Advice for the future.

[Seirende]

I'm taking stock of my goals and trying to figure out good ways to accomplish them.

My major goal is to be a mid-level provider (PA or NP) working with under-served populations, potentially rural.

Short(er)-term goals so far:
Due to a need for year-round sunlight, I'll be moving from WI to the Appalachian mountains in a month or so (weather-dependent).
I want to get a BSN, so I'm hoping to start on my RN in the spring semester.
I feel that my skillset is more suited to community paramedicine and/or IFT than 911, so I'll be exploring companies that provide one or both of those services.

Any sage advice on steps to take toward these goals? Any pitfalls that I should avoid?

 

[akflightmedic]

I would start by narrowing down the "Appalachian Mountains" to a more specific area....I mean the Appalachian Mtns covers a whole lot of states. And the range itself starts in Newfoundland, Canada and goes as far south as Alabama. So where specifically would you like to relocate to?

 

[Carlos Danger]

Any sage advice on steps to take toward these goals?

Everyone wants to be a MD or PA or CRNA, or to move to where the awesome job is, or to get in great shape, or to backpack across Europe. Why do so few do it? Because they just don't do it.

Don't put it off, and don't succumb to paralysis by analysis or to self doubt. Make a plan now - it need not be perfect - you can adjust it on the fly as needed - and make it work.

 

[Seirende]

I would start by narrowing down the "Appalachian Mountains" to a more specific area....I mean the Appalachian Mtns covers a whole lot of states. And the range itself starts in Newfoundland, Canada and goes as far south as Alabama. So where specifically would you like to relocate to?

If you use the context clues, you could probably guess that I'm not headed to Canada.

The shorter days are starting to push me into hibernation mode, so I'm going be headed for Kentucky/Tennessee and rambling around the range until I find a place to settle for a bit.

Everyone wants to be a MD or PA or CRNA, or to move to where the awesome job is, or to get in great shape, or to backpack across Europe. Why do so few do it? Because they just don't do it.

Don't put it off, and don't succumb to paralysis by analysis or to self doubt. Make a plan now - it need not be perfect - you can adjust it on the fly as needed - and make it work.

You know the story of the Flight of Icarus? I've lived my life as a flight, winging it and losing a few feathers along the way. I'm hoping for some Daedalus-type advice... "Neither too close to the sun nor to the sea."

Honestly, I've erred away from analysis and self-doubt and now need to push more in that direction.

 

[hometownmedic5]

You say you want to get a BSN, then be either a PA or NP, then you go on to say you want to be a transfer or community paramedic. I can see why you're confused, since it seems like you have no end goal, at least not specifically.

If you want to be a PA, don't take nursing course. Take pre med courses, build your contact hours with your current cert as a medic and, when qualified, apply to PA schools.

If you want to be an NP, get your RN, BSN, and then your MSN/NP and go into practice.

In short, pick a path and commit to it. You'll never make any significant headway until you know what you want to be. It sounds like your at the point where its time to stop generalizing and get down to specifics. Sit down, make a list, do your research, figure out where you want to go then figure out how to get there, but before you'll get anywhere, you need a destination. The mid level providers end up being somewhat close, but the paths to get there are different, so you need to know where you want to end up before you can pick a path.

 

[Seirende]

Thanks for the input so far!

I made an unordered list up there at the top; it seems that it might be helpful if I laid out something of my game plan.

I'm heading south because the winter worsens my depression to an almost unbearable extent. Once there, I'm going to need to support myself, hence the looking for work in my field, hence community paramedicine or IFT. I'm going for a BSN specifically because it has multiple drop-out points - LPN and RN - and I want a backup plan. My understanding of PA is that the only entry requirement is a bachelor's. If end up picking the medical model over the nursing model, I'd like to have some education in the nursing track to sort of round it out.

In short; I'm heading south, getting a job, and going to school, in that order.

What do you guys have to say about the way to get to PA vs. the way to NP? Any advice specifically on looking into community paramedicine? Any good programs that y'all know of?

 

[MonkeyArrow]

If end up picking the medical model over the nursing model, I'd like to have some education in the nursing track to sort of round it out.

