Better psych education for FNPs?

[ruralnurs]

I was not sure how to name this topic.

I am an FNP and just recently a psych mental health NP. I have been approached by the state university where I live to help consult on improving the mental health education of the non-psych (mostly family) NPs. I am very excited as I think that the psych portion of most FNP programs is minimal and I feel that many primary care providers are doing lots of psych and sometimes they feel overwhelmed or simply don't know what is evidenced based medicine and so don't provide optimum care. This is compunded by the fact that there is often not any mental health care around so primary care providers feel obligated (and we are glad they are willing to help).

Also in the diagnostics area. I have seen primary care providers give a mental health diagnosis without meeting the diagnostic criteria, and then a person is getting treated for somthing they don't have and not getting treated for somthing they do have.

Anyway, as non-psych providers or students, where do you feel there should be improved education?

Also for any psych providers, wehre have you seen deficits that may be improved with better education?

All info is appreciated.

Thanks!

[zenman]

At Rush University, where I did my PMHNP, the FNP guys were required to take a Major Psychopathological Disorders course. I think they should also take a psychopharm course if they want to be more effective with this population. The single pharmacology course most NP programs require just doesn't cut it. We took 2 courses and that was for psych meds.

If NP programs would combine theory, research and role into one intensive 3 hr course, they would have space for these other needed courses.

[ruralnurs]

Thanks for the response Zenman. I do think that more indepth psychological disorder education as well as psychopharm. I feel evidenced based medicine is so important and so many non-psych providers (in my experience) don't do evidenced based care because they don't know it.

thanks!

[BCgradnurse, MSN, RN, NP]

I wish I had more education in psych. I see a lot of patients with psych issues who have nowhere else to go either because of insurance or lack of community resources. I do feel out of my league for anything more complex than simple anxiety or depression. Even the MDs feel this way. We do a lot of "consensus" practicing-the providers talk to each other, look up stuff, and try to come up with at least a short term plan for a patient. It's not pure evidenced based practice by any means, but it's all we have. Thankfully, we recently hired an PMHNP who we plan on keeping VERY busy!

[ruralnurs]

Thanks for the input BCGradnurse. I think that one of the things I hope to put into the program is simple tips and pearls. I have read someplace (don't remember where) that about 70% of anxiety and depression is treated by primary care providers. So you are not alone and will probably continue to see anxiety and depression. And those two do have evidenced based guidelines. My pet peeve (and I may be getting myself into trouble here) is PCPs putting someone with anxiety on long term benzos. But I think one of the most important things is to not stop thinking like a provider just because someone has a mental illness.

I have cared for a person that came in to our in patient unit after a suicide attempt and they had been seeing their primary care provider pretty consistently for increasing depression and after doing labs we found a crazy high TSH. The PCP did not even check!

I have found so many physical problems in folks with mental illness that should have been caught (like UTIs in the elderly and medication interaction with polypharmacy) and may have been causing or exacerbating a mental condition. It seems like many providers see the mental illness diagnosis and stop looking any further.

I think another important point is to know when to refer. And that is a hard one because there is not always someone to refer to, or the person has no $ or ins. I am glad to hear that you will have a psych NP available.

Thanks for your view on things.

[zenman]

I wish I had more education in psych. I see a lot of patients with psych issues who have nowhere else to go either because of insurance or lack of community resources. I do feel out of my league for anything more complex than simple anxiety or depression. Even the MDs feel this way. We do a lot of "consensus" practicing-the providers talk to each other, look up stuff, and try to come up with at least a short term plan for a patient. It's not pure evidenced based practice by any means, but it's all we have. Thankfully, we recently hired an PMHNP who we plan on keeping VERY busy!

If you're PMHNP gets swamped, just give me a call!

[BCgradnurse, MSN, RN, NP]

Will do, Zen. We were just awarded an $11 million grant to expand our center and increase services, so we will be looking for more providers in about a year.