FNP after PMHNP

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Specializes in Outpatient Psychiatry.

Hello all. I'm in the terminal year of a three year PMHNP program, and throughout the last couple of years, as well as my time earning the BSN, I have entertained the thought of training in family practice as well. I don't want to practice exclusively in that area, but I would like the enhanced training and scope to diagnose and treat other common disorders that I'm sure to see (URI, HTN, cold, presumptive staph infx, etc).

Chiefly, I want to focus on psych as that's the need here as well as my primary interest. I'm on the fence, however, because I question how much exposure to "everything from birth to death" I could get in a FNP program.

I also would love to avoid putting my fingers in people's holes. I know that sounds stupid, but it's true nonetheless. I had to do that in advanced health assessment and don't want to again, and reproductive health seems to be a stand alone class here and I have no idea how many hernia checks and DREs I'd have to do on top of pelvics in school.

Yes, the last paragraph is ridiculous I know, but that whole "area" of nursing is why I got out of hospital nursing a year to the day I started, lol. I then went to clinic stuff with vast primary care exposure and admin/case mgmt and now work in psych intake while I'm doing my PMHNP clinicals.

Looking for insight. Best regards.

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Why not just take FNP pharm course if that was not included in current course work as well as primary care courses, and forget the FNP clinicals? As a PMHNP I need to be able to recognize when medical conditions/drugs, drug interactions etc might be affecting psych conditions and vice versa. But I refer out so I don't have to be sticking my fingers into any holes.

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Specializes in Outpatient Psychiatry.
Why not just take FNP pharm course if that was not included in current course work as well as primary care courses, and forget the FNP clinicals? As a PMHNP I need to be able to recognize when medical conditions/drugs, drug interactions etc might be affecting psych conditions and vice versa. But I refer out so I don't have to be sticking my fingers into any holes.

Actually, it's kind of odd in a way. We're similar to the FNP program in that we take the exact same advanced health assessment theory and practicum (the hole sticking part), advanced pharmacology (most educational class I've EVER had), and advanced physio/patho along with a conglomerate of nurse-esque research, theory, etc.

The odd thing is that the PMHNP program is a semester longer in theory and has a standalone psychopharm class. The FNP folks do not get a second pharm class and take theory and practicum in "child and family, reproductive health and the family," and "management of the older adult." I'm not sure where in there they get exposure and training to the things I'm interested in.

I also can't really shake the answer out of anybody about whether it would be out of my scope to "diagnose" and treat something like OM with some Augmentin, etc. I'm not opposed to it. I just don't want to break the law, lol. I know of a psych NP who works in a hospital setting and frequently is voluntold to sew up cutters, and he prescribes antibiotics when warranted. I know of a couple more who routinely prescribe KCl, Zofran, etc where needed. Easy things. They round on a geriopsych unit too and sometimes prescribe for the UTIs that show up. No one has evidently told any of them they can do that. They just do it.

I know my state's scope for all APRNs says something akin to "all advanced practice nurses should be able to conduct a full physical exam" so what's the point if you can't do anything about it? I just want to keep it simple. I'm not afraid to refer out in the least!

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When I was working inpatient psych we would consult hospitalists for any acute problem. I think there was only a couple times I prescribed for any minor physical complaint. The hospitalists would fare much better in court vs someone who rarely treats physical conditions. Yes, I learned to do a complete physical but in a psych unit you do a briefer exam and focus more on neuro part. If a patient was being admitted from med-surg we skipped the exam as the hospitalist had already done a bang-up job. Now that I'm in an outpatient clinic I don't do any physical exams at all but my knowledge base and years of experience in areas other than psych serve me well. For example, when I have someone with fatigue is it due to depression of some medical condition? I'll run a bunch of labs and based on the results, might be sending them to also visit primary care. In order to pick out the courses you want you'll need to review the course descriptions as you can rarely tell anything by the title of the course.

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Specializes in Outpatient Psychiatry.

I wouldn't want to make it a habit of treating outside psych. I don't know...maybe I just want to be able to..? I hope to go to work in a clinic or outpatient setting where there may not be any type of primary care oriented specialty to the H&Ps, etc. I have yet to train in a setting like that so I'm not sure what the psychiatrists do in that situation (probably nothing). I've actually read one psych theorist that suggested physical exams and other treatment is not therapeutic with regard to their mental health. I can see both sides of that.

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