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Are PMHNP allowed to prescribe outside of their specialty like BP meds or antibiotics?

Posted

Specializes in Psych. Has 2 years experience.

One thing attractive about being a nurse practitioner to me is the ability to give more advanced care. I'd like to also help patients if they come in and also have issues with blood pressure or heart rate etc. and be able to prescribe ACE inhibitors and antibiotics if needed as part of their treatment. Is this possible? Can I prescribe a BP med as well as an antipsychotic? Some patients that have mental issues can have issues regarding their BP so it wouldn't make sense to me that I wouldn't be able to prescribe that as well to help. (ACE inhibitors can give issue with lithium due to sodium)

If it helps I'm in New Jersey.

umbdude, MSN, NP

Specializes in Psych/Mental Health. Has 4 years experience.

Can they? Yes. Should they? Absolutely not.

If a psych NP writes a prescription for an antibiotic, it'll be filled. If something happens and the NP gets sued, she/he will almost certainly lose because they're prescribing outside of scope. Nothing in the PMHNP curriculum adequately prepares us to diagnose/treat infectious diseases or other chronic medical conditions.

It is within scope to prescribe BP meds or few other ones as long as the NP is doing so within the context of treating psych.

Most psych providers simply refer patients to primary care. If you, for whatever reason, want to do both, you should consider adding an FNP or AGPCNP cert.

The0Walrus, BSN, RN

Specializes in Psych. Has 2 years experience.

2 minutes ago, umbdude said:

If you, for whatever reason, want to do both, you should consider adding an FNP or AGPCNP cert.

This would take at least another two years right or is there some extra certificate I can get it?

Edited by The0Walrus

umbdude, MSN, NP

Specializes in Psych/Mental Health. Has 4 years experience.

1 minute ago, The0Walrus said:

This would take at least another two years right or is there some extra certificate I can get it?

I'm not entirely sure. Each school is different. If you already have a PMHNP, it'll probably take at least 1 to 2 years.

It'll likely take you less than 2 years as it'll be a post masters cert in FNP.

As stated above, don't do it unless you want to be liable should something go wrong. I'd argue most psych practices you'd work for would also disagree with you prescribing meds outside the context of psych for fear of liability on their practice.

Edited by ToFNPandBeyond
Added more

sleepwalker, MSN, NP

Specializes in Occupational Health. Has 17 years experience.

Why would you? If you're not that pt's PCP then you're over-stepping. Even if you have a dual certification (e.g. PMHNP & FNP) I would certainly not be treating a pt for primary care issue unless you have that type of established relationship.

verene, MSN

Specializes in mental health / psychiatic nursing.

Can they? Yes. Should they? It depends.

Prescribing metformin relating to blood glucose regulation secondary to atypical antipsychotic side effect -OK. Prescribe it for diabetes - you may lose your license.

Can I prescribe blood pressure medications - yes. I can prescribe prazosin for nightmares, propranolol for anxiety, etc. I can't prescribe them for hypertension though.

I can continue orders for things like HIV medications on admission/medication reconciliation but cannot change the medications. I can prescribe commonly used PRNs (e.g. tylenol, maalox) under organization's protocols (which are approved by director of medical).

If you want to manage both physical and mental health you will need to become dual-certified.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

They absolutely can, credentialing and scope of practice-wise. It is a question if they should. It is absolutely no question that many of them do not do even things they should.

One of my favorite pet peeves is "suddenly" confused/agitated/mildly psychotic patient getting a bunch of various new meds from inpatient Psych provider on call while going into into acute renal failure with Pepcid, Neurontin, Mirapex and other renally dosed stuff still onboard. Then it is my first thing in the morning to discontinue, change, dose and re-dose everything and essentially fix the problem.

If one would like to really get into business, any combination of FNP (or ACAGNP for inpatient work) and PMHNP is mandatory. What is main and what certificate in this credentials alphabet soup is not important and post-Masters only take 3 to 4 semesters to complete.