Can a FNP in IL work and do psyc evals in outpatient settings?

pedspnp · Sep 8, 2015

Do you mean PMHNP, PNP is a pediatric nurse practitioner . I'm not sure how much psych nursing was in your FNP program I know as a PNP I am able to treat ADHD after consulting with behavioral health and our psychiatrist , anything more complex goes to Behavioral health / psych for evaluation. Good luck

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PG2018 · Sep 8, 2015

You say you can't get an answer from your state board. Are they nebulous and wishy washy everywhere? My state board is like that. Regardless, you need to pressure them until they give you an answer. I once had to call three politicians and a lobbyist to get my state board to put down their sudoku book and do something. Just stay on them. They're the only ones that can answer this for you.

seckmann1 · Sep 8, 2015

Sorry, I meant the pmhNP. I have a job offer paying VERY well, but I need to do at least one psyc eval a week. I called my state board of nursing and they said, "you can work for them, but not as them." I said, what does that mean? If I'm in a family practice doctor's office, I'm working as a NP, I'm not working as a doctor. So to me, that answer didn't make sense. I can work for a psychiatrist, but not as one??? I was told to call back later when their computers were up and running.

So, I guess I'm just wondering if there's any FNP's out there who currently work in this area or do psyc evals currently? Or is this too risky of a position to take?

PG2018 · Sep 8, 2015

Sorry, I meant the pmhNP. I have a job offer paying VERY well, but I need to do at least one psyc eval a week. I called my state board of nursing and they said, "you can work for them, but not as them." I said, what does that mean? If I'm in a family practice doctor's office, I'm working as a NP, I'm not working as a doctor. So to me, that answer didn't make sense. I can work for a psychiatrist, but not as one??? I was told to call back later when their computers were up and running.
So, I guess I'm just wondering if there's any FNP's out there who currently work in this area or do psyc evals currently? Or is this too risky of a position to take?

If it's legal it's not risky. You can learn how to do it with some time. Most people are really bad at mental status evaluations so that's something to work on as well as psychopharmacology. I'd recommend a lot of CME in psychiatry.

I think your board's reply is about right because it's politicized and be given any number of meanings, and the stall tactic regarding the computers fits as well. Why do they need a computer to interpret a practice regulation? Those of us in psych aren't fans of non psych people doing psych jobs, but the pay (and often hours) attract people. The pay differential is quite remarkable when comparing a new PMHNP in an outpatient clinic with 16 patients and a new FNP in an outpatient clininc with 10 patients and 5+ walk-ins.

Psych evals aren't hard. So a quick template for psych evals is similar to somatic medicine. Here's the order I prefer it when I'm in some position to free text it from scratch although I use a point and click EHR.

Chief Complaint

HPI

Sub. Abuse

Past Psych Hx.

Fam. Psych Hx.

Social Hx. (a lot of PMHNPs spend DAYS on the social history because they get wrapped up in some RN-esque babbling role)

Mental Status Exam

Somatic ROS (but mine is highly focused so CV if the meds have a CV action, weight loss/weight gain, always endocrine and neuro, MSK when they speak of dystonia, GU in bed wetters, GI when I think about, and integument when SJS may come into play, respiratory in kids solely because I'm fascinated by the number of asthmatic children I see - like when I was a kid nobody had asthma)

Then I do an A & P to refer to on the next visit.

On med checks, I do a MSE and a brief narrative on behavior changes and health changes (the A) and what I'm doing with their treatment, i.e. continuing or augmenting with or what I'm thinking about doing on the next visit (the P)

Jules A, MSN · Sep 8, 2015

Sorry, I meant the pmhNP. I have a job offer paying VERY well, but I need to do at least one psyc eval a week. I called my state board of nursing and they said, "you can work for them, but not as them." I said, what does that mean? If I'm in a family practice doctor's office, I'm working as a NP, I'm not working as a doctor. So to me, that answer didn't make sense. I can work for a psychiatrist, but not as one??? I was told to call back later when their computers were up and running.
So, I guess I'm just wondering if there's any FNP's out there who currently work in this area or do psyc evals currently? Or is this too risky of a position to take?

In Maryland you have to have the PMH board certification or could run into licensing trouble. My guess is they mean you can work in psychiatry but not as a psychNP, as a FNP doing H&Ps not psych evaluations. Personally I think PsychGuy is too humble because I do not think it is easy to do a decent psych eval as evidenced by many patients I have cared for on the acute unit after they decompensated from a shoddy diagnosis and medication regimen.

It definitely will depend on what your BON says and I'd advise against taking the word of other FNPs who have decided the money we make is worth driving out of their lane. My big concern if I were only a FNP would be that even if the board OKd it the minute something went wrong you will likely be trampled by a stampede to get your license for practicing out of your scope.

sadiemae1123 · Sep 9, 2015

If you do finally get a response from the BON giving you the okay, I would definitely get it in writing and save it for my records. You should also make sure whoever gives you they final okay actually has the authority to do so.

You should also check with your malpractice carrier to make sure you will be covered to work in this specialty.

All in all, it would probably be best to get a lawyer well versed in dealing with the BON/scope of practice issues to make sure everything is on the up and up before starting the job.

I wouldn't just rely on your future employer for guidance in this manner. It may seem like a great employment package to you as an FNP, but they are still getting off a lot cheaper than hiring a psychiatrist or PMHNP. And if things go south, they can just say you misrepresented your credentials to them and walk away with a small fine while you end up without a license and a lot of legal debt.

Jules A, MSN · Sep 9, 2015

If you do finally get a response from the BON giving you the okay, I would definitely get it in writing and save it for my records. You should also make sure whoever gives you they final okay actually has the authority to do so.
You should also check with your malpractice carrier to make sure you will be covered to work in this specialty.
All in all, it would probably be best to get a lawyer well versed in dealing with the BON/scope of practice issues to make sure everything is on the up and up before starting the job.
I wouldn't just rely on your future employer for guidance in this manner. It may seem like a great employment package to you as an FNP, but they are still getting off a lot cheaper than hiring a psychiatrist or PMHNP. And if things go south, they can just say you misrepresented your credentials to them and walk away with a small fine while you end up without a license and a lot of legal debt.

Well said especially about getting it in writing and not believing an employer who might encourage you to work outside of your scope. They do not have any interest in preserving your license.

elkpark · Sep 9, 2015

OP, if you presented to a psychiatrist's office to get help with your own psychiatric issues, would you be expecting to be seen by a mental health professional trained in the specialty, or would you be okay with an FNP seeing you?

seckmann1 · Sep 9, 2015

I have a degree in psychology too, with experience as a mental health therapist. I don't, however, have training in psychiatry as a nurse practitioner. I think you're all right that it's a bit risky even if the BON gives the ok.

PG2018 · Sep 9, 2015

Hey, I was trying not to leave any intimdating juju on the threads for future clinicians. We've got to retire some day, Jules. I think the most challenging thing to do in a psych eval is to get a straight, whole story. If they're psychotic or manic then hey good luck. Otherwise, get your BS meter and spare batteries ready. You'll find them on the shelf between Saddock and Stahl. I had my own because I used to make a living shoveling BS so I'm comfortable stepping in it. You'll also soon learn that our population often has no self-insight so "how's your anxiety" is a rather challenging question for many.

There's also a faction of patients who think we know their thoughts, can interpret dreams, know what Freudian motive was behind them scratching their nose, hypnotize them, and at our pinnacle "be like Dr. Phil." I don't really tell them otherwise, lol.