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?

[msn10]

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.

As an educator for ADN, BSN, and now MSN students, let me say that as an NP, your diagnosing ability is only limited to by your experience and your pursuit of additional educational opportunities after graduation; you won't learn all you need to in school whether you are a physician or NP.

You do have a scope of practice per your state, however. As an example: An FP or IM MD or DO usually wouldn't diagnose cancer because quite frankly, they could be sued because it is out of their scope of practice. They would refer to an oncologist if they believed there was a chance of CA.

The one statement you made about nursing being a reactionist model I believe is incorrect. I would bring that same question to a nursing instructor and see how they feel about it. It would take way too long on this thread for me to explain how nursing should be the exact opposite of that statement. BTW a PA is much more reactionist than an MD or an NP.

Lastly, IMHO, don't go into nursing just because you want to be an an NP. An NP is a nurse and us regular nursing instructors see many new students who want to do advanced practice without even understanding the foundation of nursing first.

If you want complete autonomy, no supervision, and all of the diagnosing and prescriptive authorities you desire, without worrying about what state you are in, than I suggest you consider medical school.

[guest_57352]

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......

What the hell?? When did I say becoming a nurse was the low road? My statement was: Shadowing MDs, I found that they spent too little time with patients and so I'd rather be a NP. Is it wrong of me to want to spend more time with patients?? Is choosing to go into the profession for that reason somehow "incorrect"? I never degraded the NP profession at all!! I said I wanted to be a doctor, but after research decided a better fit for me would be a nurse practitioner. It was you who assumed that switching from MD to NP was the "low road" - not me.

And once again, everyone immediately jumps on my case and tells me I shouldn't be a nurse or a NP. Newsflash people: Not every nurse was born with some inherent, inborn love and knowledge of the nursing profession. I'm allowed to consider other careers before settling on nursing. I'm allowed to ask questions about nursing. Ultimately I will decide what's best for me, and weighing pros and cons, I'd rather be an NP than a doctor. So please, stay on topic, and stop trying to tell me that I shouldn't be a nurse, etc - because I'm ignoring those comments. They are discouraging and not helpful at all.

Second - when did I say I didn't want to be a nurse first? I said my goal is to be an NP, but does that mean I can't enjoy nursing along the way? Once again, everyone jumps down my throat and tells me I can't do this because of whatever reason...you guys have to stop acting this way toward potential nurses...

[msn10]

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.

Dear Op,

That was your original question, but you stated you shadowed a doctor first and you are comparing the md model with the nursing model. Yes, there have been a few snarky comments on this thread, and we all should be behaving like professionals.

With that said, many other nurses are giving their viewpoints based on your question. I believe, from what I see our NP's learning is not as intense as the md students/residents. Not the NP school isn't tough, but the MD's residency is just that, they stay overnight, they are on call, and they are pretty much brutalized in rounds if they do not diagnose correctly. One of the facilities I teach at is a very large medical complex that has medical school students and nursing students. We have 6 NP programs:

Adult

Older Adult

Acute Care

Health Care Systems Leadership

Acute Care Pediatrics

Primary Care Pediatrics

Nurse Midwifery

So we have a variety of specialties and in our state, NP's have prescriptive authority and are completely independent. Our NP's are very good at what they do and they have more time with the patients. But even though they are independent, most still work for doctors or clinics and do not have the autonomy you may be searching for.

[highlandlass1592, BSN, RN]

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.

Many people have posted replies to your questions and tried to answer them to the best of their abilities, myself included. For some reason, instead of understanding what these answers are saying, you are spinning of in a different direction. Then accusing others of not being on topic..so not true.

I'm going to try one last time: if I'm not able to help you or you continue to take offense (which is what is coming across in your replies to my posts and others) then I'll bow out of your thread.

YES, NP'S IN THE SAME FIELD AS AN MD MAY HAVE ENOUGH EDUCATION TO INDEPENDENTLY DIAGNOSE. I can't make it any plainer. As an NP, I can diagnose any and all condtions, I can diagnose all day long. You speak of wanting to know if you'll have enough education to diagnose complex ailments...you will have all the education you want.

