Job Prospects in Health Care Fields

Parents Forum
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<p>The programs have been small because small classes are better suited for hands on learning. Plus the programs are pretty intense. There are also limited opportunities for clinical experience for PA’s, who often work in doctor’s offices, which is different from medical students who do the majority of their clinical work at hospitals.</p>

<p>My kid’s grad class are all in the same classes together all day. Half of them have been together since they entered as freshmen, which makes for great cooperative learning.</p>

<p>Schools are adding PA programs, and PA programs are expanding. Traditionally, most graduate slots become available when students who entered the 3+2 program dropped out, so there are VERY limited openings for people coming from outside the school’s program. My daughter’s school doubled the size of the grad program the year my daughter started her grad classes, taking in new students. For the 24 slots that were opened, there were over 800 applicants.</p>

<p>NO ONE is a “shoe in” for PA graduate programs unless they started the program as a freshman.</p>

42

<p>One of the reasons for a shortage of nursing spots is reportedly because of a shortage of qualified people who want to be nurse educators. Another is limited clinical opportunities in some areas, particularly rural areas and small towns. A third reason is that nursing programs are expensive to colleges because of the low teacher to student ratios in higher level classes.</p>

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<p>Oh, lje, I’m so sorry. I shocked that it’s gotten so competitive. Best wishes to your D in pursuing an NP program. </p>

<p>I think the reason the programs are small is that they can’t find enough college instructors. These people can make more money practicing. (cross-posted with Charlie) My son has had no problem finding clinical work, and most has been at hospitals. I think these places are so desperate for mid-level providers that they will go out of their way to find someone to train them, once they get to that final phase. </p>

<p>KKmama… My son’s program has (9) 5 week rotations, but psych isn’t one of the 9. They have to do internal med., ob/gyn (mostly gyn, as physicians seem to want total control over their ob patients), peds, general surgery, family practice, ER, research, and (2) electives.</p>

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<p>Wow! Well, I guess proceed with caution. As i said, I have a friend who’s daughter should be a shoe in and she hasn’t received an acceptance letter yet. I do think she has an interview at a school though. My D is a bit pessimistic by nature and that might serve her well in some ways as she navigates this terrain. </p>

<p>Perhaps applying to NP and PA programs simultaneously is something to think about.</p>

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<p>Toledo: daughter’s school does (6) 6 week rotations required for peds, family med, orthopedics, general surgery, cardiology and emergency, and 3 week rotations in psychiatry and ob/gyn. (During her ob/gyn she did a little bit of ob, but mostly she covered the gyn appointments while the doc was out delivering babies and the NP covered the ob appointments. She was with the practice we go to, so they know her; just told her to call in the NP if she had questions.) Then there is a 3 month rotation in their chosen specialty. She will do that one with our doctor, since she took the government grant for internal medicine/family practice. They are on their own for researching and writing their masters thesis during the rotation time.</p>

<p>Rotations are difficult in this area because DeSalles, Marywood, and Kings are all in a very close proximity, and docs are so busy that they aren’t always happy to be supervising a student. And many are also hosting med students. Daughter didn’t have her peds assignment until 2 days before starting - her peds prof finally took her on. Another PA student from out of the area that was with her during her ER rotation was being bumped all around PA and OH.</p>

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<p>I’ve been following along for awhile…</p>

<p>My D is early in the process…half way through her sophomore year as an undergrad Nursing (BSN) major, and will begin her clinical rotation next month. I can tell you that it was VERY competitive just to get into the nursing program itself. Her classes are pretty demanding…IMO these students will be worth every penny if they can successfully navigate this program.</p>

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<p>I am a student who was originally pre-PA and I’m currently applying to direct entry MSN programs because I changed my mind, for many reasons. I’m very well versed in this area, so I can help you out…</p>

<p>There were many things that led me to change my mind and to pursue being an NP rather than a PA. PAs are great, and are certainly essential in the midlevel provider role. However, I truly believe that pursuing an MSN to become a nurse practitioner is what is best for me, personally. First of all, PA programs require many prerequisites that most med schools would require - pretty much everything besides physics and calculus, and then some others that med schools actually don’t require, like anatomy and physiology. I was really frustrated that I had to go through organic chemistry and biochemistry. I almost felt like I should’ve just went ahead and went to med school when I was taking so many of the pre-med courses… but I didn’t WANT to go to med school, as I felt that path wasn’t right for me. I had originally chosen PA school because I loved science, was fascinated by health care, and wanted to combine my interests with a lifelong passion for serving others without committing to 10-14 years of school and residency.</p>

