3 Ways NP Programs Should Be More Like PA Programs

Nurse practitioners and physician assistants work in very similar settings and in many cases are even used interchangeably. In the emergency department where I work, for example, NPs and PAs are hired for the same positions without a preference among management for one over the other. Although these medical providers work alongside each other performing the same job responsibilities and with similar scopes of practice, there are a few ways the nurse practitioner and physician assistant education looks different. 

When I graduated from my NP program and accepted my first nurse practitioner position in a walk-in clinic, I often found myself wishing I had become a physician assistant rather than a nurse practitioner (gasp!). While my sentiments have changed, I do think there are a few benefits of the PA approach to education. As nurses we have a lot of pride in our profession. But, this shouldn't leave us closed off to accepting best practices from other areas of business and medicine.

Nurse practitioner programs would do well to integrate the following approaches commonly used in educating physician assistant:

1. Focus on procedural skills and diagnostic tests over theory

As a nurse practitioner student I felt that I spent an excessive amount of time writing essays on nursing theory, completing group projects and sitting in lectures discussing content unrelated to direct patient care. I can appreciate that understanding the foundation of one's profession is important. But, perhaps a brief overview would do. 

In contrast, physician assistant program curricula often contain courses titled 'Introduction to EKG' and 'Clinical Radiology'. These courses are specific to essential clinical skills, skills often lacking among new nurse practitioner grads. Integrating similar courses into the nurse practitioner education would help level the new grad NP learning curve. 

2. More hands-on clinical hours

Sure, as an NP student I found clinical days exhausting and sometimes stressful. There's nothing worse than a day of hands-on learning followed by the need to return home only to cram for an upcoming test or put the finishing touches on a research paper. But, frankly, I could have used more of these stressful days during my training. 

Nurse practitioner programs typically include somewhere around 650-850 clinical hours. Physician assistant programs, in contrast, require students to complete closer to 2,000 hours of hands-on clinical training. This added experience is noticeable in the first years of practice. The playing field eventually levels out, but ramping up the number of clinical hours required of NPs would benefit new nurse practitioners

3. Transparency in objective program data during the admissions process

The other day I was perusing a few physician assistant program websites. I was caught a bit off-guard when I noticed nearly every program listed pass rates on the NCCPA certification exam for their graduates. In contrast, nurse practitioner programs guard their stats a little more closely. Yes, some NP programs list certification pass rates for recent grads but most do not. If students think to inquire about such information during the admissions process, many schools will reveal their scores. I have encountered a few nurse practitioner programs, however, who refuse to share data regarding NP student certification rates among their graduates. 

I recommend that every NP program applicant ask schools of interest what percentage of graduates pass the certification exam on the first attempt. Wouldn't it be nice if aspiring NPs didn't have to dig for this information, but rather it was posted outright?

I don't mean to get down on the nurse practitioner education. I feel that my NP program prepared me well for practice. But, like most things in life, it could have been even more effective with a few modifications. Looking outside of the nursing realm to how other professions educate their students can lead to valuable insight and improvement. 

Where do you think nurse practitioner programs stand to improve?

 

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Comments

I agree, I'd add that the "lunch and learns" should be shared amongst MD, PA and NP students, my school had the NPs in a building clear across campus from the MD/PAs so there was no sharing of lectures. I feel at a pretty large disadvantage and am on a slow learning curve looking up things in practice that I feel I should have been taught, then drilled into me. But for instance we never received a proper lecture on diabetes. It was a group presentation/ project. That was it.
I had a great ED job but unfortunately, I just wasn't exactly ready, so am happy now with a private practice and a MD who will help me when I ask. --NP

Barbara H

I agree, I'd add that the "lunch and learns" should be shared amongst MD, PA and NP students, my school had the NPs in a building clear across campus from the MD/PAs so there was no sharing of lectures. I feel at a pretty large disadvantage and am on a slow learning curve looking up things in practice that I feel I should have been taught, then drilled into me. But for instance we never received a proper lecture on diabetes. It was a group presentation/ project. That was it.
I had a great ED job but unfortunately, I just wasn't exactly ready, so am happy now with a private practice and a MD who will help me when I ask. --NP

Barbara H

The three reasons are exactly why, as an RN ready to further my education, I chose to go to a PA program, rather than an NP program. My RN program (BSN) was heavy on the theory. We were told we would be the 'nursing leaders' - so that when I graduated from RN training, I didn't know how to do bedside nursing very well. Sure, I learned, but I was behind the curve for awhile. I did not want the same thing to happen when I returned to get my 'clinician training' - I looked at NP programs, which, at the time, were Masters programs, and the students I saw coming out did not know how to practice.
It so happened, at the time, by attending the Primary Care Associate Program at Stanford University, I was able to get both my PA and NP certificates - this is no longer possible.

