Nurse Practioner Diagnostic Ability

  1. 0 Hey everyone,

    I'm a pre-nursing student (hope to be accepted in a few weeks to a BSN program!) and my goal is to become a NP or CRNA, though I'm equally split right now. I have a question about the diagnostic ability of an NP that I was hoping some current NPs or NP students could help me answer:

    So one of the draws of the healthcare field for me is the challenge of figuring out what is wrong with people. I wanted to be a doctor for a long time, but after shadowing one I realized they spend 95% of their time doing insurance and about 3 minutes per patient. In addition, the hundreds of thousands of dollars in loans is a little daunting, so I decided I wanted to either be a PA or NP. I figured we'd do essentially the same thing as a doctor. I finally settled on NP because I don't want to have a doctor supervision requirement.

    I realized today, however, that NPs are trained in the nursing model. Nursing is primarily set up as a reactionist field, more of a "this is happening so give this" approach instead of the medical model's "let's find out WHY this is happening." My question is, does this continue past the RN degree and into NP? How much education do NPs receive in diagnosis of illness? Do they learn a wide range of illnesses like doctors do - everything from cancer to skin diseases, etc, or do they just learn a brief overview of the most common problems. I'm really curious because I will be upset if after NP school I find myself unable to diagnose anything more challenging than the very common ailments, having to call a doctor in.

    I really just want to make sure NP school has a lot of time dedicated to advanced diagnostic abilities and covers a lot of material covered in medical school. Can anyone help me out?
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  3. Visit  guest_57352} profile page

    About guest_57352

    From 'Rochester, NY'; Joined Jul '10; Posts: 333; Likes: 61.

    41 Comments so far...

  4. Visit  klbinaug} profile page
    1
    For years my family's (very competent) primary care practitioner has been a Nurse Practitioner. In fact, when I was younger I thought he was doctor. He always diagnoses and prescribes (or refers to a specialist, if need be) and not once have I seen him consult a physician.
    irishrnbsn likes this.
  5. Visit  irishrnbsn} profile page
    0
    I am an RN,BSN who has just applied for a DNP (Doctorate of Nursing Practice) program, which is going to be the required degree for a nurse practioner soon. As an NP you are technically always under a Doctor. Your patients may never see that Dr. but if she/he gives you a prescription the Drs name may be on it as well, printed at the top. NPs cannot as of yet prescribe narcotics, PAs can. I am not sure why you think the nursing model doesn't diagnose, just treat, but you haven't gone to nursing school yet so you may not be as familiar with it. NPs usually are just more personable, take a little extra time, look at the whole picture, etc. Like you said Drs are in and out. My thought on PAs is this. Any person who has a bachelor's degree even if it is in say History can go to school for I believe it is less than 2 years and bam he can see patients, write prescriptions etc. But for a nurse to do that they must go through at least 6yrs + of school that is all medically based. I say go to nursing school, work as a nurse for a bit even just a year or 2 and then look back into it. With the health care changes coming it may be very different than it is now.
  6. Visit  guest_57352} profile page
    0
    Thanks! That's good to know, klbinuag.
    irishrnbsn, I totally agree with you, and I'm more interested in nursing at this point, but I still just want to know the level of diagnostic abilities. I think you have the education of a PA a little wrong though...they learn quite a lot. PA school is like a condensed version of medical school.

    Any current NPs or NP-students want to chime in?
  7. Visit  roser13} profile page
    2
    Quote from irishrnbsn
    I am an RN,BSN who has just applied for a DNP (Doctorate of Nursing Practice) program, which is going to be the required degree for a nurse practioner soon. As an NP you are technically always under a Doctor. Your patients may never see that Dr. but if she/he gives you a prescription the Drs name may be on it as well, printed at the top. NPs cannot as of yet prescribe narcotics, PAs can.
    Irishrnbsn, could you please give your source for your assertion that DNP will soon be the required degree for nurse practitioner? I believe that to be an erroneous statement.

    Also, the NP that I worked with several years ago certainly did prescribe narcotics whereas the practice's PA could not.
    Last edit by roser13 on Apr 4, '11
    xtxrn and ktliz like this.
  8. Visit  Winnie04} profile page
    6
    Hi,
    I am a NP student and I just wanted to note that there are some inaccuracies in the prior post regarding NP autonomy and authority to prescribe opioids. There are indeed states where NP's may practice without any physician supervision/collaboration (New Hampshire is just one example). Also, the ability of a NP to prescribe opioids is dependent on state regulations.

