PMHNPs - also doing primary care? - page 5

by myelin

7,138 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


  1. 1
    Totally agree with you...as a Psych NP we can manage 'some' problems and I use the term 'some' lightly for a reason. If you are treating manageable symptoms like changes in BP, as a result of an antipsychotic, yes. If you are treating a UTI, Diabetes, Hypothryroidism...NO...and before the messages start, yes, you may have done this in your practice and never had an issue but, beware. As a psych np, you are not trained to manage diabetes even if your seroquel, abilify, zyprexa or risperdal caused it.
    There seems to be a thought that since some psychiatrists engage in such practices Psych NPs can too. Well, we can until something happens and it becomes an issue. Case in point, a great friend of mine (a psych NP) worked on an inpatient unit and would round for extra money on the weekends. It was a free standing MH hospital. A patient came in and had to have meds reconciled. The covering doc gave initial orders, but the NP changed the orders once she assessed the Pt as he stated he was taking something else. She changed his insulin to what he thought he was taking which ended up being the insulin he actually had a reaction to. She not only loss her job, she was sanctioned, fined and sue for a lot of money. Her lawyer who was a former psych np herself provided this wonderful pearl:
    Psychiatrists are MDs who have to rotate in all areas of medicine before specializing. Psych NPs choose to their specialty to practice in psych. You may treat minor medical issues that may arise out of side effects of antipsychotic meds, but diabetes, hyper or hypothyroidism is not a minor medical issue. UTI's are medical issues and although you may know how to treat them, you were not trained to treat them and can be sued if what you are prescribing causes an unintended/adverse reaction. If you want to treat physical health conditions, go back and get certified as a FNP. Needless to say she no longer practices.
    I am certified as both as have seen both sides of this issue. FNPs prescribing high doses of seroquel as sleep meds and psych nps prescribing synthroid without any real knowledge of treating thyroid disorders.
    All NPs need to understand the fundamentals. Psych NPs need to understand how physical health conditions and medications affect psychiatric disorders and psychotropics. Understanding and treating is two very different concepts that often get blurred in our profession. You may be asked to engage in such practices, but I would caution you if you can not prove in you training that you completed clinicals and coursework to treat physical health conditions, you need to thinik twice before treating.
    elkpark likes this.
  2. 0
    Bits and pieces about my perspective on things mentioned in this thread:

    1) Psychiatry is an art AND a science.

    2) As a whole, I give meds 20% of the credit; the other 80% is on the client.

    3) I remain aware of medical Dx's that might mimic any given psych, and certainly I'll order tests to rule in/out a medical cause of presenting symptoms, but to Rx meds to treat things like HTN, diabetes, pain, hypothyroid, pernicious anemia etc. adds significant risk to my license; I opt to refer. Put it this way...patient come in with BP 195/101 (no other symptoms). Assuming the BP is not a SE of my Rx, do I order clonidine 0.2 mg daily, or tell them to get to the local urgent care/ER? Have I any any way whatsoever done anything which could possibly bring harm to the patient with the latter suggestion? Can the same be said of the former? Which of my actions are more easily defended in court/before the BON, should they follow my treatment plan and something goes tragically wrong??

    4) Benzodiazepines = a pill form of alcohol. Is it good medicine to tell someone to have a shot of tequila TID PRN anxiety? Long term use ultimately worsens anxiety, depression, ST memory deficits, etc. That said, I avoid the words "always" and "never". Short term, PRN use while waiting for the SSRI to do it's thing can be a reasonable option...fortunately not the only option, though.
  3. 0
    Quote from PMHNP10
    Put it this way...patient come in with BP 195/101 (no other symptoms). Assuming the BP is not a SE of my Rx, do I order clonidine 0.2 mg daily, or tell them to get to the local urgent care/ER? Have I any any way whatsoever done anything which could possibly bring harm to the patient with the latter suggestion? Can the same be said of the former? Which of my actions are more easily defended in court/before the BON, should they follow my treatment plan and something goes tragically wrong??
    Just wondering why you would use Clonidine in this case (doesn't fall into hypertensive urgency/emergency range and med is not typically first line antihypertensive choice). Also, why daily dose for a drug that is usually started BID.
  4. 0
    Mostly it was to demonstrate my point that i dont treat HTN. I just pulled the first med that came to mind without giving any further thought such as if on any other anti hypertensives or dosing. Fwiw I've rx'd kapvay for ADHD which calls for bid dosing, so the form with a reduced half-life isn't a daily med.
  5. 0
    Quote from PMHNP10
    Mostly it was to demonstrate my point that i dont treat HTN. I just pulled the first med that came to mind without giving any further thought such as if on any other anti hypertensives or dosing. Fwiw I've rx'd kapvay for ADHD which calls for bid dosing, so the form with a reduced half-life isn't a daily med.
    Got it. Just a friendly reminder on my part...there are people on this site that are quick to point out things and that's understandable in a professional forum like this.


Top