No you don't. It will add nothing of value to your PA education; most NPs I speak with say they like the PA "medical" model over the NP "nursing" model. Part of what will make you a good clinician is experience. Get that in the field now, being and learning as much as you can. Try to make your first job out of professional school at a high volume, high intensity place.

 

[EpiEMS]

I went through the math (elementary math, anyway) of PA vs. NP once before...I am more in the NP camp, based on what I've seen.

- PA requires a bachelors with a certain group of prerequisite courses - mostly the same as medical school, albeit a couple more applied courses (A&P). Prerequisites vary by school.

- NP requires less in the way of prereqs, but obviously you have to be an RN beforehand (either a bachelors in another field and an RN, or a BSN, generally).

- PA is ~2 years, full time. NP programs vary, and are often part-time.

- NPs specialize - either FNP, PNP, Psych NP, etc. and are a bit more restricted insofar as switching fields, while PAs are basically free to choose whatever they like. If you like rural underserved populations, NP makes more sense (Family NP) - you have more clinical autonomy (state law dependent) than a PA, and there are often health department NPs that serve functions like this.

If I were somebody who valued optionality, I think the NP track is better - you have multiple exit points (so you don't lose out completely if you decide to stop part-way through) - and you have more clinical autonomy.

Why not try an ASN, upgrade to a BSN, then pursue your NP (MSN, typically, though they are moving to a DNP model)?

Btw...what is your current level of education/educational background? This may change things a bit.

 

[Seirende]

No you don't. It will add nothing of value to your PA education; most NPs I speak with say they like the PA "medical" model over the NP "nursing" model. Part of what will make you a good clinician is experience. Get that in the field now, being and learning as much as you can. Try to make your first job out of professional school at a high volume, high intensity place.

My current situation is that I'm dealing with major depressive disorder. I'm drawn to community paramedicine or IFT partly because I need to avoid a high intensity pace.

What degree would you recommend for the PA track?

I'm sorry to keep talking down the advice that you guys are giving, but it helping me to clarify where I'm going. My sincere thanks.

 

[Seirende]

@EpiEMS , thanks for the excellent summary! I greatly value optionality and autonomy, so NP is starting to sound like the preferable choice for me.

My current education is the one year technical certificate. I did another semester at the technical college where I went through the paramedic program, but I was saddened by the low academic standards and decided to look elsewhere.

 

[Seirende]

My current education is the one year technical certificate. I did another semester at the technical college where I went through the paramedic program, but I was saddened by the low academic standards and decided to look elsewhere.

I just realized that this makes me sound very snobbish, haha. By low academic standards, I mean eighth-grade level learning, not, "They just didn't appreciate my special talents."

 

[EpiEMS]

My current situation is that I'm dealing with major depressive disorder. I'm drawn to community paramedicine or IFT partly because I need to avoid a high intensity pace.

I think that most family practice NP roles are going to be fairly low-intensity - a buddy of mine who is dealing with some similar issues (as well as an aversion to high-acuity patients) is taking a similar route.

What degree would you recommend for the PA track?

I don't believe the degree matters, merely that you have a bachelors, the required prerequisite courses, and the requisite clinical experience.

My current education is the one year technical certificate. I did another semester at the technical college where I went through the paramedic program, but I was saddened by the low academic standards and decided to look elsewhere.

Gotcha - what other institutions are you considering? What courses have you taken for that, in addition to the paramedic classes? A&P?

By low academic standards, I mean eighth-grade level learning,

I don't think this is atypical for EMS initial education, frankly!

 

[Carlos Danger]

What do you guys have to say about the way to get to PA vs. the way to NP?

For someone in your position, NP absolutely makes more sense.

First, the "medical model" vs. "nursing model" is a non-issue. Yes, "nursing theory" is unfortunately a thing and you'll have to endure incorporating it into papers and such. But as far as the the actual clinical content of a FNP program vs. a PA program, there is no difference. They learn the very same things.

In practice, NP's and PA's tend to have identical scopes of practice, responsibilities, and compensation, and are used interchangeably. Some hospitals or practices prefer one over the other, but that's a very localized thing and I don't think either has a distinct advantage over the other in that way.

Generally speaking - it depends on the state - NP's legally have more autonomy. I don't think it matters much in actual practice in most cases, but if you want to run your own clinic in a rural area and have as few legal restrictions as possible, you are probably better off with NP licensure.

