Nurse Practioner Diagnostic Ability

[guest_57352]

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?

[JTworoger]

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.

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.

[guest_57352]

I've researched all about NPs, PAs, and MDs. I don't think an NP is like an MD. I'm asking for current NPs or NP students to simply give me an idea of how far in depth they believe their diagnostic abilities go. I'm asking if they feel they can diagnose the majority of illnesses themselves, based on symptoms and tests, or if they feel they can only diagnose the most basic things.

I know a patient can go to the hospital for something simple, say a URI, and see no one but the NP. The NP can order the URI test, interpret it, and prescribe the necessary antibiotics. The NP can then discharge the patient - the entire process was lead completely by the NP with no input from the doctor, as this is a common thing.

My question is - at what level does the NP education begin to falter? How complex can a case be before the NP has to call in a doctor. That's what I'm trying to ask: I want to know the limits of the NP's diagnostic abilities and medical education. I can't get that from reading general overviews from Wikipedia. I'm trying to be proactive and go to the source - asking NPs and NP students. Could someone relevant please answer my question and stop trying to judge the reason for my asking or my "inability to research"? Thank you!

[roser13, ASN, RN]

OK, so we have a temper. Let me make a couple of points:

First off, the majority of the responses that you apparently consider irrelevant (as in "10 comments and you're the only one to respond to me!"), were trying to help you gather correct information, since one of the initial responses was misleading and just plain wrong. Don't worry, though. I for one will not bother to correct any more off-base posts.

Secondly, if you are only interested in NP's' input why did you post your question in the General Forum, rather than the Advanced Practice forum? That way "someone relevant" may answer your questions, although perhaps not to your satisfaction.

[apocatastasis]

that's why the scope of an NP's practice is roughly half that of an MD's.

There are scopes, not a or the scope. And for some specialties, the scopes of NPs and MDs are similar (e.g. psychiatry).

[guest_57352]

lol, I don't have a temper at all. The inability to offer inflection and tone on a forum leads to misunderstandings such as the one you just experienced.

I posted in General because I posted the same thing in the NP forum, but it's a MUCH less active forum. It's been there for over 24 hours and I've not received one response, so I decided to post it here too.

Finally, I am grateful for the correction of misinformation, but 10 responses to that and not one actually answered my question about the level of understanding NPs have.

So, back on topic now!

[79Tango]

"I'm asking for current NPs or NP students to simply give me an idea of how far in depth they believe their diagnostic abilities go. I'm asking if they feel they can diagnose the majority of illnesses themselves, based on symptoms and tests, or if they feel they can only diagnose the most basic things."

The answer to this could be very subjective. Every NP or PA is going to have a different "level of understanding." Ive seen NP/PAs consulting RNs before making a diagnosis. In fact, Ive seen CNA and EMTs who also feel they have in-depth diagnostic abilities.

[guest_57352]

"I'm asking for current NPs or NP students to simply give me an idea of how far in depth they believe their diagnostic abilities go. I'm asking if they feel they can diagnose the majority of illnesses themselves, based on symptoms and tests, or if they feel they can only diagnose the most basic things."

The answer to this could be very subjective. Every NP or PA is going to have a different "level of understanding." Ive seen NP/PAs consulting RNs before making a diagnosis. In fact, Ive seen CNA and EMTs who also feel they have in-depth diagnostic abilities.

Agreed, but I was hoping for more concrete answers. I.e. - "I can diagnose 95% of what comes in. If someone comes in with a strong headache and I find a spot on a CAT scan, I definitely don't feel comfortable calling it a tumor. I need an MD to come in and look at it."

See what I'm getting at here? I just want to know...how far an NP can go before they have to pull back and call in an MD. I'm not talking about "referring to specialists" - all MDs and NPs do that. I mean a FNP calling in a generalist MD to make a diagnosis due to lack of knowledge. Boiled down:

How often does the average NP feel "stumped" when presented with a case, and have to refer to an MD (in the same field as the NP) who ultimately makes the diagnosis?