    You might find the Pearson Report helpful- it is a report that provides an overview of each state's legislation in these areas (but fyi it looks like you have to have a subscription to read the 2011 report): http://www.pearsonreport.com/

    However, the 2009 report is still available without a prescription: http://www.npwh.org/files/public/PEARSON.pdf
    CurlyKirby, msn10, blondy2061h, and 3 others like this.
  9. Visit  Freedom42} profile page
    1
    Quote from irishrnbsn
    I am an RN,BSN who has just applied for a DNP (Doctorate of Nursing Practice) program, which is going to be the required degree for a nurse practioner soon. As an NP you are technically always under a Doctor. Your patients may never see that Dr. but if she/he gives you a prescription the Drs name may be on it as well, printed at the top. NPs cannot as of yet prescribe narcotics, PAs can. I am not sure why you think the nursing model doesn't diagnose, just treat, but you haven't gone to nursing school yet so you may not be as familiar with it. NPs usually are just more personable, take a little extra time, look at the whole picture, etc. Like you said Drs are in and out. My thought on PAs is this. Any person who has a bachelor's degree even if it is in say History can go to school for I believe it is less than 2 years and bam he can see patients, write prescriptions etc. But for a nurse to do that they must go through at least 6yrs + of school that is all medically based. I say go to nursing school, work as a nurse for a bit even just a year or 2 and then look back into it. With the health care changes coming it may be very different than it is now.
    NPs are not "technically always under a doctor." Their degree of independence varies by state. In my state, NPs are independent following a two-year residency. PAs never practice independently.

    NPs can prescribe narcotics; again, this varies by state law.

    An NP has not necessarily completed six years of education, and none of it is "medically based." It is based in nursing and less than what MDs receive; that's why the scope of an NP's practice is roughly half that of an MD's. Some NPs complete entry-to-practice programs that put them in the field with master's degrees after three years of full-time education.
    Altra likes this.
  10. Visit  Winnie04} profile page
    2
    Quote from irishrnbsn
    I am an RN,BSN who has just applied for a DNP (Doctorate of Nursing Practice) program, which is going to be the required degree for a nurse practioner soon. As an NP you are technically always under a Doctor. Your patients may never see that Dr. but if she/he gives you a prescription the Drs name may be on it as well, printed at the top. NPs cannot as of yet prescribe narcotics, PAs can. I am not sure why you think the nursing model doesn't diagnose, just treat, but you haven't gone to nursing school yet so you may not be as familiar with it. NPs usually are just more personable, take a little extra time, look at the whole picture, etc. Like you said Drs are in and out. My thought on PAs is this. Any person who has a bachelor's degree even if it is in say History can go to school for I believe it is less than 2 years and bam he can see patients, write prescriptions etc. But for a nurse to do that they must go through at least 6yrs + of school that is all medically based. I say go to nursing school, work as a nurse for a bit even just a year or 2 and then look back into it. With the health care changes coming it may be very different than it is now.
    Although the AACN recommends that the DNP is the required degree for entry to practice by 2015, it does not have the authority to mandate it. It will depend on each state and whether or not the state changes its practice act to require the DNP for NP's.
    Freedom42 and roser13 like this.
  11. Visit  highlandlass1592} profile page
    1
    Quote from irishrnbsn
    I am an RN,BSN who has just applied for a DNP (Doctorate of Nursing Practice) program, which is going to be the required degree for a nurse practioner soon. As an NP you are technically always under a Doctor. Your patients may never see that Dr. but if she/he gives you a prescription the Drs name may be on it as well, printed at the top. NPs cannot as of yet prescribe narcotics, PAs can. I am not sure why you think the nursing model doesn't diagnose, just treat, but you haven't gone to nursing school yet so you may not be as familiar with it. NPs usually are just more personable, take a little extra time, look at the whole picture, etc. Like you said Drs are in and out. My thought on PAs is this. Any person who has a bachelor's degree even if it is in say History can go to school for I believe it is less than 2 years and bam he can see patients, write prescriptions etc. But for a nurse to do that they must go through at least 6yrs + of school that is all medically based. I say go to nursing school, work as a nurse for a bit even just a year or 2 and then look back into it. With the health care changes coming it may be very different than it is now.
    And as an additional f/u to others posts..NOT ONE state has enacted legislation to make the DNP the requirement for NP's. A word of caution: before making such sweeping statements and carrying them forward as fact, it might be wise to check into various states. It's in this way that misinformation gets spread.
    roser13 likes this.
  12. Visit  highlandlass1592} profile page
    3
    Quote from SyberianPuppy
    Thanks! That's good to know, klbinuag.
    irishrnbsn, I totally agree with you, and I'm more interested in nursing at this point, but I still just want to know the level of diagnostic abilities. I think you have the education of a PA a little wrong though...they learn quite a lot. PA school is like a condensed version of medical school.

