Content That Psychcns Likes

Content That Psychcns Likes

Psychcns 10,879 Views

Joined Feb 10, '06. Psychcns is a Psych APRN. She has '30' year(s) of experience and specializes in 'Psychiatric Nursing'. Posts: 823 (42% Liked) Likes: 739

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  • Jun 24

    I would also recommend arranging for some help with the child care end of things. You might be able to find coverage for 100% of your private practice patients, but maybe not. You might feel best in the long run if you plan to see a few of those patients (a couple of hours per week?). Pre-arranging some help with the baby care would probably make that possible.

    That's the burden of solo practice.

  • Jun 22

    you can't argue with goobers, and that's Fox's demographic. Let 'em cluck & coo to themselves, the next story they'll post is about how they can't find Doctors who speak engrish, and another one will be about how wonderful it is to de-fund colleges.. People who support & agree with Fox's "fair" reporting are really bad at connecting the dots.

  • Jun 20

    I am not an NP, but used to have a job as a CNS where I interacted with medical supply companies, infant formula companies, etc. all the time. I required them to call ahead and schedule a semi-appointment with me. For them to expect me to drop everything and spend 15-30 minutes with them at the drop of a hat was not reasonable of them -- and I told them so. They should at least call me the day before, give me an estimated time of arrival, and ask if I would have time to meet with them. They soon learned that if they just dropped in with no warning ... I would smile and politely tell them that I had a meeting to go to ... and if they wanted to meet with me, they should call ahead and get on my schedule.

    Hiding, etc. is not professional. Addressing them directly and asking them to treat you like a professional and be respectful of your time teaches them and establishes a professional foundation for your relationship.

  • Jun 17

    I've been seeing the same NP for my women's health for over two decades, I apparently like this arrangement!

    I like taking my kids to NPs as a first line of care because it's a little easier for me to participate in their treatment planning however I haven't had any difficulty doing the same with any of the MDs either. Any of them have been cooperative with my questions and requests for referrals. Having been blessed with excellent insurance (so far) my kids have been referred and seen by Stanford specialists whenever we needed to r/o potentially serious conditions. Heart murmur and atypical migraine symptoms, referred and evaluated timely by Stanford pediatric cardiologist and neurologist. Minor illnesses, worked out mutually agreed upon out patient treatments. What's not to be thoroughly satisfied with?

    Whether they like dealing with this mom is a whole 'nother topic but I think it's been okay

  • Jun 17

    Update: I got the job!!! [emoji2] Now to take/pass the board exam so I can start working this summer!

  • Jun 17

    Okay, educated ladies and gentlemen, lets be respectful of each others' opinions please!

    We cam RESPECTFULLY disagree without being DISAGREEABLE.

    Thanks....

  • Jun 17

    a counselor is not the same as other providers, in the way that they may provide advice to a patient. CBT is not about advice, but about assisting a patient in developing new ways of thinking. It takes a lot of experience to guide and lead questions in a manner that is beneficial to a patient.

    That being said, acute care is not the time for in depth CBT. CBT often involves "unbuilding" a client's foundation. It can be risky to remove a person's safety net and coping skills (even if they are not good ones) without being able to provide them with continued care.

    Maybe look up different kinds of therapy? I personally think that CBT is currently one of the buzzwords, which is probably why you landed on it

  • Jun 13

    Quote from Psychcns
    A CNS is an APRN with prescriptive authority in 36 states. My DEA calls me a mid-level practitioner. In many states CNS and NP are interchangeable.
    Honestly did not know that.... had no idea... my only experience with CNS's were masters prepared kind of "uber-nurses" that served as special clinical resource people and educators.

    Corrected.

  • Jun 11

    My psych NP took my family from a state of crisis due to one family member's psychosis to a state of peace, cooperation, love. No doctor even came close to helping us. We struggled for years before finding her. She is my rock.

    I personally know another psych NP with zero integrity.

    I worked with two psychiatrists; one of whom was a gem and one who was so-so.

    So I guess it depends.

    In primary care, I tend to prefer the MD when I am sick and the NP when I'm not. I prefer my WHNP to my gynecologist whom I despise for regular care because she makes a big deal out of everything. Period too heavy? Let's take out your uterus! Um, no.

    For my kids, I knew one NP who was so incompetent I had to tell the office not to schedule us with her. The others were great and so was the PA. One doctor was smart and a great diagnostician but rude.

  • Jun 11

    Totally agree, the threat of losing their (MD’s) cash cow incites defensiveness and/or “Might-Makes-Right” arguments. The medical professionals that maintain altruism are typically more understanding and look at evidence.

