PMHNPs - also doing primary care? - page 4

by myelin 7,381 Views | 44 Comments

Hi everyone, I have a quick question. I was meeting with a student who is in the PMHNP MSN program that I am due to start next fall, and she made some interesting comments. She basically said that PMHNPs can sometimes be expected... Read More


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    Quote from mtsteelhorse
    "You never know, you might love stats. I hate most math, but I really love stats."

    Where did you take it? Online by chance?
    No. I dislike online education, personally. I took it in-person at a university, my professor was fantastic. Coming to class every day and engaging with my professor on a personal level made me really love the subject. Stats is great. It propelled me to go on and take more advanced stats courses later on.
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    Quote from Psychcns
    When then the PMHNP role came along in the 90's, it appeared it would allow the APN to do primary care and Psych..after you do your physical exam you do your mental status and you treat everything..
    My training was in therapy (and meds) and I was horrified...
    I currently do only med mgt,(only locums)
    I would like to know more about treating primary care problems because I think it helps my med management ( thank you Trauma for the reference info).
    40 hrs per week of med mgt can be draining--it works for me doing it as a locums..
    Hi, could you describe what a typical med management session is like? I'm strongly considering PMHNP and my primary interest is medication management (with a little bit of therapy). Also, as a psych NP, are you trained to do medication therapy management for other medications as well? For example, can you give med therapy management to a dialysis patient? Not diagnose or treat them, but just to help them manage their meds?
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    Let me break this down for you. If you didn't take 3-4 courses in primary care plus 500 or so hours in primary care, stay away from it. Psychiatrists can do what they want as they learn and have clinical in all areas. However, most that I know stay away from anything other than their speciality.

    I've had horrible results from primary docs and NPs trying to dabble in psychiatry and it's taken me months to get a patient straightened out. On the other hand, you must know all medical conditions that effect psychiatry or mimic psychiatric symptoms as well as all medications that might cause psych symptoms or interfere with psych meds.

    Benzos are for short term use and not with all patients, not recommended for PTSD for example. It can take years of agony for some people to get off them.
    Last edit by zenman on Jan 14, '13
    elkpark likes this.
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    Quote from Applehead

    Hi, could you describe what a typical med management session is like? I'm strongly considering PMHNP and my primary interest is medication management (with a little bit of therapy). Also, as a psych NP, are you trained to do medication therapy management for other medications as well? For example, can you give med therapy management to a dialysis patient? Not diagnose or treat them, but just to help them manage their meds?
    @applehead--typical med management session--
    People come to you because they are suffering. Usually you do a diagnostic evaluation where you ask questions about chief complaint, history of present illness, past medical and psych history etc. you are looking for a diagnosis, and for symptoms you can medicate. The more a patient feels they are comfortable with you, the more they may tell you, the better you become at choosing medications
    At med follow up visits, you want to know if the medication is working, are there side effects, are there labs to order? I also discuss symptom management, use of therapy, sleep hygiene if sleep an issue, and whatever else comes up but I keep it focused on meds and symptoms because this is why the patient is seeing me. I also review their most recent therapy note if available and ask about how therapy is going.
    If they are not satisfied with their meds, I discuss alternatives--ie trying a different med, raising or lowering the dose, adding a med etc
    A lot of the session is forming a relationship with the client and engaging them in choosing a medication that will make their life more bearable.
    Hope this helps
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    And I have a soldier coming today to resume services (new to me) and he's been on 11 meds at one time or another. Psych can get pretty challenging.
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    As an RN (PMHNP wanna be) I see a LOT of veterans on long term benzos. What's up with that?
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    Quote from mtsteelhorse
    As an RN (PMHNP wanna be) I see a LOT of veterans on long term benzos. What's up with that?
    Benzos are here to stay. They seem to work for some. If people come to me on benzos I try to change them to something long acting like Klonapin. Sometimes they are fine changing to non benzo like buspar or SSRI. I teach about the addictive quality of benzos and after a while you are medicating withdrawal. I also sometimes tell people on benozos that they have to be in therapy to learn coping skills.
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    Yeah, clonazepam is the one I see used most often.
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    A lot of providers not keeping up with latest data is why you see benzos for PTSD.
    elkpark likes this.
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    Quote from zenman
    A lot of providers not keeping up with latest data is why you see benzos for PTSD.
    I stay away from Klonapin for PTSD. Try to convince pt to try prazosin or clonadine. Effexor maybe. Exposure based therapy or EMDR effective, I am told..at least to some extent.


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