<p>Then, there’s also the fact that many of these programs require 2000 hours of direct patient care, or two years. This is a big requirement, and a very important one to PA school, as PA school is NOT meant to be a starting point for those who are new to medicine. This profession is meant for people who have been working in healthcare for some time, and who want to pursue further education and training, in order to be an extension of a physician. For me, there was just no way I could complete all of these hours during my undergraduate career, along with taking the necessary prerequisites and receive competitive grades for admission, but I was reluctant to take time off. So this is also another major consideration… taking time off after graduation and working full time in healthcare isn’t always appealing. </p>

<p>A major difference between PA vs NP is that NPs are trained as nurses, in the nursing model, whereas PAs are trained in the medical model. In practice, they do almost the same thing, and they are both midlevel providers that are essential to healthcare. However, it is important to note that their education IS different. The nursing model is much more holistic than the medical model, and combines science along with many different nursing theories, whereas the medical model is science ONLY. NPs are trained as nurses first and foremost, and yes, they must obtain a BSN and work as an RN first (more on this later). Anyways, the difference in education is important to some people, but I really don’t think one is better than the other. It is pure preference. Another major difference in the education between the two is that PAs are trained as generalists, and do clinical rotations in many different areas. NPs must pick a specialty, and only do clinical rotations in their chosen specialty. Specialties range from family NP (they can work in many areas, very versatile so they are most competitive), pediatric NP, adult NP, adult acute care NP (trauma, ICU, surgery, etc), pediatric acute care NP, neonatal NP, women’s health NP, midwife (second most competitive specialty)… and I’m sure I’m missing some. However, I’m sure that gives you a good idea of the differences. It is important to note that PA programs have students do more clinical hours, but NPs do not need as many because they are only focusing on ONE specialty, so it works out, and works well. It is also assumed that most NPs have extensive experience as a bedside RN. </p>

<p>The program you spoke of at MGH does have a direct entry MSN program, similar to programs I am currently applying to. This is how these programs work: they are around 3-4 years long, education wise. Most of them ensure that you will graduate with both a BSN and MSN in around 3 years, meaning you will be able to work as an nurse practitioner in whichever specialty you have chosen (this is typically done when you first apply to the program). The first 18 months in the program is spent obtaining a BSN degree. After graduation, students must take the NCLEX and work on obtaining a nursing job. Most of these programs DO require you to work as an RN either for a year before beginning the MSN portion, or during the MSN portion, because they understand that it is hard for graduates to get jobs without bedside RN experience as a nurse practitioner. After this (every program’s requirements are different), students may then begin the MSN portion which takes around a year full-time, sometimes 2 depending on the specialty or if the student is doing the program part-time (many do so they can continue to work as an RN). So the programs are not really “direct-entry”, but rather they guarantee you will be admitted into the MSN specialty of your choice after fulfilling a work requirement (or requiring that you work while in the MSN specialty part-time). Schools that have these programs other than MGH are Yale, Boston College, University of Illinois-Chicago, Johns Hopkins, University of Pennsylvania, NYU, Vanderbilt, Thomas Jefferson, UCSF, Marquette, Northeastern, Duke… and I can’t think of the rest off of the top of my head, but there are so many throughout the country. Every school calls their program something different, and has different requirements and regulations, but they all have the same end goal. </p>

<p>I’m sorry that this was so long, but I hope I answered more questions for you. Please let me know if there is anything else I can help with, or answer for you!</p>

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<p>Thanks for posting. That was very interesting. Will NPs need more than an MSN beginning in 2015?</p>

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<p>thanks ufhopeful24, I never really understood the difference but it makes sense that PAs are trained in the medical model.</p>

50

<p>The American Association of Nursing Colleges (AANC) has been spearheading a drive to require that students have a Nursing doctoral level degree (DNP/Ph.D) in order to be eligible to take the National NP certification exam (required for licensure) beginning in 2015. This is not likely to happen for a large number of reasons (much too long to list here) in 2015 but I suspect it will eventually be implemented. In line with this apparent eventuality some top universities (i.e. Pitt) have already eliminated offering a MSN-NP degree and offer only a DNP Program. Other top MSN Programs (i.e. Penn) are continuing to offer the MSN-NP Degree. There is a raging battle in the Nursing community over this. Not to get into a debate here , but requiring the DNP degree will reduce the number of future new NP’s at a time when increasingly larger number of indivduals will be accessing medical services as a result of the Healthcare Reforms. The timing couldn’t have been much worse. We shall see what happens.</p>