[JDPBSN]

Hi there I’m and Acute Care/ Critical Care NP student. Here are some answers to your questions. After looking at your last comment, the reality is this… Your comment on “95% of what comes in” bothers me. I don’t think most MD’s can diagnose 95% of what comes in without consulting attendings, specialists and experts in a particular field. Medicine is just too complex and no one is the see-all-end-all, hence the terms specialist and expert in practice. If you come out thinking as an NP, or even as an MD, you can diagnose anything that comes through the door without referring or consulting, you would be danger to the population period.

- In most states the NP has a collaborative agreement with an MD/DO, i.e. looks a few charts a month, available for phone consult, can see a patient that is beyond what I do/comfortable treating, covers me when I’m out of town. Some states require supervision—working with the MD/DO in the setting. As stated, “you are technically under the doctor”, this is not true. You have your own license; you recognize what is beyond your scope, refer and consult with attendings, and specialists. Going into court and saying “well that’s what the doctor said and wanted…” will not fly, you would be held accountable and so is your license.

- There are different NP roles and educational preparation. Although the same degree (MSN/DNP) different scopes and population of patients provided for. Pediatric NP, Adult NP, Geriatric NP, Family NP and the Acute/ Critical NP- the title suggests their populations.

- Yes, we learn diagnosis and symptomatology—comparable to the MD/DO, but pertaining to our population. Some practice more holistic and use the nursing model as a guide, whereas some adopt more of a medical model because that is the setting we practice in i.e. hospital wards. Yes, we can prescribe narcotics—but state specific.

- There are NP residencies available post graduation, or you are taught/ precepted under practicing NP/DO/MD’s until deemed competent in that specialty.

- The DNP is a real movement, whether the state/ nursing organizations adopt this or not. Most schools are leaving the MSN for advanced practice nursing and moving towards the DNP. There are 3 NP programs in my city, 2 which have moved their NP’s completely to the DNP. NP’s are getting 55-60+ credit hours in a masters and the hours in this degree are close to a doctorate level as they stand.

- My diagnostic abilities are clearly this: I am boarded pertaining to my specialty, I can treat and diagnose according to my states laws/ hospital policies, I know what my training consisted of and practice within that mindset, if I want to do something beyond my initial training—I get adjuvant training and documentation/ credentialed, and always practice within the scope.

I hope this helps. Please be aware that some schools require an X number years of experience as an RN, before NP matriculation. As stated, there are NP forums. You should shadow an NP for a day.

[irishrnbsn]

Sorry, I should have clarified I live in Florida, so calm down before jumping down someones throat. All you had to say was it is different in different states. In Florida you have to have an agreement with a physician to work, see below from the Board of Nursing and you cannot prescribe narcotics here as an NP either (PAs can):

An Advanced Registered Nurse Practitioner shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist. The degree and method of supervision, determined by the ARNP and the physician or dentist, shall be specifically identified in the written protocol and shall be appropriate for prudent health care providers under similar circumstances. General supervision by the physician or dentist is required unless these rules set a different level of supervision for a particular act.

It goes on to say that it is up to the ARNP and MD to come up with said agreement being very specific about everything the ARNP is allowed to do so it looks like it depends on what the MD you are working with is comfortable with you doing. Just because the state says you can, it is up to this agreement.

Also some colleges here in Florida are dropping ARNP programs and only offering DNP degrees, this may have to do with the state or our patient population. Many doctors I work with seem to believe that MDs are going to become pretty scarce and DNP is the way to go.

[irishrnbsn]

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.

What field would you consider nursing in, if it requires no medically based learning? I'm pretty sure I had to learn alot about medication, anatomy, pathophysiology, etc to get my nursing degree. No, it isn't to the extent of Doctors and I didn't say it was, I comparing NPs to PAs at that point. It's true nurses have a different approach to caring for patients, but we still know what's going on in the body.

[irishrnbsn]

I apologize for all those that have attacked you, you can easily see why you hear "nurses eat their young" frequently. If we would stop b*tching at each other, and instead worked together, maybe we could make some positive changes for nurses in this country.

[79Tango]

What about a FL PA that is practicing with an Associates degree? Can they be compared with a MSN or NP?