Are they training me to be a nurse or a doctor?

[Lemon Bars]

I just completed the first week of my BSN program. I am a little confused with the way some of the material is being presented both in class and in my textbooks. We are discussing taking a history, performing a physical assessment, MAKING A DIAGNOSIS, DEVELOPING A PLAN OF CARE, implementing and evaluating the plan of care. We have been discussing what interventions we would perform if the patient develops certain conditions and what medications we would give.

So far, there has been almost no mention of the involvement of a clinician such as an MD, DO, NP or PA. I know that a nurse often sees the patient before the clinician, takes a brief or more extensive history depending on the healthcare setting, and does a nursing physical assessment. But making a diagnosis and developing a plan of care? Isn't the DOCTOR (or NP, etc.) supposed to make the diagnosis, develop the plan and give the orders for the patient? I have just learned there is something called a "nursing diagnosis" but shouldn't such a diagnosis be considered preliminary until the clinician makes the actual diagnosis and then gives orders?

Nurses are smart yes, but clinicians have much deeper training in pathophysiology and pharmacology. They also have the legal responsibility and liability for the diagnosis and treatments. Why are my instructors not sprinkling their lectures with statements like, "When the patient has XX condition, the physician will typically prescribe YY, which the nurse needs to understand is because of ZZ."? Why is there barely any mention of doctors and their orders?

[WookieeRN, BSN, MSN, RN]

Nurses make nursing diagnoses, not medical diagnoses. Nursing diagnoses are based off the patients response to a medical diagnosis.

[sara567]

A nursing diagnosis is what you will be doing for every patient. Without reiterating your entire lecture: go back and reread/listen. A nursing diagnosis and a medical diagnosis are totally different.

You will also be very well versed in this by the time you are done with school. There will be many, many, many care plans you will be doing.

[synaptic]

Usually nursing classes have NURS in front of them on the registration thing online.

[AJJKRN]

Your education, clinical experience, and hopefully eventual work experience is all teaching you how to anticipate and troubleshoot what is going on with your Pt. The NURSE is the APP's (advance practice providers) eyes and ears and the NURSE is often the one performing the assessment while gathering data and anticipating/troubleshooting any possibilities to stabilize the situation with relaying all back to the APP. The NURSE will often be carrying out the orders and plan of care. If you want to be a NURSE then please get familiar with the term "critical thinking".

APP orders, standing protocols, ACLS & BLS are all implied as a NURSE will practice within their scope.

[TheCommuter, BSN, RN]

We are discussing taking a history, performing a physical assessment, MAKING A DIAGNOSIS, DEVELOPING A PLAN OF CARE, implementing and evaluating the plan of care.

You've just summarized the nursing process of ADPIE (Assessment - Diagnosis - Planning - Implementation - Evaluation). Yep, you're learning to become a nurse...

[sailornurse]

I just completed the first week of my BSN program.

Wow, one week? Did you ask your instructor to explain before coming to AN? it's going to be a long couple of years for you if you do not clarify in class.

[akulahawkRN, ADN, RN, EMT-P]

You've just summarized the nursing process of ADPIE (Assessment - Diagnosis - Planning - Implementation - Evaluation). Yep, you're learning to become a nurse...

OP: This is what's going on. You're learning how to be a NURSE. Along the way you'll learn a LOT about the MEDICAL side of things but in nowhere close to the same depth as any Medical Practitioner. The principal reason for doing this is to allow you to anticipate MEDICAL orders for care and to be able to implement parts of the MEDICAL care plan. You'll be implementing a NURSING CARE PLAN on your own and in concert with a Medical Practitioner who cannot tell/order you NOT to implement your Nursing Care Plan because that's not their domain or their focus.

You're one week into a program that will span at least a couple years of academic life. You'll learn a LOT between now and graduation.

One other thing to remember: the diagnostic process used by Nursing, Medicine, and Auto Tech is identical. You gather data, you evaluate the data and come up with a diagnosis, develop a plan to rectify the problem, implement it, and evaluate your plan's effectiveness. Here's where they differ: it's all in the focus. You will diagnose, it just won't be a MEDICAL diagnosis.

