Reply To: BSN a must?

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Jake: Yes, there is a difference between a PA and an NP in that the PA works under a physicians license while an NP works under his/her own. Having been a combat medic and a (damned fine) ER nurse, I know you understand the role of the paramedic, who has a certificate and not a license. They work under the license of Dr. H, while you and I work under our own licenses, although we take our orders from Dr. H, if for no other reason than he is bigger than both of us put together.

They each have their own specialties and training, but as far as primary care goes, both the PA and NP have the role of seeing patients and diagnosing and treating problems up to their skill level, which is less than that of a residency trained physician. You state the year of additional management, informatics, and research will help prepare them for their role. I assume you are talking about NPs who want to put up their own shingle. You and I both know that the world of medicine has become too complicated for the providers to actually run their own businesses anymore. Yes, any type of additional education is a good thing to have, but if that is what they are teaching, I don’t think that will really make them better providers

I think nursing has to decide if they want NPs to be functioning own their own on par with physicians or at a level below that. If NPs are not going to be expected to be residency trained, then we can agree that while they will be ‘doctor’ their skill and expertise will not match that of a physician, so calling them “mid-level” is not a derogatory comment. If they are going to be a mid-level provider, I think it is silly that they are required to have the same amount of schooling as a physician. If you want to push the issue and say they will be totally independent providers at the doctorate level, then I think the additional few years of rigorous on the job training is required.

As far as the teacher issue goes: I would put your skills and experience up against anyone’s too, including my own mad skills. I freely admit, you rock, but you are also an exception. Not many people get trained as a combat medic and work at that level before getting their RN. Not many people get to work in the military system, where the rules are much different. Not many people get paid to go to school, instead of having to pay and take out loans. You are very fortunate to have Uncle Sam paying for your doctorate degree, and you will make a wonderful provider, and if you wanted to teach, you would excel at that too. My point is, getting a doctorate level degree is a financial hardship many people can not take, and with the current wages of nursing instructors, they will never be able to pay back those loans. We both know that I (a lowly ADN nurse) make more than many nursing instructors.

Also, you have worked, hard, at every level you have obtained, and that will make you excellent, whereas I know some people that stayed in school full time, without working as a CNA, LPN, RN, etc and never touched a patient other than at their clinical rotations in school, who have come out with a Master’s in nursing and went into teaching. Again, I’m not saying education is bad, but I think they are going a little bit overboard with a PhD requirement. I’ve been a ‘guest instructor’ a few times in nursing schools, and I have actually taught high school math and science for a year, so I think a look at experience is a better indicator of instructor success than letters after their name.

I will give them that the new requirements will now include instruction on how to actually teach, which is a good thing. In the past many nursing schools just required a Master’s level degree for their instructors. I would argue that an experienced RN with a master’s in education would make a better nursing school instructor than a new grad NP who decided not to go into primary care.

Thank you for keeping me on track. Hope you are working this weekend, and not just to cover me in case I get suspended.

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