    Any current NPs or NP-students want to chime in?
    PA's have a condense, very general education. I work with PA's now and there are definite drawbacks to their model of practice, most glaringly not looking at patients holistically.

    As to the diagnostic ability of an NP, I am not sure where you came up with the idea that NP's may not be proactive or able to adequately diagnose. In fact, I find it concerning that you seem to feel that nursing in general is reactionary! I am a proactive nurse, I would rather PREVENT something from happening instead of having to react to an event. And honestly, at times, ALL disciplines are reactionary....including doctors. Patients don't read the textbooks...they don't follow the "ideal patient" when they become ill.

    Important to note, your post shares that you are a pre-nursing student. Why not actually get through nursing school and become a nurse before commenting upon the nursing profession in such a way? You'll have plenty of time to determine which area of practice you choose to specliaze. And you'll hopefully learn quite a bit along the way that will answer these questions.
    loriangel14, roser13, and elkpark like this.
  13. Visit  blondy2061h} profile page
    1
    Quote from irishrnbsn
    I am an RN,BSN who has just applied for a DNP (Doctorate of Nursing Practice) program, which is going to be the required degree for a nurse practioner soon. As an NP you are technically always under a Doctor. Your patients may never see that Dr. but if she/he gives you a prescription the Drs name may be on it as well, printed at the top. NPs cannot as of yet prescribe narcotics, PAs can. I am not sure why you think the nursing model doesn't diagnose, just treat, but you haven't gone to nursing school yet so you may not be as familiar with it. NPs usually are just more personable, take a little extra time, look at the whole picture, etc. Like you said Drs are in and out. My thought on PAs is this. Any person who has a bachelor's degree even if it is in say History can go to school for I believe it is less than 2 years and bam he can see patients, write prescriptions etc. But for a nurse to do that they must go through at least 6yrs + of school that is all medically based. I say go to nursing school, work as a nurse for a bit even just a year or 2 and then look back into it. With the health care changes coming it may be very different than it is now.
    This varies widely based on entity. In my state NPs can prescribe narcotics. In many states PAs cannot. NPs got the ability to prescribe narcs before PAs did in my state. Further, NPs do not have to "work under" a doctor in my state. They simply need to meet with a collaborating doctor on occasion.
    Batman25 likes this.
  14. Visit  guest_57352} profile page
    0
    Quote from highlandlass1592
    PA's have a condense, very general education. I work with PA's now and there are definite drawbacks to their model of practice, most glaringly not looking at patients holistically.

    As to the diagnostic ability of an NP, I am not sure where you came up with the idea that NP's may not be proactive or able to adequately diagnose. In fact, I find it concerning that you seem to feel that nursing in general is reactionary! I am a proactive nurse, I would rather PREVENT something from happening instead of having to react to an event. And honestly, at times, ALL disciplines are reactionary....including doctors. Patients don't read the textbooks...they don't follow the "ideal patient" when they become ill.

    Important to note, your post shares that you are a pre-nursing student. Why not actually get through nursing school and become a nurse before commenting upon the nursing profession in such a way? You'll have plenty of time to determine which area of practice you choose to specliaze. And you'll hopefully learn quite a bit along the way that will answer these questions.
    10 comments and you're the only one to respond to me! Thank you!

    Anyway - I am not trying to attack the nursing profession in any way, after all I'm trying to join it. Please understand that I am simply asking questions about the profession and about the differences between the medical and nursing model. They are both different, and neither one is "correct." For me, the model I want to follow is one that focuses on diagnosing illnesses and finding out why they exist - this is very much like the medical model. My question was simply: does the NP curriculum become similar to the medical model, and are NPs able to diagnose many ailments outside just common, run of the mill things, without calling a doctor.