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<p>Like the poster directly above me stated, it may EVENTUALLY happen, but it is unlikely to happen by 2015… or even 2020. It is currently just a suggestion, and is not a mandate. According to a nursing board that I frequently read, they have apparently also been pushing to make the BSN the starting point for all nurses, and have been trying to get rid of the ASN, but this has never happened either, and probably won’t ever happen. Many nurses seem to think that for this reason alone, the mandate for DNP will never happen. Although there’s nothing wrong with getting a DNP… if this WERE to happen, nurse practitioners with the MSN would be grandfathered in anyways. Nursing is a cool field though… many hospitals would probably pay for the NP to get their DNP at a local school or online school anyways! This is very common. I’m actually applying to a wonderful program at a fantastic school that I mentioned above that does loan repayment in exchange for working at their hospital - and 95% of graduates who wanted to take part in this program WERE able to get a job there, so it’s definitely not too difficult! Also, the DNP is less clinical rotation based and much more research based (meaning not clinical based at all), as well. </p>

<p>Other things to note: these programs are still competitive. However, I’m not sure if they are as competitive as PA programs, simply because many people are not aware they exist so I think a lot less people apply (600 for Penn for 85 spots this year, 1000 for 120 spots for Johns Hopkins). Direct patient care experience is valued for these programs as well, but the emphasis isn’t placed on it like it is for PA school.</p>

<p>Speaking of direct patient care experience, CNA work will suffice for admission to PA school. I was in the pre-PA club at my undergrad, and they had admissions from our PA school come and talk to us and they told us that anything where you are close enough to smell the patient counts… so I guess it’s also how you spin the things that you did. Some volunteers are “hands-on” enough to count their experience as direct patient care, I guess.</p>

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<p>“According to a nursing board that I frequently read, they have apparently also been pushing to make the BSN the starting point for all nurses…”</p>

<p>Where I am, that’s a non-starter. In our state, the only places that BSNs are required are for school nurses and public health nurses, and these are the lowest paid nursing positions in the state. Employers regularly prefer ASN nurses with two full years of experience to BSNs without any. Many of the students in the four-year programs are rejects from the community college programs, which are far more difficult to get in, and the state has made a major investment in the community college programs. Hospitals prefer to hire two-year nurses with certificates in particular specialties. </p>

<p>We also have several colleges that are trying to market two-year add-on programs for nurses to get their BSNs. They are begging for students (and without much success).</p>

<p>(And, as noted, there are two-year RNs, like my wife, who make more than the average NP, and have more flexible working environments.)</p>

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<p>mini, it is the shortage of nurses that keeps the AA programs around. PTs now need doctorates, Social Workers need masters degrees, Occupational therapists also need masters degrees. Nurses are the only health profession that are stuck and it does not reflect well on the profession that the requirement for higher education is not required in nursing.</p>

<p>Perhaps in your state AA nurses have great flexibility but I am licensed in 3 states and having a BSN has given me the most flexibility.</p>

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<p>It certainly is the shortage of nurses that not only keeps the AA programs around, but has them expanding, while the two-year extender BSN programs are begging for students. As noted, only two nursing positions in our state require a BSN, and both are poorly paid. What employers do want is experience, and because he AA nurse after four years will have two years more experience than a new BSN, they will usually be hired first.</p>

<p>Not all nursing positions are flexible of course. My wife just happened to choose one that gives her great flexibility, virtually no contact let alone supervision by docs and hence much independent practice, and pay that is higher than the average 10-year NP in our town. She might have chosen differenty</p>

<p>I don’t really think it is matter of nurses being “stuck”. I think it is more a function of experience that two-year nurses can do the job, and can do it well. (I was senior staff to our state’s board of health that reviewed this for more than a year, and that was our finding.) It is further a function that it is much harder to get into the two-year programs than the four-year ones (in my wife’s class, it was quite literally harder to get into than to get into Harvard), and so the quality of two-year nurses here (I can’t speak for other places) is extremely high.</p>