Susan

I'm seeing a lot of incorrect information in the comments here so please allow me to address a few of the misunderstandings about PAs. "One of the reasons PA programs require so many clinical hours is because many of them have never even touched a patient." This is simply not true. Almost every PA program requires hands on experience before even applying. For most schools the bare minimum is 1,000 hours, with a national average of more than 3,000 hours for admitted students according to the AAPA. There are *very* few schools that do not require experience, and the few that don't explicitly require it still typically admit students with at least some experience. "PA programs admit students with BA degrees so their standards are lower." Many PAs come from other backgrounds besides healthcare (myself included) which often means they may have a degree in a field other than the sciences. This does NOT mean that they can enter these programs with no understanding of the hard sciences. Students must complete and do well in advanced coursework in Anatomy, Physiology, Biology, Chemistry, Microbiology and Statistics at a minimum. Many programs have further requirements with coursework in Genetics, Physics, Organic Chem, Biochem, and other upper level bio courses. "You don't even have to have a bachelors to be a PA, you can do it at a community college." While this may have been true at one time, it is no longer the case. Most PA programs are masters level and the few that aren't must convert to master's level by 2020 to keep their accreditation. The PA profession is still relatively young, having just celebrated it's 50th anniversary this year. It has been through many changes and growing pains during that time, and will continue to do so for the forseeable future. For further information about PA education check out this briefing from AAPA: https://www.aapa.org/wp-content/uploads/2016/12/Issue_Brief_PA_Education...

Alyssa

My personal thoughts on 3 things NP programs need: 1. Focus on procedure skills and diagnostics verses theory didactics. My entry into practice was associates degree with lots of didactic and lots of clinical , ten years later my BSN focused on a LOT of theory and didactic and scarcely any clinical that I recall. Then 10 yrs after that my MSN program pretty much followed the BSN didactics, very repetitious info with lots of busy work, providing the instructors with something to critique and grade, little hands on except when we were called on to demonstrate how to estabish rapport and interview a client! Post-masters FNPcertificate about 10 yrs later had an unbelievably high level of didactic verses hands on learning and practice. Again we were called on to demonstrate how we approach and interview clients verses real-time guidance in procedures and diagnostics.

Most of my actual hands on learning/practice took place after graduation. My personal experience is perhaps a great argument for the quick implementation of post graduate 6-12 month internships where new NPs are given the room to learn by doing with an attentive, kind, and competent practicing NP, MD, or DO in your chosen area of interest.
2. More clinical hours. Hands on time always builds skill and confidence in ability to handle situations. 3. Program data transparency. If the program rejects or demeans your request for more information perhaps you need to find another program! LSS

Finally as a side note, who coined the phrase 'mid-level'? Who benefits from the mid-level designation? What does that phrase convey in the healthcare arena to our clients; to potential employers; to MD/DO colleagues; to ancillary services personnel; to third party payers including CMS! Follow the money people this isn't rocket science!

Linda Stone

I am a PA and I have precepted both a PA and NP student. I agree with the post and I can tell you that there is a visible/tangible difference in their preparedness in clinic. Besides the lack of procedural and diagnostic interpretive skills, I noticed a difference when I would "pimp" the students. I had to teach my NP student basic Pathophysiology because they couldn't explain the pathophysiology of the common diseases in Primary Care and told me they never learned it to the extent I expected. The PA student knew most of the time because these were drilled in us. Also PK and pharmacology was another weak area for the NP student and some of my NP colleagues for that matter. I do envy the NP lobby power though, so you got that going for you.

JPA

I agree with this article. I am a PA and have worked with NPs in clinical settings which require procedures and radiologic interpretation. I was very surprised by how, for instance, an NP in one setting did not know how to read an xray, or how alien (and therefore daunting) performing (and becoming independent with performing) procedures was to them. I think NPs would be far more confident and comfortable - especially in acute care or surgical settings - if they had the kind of training we did.

Kitt Richards

Quite a few posts assume PAs go into school with limited experience and therefore need those 2000 hrs of clinical rotations. That's not very accurate. My program has a "minimum of 2000 hrs" patient experience, that's just a threshold to weed out applicants. My class average patient care experience is 10,000 hrs. These are not hrs as a scribe. My class has 4 nurses a few paramedics, a few Emts and a lot of combat medics. Far from limited patient care experience.

Steven

Colleen,
I agree with what you said about making sure we stay in our scope of practice, but if you think we only see "well" patients in primary care you are mistaken. Patients sometimes show up in my office clearly having needed to go to the ER and I often have to think much more critically than you might think, even when they don't need to go to the ER. I very much agree with many that we do not get as much clinical training as we should. I would have loved more time with clinical and less time with papers. Thankfully I am with doctors who treat me like I'm an intern and that is a tremendous help to me! I did meet PAs during my clinicals who were getting certain rotations that I did not and was always jealous.

Anonymous

NP programs need to return to the previous prerequisites for admission:
2-3 years of clinical RN experience and
demonstrated assessment expertise
If a NP program will not allow a student to be mentored and taught by a MD or DO, then the prospective NP should find another program.

And a further thought --- NP students should be allowed to study 1-3 business course so they will be somewhat prepared to open their NP owned practice.

Bill

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