    Also - I'm not going to become a nurse BEFORE I find this out. If it turns out that being a NP isn't what I expected, I won't become a nurse at all. It seems sort of dumb to spend time and money becoming a nurse only to find out it's not what I want...hence why I'm asking.
  15. Visit  JTworoger} profile page
    3
    Quote from syberianpuppy
    10 comments and you're the only one to respond to me! thank you! :d

    anyway - i am not trying to attack the nursing profession in any way, after all i'm trying to join it. please understand that i am simply asking questions about the profession and about the differences between the medical and nursing model. they are both different, and neither one is "correct." for me, the model i want to follow is one that focuses on diagnosing illnesses and finding out why they exist - this is very much like the medical model. my question was simply: does the np curriculum become similar to the medical model, and are nps able to diagnose many ailments outside just common, run of the mill things, without calling a doctor.

    also - i'm not going to become a nurse before i find this out. if it turns out that being a np isn't what i expected, i won't become a nurse at all. it seems sort of dumb to spend time and money becoming a nurse only to find out it's not what i want...hence why i'm asking.
    syberianpuppy,

    not to get rude or give you false hope or anything... but before you came onto the site full of nurses, shouldn't you of researched it yourself the difference between a np and a md? let me post the definition for np then you decide whether or not its what you want to do. regardless of what you decide to do, you will still be a "nurse" and required to follow the ethical practices as a "nurse."

    a nurse practitioner (np) is an advanced practice registered nurse (aprn) who has completed graduate-level education (either a master's or a doctoral degree). additional aprn roles include the certified registered nurse anesthetist (crna)s, cnms, and cnss. all nurse practitioners are registered nurses who have completed extensive additional education, training, and have a dramatically expanded scope of practice over the traditional rn role. to become licensed/certified to practice, nurse practitioners hold national board certification in an area of specialty (such as family, women's health, pediatrics, adult, acute care, etc.), and are licensed or certified through the state nursing boards rather than medical boards. the core philosophy of the field is individualized care. nurse practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families. nps make prevention, wellness, and patient education priorities. another focus is educating patients about their health and encouraging them to make healthy choices. in addition to health care services, nps conduct research and are often active in patient advocacy activities.
    nurse practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, ordering and interpreting diagnostic tests. nps can then diagnose the disease and then provide appropriate treatment for the patients, including prescribing medications . nps can serve as a patient's primary health care provider, and see patients of all ages depending on their specialty (family, pediatrics, geriatrics, etc).

    in the united states, nurse practitioners have a national board certification. nurse practitioners can be educated and nationally certified in areas of family health (fnp), pediatrics, including pediatric acute/chronic care, pediatric critical care, pediatric oncology and general pediatrics (pnp), neonatology (nnp), gerontology (gnp), women's health (whnp), psychiatry & mental health (pmhnp), acute care (acnp), adult health (anp), oncology (fnp, acnp, anp, pnp or anp) emergency (as fnp or acnp), occupational health (as anp or fnp), etc. in canada, nps are licensed by the province or territory in which they practice.

    scope of practice

    in the united states, because the profession is state-regulated, care provided by nps varies widely. some nurse practitioners work independently of physicians while, in other states, a collaborative agreement with a physician is required for practice.[color=#0645ad] the extent of this collaborative agreement, and the role, duties, responsibilities, medical treatments, pharmacologic prescriptions, etc. afford an np to perform and prescribe again varies widely amongst states of licensure/certification practice.[color=#0645ad][ a nurse practitioner's role may include the following:
    • diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g. [color=#0645ad]diabetes, [color=#0645ad]high blood pressure)
    • obtaining medical histories and conducting physical examinations
    • ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests, bone [color=#0645ad]x-rays, [color=#0645ad]ekgs)
    • prescribing [color=#0645ad]physical therapy and other rehabilitation treatments
    • prescribing drugs for acute and chronic illness (extent of prescriptive authority varies by state regulations)
    • providing [color=#0645ad]prenatal care and family planning services
    • providing well-child care, including screening and [color=#0645ad]immunizations
    • providing primary and specialty care services, health-maintenance care for adults, including annual physicals
    • providing care for patients in acute and critical care settings
    • performing or assisting in minor surgeries and procedures (with additional training and/or under physician supervision in states where mandated; e.g. dermatological biopsies, suturing, casting)
    • [color=#0645ad]counseling and educating patients on health behaviors, self-care skills, and treatment options
    all this information was pulled from http://en.wikipedia.org/wiki/nurse_practitioner if your interested reading this further.
    Batman25, Fribblet, and loriangel14 like this.


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