Nurse Practioner Diagnostic Ability

Nursing Students NP Students

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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?

Specializes in Med/Surg/Telem.

Thank you for backing me on the DNP thing (people are very particular about semantics here, I'm not publishing this in a magazine for Christ's sake), where I am schools are also going to DNP programs only.

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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.

Nursing, whether as a generalist or an advanced practice nurse, is "in" the field of nursing. There is nothing about pharmacology, anatomy, or pathophys that is unique to medicine. People from a number of different disciplines study these subjects and use them in lots of different ways besides practicing medicine.

In my psych CNS program a hundred years ago, the content of my graduate program was v. similar to what the social work interns and psychology fellows with whom I shared clinical placements were studying in their programs. We had a number of seminars together at the clinic, and we were held responsible for a lot of the same knowledge. However, that didn't change the fact that my classmates and I were studying to beome CNSs, the social work interns were studying to become social workers, and the psychology fellows were studying to become psychologists.

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Specializes in Med/Surg/Telem.

I didn't even know you could become a PA without a Bachelors degree in something. Maybe out of the military? Not sure. I'd have to check that out.

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Specializes in Med/Surg/Telem.

Well call me crazy but I consider psychology to be in the medical field as well and any social worker that works in a medical facility also works in the medical field in my book, we all have varying degrees of knowledge and scopes of practice, but to me its in the medical field.

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Yes, you can be licensed in Florida as PA with an Associates degree in PA studies.. Prescription Privledges and everything.

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Specializes in Med/Surg, Ortho, ASC.

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):

Likewise.

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Specializes in Critical Care.
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?

JD offered you the same information I was going to. I think the important point to take from this discussion is that NO ONE practices in health care alone. MD's all the time consult other services for areas they aren't familiar with, why should NP's be any different?

As someone else recommended, why not shadow a few NP's for a clear cut idea as to what their practice entails? I'd especially encourage it for, as it's been discussed, each state has its own restrictions/practice issues that its NP's must follow. It would not make sense for me to share with you how an NP practices in Michigan (where I live) if you don't live here as well.

I'd have to question if you're truly understanding the concept of the scope of an NP. You've brought up a couple of times now the diagnostic ability of an NP,if it's more restricted than an MD. The issue is actually a complex one. For example, I am starting an Acute Care NP program this fall. I have 13 years experience in Critical care and specifically love the cardiac surgery patient population I work with. Once I'm an NP, I can't wait to come back to my ICU and have the autonomy to manage critical patients. I have NO desire to work with general patients with chronic issues, say in a family clinic setting. Does the fact that I won't be certified in family care and can't see pediatric patients mean I'm less than a general practice MD or FNP? No, it means I'm practicing in a different area. Would they be able to come to my unit and manage what I deal with? Nope, doesn't mean I'm smarter, again just means I specialize in a different arena.

I think the easiest way to answer your question is that the question itself is flawed. You're looking to compare apples and oranges. Are NP's as able as MD's to manage patient conditions in their area of specilaity? Yes. Does that mean I'm going to be able to be as good as an MD who's had over 20 years experience in the acute care setting? Of course not, not necessairly because I won't be an MD but because they have more exprience and hopefully have learned from those experiences.

You mentioned if you don't plan on going to nursing school if you aren't able to overcome this deficit, as you perceive it. (I'm paraphrasing here.) I'm going to suggest that nursing may not be for you. This is entirely my opinon, which is very limited due to the circumstances of posting on a BB and interacting through the internet. I think the key to nursing is understanding it IS different than the medical model. That's what I'm proudest of. I do things MD's can't do and by the same token, they do things I can't do and honestly have no interest in. That's not saying I can't diagnose a disease because I can. It's just different. Based upon your posts here, my suspicion is you would not enjoy the nursing model. But again, that is my opinon, based upon very limited information.

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Specializes in Critical Care.
Thank you for backing me on the DNP thing (people are very particular about semantics here, I'm not publishing this in a magazine for Christ's sake), where I am schools are also going to DNP programs only.

No one is jumping down your throat but your initial reply to the OP contained incorrect information, which other members are trying to politely correct. Your comment "I'm not publishing this in a magazine, for Christ's sake" is interesting as it seems to support your idea that it's ok to relay incorrect information. That's definitely not a professional attitude to take. If you come on this board and post authoratively that you have correct information, you shouldn't take it personally when you are corrected.

