Nurse Practioner Diagnostic Ability

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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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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.

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Specializes in Med/Surg/Telem.

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.

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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?

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Specializes in Med/Surg, Ortho, ASC.
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.

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Specializes in cardiac electrophysiology, critical care.

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

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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.

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Specializes in cardiac electrophysiology, critical care.
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.

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Specializes in Critical Care.
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.

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Specializes in Critical Care.
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.

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Specializes in Oncology.
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.

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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! :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.

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