Differential diagnosis: NP or CNS?

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Specializes in Med surg, cardiac, case management.

I'm kind of curious which type of APN is more associated with differential diagnosis.

When I'm at clinicals and I see a patient who's having difficulty I wonder what about their treatment could be improved....ie "Mrs. Smith seems increasingly confused. Is it her condition, her age, or her medications?"

I remember being originally told that this was a function of a CNS; however, I also know that NPs do this as well (though perhaps more at a primary care rather than hospital level).

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Specializes in FNP.

Differential diagnosis is something I do with every patient I see in the clinic settiing. (I'm an FNP). I expect it would be the same in any setting. Otherwise you could be missing things, to the detriment of your patient.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I'm kind of curious which type of APN is more associated with differential diagnosis.

When I'm at clinicals and I see a patient who's having difficulty I wonder what about their treatment could be improved....ie "Mrs. Smith seems increasingly confused. Is it her condition, her age, or her medications?"

I remember being originally told that this was a function of a CNS; however, I also know that NPs do this as well (though perhaps more at a primary care rather than hospital level).

Differential diagnosis is a term used in Medicine to describe the steps a clinician undertakes in analyzing a patient's presenting complaints, signs and symptoms to uncover a medical diagnosis or clinical disorder. It involves ruling out possible causes of the presenting signs and symptoms to arrive at a conclusion of, in the clinician's expert opinion, "what is wrong with the patient".

Since many NP roles overlap with medicine, NP's are trained in differentail diagnosis and always utilize it in their practice. CNS, on the other hand, may use differential diagnosis in states where their roles overlap with NP's. Differential diagnosis is not a nursing function, thus, is not a traditionally CNS role.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Good explanation, pinoyNP Thank you.

Joe, check out this thread about NP and CNS.

Different roles for CNS's??? Come on guys share what you do!

As pointed out, it depends upon the state BON if CNS SOP is same as NP. Some states do not recognize the CNS.

In Illinois, for example, the CNS and NP are the same.

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Specializes in Med surg, cardiac, case management.
Differential diagnosis is a term used in Medicine to describe the steps a clinician undertakes in analyzing a patient's presenting complaints, signs and symptoms to uncover a medical diagnosis or clinical disorder. It involves ruling out possible causes of the presenting signs and symptoms to arrive at a conclusion of, in the clinician's expert opinion, "what is wrong with the patient".

Since many NP roles overlap with medicine, NP's are trained in differentail diagnosis and always utilize it in their practice. CNS, on the other hand, may use differential diagnosis in states where their roles overlap with NP's. Differential diagnosis is not a nursing function, thus, is not a traditionally CNS role.

So is diagnosis then always a medical, not nursing, function? And does that mean that NP is a medical, not nursing, role?

A tricky question, I know. But one question that has periodically dogged me is "Should I become an MD instead?". I never wanted the intense focus on the pathophyiology of disease that characterizes the MD, I always wanted the broader focus of the RN.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
So is diagnosis then always a medical, not nursing, function? And does that mean that NP is a medical, not nursing, role?

The APN is a nurse who overlaps in medicine. So, to answer your question, yes, we provide medical diagnoses. I diagnose every single time I see a patient.

Here is a thread you may find helpful with this discussion:

Do NP's Practice Medicine?

And, this controversial thread:

Curious...using the title "Doctor" for a DNP...

I'm glad to see you asking questions about the roles, Joe. Keeping informed, gathering the information, making the final decision about what you want to do in life........very good!!

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As a psych CNS, I do not (cannot, in my state, and don't want to) Rx meds, but I certainly diagnose psychiatric disorders and practice differential diagnosis all the time and Rx (and provide) psychotherapy and other psychotherapeutic interventions.

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Specializes in Med surg, cardiac, case management.

I'm glad to see you asking questions about the roles, Joe. Keeping informed, gathering the information, making the final decision about what you want to do in life........very good!!

But I wonder if this is premature...I've only had clinical rotations in med/surg, rehab, and psych. I won't get into ICU, OB-GYN, or peds until fall or next year, and I don't know if I'll get an opportunity to see ER or OR.

I struggle to figure out what I want to do because I've seen so little.

Which may be an issue with the direct-entry MSN: You're pushed to be an APN but haven't had a chance to get a broad view of the field.

I've always had an interest in pain management and palliative care, and to a lesser extent oncology, but that still doesn't provide very specific guidance....

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Specializes in Education, FP, LNC, Forensics, ED, OB.
But I wonder if this is premature...I've only had clinical rotations in med/surg, rehab, and psych. I won't get into ICU, OB-GYN, or peds until fall or next year, and I don't know if I'll get an opportunity to see ER or OR.

I struggle to figure out what I want to do because I've seen so little.

Which may be an issue with the direct-entry MSN: You're pushed to be an APN but haven't had a chance to get a broad view of the field.

I've always had an interest in pain management and palliative care, and to a lesser extent oncology, but that still doesn't provide very specific guidance....

Gathering information and researching the different specialty areas of nursing and/or medicine is never premature, Joe. You have a small "taste" of nursing and medicine. You have inner stirrings about this and you know you want to have something to do with one or the other.

Nursing (Advanced Practice as in NP, CNS, CRNA, CNM) is a blending of nursing and medicine. If this is something that interests you, you are doing the right thing by asking questions here. You also, might shadow an NP or CNS (or other APN) to see what they do on a daily basis.

I agree that it is difficult for many who are not nurses, yet in programs that take them straight to the APN role. I've often wondered how one can say with total clarity, what they want to pursue if they've never worked as a nurse? I've also said, "how can one advance their practice/role as a nurse without nursing experience". But, it's all an individual choice.

Keep on asking the questions, researching........you'll finally make the right decision for yourself in the end. It may be nursing. It may be medicine.

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Which may be an issue with the direct-entry MSN: You're pushed to be an APN but haven't had a chance to get a broad view of the field.

...

This is one of the (several) problems many of us have with the whole idea of direct entry MSN programs. How can you know with any confidence that you want to specialize in a particular advanced practice nursing role if you have no experience with nursing, period?

I have known (so far) a few DE grads who found out after they had invested the time, effort, and expense in completing an expensive and demanding DE program that they didn't like being an NP, CNM, etc. -- now they're stuck with a degree and career track that they don't want, and have to spend lots more $$$, time, and effort to get into something they do.

It is a very common experience for nursing students to begin a nursing program sure that they are most interested in, and definitely want to specialize in, one area of nursing, only to find that, by the time they graduate, they have developed completely different interests and end up pursuing some entirely different area of nursing (I was one of those people ... :)). That's fine and works very smoothly for "regular," generalist nursing graduates, who can change specialities as often, and as many times, as they can talk someone into hiring them into a new area -- but it doesn't work for APNs ...

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I'm kind of curious which type of APN is more associated with differential diagnosis.

Hmmm I don't really follow your question but I will shoot for an answer.

As a functioning FNP I consider and write down my differential diagnosis almost all the time. This was one of the larger factors I was taught by several doctors / NPs / PAs I have worked with over the years.

1) One its good practice

2) One can't remember everything so if/when the patient comes back it helps keep track of thought process.

3) The primary diagnosis could be affected by the differential diagnosis but at the time of appointment there was no way of knowing. The differential diagnosis could actually be the correct diagnosis but it's too early in the process to differentiate.

The main point is: If the patient's condition does not improve, the diagnosis must be reassessed.

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