New NP and Psych Pts

[newnp2012]

I originally posted this yesterday but apparently it was lost in the database issues they had last night.

I am a new np working in a family practice. Alot of my pts have depression and other psych issues I need help on how to manage, switching medications or which would be best for certain types of psych issues, etc. I feel so defeated sometimes! How long did it take you to feel comfortable in your position to where you didnt feel as though you had to look everything up?? Does this NP thing ever get any easier???

[zenman]

I wondered where my reply to you went! Get the book "Psychiatry Essentials for Primary Care," by Schneider and Levenson. It's a great book that all primary care providers need.

[harmonizer]

Also please refer to psych providers when appropriate.

I saw patients coming to ER with major psychological issues (bipolar, major depression, suicidal) with no psychiatric providers for years and inadequately managed by primary care. It's a liability if you do not refer.

[BCgradnurse, MSN, RN, NP]

I was in your shoes 3 years ago. I worked as a primary care NP in an area where psych providers were scarce. I used the book Zenman mentioned as my go-to reference. Patients with any hint of suicidal or homicidal ideation were sent to the ER, but follow up often came back to the PCP. It stinks for the PCP and patients; it's not the best way to care for patients with significant MH issues, but sometimes there are no other options. In my area, the average wait time to see a psychiatrist/ psych NP is 4 months, unless you have really good private insurance. You can't leave these patients untreated for that long. Talk to your colleagues and see how they deal with these patients. It does get easier, but try to refer if you feel a patient is too complex.

[harmonizer]

BCgradnurse, You must be in a shortage area then. I am always able to make appointment for them to see a psych provider within a month. A lot of these patients still only have primary care provider. Maybe the patient failed to follow up due to distance and etc..

[BCgradnurse, MSN, RN, NP]

It's a combination of poor/no insurance and lack of providers. There were a few agencies that would see these patients, but they required the patients to have 3-4 visits with a therapist before they could see a prescriber. It took 6-8 weeks to have that initial therapist visit. So, the responsibility for prescribing fell on the PCP, and we were not all that comfortable with it. We didn't spend a whole lot of time in school on psychopharmacology, unfortunately. To be honest, it's one of the reasons I left primary care.

[mammac5]

LOVE your comment that, "We didn't spend a whole lot of time in school on psychopharmacology..." Very true in my experience as well. I recall in one lecture presentation on psyciatric issues in primary care there was a LOT of talk about refer, refer, refer to psych. I raised my hand and asked how would we handle this in my rural area where psychiatrists are few and far between and there is no one to refer to. Although I know the lecturer meant very well, the truth is that when you're in an academic setting and in an area with multiple universities, it may be easy peasy to refer to psych. Not where I live!

The truth of the matter, in a rural area, is that people end up being brought to the ER over and over and over again by law enforcement. They are started on meds that they may never refill secondary to noncompliance, side effects, finances, etc., and have no follow up. Many have been dismissed from primary care practices in the past after "failing" urine drug screens; sometimes they are legitimate abusers, sometimes they are self-medicating for their psych issues. At any rate, it's hard to find PCP for these folks.