The nursing route is FAR more flexible than the PA route. You can work full-time the whole way through, if you wanted or needed to, without much trouble. It's very easy to find part-time BSN and NP programs, or full-time programs that are scheduled in a way to be easier on someone who is working full time.

The only downside to NP as compared to PA is that it may be harder to switch specialties as a NP, but this depends. FNP's work in almost any setting, but there are some restrictions on them managing young pediatrics or working in ICU's, for instance. This is offset at least somewhat by the facts that 1) you see relatively few PA's in those specialized roles, either, and 2) it's becoming more common to find NP programs that offer certification in more than one area, i.e. FNP/PNP or FNP/ACNP.

PA educational programs I think generally provide a better foundation in basic science, basic medicine, are more standardized and probably of higher quality across the board than NP programs. But there are plenty of exceptions to that rule, so it doesn't mean that you have to settle for less rigorous education - it just means that you have to do your research on programs. There are lots of programs to choose from.

If I were young and single and in your position, I'd work as a paramedic while I earned my BSN, then I'd work as a RN in whatever role I was most interested in for a year or two, and then I'd find a high-quality NP program where the didactics were mostly online that offered dual certification in FNP + ACNP or PNP.

Another option is to get a two-year degree in nursing and work as a RN while you get your BSN. Whether or not that makes sense depends on how soon you can get into the ASN program (in many cases they are actually more competitive than BSN programs) and what types of jobs are available for a ASN in your area. If you like doing EMS, it's probably simpler and easier to keep doing that while you get the BSN right off the bat.

 

[MonkeyArrow]

PA educational programs provide a better foundation in basic science, basic medicine, are more standardized and probably of higher quality across the board than NP programs. But there are plenty of really good NP programs out there too, so this doesn't mean that you have to settle for less rigorous education - it just means that you have to do your homework. There are lots of programs to choose from.

This here is the real caveat IMO. We have tons of ED nurses that I work with currently starting/in/finishing NP school. The majority of these are hybrid/almost completely online. Now, why is this a problem you ask? I am highly skeptical of the ability to impart the necessary knowledge needed to competently and correctly diagnose, treat, and prescribe based on an online classroom. Often times, I feel as though the quality of their (online) education suffers. I would go so far as to say I wouldn't feel comfortable being treated by them, whereas I see a vast difference in our NPs that went to a brick-and-mortar school in terms of clinical knowledge, skills, ect. Often times, traditional school are affiliated with better institutions, that have better faculty, more resources, and better clinical rotation sites.

 

[Carlos Danger]

This here is the real caveat IMO. We have tons of ED nurses that I work with currently starting/in/finishing NP school. The majority of these are hybrid/almost completely online. Now, why is this a problem you ask? I am highly skeptical of the ability to impart the necessary knowledge needed to competently and correctly diagnose, treat, and prescribe based on an online classroom. Often times, I feel as though the quality of their (online) education suffers. I would go so far as to say I wouldn't feel comfortable being treated by them, whereas I see a vast difference in our NPs that went to a brick-and-mortar school in terms of clinical knowledge, skills, ect. Often times, traditional school are affiliated with better institutions, that have better faculty, more resources, and better clinical rotation sites.

There's no problem with online education at all. It's the way things are going. The same information that is relayed verbally and by powerpoint in a classroom can be relayed verbally or in print and by powerpoint on a computer screen. If there is a difference, it's probably that students who go to a traditional school with a traditional schedule are possibly more focused and might study more/harder.

Many PA and medicine programs use online content pretty heavily as well, and I recently read about a medical school somewhere where I think ALL the didactic is online. It might not be as ubiquitous as it is with NP programs, but it isn't uncommon. Duke and Georgetown are very well respected schools and both have NP programs that are mostly online, FWTW.

 

[GBev]

What degree would you recommend for the PA track?

I just finished applying to PA schools after graduating with a BA in history and an MBA. Any bachelor degree will work. In fact, in my experience, the more diverse the degree is, the more it sets you apart. Advanced practice programs are saturated with pre-med and biological science students. Having history and business degrees gave me something interesting to talk about in interviews.

