Addiction Medicine & NP role

AddictionNP, MSN, NP · Sep 16, 2019

I have a new grad friend who is a FNP and works in pain medicine/addiction and he loves it. I have a bit of a psych background and would love to work addiction medicine but there are no openings in my area thus I took a job in occupational medicine which I like as well.

Goodluck in your decision.

HAL_APRN19 · Sep 18, 2019

Thank you for your insight! I also have outpatient psych background; which is probably what makes me attractive to companies who have reached out and are actively considering me. What makes me hesitant is (what I feel) the potential for blurred lines within scope of practice to exist in these type of settings. I'm told I would act in a primary care provider capacity due to mental health patients suffering from comorbid diseases; however, wouldn't a PHMNP be better suited for these? Maybe it's my nerves working on me... I welcome all opportunities, I just don't want to practice out of my scope (if I'm making any sense). LOL

Again, thank you for your reply!

AddictionNP, MSN, NP · Sep 19, 2019

Yes a PMHNP would be better suited but pain management/addiction medicine often hires social workers (MSW) to do the counselling part and the FNP deals with the medication part. At least that is how it is in California and where my friend works. As a FNP you can prescribe psych medications...

lcTex · Nov 1, 2019

Probably too late for this advice to matter for you, but in case anyone else has the same Q, thought I would weigh in.

I'm an AGNP working in a withdrawal management and residential treatment facility. I don't feel that having a medical/primary care focus is a limitation, and often it is a significant benefit because many clients do no have a lot of engagement with the health care system so there are huge opportunities for health interventions and teaching. Your role as a medical provider is different than a PMHNP, but no less important. You will need to be comfortable working with complicated psych comorbidities and able to do your assessments with clients with psychosis, trauma/PTSD, SI, etc. However, just like in almost any other type of setting, if there are patients with complicated psych needs (ie schizophrenia, failed on multiple drugs, etc), you would refer them to a specialist and that is entirely appropriate. Substance use disorders really do encompass the whole person, so it is unlikely that any one provider will be able to meet all of the needs of an SUD patient. Don't hold yourself to that standard, just focus on maximizing the strengths you bring to that role.

umbdude, MSN, APRN · Nov 2, 2019

It depends on what you're doing there. If it's simply helping people detox or starting/continuing them on MAT, it should be fine. However, many of these folks are on numerous psychiatric meds and it's important not to tinker with the meds that are out of your scope (e.g., mood stabilizers and antipsychotics). The line can be blurry at times and sometimes supervising MDs aren't aware of NP scope.

HAL_APRN19 · Nov 6, 2019

IcTex and Umbdude-

Thank you both for taking the time to reply. I truly appreciate the information you shared with me. I actually ended up declining the addiction position due to conflicting information being given to me. Fortunately, another opportunity came up and I've accepted a medical provider position for a psych hospital. I have the opportunity to expand to the addiction unit within the facility later on if I was interested; so I think there is a lot of potential for growth. I'm excited and anxious about my first NP due to the challenges I will face in caring for these patients. But as IcTex mentioned, these patients often do not have access to healthcare once discharged, so I feel I can contribute greatly in my role as a primary care provider for them while they're inpatient with us. Wish me luck! ? Again, thank you everyone for contributing!