You then go on to use other people's posts as evidence that nurses "eat their young" and if we as nurses started working together we could make a positive change for nurses in this country. As someone who is working VERY hard to make such a change for nurses, that comment is frankly nonsense. The majority of posters here are attempting to help someone seeking out information. If we don't share correct information, then this entire thread is useless. Again, please check your facts before posting information as if it's written in stone.

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JD offered you the same information I was going to. I think the important point to take from this discussion is that NO ONE practices in health care alone. MD's all the time consult other services for areas they aren't familiar with, why should NP's be any different?

As someone else recommended, why not shadow a few NP's for a clear cut idea as to what their practice entails? I'd especially encourage it for, as it's been discussed, each state has its own restrictions/practice issues that its NP's must follow. It would not make sense for me to share with you how an NP practices in Michigan (where I live) if you don't live here as well.

I'd have to question if you're truly understanding the concept of the scope of an NP. You've brought up a couple of times now the diagnostic ability of an NP,if it's more restricted than an MD. The issue is actually a complex one. For example, I am starting an Acute Care NP program this fall. I have 13 years experience in Critical care and specifically love the cardiac surgery patient population I work with. Once I'm an NP, I can't wait to come back to my ICU and have the autonomy to manage critical patients. I have NO desire to work with general patients with chronic issues, say in a family clinic setting. Does the fact that I won't be certified in family care and can't see pediatric patients mean I'm less than a general practice MD or FNP? No, it means I'm practicing in a different area. Would they be able to come to my unit and manage what I deal with? Nope, doesn't mean I'm smarter, again just means I specialize in a different arena.

I think the easiest way to answer your question is that the question itself is flawed. You're looking to compare apples and oranges. Are NP's as able as MD's to manage patient conditions in their area of specilaity? Yes. Does that mean I'm going to be able to be as good as an MD who's had over 20 years experience in the acute care setting? Of course not, not necessairly because I won't be an MD but because they have more exprience and hopefully have learned from those experiences.

You mentioned if you don't plan on going to nursing school if you aren't able to overcome this deficit, as you perceive it. (I'm paraphrasing here.) I'm going to suggest that nursing may not be for you. This is entirely my opinon, which is very limited due to the circumstances of posting on a BB and interacting through the internet. I think the key to nursing is understanding it IS different than the medical model. That's what I'm proudest of. I do things MD's can't do and by the same token, they do things I can't do and honestly have no interest in. That's not saying I can't diagnose a disease because I can. It's just different. Based upon your posts here, my suspicion is you would not enjoy the nursing model. But again, that is my opinon, based upon very limited information.

Thanks for your answer, but the two things I bolded in your post make no sense to me. First, did you even read my question? It says do NPs in THE SAME FIELD as an MD necessarily have the same diagnostic ability. Your response is that I'm comparing apples and oranges and that each different field has different abilities...but I asked, within the field, can the NP diagnose as many ailments as the MD?

Second - I never called it a deficit or used the word overcome. I said I want to be a NP (possibly) because I'm interest in the challenge of treating complex patients and want to make sure that I will, in fact, have the education necessary to treat complex illnesses and conditions. I think I'm allowed to ask that question before committing my life to something, don't you? I find it very annoying that everytime someone questions an aspect of nursing, people are quick to say "Nursing is not for you!!!!" It sort of upsets me that instead of encouraging me to explore career options and ask questions, current nurses and more inclined to discourage me and other prospective nurses from going into the field.

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Specializes in Psychiatry, ICU, ER.

Wrong thread!

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Wrong thread!

.......huh?

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Specializes in Cardiac.

SyberianPuppy...

There is a definite reason why the people on this website question one's motive on why they want to become a nurse. You stated in your original post that you have always wanted to be a doctor but due to time spent with patients and cost you wanted to become a nurse instead. People here take great offense to those that think that becoming a nurse is the "low road" compared to being a doctor. The roles of nurse and doctor GREATLY vary!! As for MD vs NP, both may taught nearly the same material, but the roles vary GREATLY!! You seem to be hung up on what diagnostic skills you will be taught in nursing, but what you need to consider is the rest of the nursing profession.

My suggestion is this: if you heart lies in becoming a doctor, then money should not be the issue (you will make plenty enough in the future to pay for your student loans). If, on the other hand you want to become a NURSE practitioner, then you should want to become a NURSE FIRST!! 1) you need to get accepted to nursing school, 2) you need to graduate from said nursing school, 3) you need to get your license, 4) you need to gain experience as a NURSE then you may apply to an NP school.

Do not put the cart before the horse......

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