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Joined Feb 10, '06. Psychcns is a Psych APRN. She has '30' year(s) of experience and specializes in 'Psychiatric Nursing'. Posts: 882 (44% Liked) Likes: 857

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  • Aug 13

    To the APRN hecklers, critics and malcontents.Many of you say that your MSN nursing education has too much “fluff”, referring to classes like cultural competency, and management that have no relevance to your jobs. I have read very little about how you will address this with the people that accredit NP curriculums.

    I am not sure of the credentialing process at all but I did find the American Association of Colleges of Nursing on the web and this seems like a place to start. In 2013 they developed NP competencies in which we are all expected to be proficient.

    These competencies expect cultural competency, trauma informed care, as well as all the things you complain there is not enough of such as pathophysiology, pharmacology, physical assessment. I have been in nursing since the early 80’s and have been through a few transitions in health care and in my own nursing career. Now I just try to keep up. I have no venom to toss at nursing leaders. I am very grateful to the nursing profession for my livelihood. I work locum tenens as a psychiatric APRN. My advanced practice nursing skills allow me to find work in interesting settings on a limited basis. This semi nomadic lifestyle is mine by choice. Everyone wants to hire me permanently.

    The APRN role exists because of the dedication of nursing professionals with advanced degrees who have done the hard political work of fighting for the opportunity for all of us to practice to the full extent of our education. This means that our education prepares us to diagnose and treat illnesses in our respective specialties. We have a record of patient outcomes similar or better than MD’s. We are not MD’s and we are not junior MD’s, we are nurses. If we were MD’s we would be regulated by Boards of Medicine, physician extenders of some sort. As nurses, regulated by Boards of Nursing, we are eligible in many states for independent practice. There is an overlap between MD’s and NP’s and this is where a lot of NP’s and MD’s practice: Seeing patients one at a time in inpatient or outpatient settings. Since we are doing the same job as MD’s in many cases we do need to catch up on their rich science background and the intense mentoring they get in residency.

    Or we can wonder how much education do we or they really need to do this job? We probably do not need nursing theory at this stage of our development as a profession though I did like my theory classes. We probably do not need healthcare management classes though I learned in those classes also. In today’s day to day NP jobs we need to keep our diagnostic and prescribing skills sharp to give patients the best care that we can. We often have MD role models and some are surprised we are doing the same jobs as them and many are happy to consult on cases and make use of their intense education. To my colleagues who are angry with the nursing profession that benefits you, I would encourage you to review the history of nursing (we were housecleaners one hundred years ago), and as science developed nurses had to fight the AMA to be professionals as opposed to handmaidens or servants.

    At one time only an MD could take a blood pressure. Now we are fighting for the right to practice to the full extent of our education. We are nurses and we need to continue to define ourselves differently from physicians. That we are different from the medical profession has benefited us politically and gives us the responsibility to self-regulate our profession.The people with the energy and aptitude to criticize should learn to become political. Start by looking up the website I note above and figure out how to have input into curriculum development. You might have to join a committee. This is how hard work often starts. As in today’s general politics it is possible the nursing leadership is losing touch with its base.

    Those who see what needs to be done would benefit all of us by becoming active and help to maintain and improve standards and influence the direction of the nursing profession.Best wishes.

  • Aug 13

    Also, call the person who is prescribing your
    medication, tell him/her you are still depressed
    and you would like a referral for counseling. You
    do not have to suffer alone. Give yourself
    time to heal..

  • Aug 13

    You might want to get some psychotherapy to help you sort everything out and be successful at the new job. Best wishes.

  • Jul 30

    OP-since you have an interest in addiction and pain management, have you considered any additional certification. There is CARN (certified addiction registered nurse). I think there is alsocertification in pain management nursing. As elk park says, working with these patients takes expertise and sensitivity. Why not learn more about it. I would think the pt would need to manage her pain without triggerring a relapse or at least be ready to deal with a relapse. I bet there is a role for nursing in all this. At very least to learn how to best support the patient. Best wishes.

  • Jul 28

    Methadone uses a harm reduction model. It stabilizes the persons opiate addiction so they can develop coping skills. I worked in methadone for several years and I was always intrigued why people stayed on it. People organized their lives around getting their daily dose between 6am and9 am and there was mandatory individual and group counseling.

  • Jul 7

    Methadone uses a harm reduction model. It stabilizes the persons opiate addiction so they can develop coping skills. I worked in methadone for several years and I was always intrigued why people stayed on it. People organized their lives around getting their daily dose between 6am and9 am and there was mandatory individual and group counseling.

  • Jul 6

    I drive on long, winding, country roads. The roads are paved here--always a shock when I come to the United States from my expatriate home in Costa Rica. I am in the first world now: it is early spring, still chilly from winter, no leaves on the trees. I am in my second locum tenens job ever--the lady on my GPS directs me so I don't get lost. I provide psychiatric care in a rural setting where patients have poor supports, poor health, and poor dentition. "Working here is like being in Appalachia." My colleague says. I am given a schedule of continuous appointments. The mental pain that people bring to me is draining. My role is to provide psychiatric diagnoses and to prescribe medication for their mental disorders.