I never said you degraded the profession. My problem with your questions regarding NP's is that inherent in your question : "It says do NPs in THE SAME FIELD as an MD necessarily have the same diagnostic ability." is that somehow the education of an NP might be somehow inferior to that of an MD. What I and many others have tried to explain to you (and that you're just not getting)is that the education is DIFFERENT. When I graduate and pass my board, I will be bringing 17 YEARS of education to the table...what will be 17 YEARS of experience in Critical care. As a nurse, I am continually striving to educate myself because I and many other nurses realize that school in no way prepares you to be a nurse. Your real learning takes place after school, just like it does for MD's.

As for my suggestion that nursing may not be for you, you call that "discouragement". No, I'm not trying to discourage you from asking questions nor from entering the profession. I and others here have tried to share with you insight that based upon your posts, you may not be happy as a nurse. You are not speaking of the nursing model of care, which is HOLISTIC care for the patient but the ability to diagnose MEDICAL illness. I am not sure how much plainer I can make this for you. If you only seek to make a MEDICAL diagnosis, not seek to provide holistic care...then nursing may not be for you.

Nursing isn't JUST about the illness...it's about SO MUCH MORE. That is why many of us have chosen the profession. Yes, you have the right to explore any profession before you commit thousands of dollars to education and highly recommend that exploration. Nursing school is hard...period. It takes just as much commitment and endurance as training to be any other professional. You have an advantage: you are able to come on a nursing bulletin board and ask questions of professionals already practicing and reap the benefit of our knowledge and experience. Don't get mad at us for sharing just that experience. Don't tell us that we "tear down our young" for asking questions.....that comment really works me up. It always seems when an experienced nurse is asked an opinion then when the questioner gets an answer they don't like, somehow we are "eating our young". Ok, I'm over that now.

To be a nurse or not to be a nurse...true, only you can decide. Again, as I told you earlier, if you have questions about NP's and their abilities why not set up an interview or shadow experience? Ask them directly these types of questions and see about their answers. As many of us have tried to explain to you, training in NP school is not standardized; it will vary from school to school and from state to state. And an important point to consider is to become an NP, many schools require you to have job experience prior to applying. That experience counts as education...it's education on the job. And no one statement can attest to the practice of all the various NP's out there, they all have different areas of speciality which will require different skills. I will be bringing that to the table when I am able to call myself an NP.

I'd encourage you also to explore the idea of holistic care vs. strictly medical care. It was just such an exploration that helped me decide between going to NP school instead of PA school. Nursing is a complex profession, with many sub-specialities. It's difficult to make blanket statements regarding how we ALL do things.

Again, no one here has "jumped down your throat". Be responsible, be professional in your posts. We are trying to help you but you're taking our input and turning it into personal attacks. If you ask for help, then don't allow anyone to help you, it's not our fault if you don't get the answers you seek....if you feel people are "jumping on you" maybe you need to rethink the way you are posting. Sometimes, we have to realize when we point one finger at someone else, we've got 4 fingers pointing back at ourselves. Time for some reflection.

[linearthinker, DNP, RN]

The OP is far too stubborn to be a successful NP, lol. FWIW, I did answer your question in the NP forum. The answer is, certainly, but it depends on the individual. You need to grow up and calm down before deciding upon what to have for breakfast, much less what do do with the rest of your life. Good luck.

[JaxPA]

although there may be pa's around with an aa, they are rare, and that would be one salty pa. the pa programs have not offered aa's in many years. now, all programs require a 4 year degree prior to enrolling in a pa program, and most require you to take the mcat. most have changed to ms programs. very few bs pa programs still exist. the military program, ipap, is a masters program. i work in neurosurgery. we have two pa's and two np's. we do exactly the same job. both are great certifications, each with little advantages over the other. what it all comes down to is what track you happen to fall in during your education. i was an rn for 7 years before going to pa school- it was just a better fit for my situation. now just to get all you np's upset... i would say the pa track is more difficult... i don't know any pa programs that allow you to work a normal job during the week, do correspondence or internet courses... ha! end result... pretty much the same dern thing.