I still had to take two semesters of prerequisites. However, my advice is to get a degree in whatever interests you and take prerequisites as electives if they are not a part of your core curriculum.

 

[SanJoseEmt]

My current situation is that I'm dealing with major depressive disorder. I'm drawn to community paramedicine or IFT partly because I need to avoid a high intensity pace.

What degree would you recommend for the PA track?

I'm sorry to keep talking down the advice that you guys are giving, but it helping me to clarify where I'm going. My sincere thanks.

Have you considered EMT? I just graduated from UCLA's EMT program. I have chronic depression and major social phobia and did not realize how extremely difficult the social aspects of the class were until going through the first couple of days. The staff are very good in helping anyone succeed and said that they have seen every type of student. It was a four week program and in my experience, a top notch EMT program. Most programs in the nation are about 3 semesters or less. Mine was accelerated. During the program, many companies were recruiting us and a lot were IFT ambulance companies. Some IFT ambulances have CCT (critical care transport) services which can include an EMT and/or Paramedic, plus a RN or Doctor. Usually, the EMT is the driver, but the Paramedics, RNs, and Doctors are willing to help you with your future goals and also may let you perform care to the patients. It is extremely doable to work as an EMT and go to school full time simultaneously since as an EMT, you may get a lot of down time during your shifts to study or do homework. It can also be invaluable experience since you may be sitting alongside a RN or Doctor. Also, some people do not realize what a Doctor or Nurse can do until getting into school and decide that it is not for them. A nurse in the hospital told me to not commit yourself into a 4-year program unless you know it is exactly what you want to do. Being an EMT exposes you to different aspects of the hospital because you travel to different facilities everyday.

Hope this helps!

 

[Seirende]

Have you considered EMT? I just graduated from UCLA's EMT program. I have chronic depression and major social phobia and did not realize how extremely difficult the social aspects of the class were until going through the first couple of days. The staff are very good in helping anyone succeed and said that they have seen every type of student. It was a four week program and in my experience, a top notch EMT program. Most programs in the nation are about 3 semesters or less. Mine was accelerated. During the program, many companies were recruiting us and a lot were IFT ambulance companies. Some IFT ambulances have CCT (critical care transport) services which can include an EMT and/or Paramedic, plus a RN or Doctor. Usually, the EMT is the driver, but the Paramedics, RNs, and Doctors are willing to help you with your future goals and also may let you perform care to the patients. It is extremely doable to work as an EMT and go to school full time simultaneously since as an EMT, you may get a lot of down time during your shifts to study or do homework. It can also be invaluable experience since you may be sitting alongside a RN or Doctor. Also, some people do not realize what a Doctor or Nurse can do until getting into school and decide that it is not for them. A nurse in the hospital told me to not commit yourself into a 4-year program unless you know it is exactly what you want to do. Being an EMT exposes you to different aspects of the hospital because you travel to different facilities everyday.

Hope this helps!

I took the EMT class six years ago and went to paramedic school four years ago. I started this thread over a year ago and since then have been diagnosed with bipolar II and with proper treament am now stable enough to weather the WI winters. I just finished the prereqs for my local nursing program and will start that in less than a month.

 

[SanJoseEmt]

I took the EMT class six years ago and went to paramedic school four years ago. I started this thread over a year ago and since then have been diagnosed with bipolar II and with proper treament am now stable enough to weather the WI winters. I just finished the prereqs for my local nursing program and will start that in less than a month.

Oh shoot, okay good job on finishing pre reqs dude!

 

[Seirende]

Oh Seir, you had such big plans.

My current situation is that my health is what's holding me back. I have the desire, I have the raw brainpower, but my mind and body are a wreck. I ended up letting my paramedic license go because I felt it had been too long since I had used it and I actually am retaking the EMT class in preparation for my summer job as a camp health officer. I loved EMS so much, but I feel like this summer job will be my last shot for now at pursuing my dreams and if I find myself able to move forward after that, I'll try doing volunteer work for a while and eventually move back into full-time EMS (god I loved the month and a half I spent as a paramedic trainee). If I find myself still a wreck, I'll try for disability and work what hours I'm allowed and can handle and see if I can live my values the best I can with volunteer work and being kind to the people around me and all that.