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<p>Well in terms of actual tasks yes an AA nurse’s training is all about getting down skills but those extra 2 years BSN nurses are going to school gives them more theory, more ability to see the big picture of healthcare and the tools to be what my instructors called the skill to become a “change agent”. </p>

<p>Even 30 years ago, it was difficult to get into nursing programs so I interviewed at a local community college that offered a 2 year AA programs just in case I could not get into a BSN one. As they interviewed me and I discussed what I thought I might want to do with my nursing degree they kept telling me that I would not be able to do that with an AA degree.</p>

<p>Needless to say, they did not offer me admission and luckily I did get into a BSN program.</p>

<p>My son is majoring in engineering and that same discussion about whether to go to a school with more hands on experience eg Coop school like RIT or go to a program that has more theory has similar pros and cons. The difference is all engineers come out with 4 year degrees.</p>

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<p>I would not be too smug in thinking that the BSN requirement for RN’s and the DNP requirement for NP will not happen in the not too distant future. Pressure for these changes is coming not just from within Nursing but also from the Federal Government (Institute of Medicine, NIH and many other agencies). Whether rightly or wrongly (this is an unresolvable debate) the Feds appear to equate quality of care with degree levels. The Feds control a hugh percentage of healthcare dollars thru the Medicare/Medicaid systems. Medicare is in the process of formulating Indicators that in the not too distant future it will be using to determine reimbursement rates for Hospitals and other healthcare agencies. One of them is percentage of RN’s on staff with BSN’s (the higher the percentage the higher the reimbursement). From this viewpoint “years of experience” as an RN appears to be irrelevant. So in the future what do you think Hospitals will be focusing on in hiring RN’s? It will be BSN coupled with years experience (to both maximize reimbursement and to try and maximize quality of patient care). States are also looking into the same thing in their administration of their portion of Medicaid Funds. Several State Nursing Boards are already considering the BSN requirement for RN’s. It is my understanding that they propose to give RN’s without BSN’s 10 years to obtain the BSN in order to maintain their RN licenses. RN to BSN Programs may be “begging” for students right now but I suspect this will be changing in the not too distant future.</p>

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<p>I really have nothing to add to this thread, just want to throw out there that one of my husband’s nieces just started in the PA program at Springfield College (In Springfield, MA). It is currently a 5 yr program but from what I understand it is switching to a 6 yr program.</p>

<p>Just wanted to offer another option.</p>

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<p>I spoke someone last night who has been a nurse for 27 years, 2 MSNs, NE and tons of research and experience in many nursing areas. She just helped to re-establish a BSN nursing program at a local university and is directly involved with nurse recruitment for the hospital she works for. She is the director of education and organization development. She relayed information from a meeting she attended just yesterday, that while acute care nursing will still be important, that things are shifting toward a prevention and education model outside the hospital setting. Nurses with dual degrees or concentrations in sociology, psychology, education and nurses allowed “capstone” research projects for specialty interest areas at the BSN level will be sought after and be in high demand. She said they need nurses who can not only problem solve for acute and critical care, but are looking for nurses who can be part of the public health and “optimal health” and disease prevention movements. She thought it was very valuable for future nurses to have a niche that they are particularly interested in. BSN programs which allow students to research those interests through a “capstone” project were extremely valuable. She also relayed that they will need nurses who can understand research, statistics, health data and actually have the skills to interpret it and use it. This shift toward “community” nursing is due to public funding for health care at the national level. So, I would think broader education background you have, the more opportunities available; not only for the changing job market, but for the benefit of the populations you serve.</p>

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<p>A friend of mine has the equivalent of an ASN (she came from Germany in her 20’s, she is in her 40’s now). She’s been in the same hospital for 20 or so years and they are putting a lot of pressure on all of their nurses to go back and get the BSN. She’s resisting, but it comes up a lot.</p>

<p>I don’t think any new hires there have the lesser degree.</p>

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<p>All very good points mentioned by people above! I think that there are so many opportunities within nursing, whether one has a BSN, MSN or DNP, and that if you want to work in healthcare but aren’t sure which direction you want to go in, you can’t really go wrong with some type of degree in nursing. You can work in the hospital setting as an RN, work in public health (many joint nursing programs with the MPH out there), work as a nurse practitioner (which, as we’ve discussed, is incredibly similar to the PA role), work as a nurse manager, work as a nurse educator (this is a VERY cool job!), work in research, work as a professor or clinical instructor, and so many other options. The opportunities really are endless.</p>