    I am trained as a therapist--psychopharmacology came later. As a therapist , I learned how to connect with people, how to provide a safe environment, and how to draw out a history. As a psychopharmacologist, this approach helps me to find symptoms that I can medicate. I try to listen, with all my senses. I am alert for counter transference, the feeling the encounter elicits in me. "Tell me your understanding of why you are here today. What's going on with you?" I say.

    And their replies: "I don't like being around people." "I moved up here to be close to my kids and now they don't have time for me." " I suddenly found myself with a loaded gun in my mouth. I thought I was dreaming." "I was drinking and I ran my car off the road-I could have killed someone." "I can't sleep." " I get panic attacks when my uncle visits." "My boyfriend abused my daughter." "I sexually abused my daughter when she was 7."

    Staying with myself I am grounded. I start with what I am told and look for ways I can be helpful. I ask questions. I provide emotional support. I end each session handwriting a few prescriptions while I mentally review the encounter to see if I missed anything. Sometimes patients need medications but can't afford them; in these cases, I may give samples or choose from the Walmart prescription discount list.

    Time passes and the work gets easier. I am still swimming in mental anguish, a new patient every half hour, but I am getting used to it. Sometimes, I have a patient new to the facility and I can spend one and one/half hours doing a full diagnostic assessment. People wait months for these full assessments and look forward to finally having the possibility of some relief. I now have friends at work--clinicians I can talk to, a great support staff, and a helpful supervisor. My company finds me a house, a large homey condo with high ceilings so I can move from the hotel. I join a club so I can swim after work. Now, after hours of immersion in human misery, I swim refreshing laps. Driving home in my rented Nissan, I feel my tranquility and my humanness. I take care of myself. I no longer am drained. I can be there for my clients.

    I meet a hospice nurse. We reflect on our jobs, how it can be difficult to find peer support. "We are in the deep waters." She says. I feel brave to dive into other peoples hell and help them bear their feelings. I talk to my husband in Costa Rica every day on the telephone. He can't listen to much about my work day. "It's hard enough for me to keep my own head above water." He says.

    When I see a patient for a follow-up session, I often find that the meds I chose are working. People tell me: "I am sleeping through the night." "My anxiety is better." "My depression has gone. I feel like myself." "I feel better-no more mood swings." "I don't want to kill myself anymore." When people give me this feedback, I feel a sense of accomplishment. I tell myself I am a good clinician. I also know that patients can improve due to many factors including the placebo effect of medication, the relationship effect of the therapeutic encounter, or just the passage of time. What I love about my work is to know that I am a witness, or sometimes a guide, to an inner psychological place of mental and emotional healing. Sometimes I feel profoundly honored to participate.

  • Jul 1

    12 hour shift sound awful. I work as a APRN and when I'm inpatient I work with a lot of staff nurses. I don't think it's as task driven as MedSurg. And depending on the unit there is interdisciplinary collaboration, and nurses opinions and observations are valuable. If you are thinking of being a psych NP, inpatient psychiatric experience would be very helpful. You would learn a lot about diagnoses and management of patients and medications all of which would be very helpful for you as a psych NP.

  • Jul 1

    If you are willing to move how about locums to permanent positions. Or get a recruiter.

  • Jun 29

    Methadone uses a harm reduction model. It stabilizes the persons opiate addiction so they can develop coping skills. I worked in methadone for several years and I was always intrigued why people stayed on it. People organized their lives around getting their daily dose between 6am and9 am and there was mandatory individual and group counseling.

  • Jun 24

    Methadone uses a harm reduction model. It stabilizes the persons opiate addiction so they can develop coping skills. I worked in methadone for several years and I was always intrigued why people stayed on it. People organized their lives around getting their daily dose between 6am and9 am and there was mandatory individual and group counseling.

  • Jun 14

    I have been doing locums for the past few years as a Psych APRN. I am expected to assume a full pt load with minimal orientation and to be able to navigate the system to complete work.
    I think a regular job in a collegial environment would be much more supportive. I think the first few months a new PMHNP should have a reduced workload to have time to consult and look things up though I suppose not everyone needs this.

  • May 27

    @travelNP
    i have to start asking for more.Last year I went from $60 to $75 just by saying "I want..." And when a previous gig wanted me back, I said. "I make $75" they said "We'll give you $78". I should have asked for more." I will next time. Thanks.

  • May 26

    I worked in methadone maintenance as an RN a long time ago and there were always debates about the model. Clients found it stabilizes their addiction and their lives. Counseling was mandatory. Clients organized their lives around their dosing schedules with some driving many miles to be dosed between 6am and 9am when the clinic was open. A lot of axis 2 patients. Methadone seemed to have a psychological function as well as limitating craving for opiates. I learned a lot there.

  • Apr 18

    I do locum tenens as a psych np, inpatient and outpatient. I graduated from a good program in 1994, have had really good supervision over the years, went to a lot of conferences, and now I read a lot. Outpatient can be draining but I do 30 minute visits and do as much therapy as I can. Inpatient is, in some ways, a more reasonable pace but it is challenging dealing with complex medication regimens and the legal system. I think psych is a great field.


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