Don't get caught in the trap of thinking you can porifice a Medical Dx into a Nursing Dx. While it is possible, to do that you must have such an in-depth understanding of Medicine that you can take that Medical Dx right back to it's physical exam and testing basics and develop your Nursing Care plans from that. Otherwise there's NO WAY to go from one to the other. Likewise you cannot go from a Nursing Dx to a Medical Dx without going all the way back to the initial assessment data that drove the diagnosis in the first place. Yes, you'll be dealing with the same assessment and test data but Nursing and Medicine branch off from there very quickly. So... don't bother with trying to interchange the two.

Later you might be able to anticipate certain nursing diagnoses from medical diagnoses, but without seeing the patient for yourself or seeing the assessment data, you can't be certain that your anticipated Nursing Dx is correct.

In case you haven't caught on by now, I have used "assessment" a lot. That's key because you need to let the assessment data drive your nursing diagnosis process. If you always do that, you'll always do the Nursing Dx process the right way.

[applesxoranges, BSN, RN]

As a nurse in the ER, it is my responsibility to have an idea of what we may do for a patient. Patient with chest pain? I need to get a green tube, blue tube, purple tube, and possibly a dark green if the facility does point of care trops along with an ekg, chest xray, etc. D-dimer and other tests may be added on. If the person is younger, the plan may be altered.

Nursing is no where near as hard as MD or DO training. We don't need to know as much. However, I generally need to know what I want when I ask the doctor something. Hey, patient is X. Can we do this?

[Horseshoe, BSN, RN]

Your focus will be on nursing, but you also have the understand (to a degree) the medical process. You have to anticipate what the medical provider will do so that you can perform the nursing aspect. Yeah, in real life, docs may forget to order that much needed diuretic for their patient. Do you, as the nurse, tell yourself "Well, that's a medical intervention. Not my concern or job." No, you call the doc back and say "Hey, I noticed you didn't order a diuretic for Mrs. Jones. You want me to add one? She's pretty wet and says she weighed 10 lbs. less two days ago."

Patient care is a collaborative effort and most providers appreciate and depend upon the nurses to not only carry out orders, but to think critically and advocate for the patient. To do so, the nurse must understand not only their own scope and role, but that of the other team members so that they can recognize when something is either wrong or omitted.

[RunBabyRN]

One way of looking at things is this: doctors treat a group of symptoms. Nurses treat the entire person. We are, as said above, the eyes and ears for the APC/APP. We are the ones with them 99% of the time. The MD may see them here and there, and in some cases, it's only YOU. I was working in outpatient urology, and the patients saw a provider for about 5 minutes once a year, whereas they saw me about every 3-5 weeks. I had to know whether their UTI warranted a culture or antibiotics. I had to know whether their blood pressure was high enough above their baseline to call their primary doctor. I had to know when I needed to drag in the MD or the PA, even if the patient wasn't on their schedule. It was ME. Now I'm in labor and delivery, and the MD might poke in here and there while mom is in labor, but otherwise, MD doesn't make an appearance until mom is crowning. It is ME the rest of the time. So I need to know when mom's pain is bad, her magnesium needs to be stopped, her dizziness warrants a bolus of fluids, etc. Much of the time, doctor's orders are what the nurse tells the doctor to write. You need to know what's going on with your patients.

Additionally, you need to look at how they're tolerating medical treatment. Is being confined to a hospital bed because they are on fall precautions making them delirious? Or is that their infection? How might you improve their orientation? How might you keep them from pulling out their Foley? What about the patient who doesn't want their family to know how sick they are, and they're trying to appear stoic when they have 9/10 pain and they know their time is limited? You're the one fielding the family's questions and caring for the patient and hearing what's really going on in their head.

Also, as stated above, we are the patient's advocates. We need to know what's going on medically in order to do this properly. If a doc prescribes a medication that the patient can't afford, often we are the ones who hear about it from the patient, and are asking the MD to change the meds.

Remember that you are a week into your program, and you have MUCH to learn. Instead of asking why you need to know this, appreciate just how much nurses need to know. I know I was in awe that first week of my program, and very overwhelmed. It will all make sense as you go along. Nurses don't just carry out MD orders. We are so much more than that.

[Karou]

I just realized you were the OP in the thread where you wondered if you're wasting your time learning how to do thorough head to toe physical assessments.

You seem educated, intelligent. How much did you research about nursing before you decided to enter a nursing program? You seem unclear on what a nurse is expected learn and do. I realize you will learn this, but I would think you would have a slightly more clear understanding of the career you are choosing.