Family nurse practitioner's scope of practice in treating mental illness in primary care in indiana

DrCOVID, DNP · Jul 15, 2022

It has to do with scope of practice, do you have any idea what ADHD, bipolar, or Schizophrenia look like? TBH even after school, it took me about a year in practice to see it present clinically, as well as reading a few books by specialists before I really could recognize them quickly... That was after 4 years of post graduate study. Moreover, I have heard of a psychiatrist getting sued for prescribing antibiotics to a patient. We just don't do that clinically, so...

Mr.Sta, BSN, MSN, NP · Jul 19, 2022

I am not from Indiana and do not need oversight in my state, but I choose not to manage any type of behavioral type patients, I am a firm believer that specialty training is there for a reason.

Guest603994 · Dec 7, 2022

On 7/7/2022 at 8:31 AM, Mae_W said:

Hi there,

I only know Indiana is a reduced practice state, and the FNP in IN can treat GAD, depression. Are there any specific mental diseases that the FNP cannot diagnose and/or treat (any specific therapies that we need PA or MD's signature?) I think we cannot diagnose ADD, ADHD, Bipolar.

Thank you very much!

I could be wrong, but I don’t know of a single state that expands on an FNP’s scope beyond STABLE anxiety and depression with or without a collaborator. Even in states we aren’t fully autonomous, psych NPs need a psychiatrist as a collaborator. Going outside of your scope is a sure fire way to get a BON investigation and opens you up to liability. There’s a reason you refer and I don’t know of a single FNP program that teaches therapy.

“FNPs can diagnose and treat patients with uncomplicated mental illness, such as depression and anxiety, within their scope of practice (SOP). However, FNPs should be aware of areas that fall outside of their SOP, such as diagnosing and treating patients with complicated or severe mental illnesses or exceeding prescribing authority for psychiatric medications. Any breach of their SOP could lead to civil liability and disciplinary actions.”

https://nursing.ohio.gov/wp-content/uploads/2019/09/UpcomingBoardMaterials_FNP-Scope-of-Practice_8.0.pdf?highlight=license verification

Guest1144461 · Dec 8, 2022

I am a ACNP and rarely prescribe things like SSRI (like 2-3 times in my career). If I was a FNP I wouldn't go beyond simple depression or anxiety, the training just isn't there for it.

Tegridy · Dec 9, 2022

5 hours ago, Numenor said:

I am a ACNP and rarely prescribe things like SSRI (like 2-3 times in my career). If I was a FNP I wouldn't go beyond simple depression or anxiety, the training just isn't there for it.

Takes so long to get people in to see psych where I am. Sometimes we will start lamictal or something similar just to get the ball rolling more out of lack of psych in my area but I agree none of us want to deal w complex mood issues

Guest603994 · Dec 9, 2022

Did you train on the use of lamictal in FNP school? What are you starting the lamictal for? Are you diagnosing something outside of stable depression and anxiety? If so, that’s outside of an FNP’s scope, rural or not.
That’s like me saying I did a biopsy because it would take forever for them to see derm. I’ve done biopsies and sutures in the Army but it’s 100% out of my psych NP scope. Just because you can do it and bill for it doesn’t make it within your SOP and absolutely makes you liable.

Tegridy · Dec 9, 2022

31 minutes ago, Amber MSN said:

Did you train on the use of lamictal in FNP school? What are you starting the lamictal for? Are you diagnosing something outside of stable depression and anxiety? If so, that’s outside of an FNP’s scope, rural or not.
That’s like me saying I did a biopsy because it would take forever for them to see derm. I’ve done biopsies and sutures in the Army but it’s 100% out of my psych NP scope. Just because you can do it and bill for it doesn’t make it within your SOP and absolutely makes you liable.

It’s not out of a physician’s scope so I can prescribe it or seroquil, or vpa if deemed necessary for bipolar disorder. We Don’t really do lithium it’s a hassle, I don’t even see psych use it much anymore.

Tegridy · Dec 9, 2022

24 minutes ago, Amber MSN said:

Did you train on the use of lamictal in FNP school? What are you starting the lamictal for? Are you diagnosing something outside of stable depression and anxiety? If so, that’s outside of an FNP’s scope, rural or not.
That’s like me saying I did a biopsy because it would take forever for them to see derm. I’ve done biopsies and sutures in the Army but it’s 100% out of my psych NP scope. Just because you can do it and bill for it doesn’t make it within your SOP and absolutely makes you liable.

Also, psych is much more limited than general medicine. Technically I could do skin biopsies if I wanted to but I just do not have an interest in that stuff. We don’t really have a “scope” that is more of a nursing world term. We just use judgement on what we should and should not do.

Guest1144461 · Dec 9, 2022

5 hours ago, Amber MSN said:

Did you train on the use of lamictal in FNP school? What are you starting the lamictal for? Are you diagnosing something outside of stable depression and anxiety? If so, that’s outside of an FNP’s scope, rural or not.
That’s like me saying I did a biopsy because it would take forever for them to see derm. I’ve done biopsies and sutures in the Army but it’s 100% out of my psych NP scope. Just because you can do it and bill for it doesn’t make it within your SOP and absolutely makes you liable.

He's a physician. Their training even at the FM or IM level is better for mood disorders than FNPs. There are situations where its better to start something then sit and do nothing.

Guest603994 · Dec 9, 2022

9 hours ago, Tegridy said:

It’s not out of a physician’s scope so I can prescribe it or seroquil, or vpa if deemed necessary for bipolar disorder. We Don’t really do lithium it’s a hassle, I don’t even see psych use it much anymore.

1. Why is a physician on Allnurses?

2. Why is a physician giving their opinion on a nurse practitioner’s SOP?

As you said, general medicine training is far different. Additionally, I wouldn’t get a PMHNP started on how many times they’ve had to change the mess their PCP started them on. I still challenge the ongoing training any provider has outside of psych in order to monitor the psychiatric aspect of this drug.

Guest603994 · Dec 9, 2022

5 hours ago, Numenor said:

He's a physician. Their training even at the FM or IM level is better for mood disorders than FNPs. There are situations where its better to start something then sit and do nothing.

Again, why does a physician’s opinion have anything to do with this question? It is 100% outside of the FNP’s scope to diagnose and treat beyond STABLE anxiety and depression. I was speaking to the FNP’s scope as I’m aware of what a physician’s is. Adding a general medicine physician’s opinion, experience, or training is a moot point here which is why I brought up derm. It really has nothing to do with this conversation.