Family NP, Ped, NP, Psych NP

pro_student_2010 · Oct 28, 2009

PNPs and FNPs often receive some discussion in their programs about mental health issues and treatment however it is generally considered outside their scope of practice to treat mental illness independently. It is important for primary care NPs to be able to recognize signs of mental illness in order to make appropriate referals and to have some familiarity with treatment of mental disorders (both psychotherapy and pharmacotherapy) since they will inevitable have clients either in therapy or on meds. If your goal is to be a mental health provider, however, you should really be trained as a mental health provider. In nursing that would mean either a PMHCNS or PMHNP. As to the differences between the two, it really all depends on your state's definition of the roles, the practice you eventually work in, and the program you were trained in. For example, in some states CNSs cannot prescribe medications but they can in others whereas NPs usually can prescribe but cannot provide psychotherapy. Some practices will hire an NP to basically only do med checks while others will utilize the whole scope of practice. Some training programs differ in they preparation one receives based on the role (CNS or NP). You mentioned apprehension about prescribing psych meds but also realize that it might be helpful and necessary. It your fear comes more from a lack of experience, obviously that's something that can be alleviated with training and experience. It would not hurt to be trained on prescribing medication but not necessarily make that part of your practice. My advice: look into the state(s) you think you'd like to practice in and how they define and regulate NPs and CNSs. Then talk to some mental health providers or look at job descriptions to get a sense of how the practice environment is for each role (sometimes they are interchangeable and sometimes they are night and day). Finally, with a better sense of what your options would look like upon graduation, start evaluating programs on how they fit with your ideal practice allowing some wiggle room for future changes. Good luck!

ILoveIceCream · Oct 28, 2009

I'm pretty sure it's within the scope of practice of primary care nurse practitioners to treat uncomplicated mental illness (like non-refractory depression and anxiety).

Julz034 · Oct 29, 2009

Thanks everyone!

I will start checking the two out a little more in my area. I might even call the colleges and ask, or different facilities in the area.

I do plan on going into the more sever illnesses, Bi-polar, Autism, etc. So, I figured I'd definitely need the psych NP. I saw another girl ask a sort of similar question and thought she'd need psych but figured I should ask for me as well!

Thanks again!

ROLO · Dec 21, 2009

These are some really good questions regarding "crossing over" into other areas of practice. I am an adult/geri CNS student, and I am wondering what it is exactly that I'll end up doing --especially living & working in an area where advance practice nursing is in its infancy.

I have chosen an adult/geri CNS program. I had wanted to do an acute care nurse practitioner program, but the NP programs are usually a little longer than I want to do (I am working full-time while going to school, and have been in school 7 years straight, in one way or another!).

I do see ads for FNPs and adult NPs (clinic stuff). I also see adds for PMH CNSs and NPs (for the SAME job), which I find interesting, because you don't see ads like "Adult CNS/NP." Why might this be?

Also, I was wondering with my adult/geri CNS focus if I might be able to do some psych/mental health, especially since much geri deals with mental health issues. What is acceptable for the "cross over" in practice.

I know a lot of friends, aquaintances, & patients who are getting psychotropics from their primary care physicians, which seems reasonable, so why couldn't I possibly do some PMH work, especially since I have worked as a staff nurse in that area? Honestly, I do see some reasons why I would not be possibly the best choice for someone with serious mental health issues, but I do see where I could have a place.

Whispera, MSN, RN · Dec 31, 2009

I'm a psych CNS in Indiana. Here advanced practice nurses (NPs or CNSs) treat whatever their collaborating doctor treats (and what their area of specialty is--you collaborate with a doctor whose specialty matches yours). So, since I'm in psych, my collaborators have been psychiatrists. The same would hold true if I was a psych NP. If I was a family NP (FNP), my collaborator would be a family GP. If I was a pediatrics NP, my collaborator would be a pediatrician.

Here, billing for services is dependent on that collaborating arrangement with a doctor of like-specialty. Being able to prescribe is also dependent on it.

Intent in the psych CNS vs NP is that the CNS would be better qualified to do talk-therapy while the NP would be better qualified to do the physical aspects of psych and medical illnesses. That isn't necessarily how it works out. I treated patients as if I was their psychiatrist, prescribing medications and other treatments. Psych NPs I've known have worked in inpatient settings caring for the medical needs of psych patients while doctors tended to their psych medication needs. FNPs did the same work as psych NPs where I've worked.

In my graduate education, I had pharmacology (with absolutely nothing in it for psych), assessment, and anatomy and physiology. I had clinical experience in providing therapy but none in prescribing (my preceptors were social workers). I don't know what clinical experience psych NPs would have...that wasn't an option in the education my school provided. When I graduated, I could have been certified as either a CNS or an NP. That's something that happened then in the psych advanced practice nurse arena back in 2001. I don't know if it's still true.

Finally, prescribing for children is a whole different ballgame than prescribing for adults, and requires specific education (at least in Indiana). You have to be certified to prescribe, and you have to be certified as either an adult or pediatric advanced practice psych person, and you can't be certified without education as a pediatric specialist (or both if you have the time, energy, education, and money to do it). There are big rules to follow to prescribe for children. As it should be. I wasn't willing to take on the liability or the possibility of making a mistake, and chose not to pursue prescribing for children. My employer wanted me to see children, but I was able to say, "sorry, I can't; my license doesn't permit it."

Absolutely, you can treat mental illnesses as a generic NP, but you wouldn't know as many things as if you specialized. Treading into treating children's mental illnesses should be done very gently by anyone, and more gently by a generic provider (just as a generic doc should tread lightly into pediatrics, cardiology, oncology, unless he has the experience to back his treading).

I've rambled...but hopefully some of this helps!