Nursing: what is it?

[Adcadet]

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I read something today from a somewhat official source that said something like (I'm paraphrasing as I just quickly skimmed it at the time) "nursing has changed a lot - now it includes diagnosis, prescribing treatment options, and helping patients get better..."

Perhaps I'm naive, but does nursing fundamentally involve diagnosis and prescribing treatment? With the exception of nurse practitioners, and maybe CRNA's, I didn't think nurses could or would do either of these two things. Perhaps I'm just being old fashioned.

(before anybody flames me, please realize that I have the upmost respect for nurses. A significant number of family members are nurses and I have great respect for what they do. Furthermore, I've had the privilage of working with some truely phenominal hospice nurses.)

 

[Street Philosopher]

Originally posted by Adcadet
A significant number of family members are nurses

why not ask them?

 

[Adcadet]

Originally posted by Street Philosopher
why not ask them?

1. They're not near by (well, actually one of them is about 50 feet from my one day/week in another office, but I never see her)
2. They seem to be older nurses and do not follow this "newer" model that I'm wondering about.

 

[oldman]

so far no response eh? did you ask in the nursing forum?

 

[oldman]

i guess everyone is cutting into our business. if you didn't know, the pharmD students learn how to do history and physicals.

 

[MacGyver]

Actually it doesnt surprise me at all if regular nurses (non NPs) do diagnosis and treatment.

Doctors have been very passive and greedy--a few of them support advanced practice rights for midlevels so they can hire them at 1/3 the cost of another doc to their practice and make some $$$$

 

[Whisker Barrel Cortex]

There has been a change in nursing for the better and it includes diagnosis and treatment. The nurses spend much more time with the patients in the hospital than physicians and can learn a great deal about the patient that the doctor can't.

In diagnosing, nurses will often be the first ones to let the medical team know that she suspects the patient is aspirating when they eat ("He coughs severely every time he has a meal, I think he might be aspirating"). They can help diagnose depression in the hospital when the medical team does not pick up on it in their 5 minute visit with the patient. If someone is unsteady on their feet or has orthostatic hypotension, the nurse can diagnose and tell you about it.

In prescribing treatment (not medication) nurse often assess the needs of the patient that we cannot and order some treatments or recommend them. At our hospital they can arrange PT or OT without medical orders. They perform non-medical treatments that we are often not aware of that contribute to the overall wellness and comfort of the patient.

So, this line is not an example of nurses trying to overstep their duties. It is an example of what nurses can do to help both the physician and the patient throughout a hospital stay.

 

[Adcadet]

Originally posted by Whisker Barrel Cortex

In diagnosing, nurses will often be the first ones to let the medical team know that she suspects the patient is aspirating when they eat ("He coughs severely every time he has a meal, I think he might be aspirating"). They can help diagnose depression in the hospital when the medical team does not pick up on it in their 5 minute visit with the patient. If someone is unsteady on their feet or has orthostatic hypotension, the nurse can diagnose and tell you about it.

Good examples, and I believe these things happen often, and it's a great contribution nurses can make, but the nurses in these cases are not actually making the diagnosis - they're sharing their observations and opinions with the medical team. In the end it's still the doctor (MD or DO) who makes the official diagnosis. Am I wrong here? Or do you think this is the extent of what nurses can do in the realm of diagnosis (with the exception of advanced practice nurses)?

 

[Adcadet]

Originally posted by oldman
i guess everyone is cutting into our business. if you didn't know, the pharmD students learn how to do history and physicals.

Yeah, but I've also heard (from a PharmD student/grad) that the history and physical part is extremely cursory and minimal. On the other hand, I've seen a PharmD acting as an attending in a medical specialty (very specialty) clinic where he truely was an expert due to his research interests and academic work. I have no idea where he learned to interview patients or do counseling work. But he's good at it.

 

[Adcadet]

Originally posted by Whisker Barrel Cortex



In prescribing treatment (not medication) nurse often assess the needs of the patient that we cannot and order some treatments or recommend them. At our hospital they can arrange PT or OT without medical orders. They perform non-medical treatments that we are often not aware of that contribute to the overall wellness and comfort of the patient.

Will these treatments be covered by insurance if they are not prescribed/ordered by a physician? What if the prescribed treatment is against the better judgement of the physician?

 

[pricenicurn]

I think what the original poster is referring to are Nursining Diagnosis which are totally different than medical diagnosis, but related. I can give a few examples to explain and I do not think they step on doctor's toes, but compliment the healing process which is supposed to be the ultimate goal. In most states only Registered Nurses can initiate these care plans and not LPN's. They are covered by state Nurse Practice Acts.

Being a NICU RN a few we commonly use are.

Ineffective Thermoregulation related to effects of prematurirty as evidenced by temperature outside normal range of 36.5-37-1.

Implemented by:
Maintaining infant in thermo neutral environment as indicated by weight and age.
Maintaining infant in minimal stimulation environment.
Mainaining d-stix >40 by clustering care, administering food or TPN as ordered, etc
and so on

other common diagnosis for neornates, are
Impaired skin intergrity
Altered parenting
Impaired gas exchange
Infection
Altered Nutrition
Altered fluid balance


Nursing diagnosis can also be initiated as being possible "xxxxx" and preventive measures are initiated.

There are many books on the subject and this is just the basics. The idea was I think to formalize nursing activities so that they could be researched and improvements made and also to make nursing more of a "science" less or an "art.

David

 

[Febrifuge]

At the ED where I volunteer, sometimes the HUC or HCA who checks the patient in at the triage desk will type, for example, "injured wrist." The patient then gets interviewed by an RN, who takes vitals, hx, and sometimes some gross exam. Often, I'll see the RN change the stated complaint to something more specific and appropriate, for example "wrist pain."

That's just the tip of the iceberg, but until and unless the patient gets to a room and sees a PA/ MD/ DO who enters what ultimately turns out to be the actual, medical diagnosis, that listed complaint is essentially it. It's the 'nursing diagnosis,' it's the 'working diagnosis,' it's just the complaint. In any case, it's the RN who first determines what's listed as "CP" vs. what's "SOB" vs. what's "URI sx."

As an EMT, what I would do would be called 'assessment,' but it's all pretty fluid; some things are relatively easy to diagnose. I would think that this new description of what nursing entails is just a way to acknowledge what we all know-- that every member of the care team has a part to play, all of 'em are important, and few elements of care are the province of one and only one level of provider.

I wouldn't draw too many conclusions from it, really, aside from the fact that good nursing is getting the respect it's always deserved. I still would rather practice medicine than nursing, but that's me. And it's nice to see that the assumption that 'nurses never make decisions' is receding.

 

[DocWagner]

In nursing it is the "diagnosis and recognition of SYMPTOMS not disease"...as told to me by a nurse educator that was posed that exact question.

 

[paramed2premed]

Only doctors diagnose.

Paramedics may find a patient with history of orthopnea, swelling ankles, and discontinued diuretic use, perform a physical edema that reveals crackles, dependent edema, as well as ST elevation in the precordials, make a field assesment of pulmonary edema, possibly complicated by anterior MI, intiate treatment with nitrites and diuretics, and choose an appropriate destination hospital based upon the patients presentation.

But paramedics do not diagnose. They aren't trained for that.
😛