. Because of that, if you are exploring options, you have to determine for yourself if a narrow focus is what will make you happy. I have tried it and found that I am not happy for very long when working a specialty focus. I need variety. If that applies to you too, then CRNA or any of the other nursing specialties probably won't be for you.

Hence the reason I changed gears mid-stream. After completing a major portion of ACNP, I have changed my focus and even Universities (Texas..gulp! ) to FNP. After investigating more and more, my opportunity for employment and ability to be diverse was very limited as an Acute Care NP, whereas the FNP has more options..

I agree some NP programs lack using the medical model of education, but also if medical schools used more a holistic approach, both professions could be better.

R/r 911

[AZCEP]

Dang, I wish I'd gotten into this discussion earlier. :roll:

I've been a paramedic for 12 years this coming April, and have completed all the prerequisites for medical school. This last summer all of the stars aligned, and I've been accepted starting in the fall of 2008.

The reasoning is quite simple, and eerily similar to Doczilla's, if slower in developing. I'm tired of being limited in what I'm allowed to do by someone that does not understand the situation I'm in. Yes, that is quite possibly the most ego-centric statement made in quite some time, but such is the environment I'm in. My medical director dared me in not so many words to do it, so the chip is firmly planted on my shoulder.

The wife is an ICU RN, and she has been telling me to do this for a few years now. My mother-in-law is finishing her FNP as we speak, and she is of the same mind. Could be they just want a doctor they can boss around a bit though. I'm really looking forward to the challenge.

[JPINFV]

Congrats on the acceptance. What school are you going to?

[paramedicmike]

Congratulations, AZCEP!!! That's awesome!

I've been kicking around these same ideas. So this thread is timely.

Thanks, all, for your thoughts.

-be safe

[AZCEP]

Going to the Caribbean mahn. www.sjsm.org to be more precise.

Cheaper/faster/same end result/I know how much work it will take so the instructors aren't quite as important.

Hopefully I'll be able to drag myself into a classroom with all the world class diving available.

[Eydawn]

Congrats, AZCEP! Good for you!

Wendy

CO EMT-B

[Ridryder 911]

[marq=up:c0e4a0b03e]Congratulations! [/marq:c0e4a0b03e]

[chbare]

Congrats!

Take care,

chbare.

[Virginia NPP]

Hello all,

I am new to this site and would like to throw in my 2 cents about this discussion.

I am also worried about what I see as the deterioration in education of nurses and NPs and use of foreign nurses.

In terms of the regulations for NP and PA practice, they vary from state to state. So check your state board for specifics.

In general PAs are required to have "supervision" by a physician, while NPs require "collaboration". This may seem like just semantics but supervision is usually more strict and decided by the state. Collaboration is decided by the NP and her MD partner with minimum requirements by the State.

NPs are licensed in all states, PAs are licensed in most but not all. What this means is complicated, but in general think of a licensed person as more independent as they function under their own licensing body. (Which also means they can loose their license for unacceptable practice. ) PAs without license function under the MD license.

I would also like to comment on the MDs use of the term "physician extenders". This is seen as objectionable and insulting to professionals. It describes NPs and PAs almost as objects. It also does not describe NP or PA role. Midlevel practitioner is a term some states use.

Also I agree some what with the MDs recognition of a different mindset, I just think we may mean different things. Nursing has a long tradition of a wholistic approach (long before it became such an overused buzz word. Nurses and NPs are really trained to look at the whole person and intervene as needed. Although the truth is that this is much harder in these days of such pressured practice.

Physicians and PAs are trained in the biological model or "medical model". This is more a view of illness as separate from the person and treatment as specific to that illness. They often rely more on medication then NPs. Think disease /cure. Although to be fair, medical schools are finally paying more attention to the concept of the whole person.

In practice however, I think much of this is related to the personality and belief system of the provider, although training and education certainly influence them.

Sorry to go on and on, hope this is helpful to some.

Virginia Duffy PhD NPP

www.BehavioralfirstAid.com

[Dustdevil]

Quality first post, NPP. I find it is difficult to explain this "mindset" concept to people, as it is really not a concrete concept to most. It's something you have to see, if not experience for yourself. I know that, before I became a nurse, I wasn't really clear on this supposed difference between a PA and an NP. And a whole lot of medics seem to have this laughable notion that they are just as good and just as educated as any nurse, which further contributes to the misunderstanding of how different the roles of each profession are.

It's interesting that the "mid level" moniker has not trickled down to the field yet, but I am not really surprised. EMS is so isolated from structured medicine that they are frequently the last to catch on to current trends, both medical and semantic. We see it a lot here. Anyhow, I don't know if I am particularly "offended" by the misnomer, but I do agree that it is old terminology that isn't nearly as appropriate as "mid-level practitioner" or "provider", which is the term we use in military medicine.

AZCEP, congratulations, man! I guess you won't be able to teach for me at my new school in a couple of years after all. Oh well, I'll still need a medical director! :wink: