Dual roles under same employer

[Bkonasek]

Hi everyone! I am an FNP and was hired as a psychiatric np provider at an outpatient psych facility. My boss is pushing for me to start working with both the psychiatrist and seeing psych patients and then "sometimes" doing primary care under another physician. Is this legal? Having dual roles in the same facility? Tany input would be great! Thanks!

[DizzyJ DHSc PA-C]

I would say yes. As an FNP you can do primary care and mental health can be treated by primary care. It sounds like you have a collaborating physician for your psych patients and another for primary care patients. Of course depending on your state and if a collaborating physician is required and also if you need a standard care agreement. You may need to have two separate agreements. I would just make sure your malpractice coverage is aware you are practicing psych and primary care. If you were practicing in general FP and treating minor mental health that would be one thing, but if you spend days only treating mental health patients. So, you may need to make sure you're covered.

[Corey Narry, MSN, RN, NP]

Well NP's can work with more than one collaborating physician within the same group or even outside of the group in another job. However, you should think of this along the lines of risk management so I would make sure your malpractice insurance covers both primary care and psych. I would also make sure that you can defend this dual practice convincingly in terms of being adequately prepared to treat mental illness as an FNP if legal issue were to be raised against you.

[Jules A, MSN]

Depends on your BON. In my state FNPs are not allowed to practice solely in psych without having the board certification and can have their license sanctioned. If you are able do consider whether your employer will be paying you more to work in psych as the rate should be higher especially if they are going to expect you to do both somatic and psych assessments. I'm dual certed and wouldn't even consider doing both without increasing appointment time and my rate. Lastly as Juan mentioned good luck defending yourself in court if you do not have the board certification to practice in psych and yet have chosen to do so.

Sorry if this sounds irritable but the "FNPs can do anything" mantra as well as the justification of poor care due to a shortage of specialists does a disservice to this vulnerable population.

[Dodongo, APRN, NP]

Depends on your BON. In my state FNPs are not allowed to practice solely in psych without having the board certification and can have their license sanctioned. If you are able do consider whether your employer will be paying you more to work in psych as the rate should be higher especially if they are going to expect you to do both somatic and psych assessments. I'm dual certed and wouldn't even consider doing both without increasing appointment time and my rate. Lastly as Juan mentioned good luck defending yourself in court if you do not have the board certification to practice in psych and yet have chosen to do so.

Sorry if this sounds irritable but the "FNPs can do anything" mantra as well as the justification of poor care due to a shortage of specialists does a disservice to this vulnerable population.

I wouldn't be surprised if within the next decade or so the "FNPs can do anything" mantra will be a thing of the past. With the push for independent practice, the consensus model gaining traction and alternative/specialty APRN training gaining in popularity, the boards of nursing may restrict FNPs to what they are trained for - primary care.

[Jules A, MSN]

I wouldn't be surprised if within the next decade or so the "FNPs can do anything" mantra will be a thing of the past. With the push for independent practice, the consensus model gaining traction and alternative/specialty APRN training gaining in popularity, the boards of nursing may restrict FNPs to what they are trained for - primary care.

I've been told Delaware is moving toward requiring the appropriate board certification in specialties where there is one which I think is a positive move. Hopefully it would result in increased quality of care and credibility among physicians.

I'd really like to see fellowships required for all NPs, glad I didn't have to take one, but feel I definitely would have benefitted from one.

[BCgradnurse, MSN, RN, NP]

I'm with Jules. As an FNP, I don't have nearly the breadth or depth of knowledge to adequately serve as a Psych provider. Frankly, I would feel unsafe dealing with complex psych issues. I also agree that not having your psych certification would hurt you should there be a malpractice issue. Stay in the medical arena for now, and get your post master's cert in psych if you want to work in that field.

[Jules A, MSN]

I'm with Jules. As an FNP, I don't have nearly the breadth or depth of knowledge to adequately serve as a Psych provider. Frankly, I would feel unsafe dealing with complex psych issues. I also agree that not having your psych certification would hurt you should there be a malpractice issue. Stay in the medical arena for now, and get your post master's cert in psych if you want to work in that field.

You make several excellent points most especially about being realistic regarding our skill set. Although I'm also a BC FNP I don't have nearly the breadth or depth of knowledge to adequately serve as a primary care FNP. I would not be safe or competent so I stay in my lane. I only use my FNP certificate to justify making modest somatic medication adjustments on my inpatient population and I consult for assistance more often than not.

[LadysSolo]

I would not do it. Psych meds are too tricky to prescribe, adjust, and monitor without additional education and I would not want to try to defend myself without psych certification if I made a mistake.