    I’ve yet to see any evidence that NP’s provide substandard care. Articles that attempt to, do so with anecdotal, opinions; not evidence. It doesn’t take much experience to find a doc with a false sense of entitlement. Likewise, as a profession, NP’s need to be diligent to maintain professionalism and the highest level of care. We also need to stick together. I’m amazed at home many NP’s are not involved with their local professional organizations or who are not involved with local and national legislation.

    Quote from BostonFNP
    How long have you been working as an NP? I only ask because some of your comments are typical reactions in the first year or two of practice.

    I think you really answered your own question: there are good/bad docs and good/bad NPs and good/bad PAs and good/bad patients. I actually have a term I use called the "trifecta" for the many patients that come to me on a benzo, stimulant, and a narcotic. Who knows that's treating what.

    I've found that most docs that have negative comments about NPs are not the "good ones" they are the ones worried about the $ not patient care.

    Do you think that psych NPs are better educated and prepared for practice in psych compared to NPs in primary care?

  • Jun 4

    I would think if the patient is competent, they have the right to refuse all treatment and/or leave AMA. That right is precious and patients who exercise that right should not be treated in a patronizing manner.

  • Jun 3

    Quote from FNPMRL3
    The problem is.......NP school doesn't train you to "hang with the big boys." It barely trains you to assess, diagnose, and prescribe......the first year is all about learning how to research......researching.....and writing about research.......it was a TOTAL waste of my time!

    .......
    My FNP program was structured differently than yours obviously. First semester was women's health taught by midwives and women's health NPs. We were together with the women's health & midwifery students. The midwife taught us pelvimetry! The WHNP taught us the tiniest details of each day of menstrual cycle, IUD insertion, and we had to know details on OCPs! Second semester was pediatric taught by pediatric NPs. We started doing clinical hours first semester for the specialties we were in. The roles/theories & research class were interspersed along with clinical courses but no I would not say my first year was a total waste of time considering also we were taking Advance pharmacotherapeutics taught by a PharmD the first year. Yeah we wrote quite a few papers for each class but my school was not big on this maybe because all faculty were NPs (program director who is Adult NP taught advanced assessment, 3rd semester) except for the PhD that taught research & one other that taught a Border Health class. So my last 3 semesters the focus was clinicals & perfecting what we learned first year; H&ps, labs/diagnostics, prescribing. They only accepted Ten students per year back then. I applied to this school for DNP, have The Interview 2 weeks. Their DNP is for for APNs only.

    Where did you go to NP school?

  • Jun 3

    Quote from Jules A
    But why? Why shouldn't we come out of school prepared to practice independently to the full scope of our license? Although a supportive environment would be ideal I don't think it should be expected. I have concerns the unreasonable expectations of extended orientations for new NPs hurts our credibility with physicians who expect us to be ready to practice. We have one, not even new just new to our specialty, who calls the physician before ordering a multi vitamin its embarrassing.
    .
    There is a learning curve of approximately 2 years, this is in general. As a FNP, primary care you see conditions & diagnosis you only read about. The multiple co-morbid conditions combined with polypharmacy & multiple specialists (cardiology/endocrinology/nephrology) for one patient are typically in family practice, along with women's health & peds, all this is challenging for a new grad FNP. Combine this with 15 min appointments, along with referrals, review of labs/diagnostics, prior auths for Meds not covered by pts insurance etc., it takes a while to develop comfort zone where one is safe, thorough, & efficient. Physicians get this adaptation phase during residency.

  • Jun 3

    Sounds like a rough start. I'm glad that you have a supportive chair, and hopefully the other MDs will change their attitude. Maybe you can prove them wrong Anyway, good luck to you!

  • Jun 2

    Personally, I would let it slide, cont to do my best, learn from your mistakes and go on.

    I respectfully disagree with above poster who (if you read his/her posting history) is extremely unhappy in general with their chosen career path.

    You can't always be in a warm and fuzzy environment - being an NP is not always a supportive role. However, sometimes we just have to roll up our sleeves and wade right in. I've been an APN for 10 years now and my practice is big (21 MDs now) and many varied personalities. And yes...they gossip sometimes. Here's some tips I've learned when I've goofed:

    1. Admit my mistake up front. No crying, no hysterics, just the facts.
    2 Come up with a plan to remedy it. In my worst mistake, I made a prescribing error which was exceedingly costly. I enrolled in an extra pharm course, took an additional 30 hours CME in pharm, sought additional advice from some trusted NPs I know (thank you Siri) and moved on.
    3. Don't participate in gossip. Be known as someone who might be aware of mistakes other providers' make but who doesn't repeat them.
    4. Sit in on exams of the MDs who are questioning you - even if it means you have to do so on your own time. This shows a commitment to the job and profession.
    5. Find a mentor - another NP who you admire and trust who can help you navigate the ropes of the practice. Consider joining your states' APRN organization.

    Being an APN is different than being an RN - the role is similar but the expectations and responsibilities are far greater.


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