Independent practice Psych CNS

pennyroyal · Dec 4, 2005

I have been practicing independently for about 20 years. I have had a psychiatrist colleague to whom I referred for medication. In the early days nurse's did not have prescriptive rights and now I choose not to have those rights due to high insurance costs and other considerations. Finding good psychiatrists especially for children and adolescents in my area is difficult. Your question was do psychiatrists use me. They refer patients for therapy some times. Those are not always the best referrals.I find that my practice is self referring and that the best referrals come from satisfied consumers. One major problem that I have is if I do want to work for someone else in this area it seems that I have to work as a Social Worker and for what they get paid. All the APRNs (CNS and NP) are used as medicine prescribing machines and do not do therapy or much health teaching. There do not seem to be jobs for CNS, only RN,C.

elkpark · Dec 4, 2005

I agree with with pennyroyal said. In the 20 some years that I've been in psych nursing, nearly all of the CNSs I've known have had private, outpatient psychotherapy practices -- that used to be the main reason for becoming a psych CNS. When I went to grad school 11 years ago, I was considered quite an oddity because I prefered working in acute, inpatient settings -- all my classmates intended to be outpatient therapists in private practice.

The CNSs I have known in private, independent practice typically have had an informal relationship with at least one psychiatrist, to whom they would refer for medication (when indicated) and if insurance companies required that the person be seen and referred by a psychiatrist before they would pay for therapy. The psychiatrists also referred clients to them for therapy, but they were not "employed" by the psychiatrists.

Now that Rx authority has become an option for psych CNSs in so many states (not mine, thank goodness!), psych CNSs in those states are mainly employable for prescribing and med management. I interviewed a few years ago for a position in the state next to me and was told that, because CNSs can get Rx authority in that state, I would be expected to get Rx authority ASAP and be utilized by the clinic to see people for 15 minute medication appointments. I was also told that no one in that state would be interested in or willing to hire me as a psychotherapist, because my time was so much more valuable writing scrips. Of course, if you have your own practice, it is entirely up to you how much time you spend doing therapy and how much time you spend pushing pills.

The psychiatrists I've known over the years who have employed nurses have generally employed NPs to do H&Ps and med management. They have not employed CNSs as therapists, because you can hire social workers and LPCs as therapists for a lot less money.

Over the years I've been a (child) psych CNS, I've worked in acute inpatient settings, outpatient clinics (community mental health centers, as an employee), and have done a very limited amount (by my choice) of independent outpatient psychotherapy. If I wanted to do more of that, I would certainly be able to.

Whispera, MSN, RN · Dec 12, 2005

I'm a CNS who works part time with a gang of psychiatrists. I'm considered one of them in some ways. I have my own patients that I assess, diagnose, and treat (including prescribing and monitoring medications).

Psychaprn · Apr 19, 2006

I work in a private gp. practice, employed by a collaborating Psychiatrist and a PHd.(They own the practice. ) I see therapy patients and do med management.

MSNpsychnurse · Sep 12, 2006

I would very much appreciate any advice you could give me re: getting started in terms of affiliating with a gp, psychiatrist, or other practitioner; also in terms of getting a provider number/on insurance panels. Some info for you: I am credentialed via the ANCC, the prescribing priv. issue is not an option here in PA.

Thanks for your help.