Seeking info from NP specialty psychiatry

elkpark · Feb 24, 2015

There is no separate forum for specifically psych NPs, but there are lots of threads with discussion from psych NPs in the NP forum.

Jules A, MSN · Feb 25, 2015

What would you like to know?

thekid · Feb 25, 2015

Thank you for the replies.. I will be happy to do some searches with the search key. I guess my situation is a bit unique. I have the associates degree in nursing and have recently done some work as a psychiatric case manager (RN). It's not work I particularly enjoyed but boy did I get insight and experience with the SPMI patients (we contracted with an insurance company who provided medicaid and behavioral health services to disabled/poverty level). Aside from the many challenges of working in a "system" that I felt almost useless in, I have an interest in completing the master's level of education so that I could possibly open my own practice down the line.

The "system" rotated patients in and out of hospitals and different housing (like group housing, clean and sober housing, etc). I know this is par for the role, but I spent most of my time filling out housing applications or shuttling potentially violent patients to doctor's appointments, and then being part of discharge planning meetings with the insurance company who would question why our patients would end up back in the hospitals (one patient in particular would not stay in ANY housing and would choose to be homeless until her food stamps were used up, then she would state SI and end up back in the hospital, this was non-stop despite multiple interventions).

Before I divulge too much into a frustrating position, I am trying to be optimistic that there is still a method of treating people with mental illness and making it work (or at least alleviate some of their mental pain). Psychology and psychiatric medications are almost second nature to me, I don't really need to study to keep up with what is going in, it just comes very easy to me academically and also in the rare instances when I was able to help with medication management or deescalate a situation.

What I'm in most need of is a reality check, I'm in my early 40's and so I feel like I have some of the "hands on" plus "life" experience to pursue a master's degree and possibly be somewhat independent as a practitioner. But I don't want to jump from the fire to the frying pan. I don't want to believe that a master's degree will give me more opportunity to help , when it may just bring more problems . I don't want to pursue a master's for the increase in income, I really want job satisfaction.

I have , of course, googled and looked up various examples of where NP's can practice , but just like in nursing school, I don't want to graduate to find out I'm handling an overload of patients dictated by an insurance company. I hope this post makes sense. I also do not want to regret looking back on life and thinking I should have pursued the master's degree. Obviously a lot is going on in my head and I have done the positives versus negatives list, etc. My father was a very TYPE A personality and died at age 51 from heart conditions. I do not want to repeat history. I am just looking for clarity on what the NP job will really be like.

I have a young child, throw that into the mix.

Thanks for any advice.

Jules A, MSN · Feb 25, 2015

Psychology and psychiatric medications are almost second nature to me, I don't really need to study to keep up with what is going in, it just comes very easy to me academically and also in the rare instances when I was able to help with medication management or deescalate a situation.

So the above stuck out to me as either you are somewhat grandiose and think you don't need to learn about psych medications or perhaps I've lost something in the typed word and you are trying to point out that you feel you have an affinity for psych. As a RN exactly what type of medication management things have you been helping with?

Also your comment about the patient who won't accept housing please know this is not uncommon. What factors do you think are playing a part in her resistance to accept the help that is offered? What are your personal feelings about a patient like this? Just some things to mull over.

What you describe as the struggles in mental health are right on target and in my experience both in patient and outpatient as much of this is the vicious cycle our society has created since doing away with the long term facilities that, imo, so many of our patients desperately need. As a provider however I'm not doing as much of the direct dealing with the insurance agencies etc. as that is what our social workers and nurses take care of.

Psychcns · Feb 25, 2015

Maybe you could shadow some psych np's.

I do locum tenens and work as a provider 6 months per year. Inpatient and outpatient. Severely mentally ill to clinic. The setting, support, and team make a big difference in job satisfaction. I find it interesting and satisfying and by working in blocks of time I do not burn out. I study to keep up with new meds and therapy and now the DSM 5. I have psych work experience in 3 states and some states take better care of their mentally ill than others.

Jules A, MSN · Feb 25, 2015

Maybe you could shadow some psych np's.
I do locum tenens and work as a provider 6 months per year. Inpatient and outpatient. Severely mentally ill to clinic. The setting, support, and team make a big difference in job satisfaction. I find it interesting and satisfying and by working in blocks of time I do not burn out. I study to keep up with new meds and therapy and now the DSM 5. I have psych work experience in 3 states and some states take better care of their mentally ill than others.

Would you mind to share your experiences regarding which states you feel provide the best services for mental health care?

elkpark · Feb 26, 2015

Would you mind to share your experiences regarding which states you feel provide the best services for mental health care?

North Carolina used to have a v. strong public mental health system, but they did a "reform" a little over a decade ago that basically gutted the entire system. It's a shame.

Psychcns · Feb 26, 2015

I like Minnesota. They have several community free standing psychiatric hospitals throughout the state. I have my first assignment in one the end of the month. I have previous experience in a MN setting where people from these shorter stay places are referred for longer treatment. This place had a 3 month length of stay and a strong team and therapy component.

I also worked in MN in their state forensic facility-400 beds. This is a lot of beds. There is also a continuum of out patient clinics and group homes

NH on the other hand is under resourced. People spend a lot of time (days) in emergency rooms waiting for psych beds.

MA has had a lot of privatization and if something isn't making money it closes.

I read an article in NY times about a bus load of Nevada patients being sent to California because services were better.

Psych staff tend to be great to work with but the systems tend to be strapped financially. Psych is very hard mentally and emotionally and i think you need a good team environment to be effective.

PG2018 · Mar 4, 2015

In my area, there is such a shortage of Psych NPs (and psychiatrists) that supply and demand tips the favor to the provider. I can think of 5 out of 6 practice settings within a half hour drive that are kissing the bums of their psych providers to keep them happy. It's really a good field, but I feel like it's the "new CRNA" with a load of people outside the gate ready to run through. I'd say within five years the bottom will fall out.

I might add that there wasn't really anything about my undergraduate nursing experience that I really liked. Granted, my pathophysiology, pharmacology, health assessment, and to some degree research methods courses were fun and interesting. However, I didn't like any of the actual nursing stuff, i.e. OB/peds, community health, complex care, leadership, acute care, or foundational care. The primary care stuff in peds was ok, and some of the disease processes in acute care were appealing. I was otherwise neutral about my mental health course as it taught almost nothing about psychopathology or psychopharmacology.

My grad school courses such as advanced physiology and pathophysiology, advanced pharmacology for the prescriber, health assessment theory (the practicum was overly taxing), practice management, and especially psychopharm and my psych specialty courses have been super. I'm chomping at the bit to get into practice and participate in some awesome CME.

Jules A, MSN · Mar 4, 2015

In my area, there is such a shortage of Psych NPs (and psychiatrists) that supply and demand tips the favor to the provider. I can think of 5 out of 6 practice settings within a half hour drive that are kissing the bums of their psych providers to keep them happy. It's really a good field, but I feel like it's the "new CRNA" with a load of people outside the gate ready to run through. I'd say within five years the bottom will fall out.

Yup here also. It makes me shudder when I think of the glut of new providers with no experience in psych and no clue how to prescribe medications to this most vulnerable population.

Psychcns · Mar 4, 2015

I think with good supervision and an interest in therapy psych can be learned. I worry about the future and whether psych will be paid for. For a while it looked like it was going to be absorbed into primary care.